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Blood Bank Chapter 1

2. List biological properties that affect post-transfusion survival


The RBC biology for normal survival and function are affected by
a. Normal chemical composition and structure of membrane
i. Deformability
ATP
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ii. Permeability
Allows for active cation transport to prevent hemolysis and control the cell
volume
ATP powered cation pumps keep proper ratios of intracellular cation and anions
Intracellular : Extracellular
Na+ 1:12
K+ 25:1
in ATP = dehydrated cell that leads to sequestration by the spleen
b. Normal hemoglobin structure and function
Blood Bank Chapter 1

c. Normal red blood cell metabolism

3. What are the metabolic pathways essential for normal survival and function?
Red blood cells use anaerobic glycolysis [breakdown of glucose] to transport oxygen so as to not use O2
in ATP production. The Metabolic pathways are

a. Anaerobic glycolytic pathway + 3 ancillary pathways
90% ATP
Production
10% ATP
Production
Anaerobic
Glycolytic Pathway
Pentose Phosphate
Oxidative
Blood Bank Chapter 1
Luebering-Rapoport
Shunt

produces 2,3-diphosphoglycerate


produces red blood cell organic
phosphate
allosteric effector; promotes
release of O2 from red blood cell
in low O2 environment
Pentose phosphate produces glucose-6-phosphate dehydrogenase

enzyme that reduces NADP+ to
NADPH in order to maintain
glutathione which protects the red
blood cell from oxidative damage
Methemoglobin
Reductase Pathway
produces methemoglobin

converts methemoglobin [Fe3+
iron; unable to bind O2] back to
hemoglobin [Fe2+ iron]

Fe3 Ferric Icky/cannot hold O2

4. Define the hemoglobin oxygen disassociation curve
H/O Curves
A sigmoid curve of the relationship between oxygen disassociation and binding to hemoglobin
based on the PO2 of the environment

Blood Bank Chapter 1
Allosteric Changes of Respiratory Movement
Left Shift :(

O2 (R)elaxed form
Hemoglobin expels 2,3-dPG
Beta Chains come together
Salt bridges are broken

Basic Bitches
2,3-diphosphoglycerate
temperature cold bitch
Keep O2 (greedy)
Right Shift :)

O2 (T)ense form
deoxyhemoglobin
Beta chains widen & bind 2,3-dpg
anionic salt bridges form between the Beta chains

Acidic
2,3-diphosphoglycerate
temperature smokin hot
Give away O2 (sharing/nice)

2,3-diphosphoglycerate impacts O2 delivery to the tissues.
A transfusion of 2,3-diphosphoglycerate blood products to a patient can shift that person to
the left.
2,3-diphosphoglycerate is depleted in CPD preserved blood products @ 2 weeks storage tie. In
vivo recirculation of the transfused red blood cell can refrom 2,3-diphosphoglycerate in a
normal person at 6 hours. This can be affected if the transfusion recipoents acid/base
status,phosphorous metabolism, degree of anemia and severity of disease state
6. What are 2 FDA criteria to evaluate preservation solutions and list storage containers
1. Average red blood
cell survival at 24
hours post
transfusion >75%
Red blood cell of healthy person is removed and labeled with
radioisotopes then reinfused to the original owner. At 24 hours
post transfusion the radioisotopes are measured
2. red blood cell
integrity is
maintained in shelf
life of stored red
blood cell
free hemoglobin should be <1% of the total hemoglobin

Approved storage containers
*Must be CO2 permeable to maintain pH
PVC polyvinylchloride plastic breaks at low temperatures
has DEHP diethylhexyl-phthalate plasticizer
with leeches into the lipids f plasma, can help
maintain red blood cell membrane integrity
Polyolefin No DEHP
Latex-free Plastic for persons with latex allergies
7. Red blood cell storage in a liquid state
Optimum viability is 1-6C storage
Viable for X number of days depending on the anticoagulant used
8. Red blood cell storage lesion
red blood cell vitality
Blood Bank Chapter 1
% viable cells
glucose
ATP
Lactic Acid
pH [acidic due to lactic acid ]
2,3-diphosphoglycerate
H/O curve shift to the left
plasma K+
plasma hemoglobin
9. Name Anticoagulants, explain the function of ingredients and maximum storage the for red
blood cell of each
Abbreviation ACD-A CPD CP2D CPDA-1
Name Formula-A
Acid Citrate-
Dextrose
*used for
apheresis
platelet
collection
Citrate-
Phosphate
Dextrose
Citrate-
Phosphate-
Double-
Dextrose
Citrate-
Phosphate-
Dextrose-
Adenine
*25% more
glucose than
CPD
Days 21 21 21 35
Citrate(sodium
citrate/ citric
acid)
Chelates Ca; prevents
clotting
Monobasic
Sodium
Phosphate
Maintains pH during
storage to promote
adequate levels 2,3-dpg

Dextrose substrate of ATP
production

Adenine promotes ATP production
21days 35days


.25mM

11. Additive solutions for red blood cell
Additive solutions are added to concentrated red blood cell products after plasma is
fractionated from the whole blood unit. The fractionation process removes vital nutrients in the
used for red blood cell maintenance e.g. adenine and glucose of CPDA-1
viability of red blood cell
Additives add back in nutrients to extend the shelf life of the packed cells
450ml blood collection will be at a 70-85% hematocrit =100ml additive 50-60% hematocrit
This lowers the viscosity of the unit allowing for easier transfusion as well as allows for
harvesting of plasma platelet from whole blood unit
Additive Solutions red blood cell concentrates
Abbreviation Name Days Adenine Saline Glucose Mannitol Citrate & Phosphate
AS-1 Adsol 42
AS-3 Nutricel 42
Blood Bank Chapter 1
AS-5 Optisol 42
14. Rejuvenation red blood cell
Rejuvesol
A solution for liquid state red blood cell to restore and ATP and 2,3-diphosphoglycerate
450ml collection via CPD,CPDA-1, and CPD/AS-1 + 50ml Rejuvesol solution
Incubate 1hr 37C then follow deglycerolization procedure
This creates an open system and must be used in 24 hours
{

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15. Platelet storage lesion
Platelet quality during storage due to platelet activation
Platelets use TCA oxidative metabolism in reduced O2 environments leading to glycolysis
Glucose consumption
Lactic acid production more acidic pH
Acids use up bicarbonate buffer in the plasma
Platelets must be at a pH >6.2 to remain viable
<6.2 pH platelet swelling
Loss of membrane integrity
Irreversible swelling
Aggregation
No circulation or function when transfused
Platelet storage lesion platelet activation & release of granules
ATP
ADP
Platelet aggregates in sheets
17. Platelet storage
Platelets are stored at 20-25C while under constant agitation
Expiration is at midnight of the 5
th
day
18. What is platelet swirling?
A visual inspection of platelet products performed prior to distribution for transfusion purposes
No swirling action indicates there is a loss of membrane integrity and loss of discoid shape and
irreversible sphering
21. PAS-C
PAS-C is a platelet additive solution that is used on Apheresis collected platelet units if stored in
reduced plasma
This additive allows for more plasma fractionation
Platelet quality
Chapter 1 Summary Points
Blood Bank Chapter 1
Each unit of whole blood contains approximately 450ml of blood and 63mL of anticoagulant or
500mL and 70mL anticoagulant
A donor can donate blood every 8 weeks
Donor units are screened with these tests
1. Syphilis
2. HbsAg
3. Anti-HBc
4. Anti-HCV
5. Anti-HIV1/2
6. Anti-HTLV-I/II
7. NAT HIV-1
8. NAT HCV
9. NAT West Nile Virus
10. Anti-T . cruzi
Red blood cell ATP generation is 90% glycolysis10% Pentose Phosphate production
A successful transfusion is considered one where >75% survival of red blood cell post-
transfusion
ACD, CPD and CP2D preserve red blood cell at 1-6C for 21 days CPDA-1 has added adenine to
increase storage up to 35 days
Additive solutions increase red blood cell storage up to 42 days and are approved for pediatric
and neonatal populations
Red blood cells can be glycerolized and frozen 6 days post collection in CPD or CPDA-1 and
stored for 10 years
Rejuvesol is FDA approved rejuvenation solution added prior to red blood cell freezing process
to regenerate ATP and 2,3-diphosphoglycerate levels prior to freezing process
Rejuvenation can be used as a means of salvage O type or rare red blood cell units that are
outdated 3 days past outdate
Platelet concentrates from whole blood have a minimum requirement of 5.5X10
10
platelets in
at least 90% of units. Volume must be 45-65mL and sufficient to maintain the pH of >6.2 for
the 5 day lifespan of platelet product
Open system pooled platelet concentrates have a storage time of 4 hours. A closed system of
pooled platelets has an expiration of 5 days
Apheresis platelet concentrates should have 4-6X platelets as compared to platelet concentrates
prepared from whole blood. Minimum requirement is 3X10
11
platelet in 90% sampled units.
Platelet are stored up to 5 days at 20-24C under constant agitation. During transportation
platelets do not have to be agitated for a period of 24 hours
Broken or open platelet bags must be transfused within 4 hours if stored at 20-24C
Ch1 Review questions
1. What is the maximum volume of blood that can be collected from a 110lb donor, including
samples for processing?
Blood Bank Chapter 1
a. 525mL
2. How often can a blood donor donate whole blood?
a. Every 8 weeks
3. When red blood cells are stored, there is a shift to the Left. This means:
a. Hemoglobin oxygen affinity increased, owing to a decrease in 2,3-diphosphoglycerate
4. The majority of platelets transfused in the united States today are
a. Apheresis platelets
5. Which of the following anticoagulant preservatives provides a storage time of 35days at 1-6C for
units of whole blood and prepared red blood cells if an additive solution is not added?
a. CPDA-1
6. What are the current storage time and storage temperatures for platelet concentrates and
apheresis platelet components?
a. 5days at 20-24C
7. What is the minimum number of platelets required in a platelet concentrate prepared from
whole blood by centrifugation in 90% of units?
a. 5.5X10
10

8. Red blood cells can be frozen for up to
a. 10 years
9. What is the minimum number of platelets required in an apheresis component in 90% of the
sampled units?
a. 3X10
11

10. Whole blood and red blood cell units are stored at what temperature?
a. 1-6C
11. Additive solutions are approved for storage of red blood cells for how many days/
a. 42
12. One criterion used by the FDA for approval of new preservation solution and storage containers
is an average post-transfusion survival of
a. 75%
13. What is the lowest allowable pH for platelet component at outdate?
a. 6.2
14. Frozen and thawed red blood cells processed in an open system can be stored for how many
days/hours?
a. 24hours
15. What is the hemoglobin source for hemoglobin-based oxygen carriers in advanced clinical
testing?
a. Both bovine and human hemoglobins
16. Which of the following occurs during storage of red blood cells?
a. pH
b. 2,3-diphosphoglycerate
c. ATP
d. Plasma K
Blood Bank Chapter 1
17. Nucleic acid amplification testing is used to test donor blood for which of the following
infectious diseases?
a. Hepatitis C virus
b. Human Immunodeficiency Virus
c. West Nile Virus
d. All of the above
18. Which of the following is NOT FDA approved test for the quality control of platelets?
a. BacT/ALERT
b. eBDS
c. gram stain
d. Pan Genera Detection PGD
19. Prestorage pooled platelet=s can be stored for
a. 5 days
20. Which of the following is the most common cause of bacterial contamination of platelet
products ?
a. Entry of skin plugs to the collection bag

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