Philippine Red Cross Internship Notes | Study notes Medicine

Philippine Red Cross Internship Notes

Name of facility: Philippine Red Cross Western Visayas

Regional Blood Center

BLOOD SERVICES

1. Donor recruitment

2. 2. Donor screening

3. Blood collection

4. Blood component preparation

5. Blood testing

6. Blood storage and distribution

BLOOD STORAGE

STORAGE FACILITY TEMPERATURE RANGE

Blood storage area + 20 - 24 degrees Celcius

Blood bank refrigerator

(WB and PRBC)

+ 2 - 6 degrees

Blood bank freezer (Cryo

and FFP)

- 30 to -50 degrees

Platelet agitator (Plt rich

and Plt concentrate)

+ 20 - 24 degrees Celcius

Ice box/Blood transport + 10 degrees

INDICATORS

1. Facility

2. Serial number

3. ABO blood type

4. RH

5. Volume

6. Component

7. Collection Date

8. Expiration Date

9. Serology result

10. Transfusion instruction

11. Storage

** Swirling is an indication of discoid amount or healthy

platelets

PACKED RED BLOOD CELLS

+ 2 to +6 degrees C

230 - 330 ml

Grading:

o(1+) - very light swirling

o(2+) – light

o(3+) moderate

o(4+) - heavy

 The 2+ and 4+ grading are accepted

Platelet count and leukocyte

pH associated with swirling 6.2 - 7.4

Purpose of RBC in tube: FOR CROSSMATCHING

Hemoglobin: > 45 g/L Hematocrit: <80%

WHOLE BLOOD

468 to 558 ml

63 CPD A1

Hemoglobin: > 45g/L Hematocrit: >38%

PLATELET CONCENTRATE

50 to 70 ml

5 day expiry

+20 to +24 degrees C with continuous agitation

FRESH FROZEN PLASMA

150 to 250 ml

1 year expiry

-30 degrees C and below

Low levels of blood proteins (coagulation factors)

<eg: immunoglobulin>

Replacement of coagulation factors in cases of

factor deficiency <eg. Hemophilia>

Antidote to warfarin toxicity

Replacement of immunoglobulins in cases

immunodeficiency

Higher levels of Factor V and factor VIII

CRYOPRECIPITATE FROM FFP

30 ml

** Red Blood cell transfusion: each unit of packed RBC will

raise your Hgb by 1 g/dL and Hct by 3% <rule of three? ;

restores oxygen carrying capacity

PLATELETS

Important role in clotting and hemostasis

1 unit (6 pack) = 50 mL (increased plts by 50,000)

Uses:

-Thrombocytopenia: <50K (surg/LP)

-Emergent surgery: plt inhibitor (replace

inactive plts)

-Massive transfusion Protocol

CRYOPRECIPITATE

-centrifuge plasma (called precipitate)

-it contains: FIBRINOGEN, FACTOR VIII <used

when deficient>, VWF, XIII, FIBRONECTIN

- primarily used for fibrinogen levels

-1 UNIT= 15-20 ml 10 UNITS= 150-200 ml

-Goal: stop bleeding

SEROLOGY-EVOLIS MACHINE

Station for predilution plates and tip racks:

predilution: Pre dilution station and disposable tip

racks

Station for samples and reagents: Sample racks

Dispenser arm

Station for microplate loading and transport:

microplate transport and microplate dispense area

Station for wash buffer and washer

Incubators and photometers

PRINCIPLE OF EIA (Enzyme Immunoassay)

HIV p24 antigen and antibodies to HIV-1 and HIV-2

in human serum or plasma

ACQUIRED IMMUNODEFICIENCY SYNDROME

Is a virus inducing infectious disease characterized

by strongly depressed immunity.

HBsAg - in the serum or plasma indicates an

infection caused by Hep B virus

It is the first marker to appear and may be observed

2 or 3 weeks before clinical and biological

symptoms of the disease.

Hepatitis C virus - is recognized as being the main

cause of non-A and non-B viral hepatitis. HCV

infection is characterized by an acute and chronic

form that may lead to cirrhosis and hepatocellular

carcinoma.

Causative agent of Syphilis - Treponema pallidum

subsp. pallidum

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Philippine Red Cross Internship Notes Name of facility: Philippine Red Cross Western Visayas Regional Blood Center BLOOD SERVICES

Donor recruitment
1. Donor screening
Blood collection
Blood component preparation
Blood testing
Blood storage and distribution BLOOD STORAGE STORAGE FACILITY TEMPERATURE RANGE Blood storage area + 20 - 24 degrees Celcius Blood bank refrigerator (WB and PRBC)

2 - 6 degrees Blood bank freezer (Cryo and FFP)

30 to -50 degrees Platelet agitator (Plt rich and Plt concentrate)

20 - 24 degrees Celcius Ice box/Blood transport + 10 degrees INDICATORS

Facility
Serial number
ABO blood type
RH
Volume
Component
Collection Date
Expiration Date
Serology result
Transfusion instruction
Storage ** Swirling is an indication of discoid amount or healthy platelets PACKED RED BLOOD CELLS  + 2 to +6 degrees C  230 - 330 ml  Grading: o (1+) - very light swirling o (2+) – light o (3+) moderate o (4+) - heavy  The 2+ and 4+ grading are accepted  Platelet count and leukocyte  pH associated with swirling 6.2 - 7.  Purpose of RBC in tube: FOR CROSSMATCHING  Hemoglobin: > 45 g/L Hematocrit: <80% WHOLE BLOOD  468 to 558 ml  63 CPD A  Hemoglobin: > 45g/L Hematocrit: >38% PLATELET CONCENTRATE  50 to 70 ml  5 day expiry  +20 to +24 degrees C with continuous agitation FRESH FROZEN PLASMA  150 to 250 ml  1 year expiry  -30 degrees C and below  Low levels of blood proteins (coagulation factors) <eg: immunoglobulin>  Replacement of coagulation factors in cases of factor deficiency <eg. Hemophilia>  Antidote to warfarin toxicity  Replacement of immunoglobulins in cases immunodeficiency  Higher levels of Factor V and factor VIII CRYOPRECIPITATE FROM FFP  30 ml ** Red Blood cell transfusion: each unit of packed RBC will raise your Hgb by 1 g/dL and Hct by 3% <rule of three? ; restores oxygen carrying capacity PLATELETS  Important role in clotting and hemostasis  1 unit (6 pack) = 50 mL (increased plts by 50,000)  Uses:

Thrombocytopenia: <50K (surg/LP)
Emergent surgery: plt inhibitor (replace inactive plts)
Massive transfusion Protocol CRYOPRECIPITATE
centrifuge plasma (called precipitate)
it contains: FIBRINOGEN, FACTOR VIII , VWF, XIII, FIBRONECTIN
primarily used for fibrinogen levels
1 UNIT= 15-20 ml 10 UNITS= 150-200 ml
Goal: stop bleeding SEROLOGY-EVOLIS MACHINE  Station for predilution plates and tip racks: predilution: Pre dilution station and disposable tip racks  Station for samples and reagents: Sample racks  Dispenser arm  Station for microplate loading and transport: microplate transport and microplate dispense area  Station for wash buffer and washer  Incubators and photometers PRINCIPLE OF EIA (Enzyme Immunoassay)  HIV p24 antigen and antibodies to HIV-1 and HIV- in human serum or plasma ACQUIRED IMMUNODEFICIENCY SYNDROME  Is a virus inducing infectious disease characterized by strongly depressed immunity.  HBsAg - in the serum or plasma indicates an infection caused by Hep B virus  It is the first marker to appear and may be observed 2 or 3 weeks before clinical and biological symptoms of the disease.  Hepatitis C virus - is recognized as being the main cause of non-A and non-B viral hepatitis. HCV infection is characterized by an acute and chronic form that may lead to cirrhosis and hepatocellular carcinoma.  Causative agent of Syphilis - Treponema pallidum subsp. pallidum

COMPONENT PREPARATION

COAGULATION FACTORS:

Fibrinogen
Prothrombin
Tissue thromboplastin
Calcium
Labile factor/proaccelerin (FV and FVIII)
Deleted activated factor V
Stable factor (FVII and cothromboplastin)
Antihemophilic factor
Christmas factor
Stuart-prower factor
Plasma thromboplastin antecedent
Hageman factor
Fibrin stabilizing factor EQUIPMENT IN COMPO:
Refrigerated centrifuge
Plasma extractor
Digital weighing scale
Electric tube sealer
Clamp
Stripper
Blood bag

Segment and hanger grommet
Freshly collected Blood - >6-8 hrs process KINDS OF BLOOD BAGS:

Single Blood bag - for therapeutic blood donation
Double blood bag
Triple blood bag – donor
Quadruple blood bag - Aliquot TYPES OF BLOOD BAGS:  Karmi or Terumo type  63 mL of anticoagulant  55% plasma of your blood’s total volume  44% RBC  1% WBC and plts COMPUTATION OF EXPIRY DATE  Extraction date + Anticoagulant (35 days) - Number of days in the month = Expiration date PROGRAM 1  Light spin: 2400 rcf (relative centrifugal force)/rpm, 4 mins. at 22 degrees  For PRBC and Plt rich and plasma product PROGRAM 2  Heavy spin: 3600 rcf/rpm, 8 mins at 22 degrees  For plt concentrate and fresh frozen plasma products, plt poor PROGRAM 3  Heavy spin: 3600 rpm, 8 mins at +3 degrees  For cryoprecipitate ACD-A: Acid Citrate Dextrose Formula A (21 days) CPD: Citrtae Phosphate Dextrose (21 days) CP2D: Citrate Phosphate Double Dextrose (21 days) CPDA1: Citrate Phosphate Dextrose Adenine (35 days) CPDA1 with SAGM (Saline, Adenine, Glucose, Mannitol ( days) on quadrop of triple blood WHOLE BLOOD blood drawn directly from the body from which none of the components, such as plasma or plts has been removed PLATELET FUNCTION to prevent and stop bleeding; tiny blood cells that help your body form clots to stop bleeding PLATELET PLUG prevents more blood from leaving the body as well as any outside contaminants from getting in. PLT PLUG FORMATION also called PRIMARY HEMOSTASIS is the first of two steps needed for hemostasis HEMOSTASIS how the body prevents blood loss when injury happens. PRBC are produced by removal of majority of plasma forming unit of whole blood are what remains of whole blood after the plasma and plts have been removed. PLT CONCENTRATE prepared by using a centrifuge to separate the plt-rich plasma from the donated unit of whole blood contains about 60 mL of plasma and small numbers of red blood cells and leukocytes. FRESH FROZEN PLASMA plasma that has been frozen so it can be stored and used later contains coagulation factors at the same concentration present in plasma. CRYOPRECIPITATE highly concentrated source of Fibrinogen; 5 FACTORS INVOLVED: Fibrinogen, Factor VIII, VWF, Factor XIII and Fibronectin.; cryo-precipitated antihemophilic factor (Heavy spin: 3600 rcf for 8 mins at 3 degrees (Program 3) CRYOSUPERNATANT Cryo-poor plasma, cryoprecipitate depleted, cryoprecipitate reduced plasma Used to prevent or control bleeding in people whose own blood does not clot properly. (Hemophilia A (lack of FVIII) and VWF disease (lack of VWF) ALIQUOT to split up single unit, the blood bag is the spin off at the hospital and split in to smaller portions prior to use in a neonatal transfusion. Purpose of RBC sa tube is for crossmatching. PARTS OF BLOOD BAG  Needle  Needle cup  Needle indicator  Needle hub  Segment  Mother bag/Primary bag  Tab ports (transfusion set)  Cell proof closure  Segment grommet

 TTI: Transfusion Transmissible Infections  TTP: Thrombotic Thrombocytopenic Purpura  ITP: Idiopathic Thrombocytopenic Purpura  HUS: Hemolytic Uremic Syndrome DISPENSING

Whole Blood
- [WB1] Hyperbilirubinemia in infant with indirect bilirubin of 20 mg/dL.
- Hyperbilirubinemia with prematurity and/or other concomitant illness to include one or more the ff: A. Pre-natal asphyxia B. Prolonged hypoxemia C. Acidosis D. Hypothermia E. Sepsis F. Hemolysis [WB 2] Others: please specify: ____
1. Packed RBC  [R1] Signs ans symptoms of anemia (e.g pallor)  [R2] Hypovolemia from acute blood loss with signs of shock or anticipated blood loss of 10%  [R3] candidates for major surgery of Hct <30%  [R4] Hypertransfusion for chronic hemolytic anemias (e.g thalassemia)  [R5] Hemoglobin <13 g/dL and Hct <40%  [R6] Anemia with Hgb <8 g/dL or Hct <25%  [R7] Blood volume reduction of 10 ml/kg and with Hct <45% in newborns less than 4 months of age  [R8] pulmonary disease or congenital heart diseases with Hct 40-45%
Plt concentrate (____ units)  Apheresis plts [ ] 4 units [ ] 8 units  Leukocyte-poor plt concentrate (____) units  [P1] Active bleeding and thrombocytopenia <50,000/L or at a risk for intracranial hemorrhage  [P2] Active bleeding and qualitative defect  [P3] Prophylaxis for severe thrombocytopenia <20, or associated qualitative defect  [P4] Scheduled invasive procedure and thrombocytopenia <70,000/L or associated qualitative defect  [P5] Others: please specify
1. Fresh Frozen Plasma (_____ units)  Leukocyte-poor fresh frozen plasma (____ units)  [F1] Significant multiple coagulation factor deficiency or acquired  [F2] Significant congenital factor deficiency  [F3] Anti-thrombin III deficiency  [F4] Bleeding in exchange transfusion or massive transfusion  [F5] Others pls sepcify PROPER COLD CHAIN Whole blood. PRBC, FBP PC and PRP

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COMPONENT PREPARATION

COAGULATION FACTORS:

ICE

BLOOD BAG

BLOOD BAG

ICE