blood components

• Whole blood: donate every 8 weeks/2 months /56 days interval
• Pheresis


  Dealing with a particular blood component being donated
• Types of pheresis


  • Plasmapheresis: plasma only
  • Leukopheresis: WBCs or Granulocytes only
  • Plateletpheresis: platelets only
• If taking aspirin (blood thinner) → temporarily deferred until he/she is cleared for 3 consecutive days
• Aspirin acetylation


  Permanently inactivates the cyclooxygenase, blocking of thromboxane A2 appears → a platelet activating factor
• Blocked thromboxane A2 → insufficient production and impairment of the platelet due to the aspirin effect
• Donor bleeding


  1. Needle insertion: 45 deg angle → reduce to 10 – 20 deg angle when the needle is already inserted properly

  2. Time allocation for procedure: less than or equal to 15 minutes
• Blood component preparation is done 6-8 hours after the collection
• Refrigeration temperature: 1 to 6 deg Celsius except for the platelet concentrate for it is stored at room temp (20-24 deg Celsius) with continuous agitation
• Blood bag preservatives


  • ACD
  • CPD
  • CP2D
  • CPDA-1
  • CPDA-2
• ACD, CPD, CP2D


  Approved preservative solution for storage of RBCs at 1 to 6 degrees Celsius with 21 days of shelf life
• CPDA-1


  Citrate-Phosphate-Dextrose-Adenine, 35 days shelf life
• CPDA-2


  Citrate-Phosphate-Dextrose-Adenine-Two, 42 days shelf life
• Additive solution components


  • Saline
  • Adenine
  • Glucose
  • Mannitol
• Citrate


  Anticoagulant, patient dependent in blood transfusion → citrate toxicity → hypocalcemia – binding of blood with calcium

  
• Dextrose/Glucose


  ATP Source (Energy)
• Citric Acid


  Prevents Caramelization
• Phosphate Buffer


  Additional source of ATP (energy)
• Adenine


  Additional Source of For ATP Production, Provides survival
• All of the additive solution that are mainly approved in the US are for RBCs as it allows longer storage
• Rejuvenation


  Process by which the ATP and the 2,3 DPG levels are restored or enhanced by metabolic alteration
• Rejuvenation solutions


  • PIGPA
  • PIPA
• Red cells stored in the liquid state for fewer than three (3) days after their outdate are rejuvenated for 1-4 hours at 37 deg. Celsius with the solution
• Rejuvenated RBC should be consumed within the day (24 hrs. expiration after rejuvenation)
• Rejuvesol


  Only FDA approved rejuvenation solution used in blood centers to regenerate again the ATP, 2,3 DPG levels before RBC freezing
• Rejuvenation is accomplished by incubating an RBC unit at 37 Deg. Celsius for 1 hour (currently only RBCs prepared from 450mL collection can be rejuvenated) with 50 mL of the rejuvenating solution
• Packed RBC should be prepared from a single unit of whole blood which is the 450 ml
• Biochemical changes during whole blood storage

  • ⬆ pH
  • ⬆ Plasma Hemoglobin
  • ⬇ ATP
  • ⬆ Plasma Potassium
  • ⬇ 2,3-DPG
  • ⬇ Plasma Sodium
• Oxyhemoglobin Dissociation Curve


  Relationship between the partial pressure of oxygen (pO2) in the blood and the oxygen saturation of the hemoglobin

  
• Lesion of Storage – loss of RBC viability → various biochemical changes
• Lesion of storage changes

  • Decrease pH, glucose (due to decrease glucose consumption), and ATP levels
  • Lactic acid build-up
  • Reversible loss of RBC function
• Factors affecting oxyhemoglobin dissociation curve

  • ⬇ 2,3-DPG
  • ⬇ Body Temperature
  • ⬇ pCO2
  • ⬇ pO2
  • ⬆ pH
  • ⬆ Hb O2 affinity

  
• Shift to the Left: 2,3-DPG may occur when it comes to the depleted RBCs → impaired capacity of RBC to deliver oxygen to the tissues

  
• Shift to the Right: when blood needs O2 in the tissues
• p50 – partial pressure of oxygen needed for 50% oxygen saturation of hemoglobin

  
• Sigmoid shape: normal shape/characteristic of oxyhemoglobin dissociation curve

  
• ⬇ Saturation = ⬇ Hgb oxygen affinity

  
• Whole Blood


  Transfuse due to Acute blood loss (lost >25% blood vol)
• Whole Blood


  • Indicated for replacing the loss of both RBC mass and plasma volume
  • Stored at 1-6 OC
  • Transported at 1-10 OC
  • Shelf life depends on blood bag preservative: ACD, CPD, CP2D - 21 days, CPDA-1 - 35 days, CPDA-2 - 42 days

  
• Packed RBCs


  Indicated for increasing the RBC mass in patients who require increased oxygen carrying capacity