blood component prep

• Blood transfusion


  Taking blood or blood based products from one individual and inserting them into the circulatory system of another

  
• Reasons for blood transfusion

  • Massive blood loss due to trauma, surgery, shock
  • Cell producing mechanism fails
• Conditions treated by blood transfusion

  • Inadequate oxygen-carrying capacity because of anemia or blood loss
  • Insufficient coagulation proteins to provide adequate hemostasis
• Types of blood transfusion

  • Autologous transfusion (blood donor and transfusion are the same)
  • Allogenic transfusion (blood transfused to someone other than the donor)

  
• Component therapy


  Transfusion of specific blood components needed by the patient or recipient

  
• Blood component preparation


  1. Whole blood acquired, stored, and transfused

  2. Plastic bag and refrigerated centrifuges introduced

  3. Single blood donation can provide transfusion therapy to multiple patients

  4. Whole blood divided into components using centrifugation or apheresis

  
• Blood components


  • Oxygen carrying components (whole blood, RBC aliquots, etc.)
  • Platelet products (platelet rich plasma, platelet concentrate, etc.)
  • Plasma products (fresh plasma, fresh frozen plasma, etc.)
  • WBC (granulocyte concentrate)
  • Plasma derived components (coagulation factor concentrates, oncotic agents, immune serum globulin, etc.)

  
• Equipment used in component preparation

  • Blood bank centrifuge
  • Plasma expressors
  • Tube sealers
  • Plasma freezers

  
• Whole blood


  Contains RBCs and plasma, with a hematocrit level of approximately 38%
• Whole blood


  • Provides oxygen-carrying capacity and volume expansion
  • Platelets, WBC and clotting factors do not survive in stored whole blood
  • Rarely used for transfusion today
  • 1 unit increases Hgb 1-1.5 g/dL and Hct 3-5%
  • Storage temperature 10C to 60C
  • Shelf-life depends on preservatives (ACD and CPD 21 days, CPDA-1 35 days)
  • Can be irradiated to inhibit T-cell proliferation (decreases shelf-life to 28 days)
  • Total volume 450-500 mL, RBC 200-250 mL, plasma 250-300 mL, anticoagulant 63-70 mL
• Red blood cell components

  • Packed RBCs
  • RBC aliquots
  • Irradiated RBCs
  • Washed RBCs
  • Frozen, deglycerolized RBCs
  • Leukoreduced RBCs
• Packed RBCs


  • Prepared from whole blood by centrifugation or sedimentation
  • May obtained directly by apheresis
  • Prepared shortly after donation to allow manufacture of other components
  • Plasma removed varies by anticoagulant-preservatives
  • Final RBC volume 160 to 275 mL or 50 to 80g of Hgb
  • Indications: increase RBC mass and oxygen-carrying capacity, anemia with cardiac failure
  • Storage temperature 1-60C
  • Shelf life: open system 24 hours, closed system same as whole blood

  
• RBC aliquots


  • Product most often transfused during neonatal period or in infants younger than 4 months
  • Transfusions for neonates require only small volumes (10-25 mL)
  • Indications: anemia caused by spontaneous fetomaternal or fetoplacental hemorrhage, twin-twin transfusion, obstetric accidents, internal hemorrhage, iatrogenic anemia
  • Storage temperature 1-60C
  • Shelf life: open system 24 hours, closed system same as whole blood
  • Anticoagulant most often used is CPDA-1

  
• Irradiated RBCs


  • Irradiation inhibits proliferation of T-cells and prevents transfusion associated graft-versus-host disease
  • Minimum dose 25 Gy central, 15 Gy any part
  • Irradiation source: Cesium-137, Cobalt-60
  • Indications: immunocompromised patients, bone marrow/stem cell transplant recipients, fetuses undergoing intrauterine transfusion, recipients of blood from relatives
  • Storage temp 1-60C
  • Shelf life: 28 days from irradiation or original expiration, whichever comes first
• Washed RBCs


  • Complete removal of plasma which contains plasma proteins (common cause of allergic reactions)
  • Indication: increase RBC mass of symptomatic anemic patients with history of allergic, febrile, urticarial and anaphylactic reactions
  • Patient: with anti-IgA in the plasma
  • Donor: IgA in the plasma
  • Storage: 1-60C
  • Shelf-Life: open system 24 hours

  
• Leukoreduced RBCs


  • Removal of leukocytes by filtration, centrifugation, and saline washing
  • Absolute WBC count reduced to <5 x 10^6, contains at least 85% of original RBC mass
  • Indications: patients with severe recurrent febrile transfusion reactions, patients at risk for HLA alloimmunization, protection against CMV transmission
  • Storage: 1-60C
  • Shelf life: open system 24 hours, closed system same as whole blood
  • Two methods: prestorage and poststorage leukoreduction
• Frozen, deglycerolized RBCs


  • Freezing RBCs with glycerol, shelf life up to 10 years
  • Indications: rare phenotypes, autologous use, military use
  • Thawed RBCs are deglycerolized before transfusion to remove glycerol and plasma proteins
  • Deglycerolization involves thawing, washing with hypertonic solutions
  • Storage temperature 1-60C
  • Shelf life of deglycerolized RBCs: 24 hours
• Platelet products


  • Can be produced during routine conversion of whole blood or by apheresis
  • Indications: bleeding thrombocytopenic patients, cancer/chemotherapy patients
  • Not for patients with DIC and ITP
  • Random-donor platelet count 5.5 x 10^10/L, pooled platelets 3.0 x 10^11/L
  • Storage temperature 20-24C with continuous agitation, plasma stored

  
• Whole blood


  From a non-traumatic venipuncture, collected <8 hours ago, maintained at 20-240C before and during preparation, a closed multibag system

  
• Platelets from donors who are taking a platelet-inhibiting drug such as aspirin may not be used as the sole source of platelets for a patient
• Donor centers that make platelets from whole blood donations must have a mechanism to identify such donors so that they may be excluded from platelet production or they may be pooled with other acceptable products
• Indications for platelet concentrates

  • Bleeding patient who are thrombocytopenic (<50,000/uL)
  • Cancer patients during radiation
  • Chemotherapy because of induced thrombocytopenia (<20,000/uL)
  • Thrombocytopenic preoperative patients (<50,000/uL)
• Platelet concentrates are not for patients with DIC and ITP (increased platelet consumption and destruction)
• Random-donor platelet concentrates


  • Platelet count: 5.5 x 1010/L ; pooled platelets: 3.0x1011/L
  • Storage temperature: 20-24C (with continuous agitation, plasma volume 40-70 mL, pH ≥6.2)
  • Shelf life: 5 days ; if pooled: 4 hours (open system)

  
• Single donor platelet concentrates (apheresis platelets)


  • Platelet count: 3 x 1011/L (equivalent of 4-6 random donor PC)
  • Storage temperature: 20-240C (continuous agitation, plasma volume 300 mL)
  • Shelf life: 5 days

  
• For platelets transfusion for neonates: requires small volume only
• Platelets are indicated for neonates whose counts fall below 50,000 ul and who are expecting bleeding
• Factors that may be associated with thrombocytopenia


  • Immaturity of coagulation system
  • Platelet dysfunction
  • Increased platelet destruction
  • Dilution effect secondary to massive transfusion
  • Intraventricular hemorrhage
• Platelet aliquots (random donor or single donor PC) should increase platelet count by 50,000-100,000 given a dose of 5-10 mL/kg
• Random-donor platelets can be leukoreduced by using a leukoreduction filter designed for platelets
• • After treatment the WBC count must be: Random donor: 8.3 x 105/L ; If pooled, WBC count must be 5 x 106/L
  • Single donor: 5 x 106/L
• Fresh Frozen Plasma (FFP)


  • Produced from whole blood (150-250 mL) or apheresis collection (400-600mL)
  • Must be frozen within 6-8 hours of collection
  • Storage temperature: -180C and -650C
  • Shelf life: 1 year for -180C, 7 years for -650C
  • Contains maximum levels of both stable and labile CF (1 IU per mL)

  
• Plasma Frozen within 24 hours (PF24)


  • Must be frozen within 8-24 hours of collection
  • Storage temperature: -180C or colder
  • Contains all stable proteins found in FFP, slightly decreased Factor VIII
• Both FFP and PF24 is about 150ml to 250 ml (400mg of fibrinogen)
• Both FFP and PF24 are thawed at temperatures between 30-370C
• Thawed FFP and PF24 must be stored at 1-60C and must be transfused within 24 hours
• If water bath is used, the product must be placed in a protective lining or overwrap so that the ports of the unit are not contaminated by contact with water
• If not transfused within the initial 24 hour period, thawed FFP and PF24 may be stored up to 5 days but label is change to "thawed plasma"
• Plasma Cryoprecipitate


  • Contains stable coagulation factors such as fibrinogen and prothrombin but reduced amounts of factor V, VII, VIII and X
  • Prepared from FFP and PF24 thawed at 300C to 370C and maintained at 10C to 60C for up to 4 days
  • Should be not be used to treat specific factor deficiencies where other products with higher factor levels are available and it should not be used purely as a volume expander

  
• Cryoprecipitate


  • Plasma retained after thawing and centrifugation of FFP to produce cryoprecipitate
  • Must be frozen within 24 hours
  • Storage temperature: -180C
  • Shelf life: 1 year
  • Contains: albumin, Factor II, V, VII, IX, X, XI