9 Blood Components - Preparation & Indication

• Whole Blood or the mother unit, is the most common blood received in Blood Banking
• In the initial process,

  • From mother unit of whole blood, it will undergo initial centrifugation in order to separate PRBCs and PRP
  • Once separated, plasma will be expressed out (into another bag)
• In the initial process, centrifugation has the same size of washing machine
• In the initial process, not only one bag is used.

  There is also a Satellite bag, where the components will go to once it is being processed
• Initial process

  • Plasma is expressed out to form fresh frozen plasma
  • Packed RBCs will be expressed to another bag to become PRBCs
• Initial process

  • Plasma depends on storage, it can be fresh frozen plasma or stored plasma
  • Fresh frozen plasma and stored plasma difference is the freezing time within the approved period
  • PRBC is the most common unit issued to patient
  • Whole blood is rarely issued to patient
• We can derive platelet concentrate coming from 1 unit of whole blood

  Usually undergo two or more spinning procedure or centrifugation

  • Plasma after light spin = platelet rich plasma
  • PRP will undergo hard spin = platelet poor plasma
• Whole blood is the most common and is used for replacement of mass RBC and plasma volume

  • Basically, it is the immediate blood from donor
• Whole blood is diluted into an anticoagulant to blood ratio of 1:8

  • It is important to maintain at this ratio because if we undercollect, there will be imbalance in ratio and there will be excess citrate and can cause hypocalcemia.
• Whole blood

  • Coagulant usually used is citrate
  • Additives for RBC metabolism during storage are Glucose, adenine, phosphate
• Use of whole blood is limited to a few clinical condition

  • It is rare to give to recipients
  • Whole blood cannot be given immediately because there are anticipated or predicted antigens and antibodies per ABO type
• 1 unit of Whole Blood = increase Hematocrit by 3-5% or Hemoglobin by 1-1.5 g/dL (for typical 70 kg adult)
• In Pediatric patients,

  • 1 unit of Whole Blood = 8 mL/kg will increase, hemoglobin by 1 g/dL and hematocrit by 3-4%
  • It is important to get the weight of pediatrics patient
• In whole blood, increase in Hgb and Hct may not be apparent until 48-72 hours
• Acid citrate dextrose is the most common anticoagulant used in WB.

  • It has citrate and dextrose (glucose solution)
• Shelf life of anticoagulants Acid citrate dextrose, Citrate Phosphate dextrose, and Citrate Phosphate-2 dextrose is 21 days
• Shelf life of anticoagulant Citrate phosphate dextrose adenine is 35 days
• Shelf life of anticoagulant Additive solutions (AS-1), Nutricel (AS-3), and Optisol (AS-5) is 42 days
• Additive solutions are not inherent to blood bag, it is added to extend the shell life for refrigerated blood
• Additive solutions (AS-1,3,5), a mixture of glucose, adenine and normal saline, provide nutrients to stabilize cell membrane and maintain the level of 2,3 DPG, which minimizes storage lesions
• Level of 2,3 DPG for stored blood is very important because it has inverse relationship with oxygen affinity of hemoglobin
• ↑ 2,3 DPG = ↓ oxygen affinity of hemoglobin
• Storage lesions are effect or damage to RBC due to storage because RBC is organic material and may deteriorate overtime
• Additive solutions:

  • AS-1 and AS-5 contains mannitol as a membrane stabilizer
  • AS-3 contains citrate and phosphate as a membrane stabilizers
• Modified whole blood is a whole blood void of cryoprecipitated
• Modified whole blood

  • Hematocrit provides approximately 38%
  • Stored at 1-6 °C
  • Stored for 21 days (ACD and CPD) or 35 days
• To inhibit T-cells proliferation, irradiation is required in order to kill your T-cells, which is to prevent TA-GVHD which can be fatal to patient
• Dose of radiation is enough to kill your T-cells but maintains the viability of other cells particularly red blood cells

  • 25 gamma rays is an indicator to the center of blood product to kill these T-cells
• Immunocompromised patients (irradiated whole blood)

  • Patients who are receiving bone marrow or stem cell transplant
  • Fetuses receiving intrauterine transfusion or recipient of unit from relatives
• Expiry date of irradiated whole blood is 28 days from the date of irradiation or the original outdate of the unit whichever is sooner
• Minimum dose of gamma radiation is 25 Gy to central portion of unit with no less than 15 Gy to any part of the unit
• 137Cesium and 60Cobalt are the common sources of gamma rays
• In PRBC, majority of the plasma coming from the whole blood has been removed and they are purely or mostly red blood cells with minimal plasma
• For patients requiring an increase in RBC Mass, PRBC is given

  • e.g., patient who loss a lot of blood
• PRBC

  • 200-250 mL of plasma may be removed (CPDA-1)
  • Additional 50 mL may be removed if additive solutions are employed
• PRBC

  • 7-8 g/dL for patients with heart, lung or cerebrovascular disease
  • 7 g/dL for leukemic or surgical patients
  • <6 g/dL for critical patients, also for patients without diseases
• In Normovolemic patients, there is a decrease in RBC Mass but total volume of blood is normal

  • PRBC is not given immediately because it can cause Circulatory overloads
• PRBC is not used to treat nutritional anemia unless patient shows signs of decompensation
• 1 unit of PRBC = increase hemoglobin level by 1-1.5 g/dL and hematocrit by 3-5% (typical 70 kg adult)
• Aliquoted RBC is used for neonate of infants younger than 4 months

  • 10-25 mL