This document discusses the components, goals, storage conditions, and lesions of stored blood and blood products. It outlines the various whole blood components including red blood cells, platelets, fresh frozen plasma, and derivatives. The goals of blood preservation are to maintain viability and function while preventing contamination. Lesions during storage include decreases in pH, ATP, and 2,3-DPG. Various preservative solutions are used to limit these lesions. Optimal storage temperature is 2-6°C.

1. PRESERVATION AND
STORAGE

2. Components
• Whole Blood components
– Red cell concentrate
– Leukocyte poor red cell
concentrate
– Washed RBCs
– Frozen thawed
deglycerolized RBCs
– Granulocyte concentrate
– Platelet concentrate
– Fresh frozen plasma
– Single donor plasma
– Cryoprecipitate
• Plasma derivatives
– Albumin
– Plasma protein
fraction
– Factor VIII
concentrate
– Factor IX
concentrate
– Immune serum
globulin
– Rh immunoglobulin

3. Goals Of Blood Preservation
 Maintain viability and function
 Prevent physical changes
 Minimize bacterial contamination

4. Lesions of Storage
 The Various Biochemical changes which
occurs in blood cells on storage are called as
Lesions of Storage. These include:
 Decrease in pH:
Glycolysis occurs in RBCs to produce ATP
Lactic acid will produce which causes fall
of pH.

5. Contd...
 Loss of Adenosine Triphosphate(ATP):
ATP is required for red cell viability
Glucose as a fuel will be deficient in stored
blood
Deficiency of ATP causes leakage of Na+
and K+ through red cell membrane.

6. Contd…
 Decline of 2,3- Diphosphoglycerate
Fall in pH
Reduction in red cell 2,3- DPG
Increase in hemoglobin oxygen affinity
DPG depleted red cells have impaired capacity
to deliver oxygen to the tissues

7. Various chemicals are used to limit these
lesions of storage. More than 70% of red cells
should remain viable in circulation 24 hours
after transfusion of stored blood.

8. Preservative solutions used to store
blood
 1st anticoagulant preservative was introduced
in 1916. It consisted of citrate and glucose.
 2nd preservative was introduced in 1943
which was acidified citrate dextrose(ACD).
 In 1957 Citrate- phosphate- dextrose was
introduced which was less acidic than ACD.
Shelf life of blood stored in CPD at 2-4°C
was 21 days.

9. Contd...
 In 1978 citrate-phosphate-dextrose with
adenine(CPDA-1) preservative was
developed. Addition of adenine increased
the shelf life to 35 days at 2-4°C.
 Actions of ingredients in preservative
solution:
Glucose: Supports ATP generation by
glycolytic pathway.
Adenine: Synthesizes ATP, increases level of
ATP.

10. Contd...
Citrate: Prevents coagulation by chelating
calcium.
Sodium di-phosphate: Acts as Buffer. Prevents
fall in pH.
 Optimum temperature for storage: 2-6°C.
Though glycolysis is essential for red cell
viability, it can lead to fall in pH. Low
storage temperature limits glycolysis rate
and also inhibits proliferation of Bacteria.

11. CELLULAR
COMPONENTS

12. Preservation of RCC
 During preparation of RCC from whole
blood 40% of glucose and adenine present in
CPDA is removed with plasma which leads
to decreased viability of Red cells.
 So some additive solution is added to the
RCC which serves two functions:
Increases viability of Red Blood Cells and
increases shelf life upto 42 days.
Decreases viscosity of RCC allowing easy
transfusion.

13. Contd...
 The Additive solutions should be added to red cells
within 72 hours since phlebotomy.
 Additive solutions commonly used:
1) Adsol(AS-1): Saline, Adenine, Glucose, Mannitol
2) Nutricel(AS-3): Saline, Adenine, Glucose,
Citrate, Phosphate. No Mannitol.
3) Optisol(AS-5): Saline, Adenine, Glucose,
Mannitol.
4) SOLX(AS-7): Saline, Adenine, Glucose, Mannitol

15.  The plastic material used for storage of
blood products should be sufficiently
permeable to CO2 so that the pH is
maintained.
 Currently the blood is stored in plastic bag
made of polyvinyl chloride with plasticizer
di-(2-ethylhexyl) phthalate(DEHP).

16. Red Cell Freezing
 Freezing damages red cells due to intracellular
ice formation and to some extent due to
hypertonicity.
 If glycerol is added to the cells they can be
frozen and thawed without damage. Glycerol
limits ice formation and provides liquid
phase.
 Frozen RBCs are primarily used for storage of
rare blood groups e.g. Bombay blood group.

17. Contd...
 Glycerol is added to red cells with vigorous
shaking so that it permeates into the red cells.
 The freezing and storage temperature depends
on the concentration of glycerol. Two
concentrations are used: a high
concentration(40% weight in volume) and a low
concentration glycerol(20% weight in volume).
 Glycerol must be added to red cells within 6
days of collection for freezing.
 Frozen red cells can be preserved upto 10 years.

19. Platelet Concentrate

20. Preservative CPD
 CPDA
Unlike red cells, however, there is no evidence that
adenine-containing media(CPD-A) preserve platelet
function better than those without adenine.

21. STORAGE
The critical variables affecting stored
platelet health are:
1) temperature,
2) metabolic fuel availability, and
3) respiratory capacity

22. 1. Temperature
• 20 to 24ºC
• Storage above the 20 to 24ºC
temperature described as optimal by
Murphy and Gardner, but was
accompanied by increased
metabolism compared with room
temperature storage.
• The salutary metabolic effects of
room temperature storage include
– decreased in-vitro aging and
– slower accumulation of toxic
metabolites within the platelet
container.
– slowing platelet metabolic activity by
almost 60%

23. 2. Metabolic Fuel Challanges
 Pyruvate dehydrogenase, which produces acetic acid for
the aerobic citric acid cycle, appears to be downregulated
in stored platelets.
 Leading to anaerobic glycolysis and lactic acid production
 Lactic acid is buffered primarily by plasma bicarbonate,
which results in the production of CO2.
 Progressive depletion of bicarbonate thus occurs through
lactic acid buffering as well as slow spontaneous
dissociation to CO2 and water

24.  Studies using radiolabeled palmitate point to free fatty acids
derived from plasma triglycerides as the predominant
metabolic fuel for platelets stored in plasma if proper
aerobic condition is maintained
 Despite the presence of sufficient amounts of alternate fuels
(such as acetate), once PCs exhaust their supply of glucose,
they increase their metabolic rate and deplete their adenine
nucleotides, leading to cell death.
 The reasons for this are poorly understood.

25. 3. Respiratory capacity
 Maintenance of aerobic metabolism requires a PO2 above
5 to10 mmHg.
 With the decrease of PO2 to hypoxic levels there is
upregulation of glycolysis, lactic acid accumulation, and a
deleterious decrease in pH
 So continuous gaseous exchange across the the PC-PRP
container must be ensured.

26. • These problems to some extent are
overcome by
1. Continuous agitation of platelets. This helps in –
• Continuous gaseous exchanges across the storage bags.
• Less mitochondrial oxygen starvation
• Increased Aerobic metabolism through CAC.
2. Use of second generation container. (made of
polyolefin, or PVC that is thinner or plasticized with
different compounds such as triethyl hexyl trimellitate
and butyryl-tri-hexyl citrate)
• Either a circular or a flat bed movement, provides the best
results

27. Expiry –
 Should be used within 5 to 7 days if kept under proper
conditions mentioned above.

28. PLASMA

29. Fresh Frozen Plazma
• In order for a plasma product to be labeled as FFP, it
must be frozen within 8 h of collection.
• contains all coagulation factors in normal quantities
with about 1 IU/mL of each clotting factor.
• Storage
 −18°C for 1 year or −65 °C for 7 years
• Transport
 Frozen or at 1–10°C
• Expiry
 24 h once thawed and stored at 1–6°C

30. Plasma frozen within 24 h after
phlebotomy (PF24) clinically equivalent to FFP and can be used
interchangeably.
 Storage
 −18°C for 1 year
 Transport
 Frozen or at 1–10°C
 Expiry
 24 h once thawed and stored at 1–6°C

31. Thawed plasma
 Thawed plasma is any plasma product (FFP, PF24,
PF24RT24)
 that has been thawed and has been stored longer than 24 h.
 has decreased amounts of cofactors, factor V and factor
VIII.
 However, it contains acceptable levels of the other factors
including ADAMTS13
 Storage / Shelf life
 5 days if stored at 1°C to 6°C
 Transport
 at 1–10°C

32. Cryoprecipitated antihemophilic
factor or Cryoprecipitate
• Prepared from FFP when FFP is allowed to thaw at refrigerator
temperatures (1–6°C), a cold insoluble precipitate is formed.
• After centrifugation the precipitated product is called
cryoprecipitate
• Storage
−18°C for 1 year
• Transport
Frozen or 20–24°C
• Expiry
6 h after thawing and 4 h if pooled
By quality standards, cryoprecipitate must contain at least 80 IU of
factor VIII and 150 mg/dL of fibrinogen in all units tested.

33. Cryoprecipitate-reduced plasma
 Cryoprecipitate-reduced plasma (CRP) is the
plasma product (Supernatant) that remains after
the manufacture of cryoprecipitate.
 Storage
−18°C for 1 year
 Transport
Frozen or 1–10°C
 Expiry
24 h once thawed and stored at 1–6°C