M8

• Products that can be obtained from a single blood donation

  • Red blood cells (RBCs)
  • Platelets
  • Fresh-frozen plasma
  • Cryoprecipitate
  • Immune serum globulin
• Component preparation


  1. Collecting whole blood

  2. Transforming into components using centrifugation

  3. Collecting targeted components using apheresis
• Whole blood


  Collected in a ratio of 14 ml part anticoagulant preservative for every 100 parts of whole blood targeted for collection
• Whole blood component

  • 450 mL (±10%) of whole blood with 63 mL of anticoagulant-preservative
  • 500 mL (±10%) of whole blood with 70 mL of anticoagulant preservative, collected from blood donors with a minimum hematocrit of 38%
• packed Red blood cell (pRBC) preparation

  1. Separated from whole blood by centrifugation, sedimentation, or less commonly, apheresis

  2. Typically prepared shortly after donation to allow the manufacture of other components
• packed RBC components

  • Final red cell volume of 160-275 mL or 50-80g of hemoglobin suspended in the residual plasma and/or additive solution
  • Hematocrit of 55% to 65% if additive solutions are employed

  
• Platelet preparation


  1. Produced from whole blood donations by centrifugation

  2. Whole blood used must be drawn by a single nontraumatic venipuncture, and the concentrate must be prepared within 8 hours of collection
• Platelet components


  • Whole blood-derived platelet concentrates (random-donor platelets)
  • Apheresis or single-donor platelets (each contains one adult dose from a single donor)
• Platelet storage


  • Stored at 20-24°C with constant agitation and oxygen, most likely to grow bacteria if inadvertently contaminated
• Platelet quantities


  • Whole blood-derived platelet concentrates contain at least 5.5x10^10 platelets
  • Apheresis or single-donor platelets contain at least 3x10^11 platelets (therapeutic equivalent of 4-6 random-donor platelets)
• Both platelet preparation methods must maintain a pH of greater than or equal to 6.2 through the end of the labeled storage period
• Leukoreduction


  Removal of white blood cells (WBCs) from blood or blood components prior to transfusion
• Leukoreduced components


  • Apheresis, wholeb : less than 5x10^6 residual WBCs per unit
  • Platelets derived from whole blood: less than 8.3x10^5 residual WBCs per unit
  • At least 85% of the original component must be recovered after leukoreduction

  
• Leukoreduction methods

  Using special filters with multiple layers of polyester, cellulose acetate, or non-woven fibers that trap leukocytes and platelets but allow RBCs to flow through

  
• Quality control for leukoreduction


  • Nagoette chamber- designed cell counters to count WBCs at exceptionally low levels
  • Flow cytometry
• Fresh Frozen Plasma (FFP)


  Plasma frozen within 8 hours of collection
• Plasma Frozen within 24 hours (PF24)


  Plasma frozen within 24 hours of collection
• Plasma processing


  1. FFP can be further manufactured into cryoprecipitate and cryopoor plasma

  2. PF24 contains all stable proteins found in FFP with only slightly reduced levels of some factors
• PF24RT24

  Plasma frozen within 24 hours and held at room temperature up to 24 hours after phlebotomy
• Apheresis


  Procedure where whole blood is removed, separated into components, and the remainder is returned to the individual's circulation

  
• Pooling allows for multiple blood components to be transfused at a single event, except that multiple units of red blood cells are not typically pooled together
• Pooled components


  • Cryoprecipitate
  • Plasma
  • Platelets
  • Reconstituted red blood cells (for neonatal exchange transfusions)

  
• Washing

  1. Removing the extracellular solution and replacing it with normal saline

  2. RBCs are stored at 1-6°C for up to 24 hours

  3. Platelets are stored at 20-24°C and must be transfused within 4 hours
• Open system bacterial contamination and shortening the expiration
• Cryo-poor plasma (CPP)

  Plasma from which the cryoprecipitate concentrate has been harvested
• Components remaining in CPP

  • Albumin
  • Factors 2,7,9,10,11
  • ADAMTS 13
• CPP cannot be used as a substitute for FFP, PF24, or thawed plasma
• Plasma Frozen Within 24 Hours (PF24)

  Contains all stable proteins found in FFP, normal levels of Factor 5, and has only slightly-reduced levels of Factor 7 and protein c
• Apheresis


  • Procedure in which whole blood is removed from the body and passed through an apparatus that separates out one (or more) particular blood constituent, then returns the remainder of the constituents to the individual's circulation
  • Collection of a specific blood component while returning the remaining whole blood components back to the patient
  • Advantages: Large volume of blood, Removal of unwanted substance, Anticoagulant: Citrate

  
• Methods of Centrifugation

  1. Intermittent Flow Centrifugation: blood is processed in batches or cycles

  2. Continuous Flow Centrifugation: blood withdrawal, processing, reinfusion are performed simultaneously in an ongoing manner
• Whole blood used to prepare platelet concentrates must be drawn by a single venipuncture, and the concentrate must be prepared within 8 hours of collection
• Platelet concentrate requirements

  • Each unit must contain at least 5.5x10^10 platelets and should increase the platelet count by 5,000-10,000 in a 70 kg. human
  • A pool of 5 units will contain roughly 3x10^11 platelets and should give a platelet count increase similar to plateletpheresis
  • one plateletphersis should increase the adult patients platelet count to 20,000 to 60,000/uL
• Platelet refractoriness


  Failure to achieve an acceptable increment in platelet count following platelet transfusion. Platelet count must be measured within one hour after transfusion.
• Corrected Count Increment


  Absolute platelet increment/uL x Body surface (m2) / Number of Platelet transfused
• If the Corrected Count Increment is less than 5000, it is a bad increment (Platelet refractoriness). If it is greater than 5000, it is a good increment.
• Activated factor VII (rFVIIa) is a prohemostatic agent produced by recombinant DNA technology approved for use in patients with hemophilia A or B who have circulating antibodies or inhibitors, in patients with congenital factor VII deficiency, and for patients with glanzmann thrombosthenia
• Factor VIII concentrates

  Used to treat patients with Hemophilia A and have almost completely replaced cryoprecipitate as the product of choice

  
• Factor IX concentrates

  • Prothrombin complex concentrates (PCCs)
  • Factor IX concentrates
  • Recombinant FIX
• Factor XIII deficiency

  • Severe autosomal-recessive bleeding disorder associated with a characteristic pattern of Glanzmann thrombasthenia and a lifelong bleeding diathesis
• Immune serum globulin


  Indicated for patients with immunodeficiency diseases and for providing passive antibody prophylaxis against hepatitis and herpes. Intravenous immunoglobulin (IVIg) is also used in patients with idiopathic thrombocytopenic purpura, posttransfusion purpura, HIV-related thrombocytopenia, and neonatal alloimmune thrombocytopenia.