ABPath Blood Banking/Transfusion Medicine cheat sheet

Whole blood and RBC units: 1-6 C storage; whole blood/CPD/CP2D/CPDA-1 shelf life 21-35 days; additive solution (AS-1, AS-3, AS-5) RBCs stored 42 days at 1-6 C.

RBC units must have hematocrit ~55-80%; leukoreduced units contain <5 x 10^6 residual WBCs; bedside leukoreduction is discouraged in favor of prestorage filtration.

Platelets: random-donor whole-blood-derived pool stored 20-24 C with continuous agitation; shelf life 5 days (7 days with FDA-approved pathogen reduction systems).

Apheresis platelets: >=3.0 x 10^11 platelets per unit; pH >=6.2 at end of storage; bacterial detection required.

Plasma frozen within 8 h (FFP) vs 24 h (FP24): both contain labile factors V and VIII; thawed plasma usable 5 days at 1-6 C; stored frozen <= -18 C for 12 months (or -65 C for 7 years).

Cryoprecipitated AHF: prepared from FFP thawed at 1-6 C; must contain >=80 IU factor VIII and >=150 mg fibrinogen per unit; stored frozen <= -18 C for 12 months.

Granulocyte concentrates: stored 20-24 C without agitation; transfuse as soon as possible, ideally within 24 h; irradiated to prevent TA-GVHD.

Irradiation dose 25 Gy to center of canister (15 Gy minimum elsewhere); does not prevent RBC storage lesion; irradiated RBCs expire 28 days after irradiation or original outdate, whichever first.

ABO: A and B antigens on RBCs; group O has anti-A and anti-B; group AB has neither. Reverse grouping confirms forward typing.

Rh: D antigen most immunogenic; weak D testing required on initial donor/patient typing; partial D variants may make anti-D.

Antibody screen: 2-3 cell screen at immediate spin (IgM), 37 C, and AHG phases; positive screen requires identification panel.

Compatibility testing: immediate spin crossmatch for ABO, then AHG crossmatch if antibody screen positive or history of clinically significant antibody.

Clinically significant antibodies: IgG reactive at 37 C/AHG (Rh, Kell, Duffy, Kidd, MNS, Lewis sometimes); IgM cold agglutinins usually not significant.

Antigen prevalence: D ~85% in Caucasians; K ~9%; Fy(a) ~66%; Jk(a) ~77%; M ~78%; Lewis antigens are not on cord RBCs.

Direct antiglobulin test (DAT): detects in vivo sensitization; polyspecific AHG detects IgG + complement; monospecific anti-IgG and anti-C3 differentiate.

Dosage: antibodies to Rh, Kidd, Duffy, MNS may react stronger with homozygous cells; must test panel cells with known zygosity.

Restrictive RBC transfusion threshold: Hb 7 g/dL for most stable inpatients; 8 g/dL for cardiac surgery, orthopedic surgery, and stable CVD patients.

Platelet transfusion thresholds: <10 x 10^9/L prophylactic; <20 x 10^9/L for procedures; <50 x 10^9/L for major surgery/neuraxial; <100 x 10^9/L for CNS surgery.

FFP dose: 10-15 mL/kg; INR >1.5 with bleeding or before procedure; do not use FFP for volume expansion or vitamin K reversal alone.

Cryoprecipitate: fibrinogen <100-150 mg/dL with bleeding; dose ~1 unit per 5-10 kg; raises fibrinogen ~50-100 mg/dL.

Massive transfusion: >10 units RBC in 24 h; balanced resuscitation with plasma:RBC ratio ~1:1 to 1:2; use viscoelastic testing to guide.

Transfusion-related acute lung injury (TRALI): noncardiogenic pulmonary edema within 6 h; often donor anti-HLA/anti-HNA; supportive care; implicated donor deferred.

Transfusion-associated circulatory overload (TACO): hydrostatic pulmonary edema within 6 h; elevated BNP; diuretics; slower rate and lower volume.

Hemolytic transfusion reaction: fever, chills, flank pain, hemoglobinuria; stop transfusion, maintain urine output, check DAT and repeat ABO.

Blood administration: two-person verification of patient ID and unit label; 0.9% NaCl only compatible with RBCs; no dextrose or lactated Ringer's.

Infuse RBCs within 4 h of issue; platelets and plasma as quickly as tolerated; filters 170-260 micron standard; no leukoreduction filter at bedside unless indicated.

Premedication with acetaminophen/diphenhydramine not routinely recommended; only for documented recurrent febrile nonhemolytic reactions.

Febrile nonhemolytic reaction: >=1 C rise or >=38 C; most common; stop transfusion, evaluate for hemolysis, leukoreduction reduces incidence.

Allergic reactions: urticaria/pruritus managed with antihistamine and restart; anaphylaxis (IgA deficiency, haptoglobin deficiency) requires stopping and avoiding future plasma-containing products.

ABO compatibility: RBCs must be ABO-compatible; plasma must be ABO-compatible with recipient RBCs (group AB plasma universal donor).

Patient blood management: preoperative anemia optimization, minimize phlebotomy, cell salvage, antifibrinolytics, restrictive thresholds, single-unit ordering.

Pathogen reduction: amotosalen/UVA (INTERCEPT), riboflavin/UVA (Mirasol), solvent-detergent for plasma; reduces but does not eliminate risk.

Donor eligibility: >=17 years (16 with consent), >=110 lb (50 kg), Hb >=12.5 g/dL female / 13.0 g/dL male, temperature <=37.5 C, BP <=180/100, pulse 50-100.

Donation intervals: whole blood every 8 weeks (56 days); 2-unit RBC apheresis every 16 weeks; platelet apheresis up to 24 times/year; plasma apheresis every 28 days.

Deferrals: 3 days after dental work, 4 weeks after live vaccine, 12 months after tattoo/piercing (unless regulated), permanent for HIV/HBV/HCV/HTLV.

Therapeutic plasma exchange (TPE): ASFA categories I-IV; Category I examples: TTP, Goodpasture, Guillain-Barre, myasthenia gravis, hyperviscosity.

TPE replacement: plasma for TTP and coagulation factor deficiencies; 5% albumin for most other indications; 1-1.5 plasma volumes per exchange.

Complications of apheresis: hypocalcemia from citrate (perioral tingling, tetany), hypotension, citrate-induced coagulopathy, vascular access complications, allergic reactions to plasma.

ASFA Category III: individualized decision; Category IV: not recommended (e.g., TPE for rheumatoid arthritis, chronic ITP).

Extracorporeal photopheresis: used for cutaneous T-cell lymphoma, GVHD, and rejection; 8-MOP plus UVA.

HLA class I: A, B, C on all nucleated cells; class II: DR, DQ, DP on antigen-presenting cells; typing by molecular methods (SSO, SSP, NGS).

HLA matching: 6/6 (A, B, DRB1) or 8/8 or 10/10 for unrelated donor selection; high-resolution typing at allele level for class I and II.

Crossmatch: complement-dependent cytotoxicity (CDC) and flow cytometric crossmatch detect donor-specific antibodies; virtual crossmatch uses antibody specificity.

GVHD prevention: irradiation of cellular products (25 Gy) for immunocompromised recipients, directed donations from relatives, and HLA-matched products.

Hematopoietic progenitor cells: collected from bone marrow, peripheral blood after G-CSF mobilization, or cord blood; minimum CD34+ dose ~2 x 10^6/kg for PBSC.

Cord blood: lower cell dose, less stringent HLA matching (4/6 acceptable), higher risk of engraftment failure; stored in FACT-accredited banks.

CAR-T and other cellular therapies: require chain of identity, chain of custody, and FACT/CAP accreditation; label with unique patient identifiers.

Tissue banking: AATB standards; donor screening for HIV, HBV, HCV, syphilis; processing in controlled environments; sterility testing.

FDA regulates blood establishments under 21 CFR 606 (CGMP) and 610 (general biologics); deviations reported under 21 CFR 606.171 (biological product deviation report).

AABB Standards for Blood Banks and Transfusion Services: biennial edition; covers donor eligibility, collection, testing, labeling, storage, and transfusion service.

CAP Laboratory Accreditation Program: transfusion medicine checklist; peer inspection every 2 years; complements CLIA certification.

FACT: accredits hematopoietic cellular therapy programs (bone marrow transplant, apheresis, cord blood banks); requires quality management and outcomes analysis.

Quality control: RBC units 1% or 4/month for hematocrit/hemoglobin; platelet count and pH; FFP factor VIII >=0.7 IU/mL; cryoprecipitate factor VIII >=80 IU.

Quality assurance: error and accident reporting, look-back for infectious disease, proficiency testing, validation of new methods, corrective action plans.

Legal principles: informed consent for transfusion, patient right to refuse (Jehovah's Witness), blood shield laws, confidential donor information, traceability records 10 years.

CGMP: donor center SOPs, equipment calibration, environmental monitoring, label control, lot release, and validation of computer systems (21 CFR Part 11).