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Blood Products
Dr. Akshay Agarwal
WHOLE BLOOD (CPD-Adenine-1)
 Description:
 Up to 510 ml total volume (this volume may vary in
accordance with local policies)
 450 ml donor blood
 63 ml anticoagulant
 Haemoglobin approximately 12 g/ml
 Haematocrit 35 (45%)
 No functional platelets
 No labile coagulation factors (V and VIII)
Infection risk
 Not sterilized, so is capable of transmitting any agent
present in cells or plasma which has not been
detected by routine screening for transfusion-
transmissible infections, including:
 HIV-1 and HIV-2
 Hepatitis B and C
 Other hepatitis viruses
 Syphilis
 Malaria
 Chagas disease
Storage
 Between +2°C and +6°C in an approved blood bank
refrigerator, ideally fitted with a temperature chart
and alarm
 May be stored up to 35 days if collected in a
suitable anticoagulant such as citrate phosphate
dextrose with added adenine (CPDA-1)
 During storage at +2°C to +6°C, changes in
composition occur resulting from red cell metabolism
Indications Contraindications
 Red cell replacement in
acute blood loss with
hypovolaemia
 Exchange transfusion
 Patients needing red
cell transfusions where
red cell concentrates or
suspensions are not
available
 Risk of volume overload
in patients with:
 Chronic anaemia
 Incipient cardiac failure
Administration
 Must be ABO and Rh compatible with the recipient
 Complete transfusion within 4 hours of
commencement
 Never add medication to a unit of blood
 Always transfuse blood from a new venous in-flow.
Quality control of Whole blood
Parameter Quality Requirement Frequency of Control
Volume 350/450 ml +/- 10% 1% of all units
Anticoagulants 46/63ml All Units
PCV (Hct) 70% +/- 10% 4 units per month
Anti HIV-1 & 2 Negative by ELISA All units
HBsAg Negative by ELISA All units
VDRL (Syphilis) Negative by Screening
test
All units
Sterility By Culture Periodically 1% of all units
RED CELL CONCENTRATE
 Description 150–200 ml red cells from which most of
the plasma has been removed
 Haemoglobin approximately 20 g/100 ml (not less
than 45 g per unit)
 Haematocrit: 55–75%
 Indications : Replacement of red cells in anaemic
patients
 Use with crystalloid replacement fluids or colloid
solution in acute blood loss
Quality control for Packed cells / red cell
Concentrate prepared from WB
Parameter Quality
Requirement
Frequency of
Control
Volume 280ml +/- 40ml 1% of all units
PCV (Hct) 70% +/- 5% 4 units per month
Sterility By culture Periodically 1% of
all units
PLATELET CONCENTRATES (prepared from
whole blood donations)
 Description- Single donor unit in a volume of 50–60 ml of
plasma should contain:
 At least 55 x 109 platelets
 <1.2 x 109 red cells
 <0.12 x 109 leucocytes
 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 between 4 and 6 donor exposures
 Bacterial contamination affects about 1% of pooled units
 Storage :
 20°C–24°C (with agitation) for up to 5 days in specialized
platelet packs, although some centres use ordinary plastic
packs which restrict storage to 72 hours.
 Longer storage increases the risk of bacterial proliferation
and septicaemia in the recipient.
Indications Contraidications
 Treatment of bleeding
due to:
 — Thrombocytopenia
 — Platelet function
defects
 Prevention of bleeding
due to
thrombocytopenia, such
as in bone marrow
failure
 Not generally indicated for
prophylaxis of bleeding in
surgical patients, unless known
to have significant pre-
operative platelet deficiency
 Idiopathic autoimmune
thrombocytopenic purpura (ITP)
 Thrombotic thrombocytopenic
purpura (TTP)
 Untreated disseminated
intravascular coagulation (DIC)
 Thrombocytopenia associated
with septicaemia, until
treatment has commenced or in
cases of hypersplenism
Dosage
 1 unit of platelet concentrate/10 kg body weight: in a
60 or 70 kg adult, 4–6 single donor units containing
at least 240 x 109 platelets should raise the platelet
count by 20–40 x 109 /L
 Increment will be less if there is:
 — Splenomegaly
 — Disseminated intravascular coagulation
 — Septicaemia
Administration
 After pooling, platelet concentrates should be
infused as soon as possible, generally within 20
minutes, because of the risk of bacterial proliferation.
 Must not be refrigerated before infusion as this
reduces platelet function.
 4–6 units of platelet concentrates (which may be
supplied pooled) should be infused through a fresh
standard blood administration set.
 Special platelet infusion sets are not required.
 Platelet concentrates should be infused over about
30 minutes
 Platelet concentrates prepared from Rh D positive
donors should not be given to a Rh D negative
potential child-bearing female
 Platelet concentrates that are ABO compatible
should be given whenever possible
QC for Platelet concentrate
Parameter Quality Requirement Frequency of Control
Volume 45-60 ml All Units
Platelet count >5.5 x1010 4 units per month
pH >6.0 4 units per month
RBC concentration 0.5ml 4 units per month
WBC concentration 5.5 x 107 – 5 x 108 4 units per month
FFP
 Description: Pack containing the plasma separated
from one whole blood donation within 6 hours of
collection and then rapidly frozen to
–25°C or colder
 Contains normal plasma levels of stable clotting
factors, albumin and immunoglobulin, Factor VIII
level at least 70% of normal fresh plasma level
 Infection risk: If untreated, same as whole blood
 Very low risk if treated with methylene blue/ultraviolet
light inactivation
 Storage At –25°C or colder for up to 1 year.
INDICATIONS
 Replacement of multiple coagulation factor
deficiencies, e.g.:
 — Liver disease
 — Warfarin anticoagulant overdose
 — Depletion of coagulation factors in patients
receiving large volume transfusions.
 Disseminated intravascular coagulation (DIC)
 Thrombotic thrombocytopenic purpura (TTP)
Administration
 Must normally be ABO compatible to avoid risk of
haemolysis in recipient
 No crossmatching needed
 Before use, should be thawed in water which is between
30°C and 37°C.
 Higher temperatures will destroy clotting factors and
proteins
 Once thawed, should be stored in a refrigerator at 2°C–
6°C
 Infuse using a standard blood infusion set as soon as
possible after thawing
 Labile coagulation factors rapidly degrade; use within 6
hours of thawing
QC of FFP
Parameter Quality
Requirement
Frequency of
Control
Volume 200-220 ml 4 units per month
Stable coagulation
factor
200 units of each
factor
4 units per month
Factor VIII 0.7 units /ml 4 units per month
Fibrinogen 200-400mg 4 units per month
Cryoprecipitate
 Description: Prepared from fresh frozen plasma by
collecting the precipitate formed during controlled
thawing and resuspending it in 10–20 ml plasma
 Contains about half of the Factor VIII and fibrinogen
in the donated whole blood: e.g. Factor VIII: 80–100
i.u./pack; fibrinogen: 150–300 mg/pack
 Unit of issue Usually supplied as a single donor pack
or a pack of 6 or more single donor units that have
been pooled
 Infection risk :As for plasma, but a normal adult dose
involves at least 6 donor exposures
 Storage At –25°C or colder for up to 1 year
Indications
 As an alternative to Factor VIII concentrate in the
treatment of inherited
 deficiencies of:
 — Von Willebrand Factor (von Willebrand’s disease)
 — Factor VIII (haemophilia A)
 — Factor XIII
 As a source of fibrinogen in acquired
coagulopathies: e.g. disseminated ntravascular
coagulation (DIC)
QC of Cryoprecipitate
Parameter Quality
Requirement
Frequency of
Control
Volume 10-20ml Occasionally
Factor VIII 80-120 units Occasionally
Fibrinogen 150-250mg Occasionally
Leukodepletion
 Contains < 5 x 106 leukocytes per unit
 Advantages
 Reduced alloimmunization
 Reduced transmission of viruses
 Reduced NHFTR
 Reduced immunomodulation
Indications
 Thalassemia major
 Aplastic anemia
 Sickle cell anemia
 Leukemia
 Patients for organ transplantation
 Dialysis
 Multiple chronic infections
Methods of leukodepletion
 Centrifugation
 Washing
 Freezing
 Buffy coat removal
 Microaggregate filtration
 Filters
Filtration
 Advantages
 Increased efficiency of leukocyte removal
 Consistency of performance
 Minimal red cell or platelet loss
 Ease of use
 Types of filtration
 Bedside filtration
 Pre-storage filtration
Pre-storage filtration
 Closed system processing
 Done during component preparation
 Early WBC removal reduces accumulation of
cytokine and other breakdown products
 WBC containing bacteria and viruses removed
before fragmentation
 Reduction in microaggregate formation
Protocol to ensure safety
1. A blood request form.
2. A blood ordering schedule for common surgical
procedures.
3. Guidelines on clinical and laboratory indications
for the use of blood, products and simple
alternatives to transfusion, including intravenous
replacement fluids, and pharmaceuticals and
medical devices to minimize the need for
transfusion.
4. Standard operating procedures for each stage in the
clinical transfusion process, including:
 Ordering blood and blood products for elective/planned
surgery
 Ordering blood and blood products in an emergency
 Completing the blood request form
 taking the pre-transfusion blood sample
 Collecting blood and blood products from the blood bank,
Storing and transporting blood and blood products,
including storage in the clinical area
 Administering blood and blood products, including the final
patient identity check
 Recording transfusions in patient records
 Monitoring the patient before, during and after transfusion
 The management, investigation and recording of
transfusion reactions.
5. The training of all staff involved in the transfusion
6) Record in the patient’s notes:
 Type and volume of each product transfused
 Unique donation number of each unit transfused
 Blood group of each unit transfused
 Time at which the transfusion of each unit commenced
 Signature of the person administering the blood.
7. Monitor the patient before, during and on
completion of the transfusion.
8. Record the completion of the transfusion.
9. Identify and respond immediately to any adverse
effect. Record any transfusion reactions in the
patient’s notes.
TIME LIMITS FOR INFUSION
Start infusion Complete infusion
Whole blood / PCV Within 30 mins of
removing pack from
refrigerator
Within 4 hours ( less
in high ambient
temperature)
Platelet concentrate Immediately Within 20 mins
FFP Within 30 mins Within 20 mins
Warming blood
 There is no evidence that warming blood is
beneficial to the patient when infusion is slow. Cold
blood can cause spasm in the vein used for infusion.
 Dry warm towels applied locally may help, but take
care not to burn the skin. Case reports suggest that,
at infusion rates greater than 100 ml/minute, cold
blood could be a contributing factor in cardiac arrest.
However, keeping the patient warm is probably more
important than warming the infused blood.
 Warmed blood is most commonly required in:
 Large volume rapid transfusions:
 — Adults: greater than 50 ml/kg/hour
 — Children: greater than 15 ml/kg/hour
 Exchange transfusion in infants
 Patients with clinically significant cold agglutinins.
 Blood should only be warmed in a blood warmer.
Blood warmers should have a visible thermometer
and an audible warning alarm and should be properly
maintained. Older types of blood warmer may slow
the infusion rate of fluids.
 Blood should never be warmed in a bowl of hot water
as this could lead to the haemolysis of the red cells
and liberation of K+ which could be life threatening.
MONITORING THE TRANSFUSED PATIENT
 For each unit of blood transfused, monitor the patient
at the following stages:
 Before starting the transfusion
 As soon as the transfusion is started
 15 minutes after starting transfusion
 At least every hour during transfusion
 On completion of the transfusion
 4 hours after completing the transfusion
 At each of these stages, record the following
information on the patient’s chart:
 Patient’s general appearance
 Temperature
 Pulse
 Blood pressure
 Respiratory rate
 Fluid balance:
 — Oral and IV fluid intake
 — Urinary output.
 Record:
 Time the transfusion is started
 Time the transfusion is completed
 Volume and type of all products transfused
 Unique donation numbers of all products transfused
 Any adverse effects.
 4 Monitor the patient particularly carefully during the first
15 minutes of the transfusion to detect early signs and
symptoms of adverse effects.
Blood products separation and quality control

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Blood products separation and quality control

  • 2. WHOLE BLOOD (CPD-Adenine-1)  Description:  Up to 510 ml total volume (this volume may vary in accordance with local policies)  450 ml donor blood  63 ml anticoagulant  Haemoglobin approximately 12 g/ml  Haematocrit 35 (45%)  No functional platelets  No labile coagulation factors (V and VIII)
  • 3. Infection risk  Not sterilized, so is capable of transmitting any agent present in cells or plasma which has not been detected by routine screening for transfusion- transmissible infections, including:  HIV-1 and HIV-2  Hepatitis B and C  Other hepatitis viruses  Syphilis  Malaria  Chagas disease
  • 4. Storage  Between +2°C and +6°C in an approved blood bank refrigerator, ideally fitted with a temperature chart and alarm  May be stored up to 35 days if collected in a suitable anticoagulant such as citrate phosphate dextrose with added adenine (CPDA-1)  During storage at +2°C to +6°C, changes in composition occur resulting from red cell metabolism
  • 5. Indications Contraindications  Red cell replacement in acute blood loss with hypovolaemia  Exchange transfusion  Patients needing red cell transfusions where red cell concentrates or suspensions are not available  Risk of volume overload in patients with:  Chronic anaemia  Incipient cardiac failure
  • 6. Administration  Must be ABO and Rh compatible with the recipient  Complete transfusion within 4 hours of commencement  Never add medication to a unit of blood  Always transfuse blood from a new venous in-flow.
  • 7. Quality control of Whole blood Parameter Quality Requirement Frequency of Control Volume 350/450 ml +/- 10% 1% of all units Anticoagulants 46/63ml All Units PCV (Hct) 70% +/- 10% 4 units per month Anti HIV-1 & 2 Negative by ELISA All units HBsAg Negative by ELISA All units VDRL (Syphilis) Negative by Screening test All units Sterility By Culture Periodically 1% of all units
  • 8. RED CELL CONCENTRATE  Description 150–200 ml red cells from which most of the plasma has been removed  Haemoglobin approximately 20 g/100 ml (not less than 45 g per unit)  Haematocrit: 55–75%  Indications : Replacement of red cells in anaemic patients  Use with crystalloid replacement fluids or colloid solution in acute blood loss
  • 9. Quality control for Packed cells / red cell Concentrate prepared from WB Parameter Quality Requirement Frequency of Control Volume 280ml +/- 40ml 1% of all units PCV (Hct) 70% +/- 5% 4 units per month Sterility By culture Periodically 1% of all units
  • 10. PLATELET CONCENTRATES (prepared from whole blood donations)  Description- Single donor unit in a volume of 50–60 ml of plasma should contain:  At least 55 x 109 platelets  <1.2 x 109 red cells  <0.12 x 109 leucocytes  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 between 4 and 6 donor exposures  Bacterial contamination affects about 1% of pooled units
  • 11.  Storage :  20°C–24°C (with agitation) for up to 5 days in specialized platelet packs, although some centres use ordinary plastic packs which restrict storage to 72 hours.  Longer storage increases the risk of bacterial proliferation and septicaemia in the recipient.
  • 12. Indications Contraidications  Treatment of bleeding due to:  — Thrombocytopenia  — Platelet function defects  Prevention of bleeding due to thrombocytopenia, such as in bone marrow failure  Not generally indicated for prophylaxis of bleeding in surgical patients, unless known to have significant pre- operative platelet deficiency  Idiopathic autoimmune thrombocytopenic purpura (ITP)  Thrombotic thrombocytopenic purpura (TTP)  Untreated disseminated intravascular coagulation (DIC)  Thrombocytopenia associated with septicaemia, until treatment has commenced or in cases of hypersplenism
  • 13. Dosage  1 unit of platelet concentrate/10 kg body weight: in a 60 or 70 kg adult, 4–6 single donor units containing at least 240 x 109 platelets should raise the platelet count by 20–40 x 109 /L  Increment will be less if there is:  — Splenomegaly  — Disseminated intravascular coagulation  — Septicaemia
  • 14. Administration  After pooling, platelet concentrates should be infused as soon as possible, generally within 20 minutes, because of the risk of bacterial proliferation.  Must not be refrigerated before infusion as this reduces platelet function.  4–6 units of platelet concentrates (which may be supplied pooled) should be infused through a fresh standard blood administration set.  Special platelet infusion sets are not required.
  • 15.  Platelet concentrates should be infused over about 30 minutes  Platelet concentrates prepared from Rh D positive donors should not be given to a Rh D negative potential child-bearing female  Platelet concentrates that are ABO compatible should be given whenever possible
  • 16. QC for Platelet concentrate Parameter Quality Requirement Frequency of Control Volume 45-60 ml All Units Platelet count >5.5 x1010 4 units per month pH >6.0 4 units per month RBC concentration 0.5ml 4 units per month WBC concentration 5.5 x 107 – 5 x 108 4 units per month
  • 17. FFP  Description: Pack containing the plasma separated from one whole blood donation within 6 hours of collection and then rapidly frozen to –25°C or colder  Contains normal plasma levels of stable clotting factors, albumin and immunoglobulin, Factor VIII level at least 70% of normal fresh plasma level  Infection risk: If untreated, same as whole blood  Very low risk if treated with methylene blue/ultraviolet light inactivation  Storage At –25°C or colder for up to 1 year.
  • 18. INDICATIONS  Replacement of multiple coagulation factor deficiencies, e.g.:  — Liver disease  — Warfarin anticoagulant overdose  — Depletion of coagulation factors in patients receiving large volume transfusions.  Disseminated intravascular coagulation (DIC)  Thrombotic thrombocytopenic purpura (TTP)
  • 19. Administration  Must normally be ABO compatible to avoid risk of haemolysis in recipient  No crossmatching needed  Before use, should be thawed in water which is between 30°C and 37°C.  Higher temperatures will destroy clotting factors and proteins  Once thawed, should be stored in a refrigerator at 2°C– 6°C  Infuse using a standard blood infusion set as soon as possible after thawing  Labile coagulation factors rapidly degrade; use within 6 hours of thawing
  • 20. QC of FFP Parameter Quality Requirement Frequency of Control Volume 200-220 ml 4 units per month Stable coagulation factor 200 units of each factor 4 units per month Factor VIII 0.7 units /ml 4 units per month Fibrinogen 200-400mg 4 units per month
  • 21. Cryoprecipitate  Description: Prepared from fresh frozen plasma by collecting the precipitate formed during controlled thawing and resuspending it in 10–20 ml plasma  Contains about half of the Factor VIII and fibrinogen in the donated whole blood: e.g. Factor VIII: 80–100 i.u./pack; fibrinogen: 150–300 mg/pack  Unit of issue Usually supplied as a single donor pack or a pack of 6 or more single donor units that have been pooled  Infection risk :As for plasma, but a normal adult dose involves at least 6 donor exposures  Storage At –25°C or colder for up to 1 year
  • 22. Indications  As an alternative to Factor VIII concentrate in the treatment of inherited  deficiencies of:  — Von Willebrand Factor (von Willebrand’s disease)  — Factor VIII (haemophilia A)  — Factor XIII  As a source of fibrinogen in acquired coagulopathies: e.g. disseminated ntravascular coagulation (DIC)
  • 23. QC of Cryoprecipitate Parameter Quality Requirement Frequency of Control Volume 10-20ml Occasionally Factor VIII 80-120 units Occasionally Fibrinogen 150-250mg Occasionally
  • 24. Leukodepletion  Contains < 5 x 106 leukocytes per unit  Advantages  Reduced alloimmunization  Reduced transmission of viruses  Reduced NHFTR  Reduced immunomodulation
  • 25. Indications  Thalassemia major  Aplastic anemia  Sickle cell anemia  Leukemia  Patients for organ transplantation  Dialysis  Multiple chronic infections
  • 26. Methods of leukodepletion  Centrifugation  Washing  Freezing  Buffy coat removal  Microaggregate filtration  Filters
  • 27. Filtration  Advantages  Increased efficiency of leukocyte removal  Consistency of performance  Minimal red cell or platelet loss  Ease of use  Types of filtration  Bedside filtration  Pre-storage filtration
  • 28. Pre-storage filtration  Closed system processing  Done during component preparation  Early WBC removal reduces accumulation of cytokine and other breakdown products  WBC containing bacteria and viruses removed before fragmentation  Reduction in microaggregate formation
  • 29. Protocol to ensure safety 1. A blood request form. 2. A blood ordering schedule for common surgical procedures. 3. Guidelines on clinical and laboratory indications for the use of blood, products and simple alternatives to transfusion, including intravenous replacement fluids, and pharmaceuticals and medical devices to minimize the need for transfusion.
  • 30. 4. Standard operating procedures for each stage in the clinical transfusion process, including:  Ordering blood and blood products for elective/planned surgery  Ordering blood and blood products in an emergency  Completing the blood request form  taking the pre-transfusion blood sample  Collecting blood and blood products from the blood bank, Storing and transporting blood and blood products, including storage in the clinical area  Administering blood and blood products, including the final patient identity check  Recording transfusions in patient records  Monitoring the patient before, during and after transfusion  The management, investigation and recording of transfusion reactions. 5. The training of all staff involved in the transfusion
  • 31. 6) Record in the patient’s notes:  Type and volume of each product transfused  Unique donation number of each unit transfused  Blood group of each unit transfused  Time at which the transfusion of each unit commenced  Signature of the person administering the blood. 7. Monitor the patient before, during and on completion of the transfusion. 8. Record the completion of the transfusion. 9. Identify and respond immediately to any adverse effect. Record any transfusion reactions in the patient’s notes.
  • 32. TIME LIMITS FOR INFUSION Start infusion Complete infusion Whole blood / PCV Within 30 mins of removing pack from refrigerator Within 4 hours ( less in high ambient temperature) Platelet concentrate Immediately Within 20 mins FFP Within 30 mins Within 20 mins
  • 33. Warming blood  There is no evidence that warming blood is beneficial to the patient when infusion is slow. Cold blood can cause spasm in the vein used for infusion.  Dry warm towels applied locally may help, but take care not to burn the skin. Case reports suggest that, at infusion rates greater than 100 ml/minute, cold blood could be a contributing factor in cardiac arrest. However, keeping the patient warm is probably more important than warming the infused blood.
  • 34.  Warmed blood is most commonly required in:  Large volume rapid transfusions:  — Adults: greater than 50 ml/kg/hour  — Children: greater than 15 ml/kg/hour  Exchange transfusion in infants  Patients with clinically significant cold agglutinins.  Blood should only be warmed in a blood warmer. Blood warmers should have a visible thermometer and an audible warning alarm and should be properly maintained. Older types of blood warmer may slow the infusion rate of fluids.  Blood should never be warmed in a bowl of hot water as this could lead to the haemolysis of the red cells and liberation of K+ which could be life threatening.
  • 35. MONITORING THE TRANSFUSED PATIENT  For each unit of blood transfused, monitor the patient at the following stages:  Before starting the transfusion  As soon as the transfusion is started  15 minutes after starting transfusion  At least every hour during transfusion  On completion of the transfusion  4 hours after completing the transfusion
  • 36.  At each of these stages, record the following information on the patient’s chart:  Patient’s general appearance  Temperature  Pulse  Blood pressure  Respiratory rate  Fluid balance:  — Oral and IV fluid intake  — Urinary output.
  • 37.  Record:  Time the transfusion is started  Time the transfusion is completed  Volume and type of all products transfused  Unique donation numbers of all products transfused  Any adverse effects.  4 Monitor the patient particularly carefully during the first 15 minutes of the transfusion to detect early signs and symptoms of adverse effects.