The document discusses the history and development of anticoagulants and blood preservatives used for collecting, storing, and transfusing blood and blood components. It describes the early methods used and key discoveries that expanded the shelf life of red blood cells and platelets. The document also outlines the various anticoagulant solutions, additive solutions, and storage conditions used to maintain viability and prevent clotting during the collection, storage, and transportation of whole blood and its components prior to transfusion.
Rh typing and its technique , BLOOD TYPING , Rhesus (Rh) typing , procedures of rh typing, process of Rh typing, Test limitations, Sources of Error in Rh Antigen Typing, False positive reactions' reason, False negative reactions' reasons
Rh typing and its technique , BLOOD TYPING , Rhesus (Rh) typing , procedures of rh typing, process of Rh typing, Test limitations, Sources of Error in Rh Antigen Typing, False positive reactions' reason, False negative reactions' reasons
I have listed out the LE cells structure and Microscopical examinaton of LE CELLS, Difference between tart cells and le cells, clinical symptoms and diagnostic procedure.
I have listed out the LE cells structure and Microscopical examinaton of LE CELLS, Difference between tart cells and le cells, clinical symptoms and diagnostic procedure.
This presentation describes the blood components. It also describes the problems in storing those component and what methods are used to overcome them.
BLOOD TRANSFUSION IN SMALL ANIMALS- Dr. Bhavana Mohan.pptxBhavanaMohan5
The presentation gives an overview to conduct blood transfusion in small animals, which is a life saving procedure in patients with sever anemia, hypovolemia, haemoprotozoal diseases,etc.
The presentation also gives an idea on the practical aspects of blood tranfusion.
1. Bio preservation of Red Cell Components 2. CULTURED RBCs 3. solvent plasmaDrShinyKajal
1. Bio preservation of Red Cell Components
2. CULTURED RBCs
3. Solvent plasma
Hypothermic storage
Cryopreservation
Lyophilization
Desiccated RBCs
Three major sources of cells are under consideration:
circulating stem and progenitor cells from adults or from cord blood
immortalized progenitors
pluripotent stem cells.
Immortalized Progenitors
LIQUID CULTURE METHODS- by the SED (stem cell factor (SCF), erythropoietin, and dexamethasone) and STIF cocktails (stem cell factor, thombopoietin, insulin-like growth factor-2, fibroblast growth factor-2)
ENUCLEATION- separation of extruded nuclei from cRBCs
SCALING UP- using cord blood CD34+ cells in bioreactors
and treated for 4 h with TNBP (tri-nitrobutylphosphate)solvent and with Triton X-100 detergent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
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In the DSM-5, all types of substance abuse and dependence have been
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The four main behavioral effects of AUD are impaired control over
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comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
3. From ancient times, blood was called “living force” of the
body.
Greeks and romans committed suicide by letting out blood
Early times, man recognised that loss
of blood is associated with weakness
and disease
Lost blood replaced by direct drinking
blood from young & healthy animal
or man
7. Albert Hustin and Luis Agote
discover that
adding sodium citrate to blood
will prevent it from Clotting
ANTI COAGULATION!!!
8. Francis Peyton Rous and J R Turner
added glucose to sodium citrate;
allowed blood to be STORED for
sometime before transfusing
BLOOD PRESERVATION!!!
10. Anticoagulant- any substance that prevents blood clotting
Preservative- any substance added to a specimen to
prevent changes in the constituents of a specimen
In vivo, RBCs are carried and protected by the plasma,
– Optimum temperature, pH, glucose, disposal of metabolic
waste
– life span is 120 days
11. Storage lesions
A set of biochemical &biomechanical changes which occur during
storage leading to decreased viability of the cell & its
physiological functions .
RBCs:
– decreased ATP and 2,3DPG levels, pH- acidic
– poor functioning of Na-K+ Pump-accumulation of K+ in stored blood
– Oxidative damage with change in the structure of Band3 and Lipid
peroxidation
– Loss in membrane lipids affects deformability and osmotic fragility
– Morphological changes-Disc changes to echinocytes & to spherocytes
Platelets:
– Loss of discoid shape, microscopic platelet aggregate formation,
fragmentation, appearance of disintegrated, ‘balloon’ forms
12. To ensure that blood retains its in vivo
environment
Anticoagulants
Preservative
Characteristics of blood bag
Storage temperature
Shipping/transport conditions
Anticoagulants and blood preservatives
• To ensure the viability and stability of the products
• To inhibit growth of microorganisms
• To prevent clotting of the product
13. Chronology of Anticoagulants
year person anticoagulant remarks
1916 Rous and Turner Citrate dextrose RT soln 12 days
1943 Loutit and Mollison Acid citrate dextrose pH 5
1957 Gibson Citrate phosphate dextrose Prevents PO4 loss
1957 Gabrio Added nucleotides RBC metabolism
1968 Sheilds CPDA-1
1970 Beutler Additive solutions
1979 Hogman SAG 5 weeks storage
1980 Lovric CP2D (1⁰ bag) + SAG (additive)
14. Citrate
Calcium-chelating agent
Prevents coagulation by
interfering with calcium-
dependent steps in the
coagulation cascade
Citrate dextrose
The dextrose provide
nutrient for red cells
Disadv:
dilution 1:3
Cannot be heat sterilized
Risk of infection
15. Acid-citrate-dextrose
Citric acid, sodium citrate, and dextrose
(pH 5)
Shelf life of 21 days
Acid pH does not help in maintaining
2,3-DPG levels
Prevents caramelization of sugar
First used in 1:4 ratio but later
concentrated to use in 1:7 ratio
Used in apheresis procedure
Citrate-phosphate-
dextrose
Alkaline pH and PO4
help in maintaining 2,3-
DPG
Shelf life of 28 days
CPD is commonly used
16. Added Nucleotides
ADENOSINE : Restores ATP, but
marked hypotensive effect.
INOSINE : generates ATP, but
hypoxanthine formed degrades
to uric acid
GUANOSINE: Used in PAGGS-M
which provides 7 weeks of RBC
storage with recovery of 74 %
Citrate-phosphate-dextrose-
adenine (CPDA-1)
Improved ATP synthesis
Longer shelf life (35
days)
Disadv: uric acid stones
17. Citrate Phosphate Dextrose
Adenine 2 (CPDA 2)
PRC stored in CPDA - 1
ran out of glucose very
soon compared to CPD
CPDA -2 contains more
glucose than CPDA-1
Disadv: plasma and
platelets loaded with
sugar
CP2D
100% more glucose than
CPD and 60% more than
CPDA-1
used with an additive
solution (AS3): doesnt
contain glucose
18. Blood : Anticoagulant Ratio
Volume of anticoagulant –preservative solution is 1/7 the
volume of collected blood
14 ml of CPD/CPDA is used in preserving 100 ml blood
63 ml for a 450 ml collection
49 ml for 350 ml collection
At the end of the collection , venous blood (pH 7.35)
mixed with anticoagulant-preservative solution (pH 5.0 to
5.6) with resulting pH of 7.05 in the mixture.
19. Additive Solutions:
Need- With advent of component therapy , PRC usage increased (in 1970s).
40%Adenine and glucose present in anticoagulants was removed in
preparation of RBC.
Remaining RBC became more viscous and difficult to infuse in emergency
situation and decreased viability particularly in last 2 weeks of storage.
Use of additive solutions allowed maximum recovery of plasma and
preparation of RBC units with final haematocrit of about 60%
1stGeneration: SAG and BAGP-M 2ndGeneration: SAG-M and PAGGS-M
3rd Gen: AS-1 and PAGGG-M 4thGen: AS-2 and Erythrosol-1
5th Gen: AS-3 and Erythrosol-2 6th Gen: Erythrosol-81 7th Gen: EAS-64
20. SALINE-ADENINE GLUCOSE (SAG ): maintains 83% viability after 35 days storage
MANNITOL : acts as a membrane stabilizer and reduces hemolysis to acceptable levels
BICARBONATE ADENINE GLUCOSE PHOSPHATE MANNITOL (BAGP-M)
ERYTHROSOL-1: Uses half strength citrate (0.5 CPD)
ERYTHROSOL-2: Uses full strength CPD and alkaline solution with disodium phosphate Solution. 7
week storage
EAS -81 EXPERIMENTAL ADDITIVE SOLUTION
PHOSPHATE ,ADENINE, GLUCOSE, GUANOSINE, SODIUM CHLORIDE, MANNITOL (PAGGS-M)
Advantages
– Increased level of ATP and red cell viability
– Increase in shelf life of red cells to 42 days
– Extraction of more plasma/platelet rich plasma for optimal production of platelets, factor VIII yields
and FFP
Disadvantage
– do not maintain 2,3DPG throughout the storage time Therefore , blood stored in additive solutions
is not given routinely to newborn infants
21. Rejuvenation Solutions
Stored RBCs, even at the end of their allowable shelf-life can be
rejuvenated with FDA – approved rejuvenation solution.
PIPA (Sodium Pyruvate, Inosine, Adenine, Dibasic Sodium Phosphate
and Monobasic Sodium Phosphate)
Increases 2,3 DPG & ATP levels in stored RBCs.
Added at any time between 3 days post collection and 3 days after
expiry
Added directly to PRC, mixed and incubated at 37⁰C for 1 hour and
washed with saline (2 litres of unbuffered 0.9% Nacl ) and kept at 2-
6⁰C
Rejuvenated RBCs should be transfused within 24 hours after washing
Used in autologous donations/rare blood groups
22. Cryopreservation
Process of preserving biologic structure and/ function of
living systems by freezing and storage at ultra low
temperatures
Cryoprotectants
Nonpenetrating : viscous solution,reduce optimum cooling
velocity.
– Eg: Lactose ,Sucrose, Albumin, Hydroxyl Ethyl Starch(HES),
Polyvinyl Pyrrolidone (PVP)
Penetrating :Prevent damage during slow freezing and
thawing. Eg: Glycerol , DMSO
23. Cryoinjury:
Fatal effects of freezing
– Intracellular ice crystal formation
– Denaturation of proteins by high solute concentrations
– Osmotic stress during the freezing and thawing process
AUDREY SMITH (1950) Mother of cryobiology
Glycerol prevents freezing injury human RBC
– Relatively nontoxic
– Readily permeates cell at 37⁰C
Add slowly with vigorous shaking.
Frozen red cells stored for 10 years
Frozen RBC has to be deglycerolized before transfusion
Shelf life of thawed RBC is 24 hours
24. Platelets
Stored at 22-24⁰C in platelet agitator cum incubator
Continuous gentle agitation must be maintained on a flat bed agitator: if not
rapid fall in pH due to lactate and decrease in O2 consumption
pH: above 6.0 Plasma (50-60 ml) is needed for storage
Shelf life extended from 3 days to 5 days (1981) at room temperature due to
improved platelet storage bags that allowed more efficient gas exchange.
ANTICOAGULANTS:
Platelet viability best preserved with fresh heparinized blood
EDTA : Preserves platelet integrity Disadv: Cardiotoxic , rapidly removed from
circulation
Citrate-phosphate Dextrose (CPD or CP2D)
Apharesis platelets : collected into solutions containing citric acid , trisodium
citrate and dextrose. pH 5, prevents clumping of platelets
25. Platelet Additive Solutions(PAS):
Synthetic mediums introduced to replace a significant portion of
plasma volume in a platelet component
PAS being used in Europe since 1991
Primary Ingredients
– Citrate- anticoagulant
– Acetate- substrate for oxidative metabolism
– Sodium chloride- isotonicity and osmotic strength
– Phosphate-stimulate glycolysis and maintain of pH
– Magnesium/Potassium- decreases platelet activation , improves
morphology score , decreases lactate production
Tulli’s solution, Tyrode’s medium, Plasma- Lyte A
26. Adv: Reduction of allergic reactions and febrile transfusion reactions
– Facilitates ABO incompatible platelet transfusions
– Plasma can be diverted to other uses such as fractionation
– PAS supports 7 days storage of platelets
– Reduced levels of anti-HLA, HNA antibodies and TRALI
Storage Of Platelets In Frozen State
Best results found using DMSO (Dimethyl sulfoxide ) as cryoprotective agent
Stored satisfactorily in liquid nitrogen (-196c) or at -80c deep freeze
27. Approved Preservative Solutions (FDA)
ACD - approved for collection of RBC, platelets & FFP
CPD- approved for 21 days storage
CP2D- approved for 21 days storage
CPDA-1- approved for 35 days storage
Additive Solutions
– Adsol (AS-1)-Fenwal Laboratories
– Nutricel(AS-3)-Medsep Corporation
– Optisol (AS-5) Terumo Corporation
– SAG-M with CPD
REJUVENATION SOLUTIONS
– Rejuvesol (Cytosol Laboratories)
– PIPA(Phosphate , Inosine, Pyruvate , Adenine )
PLATELET ADDITIVE SOLUTION Intersol-FDA
28. Transportation & Storing of Blood &
Blood Components Prior to Transfusion
Blood Cold Chain
– System for storing & transporting blood & blood
components
– Maintenance of correct temperature at all times from
collection from donor to administration to the patient.
– Blood bank refrigerators ,Plasma freezers, platelet
agitator cum incubators, blood transport boxes
Any break in the blood cold chain: increased risk to
the recipients
29. WHOLE BLOOD AND RED CELLS
Storage at a temperature between +2 degree C to +6
degree C in a blood bank refrigerator.
Blood bank refrigerators: in built temperature monitoring,
alarm devices and a cooling fan
Shelf life ranges from 35- 42 days.
Issue of whole blood & red cells:
– blood transport box or insulator carrier
– temperature <10 degree C
– should be transfused within 30 min of taking out from BbR
30. Fresh Frozen Plasma and Cryoprecipitate
Stored at -40⁰ C or colder
Shelf life one year
Thawed before transfusion (plasma thawing bath at 30 - 37⁰C )
Once thawed, FFP and CP should be infused within 30 minutes.
Transported in a blood transport box, temperature between 2 to
6⁰C.
If not immediately required, keep at 2 to 6⁰C & transfused within
24hrs (FFP) and 4hrs (CP)
Once thawed, do not refreeze FFP or CP.
31. Platelets – Platelet Rich Plasma (Prp)/Platelet
Concentrate (Pc)
Platelets should be prepared within 8 hrs of phlebotomy
Whole blood for separation of platelets should be kept at 20-
24⁰C
Stored at 22 -24⁰C in platelet agitator cum incubator
Shelf life : 5 days
Transported in a blood transport box, temperature 22 -24⁰C
Never refrigerate
Transfuse as soon as possible.
Editor's Notes
< 2 hemolysis and renal failure
>6 to prevent bacterial gowth