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fussion's version from 2017-05-22 23:10

vaccination deferral

Question Answer
12 monthunlicensed vaccines
VZV4 weeks
rubella (German measles)4 weeks
3 weekssmallpox vaccination without complications
live attenuated and bacterial vaccines2 weeks
measles (rubeola), mumps2 weeks
typhoid (oral), yellow-fever, polio (Sabin/oral)2 weeks
symptom free after the following vaccinations toxoids, synthetic, killed viral, bacterial or rickettsial vaccinesNo deferral
recombinant vaccines (HPV)No deferral
intranasal live attenuated flu vaccineNo deferral
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travel deferral

Question Answer
CJD risk (FH, spent >3 months in the UK or 5 years total in Europe, use of bovine insulin)indefinite
Babesiosindefinite
Chagas diseaseindefinite
Received money for sexindefinite
Parenteral drug use or used a needle to administer nonprescription drugsindefinite
Receipt of dura mater or pituitary growth hormoneindefinite
Male who had sex with another male since 1977indefinite
+ve for HBV (HbsAg, anti HBc), HCV, HTLV-1) or caused HIV or HTLV infection in a donorindefinite
malaria infection(after becoming asymptomatic)3 years
lived >5 years in malaria endemic area3 years
travel to malaria endemic areas12 months
paying for sex, hx of syphilis, gonorrhea)12 months
HBV immune globulin administration12 months
received blood products, human tissue, plasma derived clotting factors12 months
HCV risk: mucous membrane exposure to blood, nonsterile skin penetration12 months
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blood products

Question Answer
Whole bloodRBCs (Hct 40%), plasma, WBCs, Plts. 500 cc
Whole blood Ineed for increase in both RBC mass and plasma volume
Whole Blood Relative CIvolume overload
Whole blood storage1-6 C Varies with preservative
RBCs consist ofRBCs (Hct 55-80%), minimal plasma, WBCs, plts., and preservative solution
RBC Mandatory QCHct < 80% for all random donor PRBCs units tested, Hb > 50 g in at least 95% of apheresis RBC units tested 300 cc
RBC Isymptomatic anemia
RBC Relative CIAIHA or hyperhemolysis in SCD
RBC storage 1-6 C within 8 hours of collection Varies w/ preservative, 24 hours refrigerated if open system, 4 hours at room temp. if open system
Frozen RBCsRBCs and 40% glycerol (deglycerolized when thawed and considered washed and leukoreduced) 250 cc
Frozen RBC ISame as RBCs, usually rare blood groups are frozen
Frozen RBC processingMust be frozen within 6 days if no AS, with AS must be frozen before exp. date
Frozen RBC storage-65 C 10 years, transfused within 24 hours or keep refrigerated at 1-6 C after thawing
Irradiated RBCs consists ofRBCs 250 cc
Irradiated RBC Isame as RBCs, irradiated to prevent TA-GVHD
Irradiated RBC storage1-6 C 28 days or original expiration, whichever comes first
Platelets (random donor)Plts. (> 5.5 x 10^10), minimal plasma, WBC ( 8.3 x 10^5 if leukoreduced), RBC (< 0.5 mL, if > 0.5 mL need to be crossmatched), pH > 6.2 50 cc
Platelets Relative CIITP
Platelets Absolute CITTP, HIT
Platelets Storage20-24 C with constant gentle agitation 5 days (may go 24 hours w/o agitation) 4 hours after pooling
Pooled platelets in closed system5 days or shortest outdate of RDP in pool, room temp
Apheresis plateletsPlts. (> 3 x 10^11), reduced amount of plasma, WBC (< 5 x 10^6 if leukoreduced), RBC (< 2 mL) 300 cc
Apheresis platelets Isame as random donor plts. Minimizes alloimmunization
Apheresis platelets storage20-24 C with constant gentle agitation 5 days (may go 24 hours w/o agitation)
FFP Imultiple factor deficiencies, PT/PTT > 1.5x midrange of normal
FFP Relative CIIgA def. pts
FFP storage-18 C 1 year, 7 years if stored at -65 C, expires in 24 hours after thawing (relabeled as "thawed plasma" after 24 hours)
Thawed plasma shelf life5 day, refrigerated
CryoCold insoluble portion of plasma; must have 150 mg of fibrinogen and 80 IU of fVIII; also has fXIII, vWF
Cryo PreparationFFP thawed and centrifuged at 1-6 C. After removing thawed plasma, precipitate must be placed at  -18 C to make cryo 15 cc
Cryo Ideficient fibrinogen or factors VIII, XIII or vWF when safer factors not available
Cryo storage-18 C 1 year, 6 hours at room temp. after thawing if unpooled, 4 hours at room temp. after thawing if pooled
Apheresis granulocytes Granulocytes (> 1 x 10^10) 200 cc
Apheresis granulocytes Ineutropenic pts. with documented infection unresponsive to standard therapy, Always irradiated
Platelet Ibleeding in thrombocytopenic patient or prophylactic for severe thrombocytopenia
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Antibodies:Ag

Question Answer
Antigens that display dosageDuffy, MNS, C/c, E/e (Rh), Kidd
Most common antibodies in immediate HTRanti-Kell, ant-Jka (Kidd), anti-Fya (Duffy), anti A
Most common antibodies in delayed HTRanti-Jka, anti-Fya, anti-DCE
Most common antibodies in HDNgroup O mom with anti IgG A, B, AB, anti-DC, anti-Kell
Antigens enhanced by enzymesABO-related (AB, I/I, P1, Le), Rh, Kidd
Antigens destroyed by enzymesDiMiNiSsh Fya, Fyb, MNSs
Mixed field reactionshigh affinity low avidity and post BMT
Antibodies that cause intravascular hemolysisABO, Kidd, P (paroxysmal cold hemoglobinuria)
Antigen not affected by enzymesKell, Diego, Colton
R1R1 given R2 blood will make what antibodiesanti E, anti c
What is the most common antibody found in R1R2 (DCe/DcE)anti-f
Most common Rh-rr
Most common RH+ in white pplR1/R1 and R1/r
Most common RH+ in black pplR0/R0 and R0/r
Kidd is a ____ transport protein, clinical significance?urea, Jk(a-b-) are resistant to hemolysis in 2M urea. Have a mild urine concentrating defect
Jk(a+b-) more common in w/b?black
Jk(a+b+) more common in w/b?white
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calculations

Question Answer
CCI (BSA x Observed platelet increment) / Number of platelets transfused
BSA(Height in cm x weight in kg / 3,600)^1/2
Number of platelets transfused1 pheresis unit has 3x10^11 platelets, 2 for 4 random donor units, 3 for 6 random donor units
CCI cut offCCI > 10,000/uL is considered adequate. CCI of 5,000 considered evidence of refractoriness
INR 2 to <4 How many units of prothrombin complex concentrate25 units/kg; not to exceed 2500 units
INR 4-6 Calculate prothrombin complex concentrate35 units/kg; not to exceed 3500 units
INR >650 units/kg; not to exceed 5000 units
Rhogam dose (vials)maternal blood volume x %fetal cells in maternal blood / 30
Rhogam full dose protects against30 mL whole blood or 15 mL RBC
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warfarin reversal

Question Answer
INR < 5lower the dose
INR 5-9 with no significant bleedhold warfarin
INR 5-9 with increased risk or minor bleedinghold warfarin, give vita K 1-2.5 mg orally
INR 5-9 with scheduled surgerygive vita K 2.5-5 mg orally, expect drop in INR in 24 hours, if not give lower dose vita K 1-2.5 mg
INR >9 with no bleedgive vita K 2.5-5 mg orally, monitor for INR in 24 hours, if not give additional vita K
INR > 20give vita K 10mg slow IV infusion, supplement with FFP as needed, consider prothrombin complex concentrate (FVIIa) for life threatening bleeding
Serious bleed at any INRgive vita K 10mg slow IV infusion, supplement with FFP as needed, consider prothrombin complex concentrate (FVIIa) for life threatening bleeding
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factor dosage

Question Answer
FVIIIKg x desired factor % x 2 or (x 1-Hct)
FXIkg x desired factor %
Cryo[Desired fibrinogen level X plasma Volume] / 250 mg fibrinogen per unit of cryo
Plasma volumekg x 0.7kg/mL x 1-Hct
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