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Blood components
1.
Blood
and
Blood
Components
DR
.
KAWITA
BAPAT
KAWITA BAPAT
2. Goals
Of
Blood
Collec;on
• Maintain
viability
and
func;on
• Prevent
physical
changes
• Minimize
bacterial
contamina;on
KAWITA BAPAT
3. An;coagulants
Preserva;ve
Solu;ons
• An;coagulants
prevent
blood
cloGng
• Preserva;ves
provide
nutrients
for
cells
• Heparin
– Rarely
if
ever
used
anymore
– An;coagulant
ONLY
– Transfuse
within
48
hours,
preferably
8
KAWITA BAPAT
4. An;coagulants
CPD CPD-A1
Storage time 21 days 35 days
Temperature 1-6 C 1-6 C
Slows glycolytic activity
Adenine None Substrate for ATP synthesis
Volume 450 +/- 10%
Dextrose Supports ATP generation by glycolytic
pathway
Citrate Prevents coagulation by binding calcium
KAWITA BAPAT
5. Addi;ve
Solu;on
• Primary
bag
with
satellite
bags
aPached.
• One
bag
has
addi;ve
solu;on
(AS)
• Unit
drawn
into
CPD
an;coagulant
KAWITA BAPAT
6. Addi;ve
Solu;on
• Remove
platelet
rich
plasma
within
72
hours
• Add
addi;ve
solu;on
to
RBCs,
ADSOL,
which
consists
of:
– Saline
– Adenine
– Glucose
– Mannitol
• Extends
storage
to
42
days
• Final
hematocrit
approximately
66%
KAWITA BAPAT
7. Changes
Occur
During
Storage
• Shelf
life
=
expira;on
date
– At
end
of
expira;on
must
have
75%
recovery
– At
least
75%
of
transfused
cells
remain
in
circula;on
24
hours
AFTER
transfusion
KAWITA BAPAT
8. Storage
Lesion
• Biochemical
changes
which
occur
at
1-‐6C
• Affects
oxygen
dissocia;on
curve,
increased
affinity
of
hemoglobin
for
oxygen.
– Low
2,3-‐DPG,
increased
O2
affinity,
less
O2
released.
– pH
drops
causes
2,3-‐DPG
levels
to
fall
– Once
transfused
RBCs
regenerate
ATP
and
2,3-‐DPG
• Few
func;onal
platelets
present
• Viable
(living)
RBCs
decrease
KAWITA BAPAT
10. Storage
Lesion
• Significant
for
infants
and
massive
transfusion.
• Other
biochemical
changes
– ATP
decreases
– Potassium
increases
– Sodium
decreases
– Plasma
hemoglobin
increases
KAWITA BAPAT
11. Prepara;on
of
Components
• Collect
unit
within
15
minutes
to
prevent
ac;va;on
of
coagula;on
system
• Draw
into
closed
system
–
primary
bag
with
satellite
bags
with
herme;c
seal
between.
• If
herme;c
seal
broken
transfuse
within
24
hours
if
stored
at
1-‐4C,
4
hours
if
stored
at
20-‐24C
KAWITA BAPAT
12. Prepara;on
of
Components
• Centrifuge
–
light
spin,
platelets
suspended
• Remove
platelet
rich
plasma
(PRP)
• Centrifuge
PRP
heavy
spin
• Remove
platelet
poor
plasma
• Freeze
plasma
solid
within
8
hours
• Thaw
plasma
at
1-‐4C
–
precipitate
forms
• Centrifuge,
express
plasma
leaving
cryoprecipitate.
Store
both
at
-‐18C
• RBCs
–
CPD
–
21
days,
ADSOL
–
42
days
–
1-‐6C
KAWITA BAPAT
14. Prepara;on
of
Components
• Summary
–
One
unit
of
whole
blood
can
produce:
– Packed
RBCs
– Fresh
frozen
plasma
(FFP)
– Cryoprecipitate
(CRYO)
– Single
donor
plasma
(SDP)
–
cyro
removed
– Platelets
–
terms
PC
(platelet
concentrate)
OR
RD
PC
(random
donor
platelet
concentrate)
KAWITA BAPAT
15. Prepara;on
of
Components
• Sterile
docking
device
joins
tubing
– Used
to
add
satellite
bags
to
maintain
original
expira;on
of
component
– May
be
used
to
pool
components
KAWITA BAPAT
16. Blood
Component
General
Informa;on
• Blood
separated
into
components
to
specifically
treat
pa;ents
with
product
needed
• Advantages
of
component
separa;on
– Allow
op;mum
survival
of
each
component
– Transfuse
only
component
needed
KAWITA BAPAT
17. Blood
Component
General
Informa;on
• Transfusion
prac;ce
– Transfusion
requires
doctor’s
prescrip;on
– All
components
MUST
be
administered
through
a
filter
– Infuse
quickly,
within
4
hours
– D
(Rh)
neg
require
D
neg
cellular
products
– ABO
iden;cal
preferred,
ABO
compa;ble
OK
– “Universal
donor”
–
RBCs
group
O,
plasma
AB
KAWITA BAPAT
18. Blood
Component
General
Informa;on
• Fresh
Whole
Blood
– Blood
not
usually
available
un;l
12-‐24
hours
– Candidates
• Newborns
needing
exchange
transfusion
• Pa;ents
requiring
leukoreduced
products
KAWITA BAPAT
19. Blood
Component
General
Informa;on
• Summary
of
storage
temperatures:
– Liquid
RBCs
1-‐6C
– Platelets,
Cryo
(thawed)
and
granulocytes
20-‐24C
(room
temperature)
– ANY
frozen
plasma
product
≤
-‐18C
– ANY
liquid
plasma
product
EXCEPT
Cryo
1-‐6C
KAWITA BAPAT
22. Whole
Blood
• Clinical
indica;ons
for
use
of
WB
are
extremely
limited.
• Used
for
massive
transfusion
to
correct
acute
hypovolemia
such
as
in
trauma
and
shock,
exchange
transfusion.
• RARELY
used
today,
platelets
non-‐func;onal,
labile
coagula;on
factors
gone.
• Must
be
ABO
iden.cal.
KAWITA BAPAT
24. Red
Blood
Cells,
Packed
(PRBC)
• Used
to
treat
symptoma;c
anemia
and
rou;ne
blood
loss
during
surgery
• Hematocrit
is
approximately
80%
for
non-‐addi;ve
(CPD),
60%
for
addi;ve
(ADSOL).
• Allow
WB
to
sediment
or
centrifuge
WB,
remove
supernatant
plasma.
KAWITA BAPAT
25. Leukocyte
Reduced
Red
Cells
(LR-‐RBC)
• Leukocytes
can
induce
adverse
affects
during
transfusion,
primarily
febrile,
non-‐hemoly;c
reac;ons.
• Reac;ons
to
cytokines
produced
by
leukocytes
in
transfused
units.
• Other
explana;ons
to
reac;ons
include:
immuniza;on
of
recipient
to
transfused
HLA
or
granulocyte
an;gens,
micro
aggregates
and
fragmenta;on
of
granulocytes.
• Historically,
indicated
only
for
pa;ents
who
had
2
or
more
febrile
transfusion
reac;ons,
now
a
commonly
ordered,
popular
component.
• “CMV”
safe
blood,
since
CMV
lives
in
WBCs.
• Most
blood
centers
now
leukoreduce
blood
immediately
aler
collec;on.
• Bed
side
filters
are
available
to
leukoreduce
products
during
transfusion.
KAWITA BAPAT
27. Washed
Red
Blood
Cells
(W-‐RBCs)
• Washing
removes
plasma
proteins,
platelets,
WBCs
and
micro
aggregates
which
may
cause
febrile
or
ur;carial
reac;ons.
• Pa;ent
requiring
this
product
is
the
IgA
deficient
pa;ent
with
an;-‐IgA
an;bodies.
• Prepared
by
using
a
machine
which
washes
the
cells
3
;mes
with
saline
to
remove
and
WBCs.
• Two
types
of
labels:
– Washed
RBCs
-‐
do
not
need
to
QC
for
WBCs.
– Leukocyte
Poor
WRBCs,
QC
must
be
done
to
guarantee
removal
of
85%
of
WBCs.
No
longer
considered
effec;ve
method
for
leukoreduc;on.
• e.
Expires
24
hours
aler
unit
is
entered.
KAWITA BAPAT
30. Red
Blood
Cells
Frozen;
Red
Blood
Cells
Deglycerolized
(D-‐RBC)
• Blood
is
frozen
to
preserve:
rare
types,
for
autologous
transfusion,
stock
piling
blood
for
military
mobiliza;on
and/or
civilian
natural
disasters.
• Blood
is
drawn
into
an
an;coagulant
preserva;ve.
– Plasma
is
removed
and
glycerol
is
added.
– Aler
equilibra;on
unit
is
centrifuged
to
remove
excess
glycerol
and
frozen.
• Expira;on
– If
frozen,
10
years.
– Aler
deglyceroliza;on,
24
hours.
• Storage
temperature
– high
glycerol
-‐65
C.
– low
glycerol
-‐120
C,
liquid
nitrogen.
KAWITA BAPAT
31. Red
Blood
Cells
Frozen;
Red
Blood
Cells
Deglycerolized
(D-‐RBC)
• Thaw
unit
at
37C,
thawed
RBCs
will
have
high
concentra;on
of
glycerol.
• A
solu;on
of
glycerol
of
lesser
concentra;on
of
the
original
glycerol
is
added.
• This
causes
glycerol
to
come
out
of
the
red
blood
cells
slowly
to
prevent
hemolysis
of
the
RBCs.
• Aler
a
period
of
equilibra;on
the
unit
is
spun,
the
solu;on
is
removed
and
a
solu;on
with
a
lower
glycerol
concentra;on
is
added.
• This
procedure
is
repeated
un;l
all
glycerol
is
removed,
more
steps
are
required
for
the
high
glycerol
stored
units.
• The
unit
is
then
washed.
KAWITA BAPAT
32. Rejuvenated
Red
Blood
Cells
• A
special
solu;on
is
added
to
expired
RBCs
up
to
3
days
aler
expira;on
to
restore
2,3-‐DPG
and
ATP
levels
to
prestorage
values.
• Rejuvenated
RBCs
regain
normal
characteris;cs
of
oxygen
transport
and
delivery
and
improved
post
transfusion
survival.
• Expira;on
is
24
hours
or,
if
frozen,
10
years
KAWITA BAPAT
34. Platelets
(PLTS),
Platelet
Concentrate
(PC)
or
Random
Donor
Platelet
Concentrate
(RD-‐PC)
• Used
to
prevent
spontaneous
bleeding
or
stop
established
bleeding
in
thrombocytopenic
pa;ents.
• Prepared
from
a
single
unit
of
whole
blood.
• Due
to
storage
at
RT
it
is
the
most
likely
component
to
be
contaminated
with
bacteria.
• Therapeu;c
dose
for
adults
is
6
to
10
units.
• Some
pa;ents
become
"refractory"
to
platelet
therapy.
• Expira'on
is
5
days
as
a
single
unit,
4
hours
if
pooled.
• Store
at
20-‐24
C
(RT)
with
constant
agita;on.
• D
nega;ve
pa;ents
should
be
transfused
with
D
nega;ve
platelets
due
to
the
presence
of
a
small
number
of
RBCs.
KAWITA BAPAT
36. Platelets
(PLTS),
Platelet
Concentrate
(PC)
or
Random
Donor
Platelet
Concentrate
(RD-‐PC)
• One
bag
from
ONE
donor
• Need
6-‐10
for
therapeu;c
dose
KAWITA BAPAT
37. Pooling
Platelets
• 6-‐10
units
transferred
into
one
bag
• Expira;on
=
4
hours
KAWITA BAPAT
38. Platelets
Pheresis,
Apheresis
Platelet
Concentrate,
Single
Donor
Platelet
Concentrate
(SD-‐PC)
• Used
to
decrease
donor
exposure,
obtain
HLA
matched
platelets
for
pa;ents
who
are
refractory
to
RD-‐PC
or
prevent
platelet
refractoriness
from
occurring.
• Prepared
by
hemapheresis,
stored
in
two
connected
bags
to
maintain
viability.
• One
pheresed
unit
is
equivalent
to
6-‐8
RD-‐PC.
• Store
at
20-‐24
C
(RT)
with
agita;on
for
5
days,
a9er
combining,
24
hours
• D
nega;ve
pa;ents
should
be
transfused
with
D
nega;ve
platelets
due
to
the
presence
of
a
small
number
of
RBCs
KAWITA BAPAT
43. Granulocytes
• Primary
use
is
for
pa;ents
with
neutropenia
who
have
gram
nega;ve
infec;ons
documented
by
culture,
but
are
unresponsive
to
an;bio;cs.
• Therapeu;c
efficacy
and
indica;ons
for
granulocyte
transfusions
are
not
well
defined.
• BePer
an;microbial
agents
and
use
of
granulocyte
and
macrophage
colony
s;mula;ng
factors
best
for
adults,
best
success
with
this
component
has
been
with
babies
• Daily
transfusions
are
necessary.
• Prepared
by
hemapheresis.
• Expira;on
;me
is
24
hours
but
best
to
infuse
ASAP.
• Store
at
20-‐24
C.
KAWITA BAPAT
46. Fresh
Frozen
Plasma
(FFP)
• Used
to
replace
labile
and
non-‐labile
coagula;on
factors
in
massively
bleeding
pa;ents
OR
treat
bleeding
associated
with
cloGng
factor
deficiencies
when
factor
concentrate
is
not
available.
• Must
be
frozen
within
8
hours
of
collec'on.
• Expira;on
– frozen
-‐
1
year
stored
at
<-‐18
C.
– frozen
-‐
7
years
stored
at
<-‐65
C.thawed
-‐
24
hours
KAWITA BAPAT
47. Fresh
Frozen
Plasma
(FFP)
• Storage
temperature
– frozen
-‐18
C,
preferably
-‐30
C
or
lower
– thawed
-‐
1-‐6
C
• Thawed
in
30-‐37C
water
bath
or
FDA
approved
microwave
• Must
have
mechanism
to
detect
units
which
have
thawed
and
refrozen
due
to
improper
storage.
• Must
be
ABO
compa;ble
KAWITA BAPAT
48. Plasma,
Liquid
Plasma,
Recovered
Plasma
and
Source
Plasma
• Used
to
treat
pa;ents
with
stable
cloGng
factor
deficiencies
for
which
no
concentrate
is
available
or
for
pa;ents
undergoing
therapeu;c
plasmapheresis.
• Prepared
by
separa;ng
the
plasma
from
the
RBCs
on
or
before
the
5th
day
aNer
expira.on
of
the
whole
blood.
• Once
separated
can:
– Freeze,
store
at
-‐18
C
for
5
years
– If
not
frozen,
called
liquid
plasma,
store
at
1-‐6
C
for
up
to
5
days
aler
expira;on
of
WB.
• Once
FFP
is
one
year
old
can
redesignate
as
Plasma,
expira;on
is
5
years.
KAWITA BAPAT
49. Pooled
Plasma/Solvent
Detergent
Treated
• Most
recently
licensed
product.
• Prepared
from
pools
of
no
more
than
2500
units
of
ABO
specific
plasma
frozen
to
preserve
labile
coagula;on
factors.
• Treated
with
chemicals
to
inac;vate
lipid-‐enveloped
viruses.
• Contains
labile
and
non-‐labile
coagula;on
factors
but
lacks
largest
Von
Willebrand’s
factor
mul;mers.
• Used
same
as
FFP.Safety
concerns
– Decreases
disease
transmission
for
diseases
tested
for.
– Doesn’t
inac;vate
viruses
with
non-‐lipid
envelopes:
parvo
virus
B19,
hepa;;s
A,
and
unrecognized
pathogens
KAWITA BAPAT
50. Cryoprecipitate
(CRYO),
Factor
VIII
or
An.-‐
Hemophilic
Factor
(AHF)
• Cold
insoluble
por;on
of
plasma
that
precipitates
when
FFP
is
thawed
at
1-‐6C.
• Cryoprecipitate
contains
high
levels
of
Factor
VIII
and
Fibrinogen,
used
for
treatment
of
hemophiliacs
and
Von
Willebrands
when
concentrates
are
not
available.
• Used
most
commonly
for
pa;ents
with
DIC
or
low
fibrinogen
levels.
• A
therapeu'c
dose
for
an
adult
is
6
to
10
units.
• Can
be
prepared
from
WB
which
is
then
designated
as
"Whole
Blood
Cryoprecipitate
Removed"
or
from
FFP
– Plasma
is
frozen.
– Plasma
is
then
thawed
at
1-‐6
C,
a
precipitate
forms.
– Plasma
is
centrifuged,
cryoprecipitate
will
go
to
boPom.
– Remove
plasma,
freeze
within
1
hour
of
prepara;on
KAWITA BAPAT
52. Cryoprecipitate
(CRYO),
Factor
VIII
or
An.-‐
Hemophilic
Factor
(AHF)
• Storage
Temperature
– Frozen
-‐18
C
or
lower
– Thawed
-‐
room
temperature
• Expira;on:
– Frozen
1
year
– Thawed
6
hours
– Pooled
4
hours
• Best
to
be
ABO
compa;ble
but
not
important
due
to
small
volume
KAWITA BAPAT
55. Irradia;on
of
Blood
Components
• Cellular
blood
components
are
irradiated
to
destroy
viable
T-‐
lymphocytes
which
may
cause
Gra9
Versus
Host
Disease
(GVHD).
• GVHD
is
a
disease
that
results
when
immunocompetent,
viable
lymphocytes
in
donor
blood
engral
in
an
immunocompromised
host,
recognize
the
pa;ent
;ssues
as
foreign
and
produce
an;bodies
against
pa;ent
;ssues,
primarily
skin,
liver
and
GI
tract.
The
resul;ng
disease
has
serious
consequences
including
death.
• GVHD
may
be
chronic
or
acute
KAWITA BAPAT
56. Irradia;on
of
Blood
Components
• Pa;ents
at
greatest
risk
are:
–
severely
immunosuppressed,
– immunocompromised,
– receive
blood
donated
by
rela;ves,
or
– fetuses
receiving
intrauterine
transfusions
• Irradia;on
inac;vates
lymphocytes,
leaving
platelets,
RBCs
and
granulocytes
rela;vely
undamaged.
• Must
be
labeled
"irradiated".
• Expira'on
date
of
Red
Blood
Cell
donor
unit
changes
to
28
days.
• May
be
transfused
to
"normal"
pa;ents
if
not
used
by
intended
recipient.
KAWITA BAPAT
58. Donor
Blood
Inspec;on
and
Disposi;on
• It
is
required
that
donor
units
be
inspected
periodically
during
storage
and
prior
to
issuing
to
pa;ent.
• The
following
may
indicate
an
unacceptable
unit:
– Red
cell
mass
looks
purple
or
clots
are
visible.
– Zone
of
hemolysis
observed
just
above
RBC
mass,
look
for
hemolysis
in
sprigs,
especially
those
closest
to
the
unit.
– Plasma
or
supernatant
plasma
appears
murky,
purple,
brown
or
red.
– A
greenish
hue
need
not
cause
a
unit
to
be
rejected.
– Inspect
platelets
for
aggregates.
• Inspect
FFP
and
CRYO
for
signs
of
thawing,
evidence
of
cracks
in
bag,
or
unusual
turbidity
in
CRYO
or
FFP
(i.e.,
extreme
lipemia).
KAWITA BAPAT
59. Inspec;on
of
Donor
Blood
• Segment
closest
to
unit
is
hemolyzed.
• May
indicate
bacterial
contamina;on
KAWITA BAPAT
60. Donor
Blood
Inspec;on
and
Disposi;on
• If
a
unit's
appearance
looks
ques;onable
do
the
following:
– Quaran;ne
unit
un;l
disposi;on
is
decided.
– Gently
mix,
allow
to
sePle
and
observe
appearance.
• If
bacterial
contamina;on
is
suspected
the
unit
should
be
cultured
and
a
gram
stain
performed.
• Posi;ve
blood
cultures
usually
indica;ve
of:
– Inadequate
donor
arm
prepara;on
– Improper
pooling
technique
– Health
of
donor
-‐
bacteremia
in
donor
• If
one
component
is
contaminated,
other
components
prepared
from
the
same
donor
unit
may
be
contaminated.
KAWITA BAPAT
61. Inspec;on
of
Donor
Blood
• Reissuing
blood
cannot
be
done
unless
the
following
criteria
is
met:
– Container
closure
must
not
have
been
penetrated
or
entered
in
any
manner.
– Most
facili;es
set
30"
;me
limit
for
accep;ng
units
back,
warming
above
6-‐10C
even
with
subsequent
cooling
increases
RBC
metabolism
producing
hemolysis
and
permiGng
bacterial
growth.
– Blood
must
have
been
kept
at
the
appropriate
temperature.
– One
sealed
segment
must
remain
aPached
to
container.
– Records
must
indicate
that
blood
has
been
reissued
and
inspected
prior
to
reissue.
KAWITA BAPAT
62. Transporta;on
of
Blood
and
Blood
Components
• WB
and
RBC
– Sturdy
well
insulated
cardboard
and/or
styrofoam
container,
wet
ice
in
ziplock
bag
to
cool,
temperature
must
be
monitored.
– Mobile
collec;on
units
should
transport
blood
ASAP
and
leave
at
RT
if
platelets
are
to
be
made.
– In-‐house
transport
place
in
cooler
with
wet
ice
and
thermometer,
monitor
temperature
every
30
minutes.
KAWITA BAPAT
64. Transporta;on
of
Blood
and
Blood
Components
• Frozen
components
– Temperature
must
be
maintained
at
or
below
required
storage
temperature.
– Use
dry
ice
in
well
insulated
container.
• Platelets
and
granulocytes
– Maintain
at
20-‐24
C.
– Transport
in
well
insulated
containers
without
ice.
• Commercial
coolers
available
to
maintain
at
20-‐24C.
KAWITA BAPAT
65. Transporta;on
of
Blood
and
Blood
Components
• Handling
donor
units
– Should
not
remain
at
RT
unnecessarily,
when
blood
is
issued
it
should
be
transfused
as
soon
as
possible.
– When
numerous
units
are
removed
from
fridge,
remove
fluid
filled
container
with
a
thermometer
at
same
;me
as
blood,
when
temperature
reaches
6
C
return
to
fridge.
KAWITA BAPAT
66. Records
• Must
be
made
concurrently
with
each
step
of
component
prepara;on,
being
as
detailed
as
possible
for
clear
understanding.
• Must
be
legible
and
indelible.
• Must
include
dates
of
various
steps
and
person
responsible.
KAWITA BAPAT
