blood and blood component therapy knowledge is essential before major operation.

1. Blood & Blood components therapy
Presented by
Dr.Md.Ashiqur Rahman Chowdhury
(MS Phase A, Resident)
Dr MD ABDUL QUIYUM
Phase B HBS, BSMMU,Bangladesh

2. Blood & Blood components
Blood is a specialized connective tissue composed of fluid
portion plasma & the cellular elements, circulating through
the cardiovascular system & carrying substances essential
for life.
Blood component refers to blood product separated
from single unit of anti co-gulated whole blood with in
6 hours of collection for clinical use or preservation.

3. Advantage Of Component Therapy
Blood components are preferred because
Patients are best treated by administration of the
specific component of blood that they lack
One donated unit can help multiple patients
Each component has specific optimal storage
conditions
Minimizes the hazards of whole blood transfusion

4. BLOOD COMPONENTS
SR N0 NAME ABBREVIATI0N
1 WHOLE BLOOD WB
2 PACKED RBC/ CONCENTRATED PRBC
RED BLOOD CORPUSCLES
3 WASHED RED BLOOD CELL SW-RBC
4 FRESH FROZEN PLASMA FFP
5 CRYODEFICIENT PLASMA CDP
6 CRYOPRECIPITATE CRYO
7 PLATELET CONCENTRATE PLT
8 SINGLE DONOR PLATELET/ SD-PC
APHERESIS PLATELET CONC

5. Whole Blood
 Def : Blood collected into an anticoagulant or preservative
solution in a suitable container which is not processed in
any manner.
 Earlier whole blood was
exclusively used
for transfusion but
now considered as a raw
material rather than a
transfusion medium.

6. Properties Of Whole Blood
450 ml of blood
63 ml of anticoagulant solution
Hct : 35-45%
Haemoglobin approximately 12 g/ml
No components have been removed
Store at 2-6 ̊C
No functional platelets
No labile coagulation factors (V and VIII)
Blood should be transfused within 30 minutes of removal of refrigeration
Transfusion should be completed within 4 hours
Shelf life :
1. Acid citrate dextrose (ACD) - 21 days
2. Citrate Phosphate Dextrose (CPD) - 28 days
3. CPDA₁- 35 days
4. SAGM- 42 days

7. Use of whole blood
• Rarely used now a days
 Indications :
Acute blood loss (greater than 25%)with hypovolemia
Exchange Transfusion
Major surgery
Drawbacks :
After storage for ˃24 hours, Platelets and WBC are
non-functional
Factor V and Factor VIII decrease with storage
Fluid overload

8. Whole Blood Cont….
Contraindication :
Risk of volume overload : Chronic Anaemia
Cardiac Failure
Administration :
1. Must be ABO and RhD compatible
2. Never add medication to a unit of blood
3. Use blood administration set
 Dosage :
Every 10-15ml/kg whole blood transfusion increase Hb 1 gm/
dl and Hct by 3%

10. Packed Red Blood Cell (PRBC)
Method of preparation:
i. Sedimentation
ii. Centrifugation: - 1500 RPM, 6 MIN, 220C
- 4200 RPM, 5 MIN, 220C
Volume: 150-200 mL
Hct: 55 – 75 % (<80 %)
Hb: 20 gm / dL
Red cell mass: 1 unit of WB
Shelf life: 35 days in CPDA 1
Storage: 2 – 60 C

11. Indications:
To replace red cell mass:
 Tissue oxygenation impaired eg. Acute/Chronic
blood loss
 Symptomatic anemia unresponsive to hematinic,
 Anemia of chronic disorders, CRF, Bone marrow
failure
 Hemoglobinopathies - Thalassemia, Sickle cell
anemia
 Those cover all the indications for giving whole
blood

12. PRBC Cont……
 Transfusion requirement of each patient should
be based on clinical status, rather than hemoglobin
value or hematocrit . There are no set hemoglobin
levels that indicate need for transfusion . the level
of 10gm/dl has been used as transfusion trigger for
many years for surgical and leukemic patients , which
has now been lowered to 7.5gm/dl.
 To improve transfusion flow, normal saline (50–10
0 ml)may be added using a Y-pattern infusion set.

13. Advantage of PRBC
Less blood group antibodies in packed cells,so
non-specific blood i.e.O negative blood can be
given to the patients with other groups.
Less plasma proteins with packed cells , so there is
minimal anaphylactic Reaction.
1 unit PRBC increase Hb 1 g/dl
In pediatric patient Hb will increase up
to 3 g/dl (10ml/kg)

14. Platelets

15. Platelets Concentrate
Platelets are small fragments of cytoplasm derived from a
Megakaryocyte.
Monumental discovery by Wright.
Duke (1910) was the first to realize that platelet transfusion
would relieve hemorrhage in the presence of Thrombocytopenia.
• Two methods to collect this component
– Random donor platelets
– Single donor Apheresis platelets

16. Random donor platelets
• A single unit of platelets can be isolated from
every unit of donated blood, by centrifuging the
blood within the closed collection system to
separate the platelets from the red blood cells(RBC)
Single donor unit in a volume of 50–60 ml of plasma
should contain:
At least 55 x 10 ⁹ platelets
<1.2 x 10 ⁹ red cells
<0.12 x 10 ⁹ leucocytes

17. Random donor pooled platelets
Unit of issue May be supplied as either:
• Single donor unit: platelets prepared from one donation
• Pooled unit: platelets prepared from 4 to 6 donor
units ‘pooled’ into one pack to contain an adult dose
of at least 240 x 10⁹ platelets.
Infection risk :
• Same as whole blood, but a normal adult dose involves bet
ween 4 and 6 donor exposures
• Bacterial contamination affects about 1% of pooled units

18. Random donor platelets
• Storage:
 Up to 72 hours at 20°C to 24°C (with agitation) unless
collected in specialized platelet packs validated for longer
storage periods; do not store at 2°C to 6°C
 Longer storage increases the risk of bacterial proliferation
and septicaemia in the recipient

19. Random donor platelets
• Advantages:
– lower cost,
– ease of collection and
– processing (a separate donation procedure and
pheresis equipment are not required).
• Disadvantage:
-is recipient exposure to multiple donors in
a single transfusion and logistic issues
related to bacterial testing.

20. Single donor Apheresis platelets
• Platelets are collected in 30-40 mins apheresis
procedure.
• Platelets and some white blood cells are removed, and red
blood cells and plasma are returned to the donor.
• A typical apheresis platelet unit provides the equivalent
of six or more units of platelets from whole blood/
random donor platelets.

21. Single donor Apheresis platelets
 Volume 150–300 ml
 Platelet content 150–500 x 10⁹, equivalent to 3–10
single donations
 Platelet content, volume of plasma and leucocyte conta
mination depend on the collection procedure
Unit of issue:
1 pack containing platelet concentrates collected by a
cell separator device from a single donor
Storage :
Up to 72 hours at 20°C to 24°C (with agitation) unless
collected in specialized platelet packs validated for
longer storage periods; do not store at 2°C to 6°C

22. Single donor Apheresis platelets
• Advantages:
-exposure of the recipient to a single donor
rather than multiple donors,
-and the ability to match donor and recipient charact
eristics such as HLA type, cytomegalovirus (CMV) status, a
nd blood type for certain recipients.
 Disadvantages:
1. Expensive
2. Time consuming

23. Indications of Platelet Transfusion
I. Decreased platelet production:
 Leukemia
 Hypo plastic anemia
 Chemotherapy
 Bone marrow transplantation
 Marrow infiltration
II. Platelet loss:
a. Hemorrhage
b. Cardiac surgeries

24. Indications Cont…
III. Platelet sequestration:
Splenomegaly
IV. Platelet qualitative defects:
Dengue
V. Dilutional thrombocytopenia eg.massive transfusion
by stored blood.
VI. Disseminated intravascular cougulation(DIC)

25. Guidelines for Platelet Transfusion
Adults:
i. Non-bleeding pt.with failure of platelet production
 Platelet count<10000/µl
 Invasive procedure with platelet count<50000/µl
ii. Bleeding patients
 DIC with platelet count<50000/µl
 Massive transfusion & platelet count<50000/µl
 Active bleeding& platelet count<50000/µl
 Diffuse bleeding following cardiopulmonary bypass & platelet
count not yet available or <100000/µl
 Platelet function defect ,regardless of platelet count.

26. Guidelines for Platelet Transfusion
iii. Pediatric Age Group
Premature infants (gestational age<37 weeks)
 platelet count<50000/µl in an infant.
 platelet count<100000/µl in a sick infant.
iv. Other infants & children
 platelet count<50000/µl
 platelet count<50000/µl with active bleeding
 platelet count<100000/µl in with active bleeding &
DIC
 Platelet function defect ,regardless of platelet count
.

27. PLASMA Component

28. Different types of frozen plasmas are available:
Fresh frozen plasma (FFP):
Plasma frozen at - 18oC or colder within 6 hours of donation.
F24 plasma:
Plasma frozen at -18oC or colder within 24 hours
Cryosupernatant or cryo-reduced plasma (CRP):
plasma remaining after removing cryoprecipitate
Solvent-detergent treated plasma
Treatment of pooled plasma prior to freezing with a solvent
and a nonionic detergent inactivates a number of lipid
envelopes virsues, including HIV, hep B and hep C.
Liquid plasma:
Plasma not immediately frozen as FFP or F24 and stored at
1-6oC

29. Fresh Frozen Plasma (FFP)
 Plasma separated from whole blood , frozen
within 6to 8 hours of collection & stored at - 180C
and below.
 plasma prepared from whole blood:
i. Primary centrifugation of WB
ii. Secondary centrifugation of PRP

30. FFP
 Volume: 175 - 250 mL
 Storage: - 200 C or <
 Thawing: 30 to 370C (administer within 6 hrs)
 1 UNIT- 5 -6% CLOTTING FACTORS FOR 70 K
G ADULT
 Dose: 10 -15 ml/kg
 Monitoring: PT / APTT
 ABO compatible
 Rh compatible at child bearing age
(anti-D Ig: 50 IU /unit of FFP)

31. Indications
 The majority of clinical situations for which
FFP is currently used do not require FFP.
 Pt presenting with bleeding for the first
time where the diagnosis is uncertain as to which
factor is deficient.
 Massive transfusion with a demonstrated
deficiency of Factor VIII and V, otherwise frozen
plasma is adequate.
 Exchange transfusion in neonates.

32. Indications
 Mainly used to replace clotting factors.
 Where multiple factors need to be replaced
 liver disease, DIC,TTP
 Warfarin anticoagulant overdose.
 Pts receiving large volume of whole bl
ood. Antithrombin III deficiency
 In reconstitution of whole blood along with PRBC or to
adjust hematocrit of PRBC for exchange transfusion in new
born.
 Lastly FFP is useful to prevent and treat
coagulopathy due to L-asperagenase in cancer pts.
 Hemophilia ,it is better to use factor concentrate.

33. FFP
 As FFP contains plasma, it can lead to allergic reactions,
anaphylaxis in IgA deficient patient and can transmit all the
plasma borne infections.
 Hence albumin should be used as a volume expander as it is
much safer.
 Similarly albumin and not FFP should be used to replace
proteins or albumin.
 If pt need both volume expansion as well as clotting
factors like in DIC, sepsis, NEC etc. one can use FFP.
 In small babies, it can lead to hemolysis if it contains
high levels of antibodies against recipient’s blood group
antigen

34. FRESH FROZEN PLASMA -
CONTRAINDICATIONS
 Should not be used when coagulopathy can be
corrected more effectively
specific therapy, such as vitamin K, cryoprecipitate,
or Factor VIII concentrates.
 Same infectious disease risk as whole blood.
 Should not be used when the blood volume
can be replaced with other volume expanders such
as 0.9% sodium chloride, lactated ringer’s, albumin.

36. Cryoprecipitate
• Originally it was developed as a therapy for Hemophilia
A (Used for 50 yrs). Enriched with fibrinogen, Fac VIII,
vWF, Fac XIII.
• Prepared from processing FFP:
- When FFP is thawed at 40C, a precipitate is formed,
this is separated from the supernatant plasma, and
resuspended in a small volume of plasma and then
refrozen at -250C.
- Can be stored for 1 year
- On ordering the cryoprecipitate is thawed in a 370C
water bath & issued in individual bags or a pooled product.
- After thawing- must be kept in room temperature
- Expiration time- 6hr for un-pooled & 4hr for pooled.

37. Cryoprecipitate
• One unit of cryoprecipitate – derived from 1 unit of
whole blood/ 250ml plasma- contains
– Volume- 10-15ml
– 150-250 mg Fibrinogen.
– 80-100 units of Fac VIII.
– 20-30% of the orginal FFP Fac XIII.
– 50-60 mg of fibronectin.
– 40-70% of FFP Concentrate vWF.

38. Indications…
1. To replace –
Haemophilia A(Factor VIII)
Von-Willebrands Disease(vWF)
Congenital or acquired fibrinogen deficiency
Factor XIII deficiency
2. To correct abnormal bleeding in DIC
3. Used in Local/topical hemostatic agent (fibrin
Glue/fibrin sealant) as a source of fibrine.

39. COMPONENT
THERAPY
IS BETTER
REMEDY