9 Blood Components - Preparation & Indication

Cards (107)

  • 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