VUMC Blood Bank Board Review - PowerPoint Presentation

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VUMC Blood Bank Board Review

Garrett S. Booth, M.D., M.S.

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PART 1

Blood

Donation-lots of questions on this topic given the numerous regulations that surround blood donors/donations

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Whole Blood

What is the standard deferral time period for whole blood donation

?

How much can be donated?

Does this impact the donor deferral time period?

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For single unit (500 mL) whole blood donation the deferral period is 8 weeks.

If someone donates by apheresis, for example, a double red blood cell donation, the deferral is 16 weeks

Yes, RBC and plasma products can be collected at the same time

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Cryoprecipitate

Can you collect just cryoprecipitate from a blood donor

?

Collection versus manufacture?

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No

Cryo is a manufactured product

Must collect FFP and then freeze. Although to thaw in 1-6C refrigerator and isolate the supernatant

Cryo=fibrinogen, Factor XIII, Factor VIII,

vWF

,

fibronectin

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Platelet Donation

What is the maximum total number of times someone can donate apheresis platelets in a 12 month time period

?

Can you give out of group platelet products?

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24 times

The time between donations is 48 hours, but cannot donate more than twice a week

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Platelet

What is the minimum dose of an apheresis platelet?

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3.0 x 10

11

platelets per product

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Medication

Which of the following psoriasis medications results in a permanent deferral?

Tegison

or

Soriatane

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Tegison

-Permanent deferral

Soriatane

-three year

deferal

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Cohabitation

If you are living with a person with hepatitis C, how long are you deferred for

?

What type of virus is hepatitis C?

What other question in the universal donor health questionnaire is designed to identify donors with hepatitis C?

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1

year

Flavivirus

IV Drug use

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Blood Exposure

While working in surgical pathology you cut yourself while dissecting a liver. How long are you deferred for?

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1 year

Contact with blood is a one year deferral

So is tattoo, needle stick, sex with HIV person, rape victim, jail>72 hours, paying for sex, being transfused, travel to malaria region

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A new mother presents for donation to show her community she is an “active contributor” and is “working to make the world for her new baby a better place”.

Despite her well intentions, how long following delivery is the standard deferral period?

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6 weeks

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WNV deferral time period

What is the deferral time period for WNV in a US blood donor?

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120 days

This is a weird one, so remember it

WNV is only tested by NAT (MP

vs

IP depending on seasonality or positivity in your community)

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Europe

My sister,

Lynde

, has lived in the UK for most of her life, if she ever decides to come visit me in Nashville, TN can she donate? Why/why not?

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No, living in UK for more than 5 years is a permanent deferral.

Preventing TA-

vCJD

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MMR

An individual moves to the US from a non-malaria endemic region and begins her vaccination program. She is given the option of getting the MMR shots at once, but opts instead to get her Measles shot only. How long is she deferred for?

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Measles- 2 week deferral

Mumps- 2 week deferral

Rubella- 4 week deferral

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Influenza

VUMC recently completed the largest vaccination event for influenza ever. These super eager VUMC employees also wanted to make the world a better place and donate blood. Can you donate whole blood on the same day you get a flu shot?

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Yes

There is no deferral for influenza vaccine

Also no deferral for

HepA

/

HepB

vaccine

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Unlicensed Vaccine

A poor college student enrolls in a clinical trial at VUMC for the money. The subject is given an unlicensed vaccine as part of the trial. Six months later a blood drive comes to his dormitory, can he donate?

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No

Unlicensed vaccine is a 12 month deferral

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Hepatitis B

A donor presents for whole blood donation, but is unsure about his vaccination history. He knows that because he recently started nursing school that he received “a ton of shots”. What is the serologic pattern for an individual that has received the hepatitis B vaccine?

HBV DNA,

HBsAg

, Anti-

HBc

, Anti-

HBsAg

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Vaccinated individual should only have anti-

HBsAg

, unless you tested them immediately following the vaccine itself

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Allogeneic Donor demographics

What are the minimum weight

Temperature

Pulse

Blood pressure

Hemoglobin

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Weight >110 pounds

Temperature <37.5C (99.5F)

Pulse (50-100)

BP <180/100

Hemoglobin >12.5 g/dL

HCT >38%

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Anticoagulant

What is the anticoagulant used in donated blood products?

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Citrate

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Storage Duration of Blood Products

Shelf LIfe of Red Blood Cells based on different anticoagulant/preservative solutions

Anticoagulant/Preservative Solution:

ACD/CPD/CP2D:     21 days

CPDA-1:     35 days

AS:     42 days

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Autologous Blood Donation

What is the minimum hemoglobin for an autologous blood donor?

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11 g/dL (HCT 33%)

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Specimen Retention

The

pretransfusion

sample (EDTA tube) must be kept in the blood bank following transfusion for what time period?

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7 days

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Hepatitis

What type of hepatitis is a recipient most at risk of obtaining through transfusion in the US?

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis E

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Hepatitis B

Risk of hepatitis B transfusion transmission is 1/300,000 to 1/400,000

Hepatitis C risk is ~1/1.5 million

Hepatitis E is not tested for, but has been shown to be transmitted in Europe. Yuck.

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CMV

Is CMV testing required for all blood donors in the US?

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NO

Leukocyte reduction and serologic testing of donors are considered equivalent in the US blood supply

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Residual Leukocytes

What is the requirement to qualify as leukocyte reduced?

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<5.0 x 10

6

residual leukocytes

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Chagas Disease

What is the screening test for

Chagas

disease in the US?

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T.

cruzi

is screened for by EIA

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Finasteride

A balding elderly male returns to donate whole blood but appears to have a some new-found hair growth. He is excited to donate today because he is contributing another unit and is going to make the wall of fame for 4 gallon donor! When asked about medications he states he is taking something to help his hair grow back so he can look better for the photo opportunity. The pill box he carries his filled with vitamins and supplements, but there are also

finasteride

pills present. Can he donate? Is there a deferral?

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Finasteride

(

Proscar

,

Propecia

)

is a 30 day deferral.

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Other stuff

Calculations

Correct count increments (CCI)

Antigen frequencies

Number of units needed to be screened

Blood donor frequencies

In general need to know some high frequency antigens, typically designated with the superscript “b” and there antithetical counterpart, the low frequency antigen

designated with the superscript

“a”

RhIG

dose calculations

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Other Stuff

Immunohematology panels

Practice, practice, practice

You should have: emailed practice panels, panels from

www.pathquestions.com

, and I have other practice books if you want (can make some photo copies).

The ASCP book has some refresher panel information (basics), these should be reviewed.

The Blood Bank Guy website (

www.bbguy.org

) also has some panels

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Other Stuff

AABB Standards (28

th

ed.) has a few nice summary tables in the middle of the book which you can photo copy (the book itself is very small, but very expensive).

Ms. M. Johnson has a copy of this text and if you are nice she may let you make a copy, but do NOT remove from the blood bank and make sure you have her permission first!!!