GALIZA, DESSIREE MARGUERETH BSMT 4

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CHAPTER 14: TRANSFUSION-TRANSMITTED DISEASES

● The primary and most crucial phase in guaranteeing that transfused blood does not spread a harmful virus is meticulous
donor screening.

● In places where cleanliness is poor, HAV is typically transmitted via the fecal-oral route.

● During the early stages of HBV infection, the primary positive test is HBV NAT, and the earliest serologic marker to develop
is HBsAg, eventually followed by HBeAg and IgM anti-HBc.

● HBIG is an antibody made from people who have a substantial anti-HBs titer and is utilized to offer passive protection to
healthcare professionals and others who come into contact with individuals who have an infection caused by HBV.

● To confer protection, a combination vaccination for HAV and HBV is offered.

● HDV infection is widespread among individuals who use drugs and may happen concurrently with HBV infection;
confirmation is based on the presence of anti-HDV or HDV RNA in the blood.

● 60% to 70% of HCV infections are asymptomatic. The window duration for HCV screening has been decreased to
anywhere from 10 to 30 days with the adoption of NAT analysis.

● In the United States, HCV is the primary trigger of the need for liver transplants.

● HEV is a new virus that spreads through blood transfusions and is the major cause of hepatitis in the United Kingdom.

● The existence of antibodies to each of the envelope and core proteins is required for the identification of HIV-1 and HIV-2
infection; HIV-positive individuals with less than 200 CD4+ T cells per microliter are deemed to be suffering from AIDS
despite the lack of symptoms.

● CMV infection caused by transfusion is a problem for seronegative allogeneic organ transplant patients and fetuses. When
a person's immune system is significantly damaged, a dormant infection might resurface.

● Because of improved transfusion procedures and care of their illnesses, the risk of CMV infection for low-birth-weight
newborns is not as high as it formerly was.

● The WB confirmatory test identifies anti-HIV antibodies and establishes which viral amino acids the antibodies engage with.

● The polymerase chain reaction, which identifies HIV infection prior to antigen or antibody tests are positive, can minimize
the exposure time for HIV.

● The leading cause of transfusion-transmitted infection is the presence of bacteria.

● Because systematic parasite infection monitoring is not presently accessible, several blood banks have included parasitic
infection-related queries to their donor questionnaires.

● Pathogen eradication techniques are in use for plasma and platelet products, and red cell derivatives are being developed.
These techniques eliminate or diminish the danger of transfusion-associated sickness caused by the window period, viral
variations, laboratory errors, and new, developing diseases.

● The FDA requires gathering facilities to inform donors who screen positive for viral markers, to inform previous recipients of
the likelihood of infection, and to isolate or isolate affected components presently in storage.

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CHAPTER 15: COMPONENT PREPARATION

● Production of blood components must be recorded to guarantee that the personnel who conducted crucial stages of the
process and the instruments utilized can be recognized for each component created.

● Centrifuges, plasma expressors, scales, sterile connection devices, sealing devices, plasma freezers, refrigerators, platelet
agitators, and environmental chambers are all present in a component production laboratory. These devices should be
cautiously selected and evaluated to guarantee that they meet regulatory criteria.

● Whole blood is generally split into components, however thanks to studies provided by the US military, it has lately gained
appeal for transfusion in trauma.

● RBCs must be manufactured using a process that distinguishes RBCs from plasma and yields a hematocrit level of below
or equivalent to 80%. RBCs that have been leukoreduced should include <5 × 106 residual WBCs while retaining at least
85% of the original RBC composition. The expiration date of RBCs is determined by the anticoagulant/preservative and
additive mixture used.

● Platelets from randomized donors must have at least 5.5 × 1010 platelets, whereas platelets from single donors have to
include at least 3 × 1011 platelets. Leukoreduced goods must include either <8.3 × 105 or 5.0 × 106 residual WBCs.
Outdate is normally 5 days, however methods are now accessible that enable platelet transfusion up to 7 days after
collection.

● FFP must be processed within 8 hours of being collected and kept at -18°C for a period of one year.

● Cryoprecipitate is made from FFP and comprises at least 80 units of antihemophilic factor and 150 mg of fibrinogen. It is
kept at -18°C for a year. Because an adult's dosage of cryoprecipitate is typically 10 units, the different parts may be pooled
and frozen again at the collecting site prior to thawing at the transfusion service.

● Irradiated RBCs require a radiation dosage of at least 25 Gy to the canister's midplane, after which the product's expiry date
adjusts to 28 days from the moment of irradiation or retains the previous outdate, whichever comes sooner. Irradiation has
no effect on the expiration period of platelet constituents.

● RBCs and platelets can be cleansed to eliminate the supernatant plasma and additive solution, which is subsequently
substituted with saline.

● RBC and platelets can be separated into portions for patients who necessitate reduced transfusion quantities, such as
babies and people vulnerable of transfusion-associated circulatory overload. Plasma aliquots are typically processed and
frozen within 8 hours of being collected at the donor facility.

● Before the transfusion, blood components can be pooled to help those who require higher dosages or specialized mixtures
of constituents.

● Human plasma may be utilized to make a vast spectrum of pharmaceuticals such as clotting factors, immune globulins,
albumin, and other proteins. Recombinant or xenographic preparations are an option for numerous items since they provide
a danger of spreading diseases.

● ISBT 128, a particular barcode system which contains parameters for the donation identification number, blood type,
product code, date of expiration, and other unique labels, is most typically used to identify blood components.

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CHAPTER 16: TRANSFUSION THERAPY

● Transfusion treatment is mainly employed for managing two kinds of illnesses: insufficient oxygen-carrying capacity due to
anemia or blood loss, and hemostasis stability when the patient lacks protein coagulation or platelets.

● In an adult, a unit of whole blood or RBCs ought to elevate the hematocrit level by 3% and the hemoglobin level by 1 g/dL.

● RBCs are used to boost RBC bulk in patients who need more oxygen-carrying capability.

● Patients who suffer from bleeding due to thrombocytopenia should receive platelet transfusions. Platelets are also
recommended as a preventative for individuals with platelet counts between 5,000 and 10,000/L.

● In a 70-kg patient, each platelet dosage should raise the platelet count from 20,000 to 40,000/L.

● A plateletpheresis product is obtained from a single donor and must comprise at least 3 × 1011 platelets.

● Plasma includes all clotting components and is used to treat patients who have several coagulation deficits due to liver
failure, DIC, vitamin K shortage, warfarin overdose, or major transfusion.

● Cryoprecipitate includes at least 80 units of factor VIII, as well as 150 mg of fibrinogen and vWF and factor XIII.

● Factor IX is used in treating people who have hemophilia B.

● Immunoglobulin (IG) is used to treat congenital hypogammaglobulinemia, to offer passive protection against specific viruses
including hepatitis A and measles, and to address autoimmune illnesses like immune thrombocytopenic purpura.

● Massive transfusion is referred to as replacing one or more blood volume(s) in less than 24 hours, or approximately 10 units
of blood in an adult.

● When the patient's type is unknown, an emergency transfusion of group O RBCs is warranted.

CHAPTER 17: ADVERSE EFFECTS OF BLOOD TRANSFUSION

● The most frequent complications of transfusions are allergic transfusion reactions and febrile nonhemolytic transfusion
reactions, although transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO)
are among the most prevalent transfusion reactions linked with death.

● Hemovigilance is a method that standardizes the classification of various transfusion responses and collects data on the
occurrence of transfusion reactions with the goal to enhance blood transfusion efficiency.

● The timing of initiation in relation to transfusion, major clinical symptoms, and dominating pathophysiological processes
separate acute and delayed serologic transfusion responses.

● TRALI, TACO, transfusion-associated dyspnea, and severe allergic responses are examples of transfusion reactions during
which respiratory signs prevail. These responses, nevertheless, have been linked with a number of other manifestations
that coincide with different kinds of responses.

● A multitude of responses have "two hits" in their pathophysiology: a recipient predisposition and transfusion of some
mediator in the transfused substance that causes the reaction.

● Citrate, a clotting agent found in retained RBCs, can produce hypocalcemia and release potassium from the cells into the
supernatant, resulting in hyperkalemia, particularly in newborns. Furthermore, RBCs and platelets go through a series of
metabolic and morphological alterations known as the "storage lesion," although the clinical relevance of these
modifications is uncertain.

● Transfusion-associated graft-versus-host disease, with a 90% fatality rate, is a relatively unusual but terribly detrimental
consequence of transfusion in which donor lymphocytes assault the immune system of the intended recipient.

● TTBI is more commonly linked with platelet compounds than RBCs, and every single one of these products is connected
with a distinct group of microbes. Platelets are more typically linked with S. aureus and gram-positive pathogens, whereas
rods containing gram-negative bacteria of the Enterobacteriaceae family have a greater association with contaminated
RBCs.

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CHAPTER 18: APHERESIS

● Blood is extracted from a donor or patient and split into its constituents during an apheresis treatment. One or more
elements are kept, while the other parts are rearranged and returned to the person.

● The procedure of extracting plasma from the blood is referred to as plasmapheresis; extracting platelets is characterized as
plateletpheresis or thrombocytopheresis; elimination of RBCs is known as erythrocytapheresis; and removal of leukocytes is
identified as leukapheresis.

● Apheresis apparatus that employs intermittent flow centrifugation (IFC) involves a single venipuncture, whereby blood is
taken and reinfused using an identical needle. Once the required element is isolated, the leftover components are reinfused
into the donor, and the first cycle is completed. Apheresis treatments performed on patients typically need several cycles to
achieve a satisfactory therapeutic outcome.

● Continuous flow centrifugation (CFC) techniques extract, process, and return blood to the person being treated all at the
same time. There are two venipuncture sites required. The phlebotomy, division, and reinfusion processes are continuous.
Therapeutic apheresis is best used for the management of category I or II diseases.

● Normal saline, FFP, cryoreduced plasma, and 5% human serum albumin constitute the alternative fluids utilized during
therapeutic plasmapheresis operations in order to preserve proper volume in the arteries and oncotic pressure.

● Apheresis problems comprise vascular access problems, drug pharmacodynamic changes, citrate toxicity, fluid disarray,
allergic reactions, malfunctioning devices (hemolysis), and infection. There have been fatalities (mostly among patients
rather than donors).

CHAPTER 22: TISSUE BANKING AS A PART OF THE TRANSFUSION SERVICE

● The movement of tissue to a different institution is referred to as dissemination.

● FDA CFR 1270 and 1271 exempt vascularized organs such as the liver, kidney, lung, pancreas, and heart.

● In accordance with the AABB's blood bank method, the tissue bank ought to possess a physician-appointed medical
director.

● A tissue committee, comparable to or equivalent of the transfusion group, should be formed.

● Tissue sent to the tissue bank has to be verified for the quality of the packaging and categorization, reconciled with the
packing invoice, and obtain certification indicating that temperature parameters acceptable for the tissue provided have
been sustained.

● The hospital tissue bank needs to keep an eye on the condition of its refrigerators and freezers at all times.

● Record-keeping must feature each step or adjust in status of the tissue with inscription of the person who accomplished it
and the date to permit for bidirectional tracking from donor to final configuration.

● Records should be kept for at least ten years after the point of transportation, transplantation, disposition, or expiry of tissue
(whichever comes first). Organizations may be obligated to keep tissue records for a period exceeding ten years if
mandated by local and/or federal regulations.

● A distinctive tissue identification number (TIN) is required to be assigned to each tissue product.

● Every year, the hospital tissue bank must validate any suppliers’ and vendors’ FDA certification.

● The Joint Commission mandates hospital tissue banks to guarantee that sources have been granted authorization by the
state government in accordance with the regulations in the state where the vendor or tissue bank is situated.

● Autologous tissue may be maintained and provided without the need to qualify with the FDA as a tissue-manufacturing
enterprise if it is utilized inside the same premises without any intervening shipments elsewhere for additional handling.