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![• Irradiation is used to prevent ta-GVHD in at-risk individuals
• Patients at most risk include those who are severely
immunocompromised and those who would fail to recognize the
transfused lymphocytes as foreign, due to human leukocyte antigen
(HLA) homology
• Indications
• Recipients of intrauterine or neonatal exchange transfusion;
premature neonates
• Individuals with congenital cell-mediated immunodeficiency states
• Individuals treated with specific types of potent immunosuppressive
therapies (purine analogs, antithymocyte globulin [ATG], certain
monoclonal antibodies); this may include those being treated for
non-Hodgkin lymphoma (NHL) or other hematologic malignancies
• Recipients of hematopoietic stem cell transplant (autologous or
allogeneic)
• Individuals with Hodgkin lymphoma (any stage of disease)
• Individuals at risk for partial HLA matching with the donor due to
directed donations, HLA-matched products, or genetically
homogeneous populations](https://image.slidesharecdn.com/bloodandbloodcomponents-231130065426-d4160035/85/blood-and-blood-components-pptx-14-320.jpg)
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blood and blood components.pptx
- 1. BLOOD AND BLOOD COMPONENTS DrG.VENKATA RAMANA MBBS DNB FAMILY MEDICINE
- 2. BLOOD COMPOSITION Blood flowsthroughout the body in the vascular system, and consists of: 1. Formed elements • Red cells, which transport oxygen from the lungs to the tissues • White cells, which defend against infection • Platelets, which interact with blood vessels and clotting factors to maintain vascular integrity and prevent bleeding 2. Plasma: • contains proteins with many functions, including antibodies and coagulation factors
- 3. BLOOD COMPONENTS • PackedRBCs • Platelets • Fresh-frozen plasma (FFP) • Cryoprecipitate • Blood components collection • The procedure consists of initial centrifugation at low speed to separate whole blood into two parts: Packed RBCs and platelet-rich plasma (PRP) • Subsequently, PRP is centrifuged at high speed to yield two parts: Random donor platelets and FFP • Cryoprecipitates are obtained by thawing of FFP followed by centrifugation • Apheresis is the technique of direct collection of large excess of platelets from a single donor
- 4. Whole Blood Before centrifugationAfter centrifugation
- 9. Anti-coagulants in bloodbag ANTI- COAGULANTS FULL FORM SHELF LIFE ACD ACID CITRATE DEXTROSE 21 DAYS CPD CITRATE PHOSPHATE DEXTROSE 21 DAYS CPDA CITRATE PHOSPHATE DEXTROSE + ADENOSINE 35 DAYS SAGM SODIUM ADENINE GLUCOSE MANNITOL (Longest shelf life) 42 days
- 10. Functions of theanticoagulants COMPONENT FUCNTION CITRATE Anti-coagulant by chelating calcium PHOSPHATE Acts as BUFFER & helps in maintaining pH DEXTROSE Provides nutrition ADENINE Provides substrate for ATP synthesis (increased shelf life)
- 11. Whole blood • Shelflife 35 days • Average unit of blood 350+49 or 450ml+63ml anticoagulant • Both red cell and plasma component can be prepared • Indication – acute hypovolemic coagulopathy requiring massive transfusion • Rarely used now a days
- 12. Packed RBCs • Types •Leukoreduced • Irradiated • Saline washed • Leuko reduced RBC • Prepared by removing a proportion of the plasma from leucocyte depleted whole blood • Chances of a febrile reaction can be reduced • Indications • Chronically transfused patients • Potential and transplant recipients • Patients with previous febrile non hemolytic transfusion reactions
- 13. • Irradiation • RBCunits can be irradiated prior to transfusion by subjecting them to 2500 cGy of irradiation, targeted to the central portion of the component, with a minimum dose of 1500 cGy delivered to any part of the component • Irradiation sources include gamma rays from either a cesium-137 or cobalt-60 blood irradiator or x-rays using a standalone machine • The 2500 cGy dose is sufficient to inactivate lymphocytes in the product • Viable donor lymphocytes can attack recipient cells in individuals who are unable to mount an immune response against them, causing transfusion- associated graft-versus-host disease (ta-GVHD) • Ta-GVHD can target all hematopoietic cells as well as other tissues, leading to bone marrow aplasia and other complications that are ultimately fatal
- 14. • Irradiation isused to prevent ta-GVHD in at-risk individuals • Patients at most risk include those who are severely immunocompromised and those who would fail to recognize the transfused lymphocytes as foreign, due to human leukocyte antigen (HLA) homology • Indications • Recipients of intrauterine or neonatal exchange transfusion; premature neonates • Individuals with congenital cell-mediated immunodeficiency states • Individuals treated with specific types of potent immunosuppressive therapies (purine analogs, antithymocyte globulin [ATG], certain monoclonal antibodies); this may include those being treated for non-Hodgkin lymphoma (NHL) or other hematologic malignancies • Recipients of hematopoietic stem cell transplant (autologous or allogeneic) • Individuals with Hodgkin lymphoma (any stage of disease) • Individuals at risk for partial HLA matching with the donor due to directed donations, HLA-matched products, or genetically homogeneous populations
- 15. • Washed redcells • Units of RBCs can be washed to reduce or eliminate complications associated with the small amount of residual plasma in the unit • Indications • Severe or recurrent allergic reactions (eg, hives) associated with red cell transfusion • IgA deficiency with circulating anti-IgA antibodies that react with IgA in the donor plasma, when an IgA-deficient donor is not available. Frozen deglycerolized red cells may be the component of choice for these individuals • Individuals at risk for hyperkalemia • Washing is done in an automated system using 0.9 percent sodium chloride immediately before infusion • The shelf-life of washed blood is four hours at 20 to 24°C or 24 hours if stored at 1 to 6°C • Frozen deglycerolized RBC units also undergo extensive washing and can be used for the same indications
- 16. PLATELETS • Storage • Roomtemperature, because cold induces clustering of von Willebrand factor (WVF) receptors on the platelet surface and morphological changes of the platelets, leading to enhanced clearance by hepatic macrophages and reduced platelet survival in the recipient • Shelf life: 5 days • Dose Adults one WBD unit per 10 kg of body weight, which translates to four to six units of WBD platelets or one apheresis unit • Pediatric dose is 5 to 10 mL/kg • Infusion rate For an average-sized adult, six units of WBD platelets or one unit of apheresis platelets are transfused over approximately 20 to 30 minutes • Patients at risk for transfusion-associated circulatory overload (TACO) can be transfused at a slower rate as long as the transfusion is completed within four hours of issuance from the blood bank
- 17. INDICATIONS FOR PLATELETTRANSFUSION • Actively bleeding patients with thrombocytopenia • Preparation for an invasive procedure if the thrombocytopenia is severe • Neurosurgery or ocular surgery – <100,000/microL • Most other major surgery – <50,000/microL • Endoscopic procedures – <50,000/microL for therapeutic procedures; 20,000/microL for low risk diagnostic procedures • Bronchoscopy with bronchoalveolar lavage (BAL) – <20,000 to 30,000/microL • Central line placement – <20,000/microL • Lumbar puncture • <10,000 to 20,000/microL in patients with hematologic malignancies • <40,000 to 50,000 in patients without hematologic malignancies • Neuraxial analgesia/anesthesia – <80,000/microL • Bone marrow aspiration/biopsy – <20,000/microL • Prevention of spontaneous bleeding • Afebrile patients with platelet counts <10,000/microL due to bone marrow suppression • For patients with fever, infection, or inflammation,transfuse at a platelet count ≤15,000 to 20,000/microL due to the increased risk of bleeding • Patients with acute promyelocytic leukemia (APL) have a coexisting coagulopathy, transfuse at a platelet count ≤30,000 to 50,000/microL
- 18. • Apheresis (singledonor) platelets • Collected from volunteer donors in a one to two-hour apheresis procedure • Platelets are selectively removed along with some white blood cells (WBCs) and plasma, and most red blood cells (RBCs) and plasma are returned to the donor • Some systems will also remove the majority of WBCs, resulting in a leukodepleted product • A typical apheresis platelet unit provides the equivalent of four to six units of platelets from whole blood (3 to 4 x 1011 platelets) • It is common in larger donors with high platelet counts for an apheresis procedure to collect enough platelets to split the collection into two separate transfusable apheresis units ("doubles," or "splits"), and sometimes three separate units ("triples") can be obtained from a single donor, increasing the operational efficiency of the collection facility and the availably platelet supply • Advantages • Exposure of the recipient to a single donor rather than multiple donors • Ability to match donor and recipient characteristics such as human leukocyte antigen (HLA) type, cytomegalovirus (CMV) status, and blood type
- 19. • Whole bloodderived (WBD) pooled platelets • A single unit of platelets can be isolated from a whole blood donation by centrifuging the blood within the closed collection system to separate the platelets from the red blood cells (RBCs) • Two manufacturing methods are used • The platelet rich plasma (RPR) method • It involves the centrifugation of the whole blood first under a sufficient g-force to pellet the RBCs (the "soft spin") but leaves most of the platelets in suspension in the RPR • The PRP is then centrifuged again in a second container at a higher g-force to pellet the platelets (the "hard spin") • The supernatant platelet-poor plasma is removed • The platelets are then resuspended in the residual plasma and stored
- 20. • The buffycoat method • In this method, whole blood is first subjected to a hard spin to allow plasma to be expressed off the top and the sedimented RBCs to be expressed off the bottom, leaving behind the platelet-containing buffy coat • Several buffy coat units can then be pooled together with plasma or platelet additive solution, and the pool is subjected to a soft spin to sediment the residual RBCs • The pooled platelet concentrate is then expressed off the RBCs and store • Advantages of WBD platelets • Lower cost and ease of collection and processing • Disadvantage of WBD platelets • Recipient exposure to multiple donors in a single transfusion and the increased work of bacterial testing • In addition, it is more labor intensive and time consuming to perform the required bacterial testing
- 21. Fresh Frozen Plasma(FFP) • Prepared from single units of whole blood or from plasma collected by apheresis techniques. • Frozen at -18 to -30°C within eight hours of collection and, when appropriately stored, is usable for one year from the date of collection • Volume of approximately 200 to 250 mL • Jumbo units - 600 mL • Contains all of the coagulation factors and other proteins present in the original unit of blood, slightly diluted by the citrate-containing anticoagulant solution used to collect the blood
- 22. • Indications • Massivetransfusion • Severe liver disease or DIC • Rare clotting factor deficiencies • Therapeutic plasma exchange inTTP • Warfarin overdose if not corrected by vitamin k and/or PCC ,depending on the clinical setting • DOSE AND INFUSION RATE • 10 to 15 mL/kg (ie, approximately three to five units) in most adults • Healthy individual – 2 to 3 mL/kg/hour • Individual with volume overload or heart failure – 1 mL/kg/hour • Individual undergoing plasma exchange – 60 mL/minute
- 23. Cryoprecipitate &Fibrinogen concentrate •Composition • Cryoprecipitate is manufactured using already frozen Fresh Frozen Plasma (FFP) or Plasma Frozen Within 24 Hours After Phlebotomy (PF24), thawing, and concentrating the proteins that precipitate • It contains fibrinogen (factor I), factor VIII, fibronectin, factor XIII, and von Willebrand factor (VWF) • Pathogen-inactivated (PI) Cryoprecipitate is made from PI plasma • Fibrinogen concentrate is purified from pooled human plasma using several purification steps and heat treatment
- 24. • Indications • Congenitalfibrinogen disorders • Cardiac surgery • Postpartum hemorrhage • Trauma and massive transfusion • DIC • Liver disease • Kidney disease • Contraindications • Cryoprecipitate and fibrinogen concentrate have no role in treating bleeding due to thrombocytopenia, platelet dysfunction, or anticoagulation • Cryoprecipitate is generally not used for conditions for which a purified or recombinant factor concentrate is available • Dose For most adults,between 5 and 10 units • Infusion rate • 2 to 5 mL per minute
- 26.
- 27. Screening of blood •Donated blood should be screened for: 1. HIV 2. HEPATITIS B 3. HEPATITIS C 4. MALARIA 5. SYPHILIS Hepatitis C: Most common transfusion transmitted infection Malaria can be transmitted by all blood products
- 32. Blood products Starttransfusion Complete transfusion Whole blood With in 30minutes of removing from refrigerator ≤ 4 hours PRBC With in 30minutes of removing from refrigerator ≤ 4 hours Platelet concentrate Immediately With in 30 minutes FFP As soon as possible With in 30 minutes Cryoprecipitate As soon as possible With in 30 minutes
- 34.
- 35. Acute hemolytic transfusionreaction • Typical time course • During transfusion or within 24 hours of transfusion completion • Mechanism: • ABO incompatibility (Type 2 Hypersensitivity) • Pre existing high affinity IgM antibodies rapidly induce competent mediated lysis, intra vascular hemolysis, and hemoglobinuria • Clinical findings • Fever,chills,chest pain,back pain tachypnea,tachycardia, hypotension, DIC , acute renal failure • Laboratory findings • Hemoglobinemia, hemoglobinuria, positive direct antiglobulin (Coombs) test (may be negative if all cells have hemolyzed), findings of DIC (prolonged PT, prolonged aPTT, low fibrinogen, thrombocytopenia)
- 36. • Implicated products •RBCs, plasma (much less common), rarely platelets • Incompatible blood product (typically ABO incompatible due to clerical error) • Treatment • Supportive • Vigorous hydration with isotonic saline and diuretics to maintain urine output • In patients with DIC and severe bleeding, PC, plasma, and cryoprecipitate or fibrinogen may be required
- 37. Delayed Hemolytic TransfusionReaction • Onset • After 24hrs ( usually 2 weeks) • Mechanism • Recipients have prior exposure to RBC antigens • After the transfusion, anamnestic response results in antibody production • Typically caused by IgG antibodies to foreign protein antigens and are associated with laboratory features of hemolysis • Presentation • Mild fever, hemolytic anemia, Coomb’s test-positive. • Management • Supportive care
- 40. Febrile non-hemolytic transfusionreaction • Typical time course • During transfusion or within 4 hours of transfusion completion • Mechanism • Interaction between donor leukocytes and recipient antibodies leads to interleukin-1 release from donor leucocytes PGE2 production fever • Causes • Proinflammatory cytokines in the BC or by recipient Abs directed against donor cell Ags present in the BC • Clinical findings • Fever • Laboratory findings • None • Implicated products • All blood products, but plasma is much rare • Prevention • Prestorage Leukocyte reduction
- 41. Sepsis/bacterial infection • Typicaltime course • During transfusion or within 72 hours of transfusion completion • Clinical findings • Fever, chills, hypotension, DIC • Laboratory findings • Bacteremia, leukocytosis, findings of DIC • Implicated products • Platelets most commonly implicated, but can be any product • Product may show bacterial contamination • Treatment • Broad spectrum antibiotics after sending cultures
- 43. Allergic transfusion reaction •Typical time course • During transfusion or within 4 hours of transfusion completion • Mechanism: • Allergic reactions are related to plasma proteins found in transfused components. • Reciepient IgE against donor components causing mast cell activation • Clinical findings • Rash, pruritus, urticaria, and localized edema • Laboratory findings • None • Implicated products • All blood products • Treatment • Antihistamines, steroids
- 44. Anaphylactic transfusion reaction •Typical time course • During transfusion or within 4 hours of transfusion completion • Clinical findings • Hypotension, angioedema, wheezing, respiratory distress • Laboratory findings • Hypoxemia, IgA deficiency, anti-IgA • Implicated products • RBCs, platelets, plasma products • Treatment • Adrenaline 0.01mg/kg ,0.5mg IM in to the mid-outer thigh • Additional treatment with steroids, antihistamine drugs, and bronchodilators may also be required
- 45. Transfusion-associated circulatory overload(TACO) • Typical time course • During transfusion or within 12 hours of transfusion completion • Risk factors • Older age, renal failure, preexisting fluid overload, cardiac dysfunction, administration of a large volume of BCs, and an excessive rate of transfusion in relation to the patient’s hemodynamic tolerance • Pathophysiology • Too much fluid is added to the system too quickly for the transfusion recipient • Clinical findings • Respiratory distress, rales • Laboratory findings • Abnormal chest radiography, hypoxemia, increased BNP or NT-proBNP • Implicated products • RBCs, platelets, plasma products, and other fluids • Treatment • Oxygen, Diuretics (furosemide) • Prevention • Identifying at-risk patients, close monitoring, a slow transfusion rate (1 RBCC over 3–4 h), and use of diuretics in hemodynamically stable patients with a history of TACO
- 46. Transfusion-related acute lunginjury (TRALI) • Typical time course • During transfusion or within 6 hours of transfusion completion • Pathophysiology • Transfusion of antibodies and or/ other non immunologic mediators to a susceptible patient • HLA class I,HLA class II and HNA 5,7 antibodies • These antibodies activate the leucocytes,which bind to the endothelium in the lungs,causing endothelial injury and edema • Clinical findings • Respiratory distress, hypotension • Laboratory findings • Abnormal chest radiography, hypoxemia, transient leukopenia, anti- neutrophil or anti-HLA antibodies (if tested) • Implicated products • RBCs, platelets, plasma products • Treatment • Supportive • Oxygen • Mechanical Ventilation if required
- 48. • Iron Overload •Each unit of RBCs contains 200–250 mg of iron • In frequently transfused recipients, iron accumulation that is left untreated will affect endocrine, hepatic, and cardiac function • Death may occur from cardiac failure or arrhythmia • Iron overload can be assessed by means of serum ferritin measurements, magnetic resonance imaging, and liver biopsy • Prevention and treatment • Careful monitoring and iron chelation
- 49. • Post transfusionPurpura • Rare reaction (~1/105 BCs) • Thrombocytopenia-related bleeding disorder developing 5–12 days after PC (and more rarely RBCC) transfusion, predominantly in women • Platelet-specific alloAbs are found in the recipient, most frequently anti-HPA-1a in HPA-1a-negative alloimmunized individuals • The delayed thrombocytopenia is due to a secondary increased production of alloAbs • The mechanisms for the destruction of the patient’s own platelets remain unclear • Management • Supportive • Polyvalent immunoglobulin • Steroids • Plasma exchange • Additional platelet transfusions may worsen the thrombocytopenia or be associated with poor increments • Prevention • Use of washed BCs or BCs from HPA-compatible donors
- 50. • Graft-Versus-Host Disease •Extremely rare adverse reaction • Mediated by engrafted donor T lymphocytes in a recipient unable to reject such allogenic lymphocytes (as in severely immunosuppressed patients or patients homozygous for an HLA haplotype shared with the donor) • Such donor T lymphocytes interact with host HLA Ags and mount an immune response, which is manifested clinically by the development, of cytopenia, fever, a characteristic skin rash, diarrhea, and liver function abnormalities 5–10 days after transfusion • Highly resistant to treatment with immunosuppressive therapies as well as ablative therapy followed by allogeneic bone marrow transplantation and is fatal in >90% of cases. • Prevention in at-risk patients • Irradiation of cellular BCs (minimum of 25 Gy) or treating BCs with pathogen reduction technology that will deplete all living cells in the component
- 51. MASSIVE BLOOD TRANSFUSION •Transfusion of ≥10 units of whole blood (WB) or packed red blood cells (pRBCs) in 24 hours • ≥3 units of pRBCs in one hour • ≥4 blood components in 30 minutes • Indications • Trauma, cardiac surgery, obstetric bleeding, and liver disease • Complications • Hypothermia • Citrate toxicity • Hypocalcemia • Hypomagnesemia • Hyperkalemia/Hypokalemia • Dilutional coagualopathy
- 52. • Hemostatic • Plasma(2 to 8 units) is transfused if the PT or aPTT exceed 1.5 times the control value due to dilutional coagulopathy • Platelets (1 apheresis unit or 6 units of WB-derived platelets) are transfused if the platelet count decreases to <50,000/microL • Cryoprecipitate or fibrinogen concentrate can be used for fibrinogen <100 mg/dL (<200 for obstetric bleeding) • Metabolic • Hypocalcemia can be caused by citrate toxicity • Symptomatic hypocalcemia is treated with intravenous calcium chloride or calcium gluconate(2 to 5 mL of a 10 percent calcium chloride solution per unit of WB or pRBCs plus plasma; maximum 10 mL) • RBC leakage during storage, longer storage, and irradiation increase the concentration of potassium in the unit
- 53. • Neonates andpatients with renal failure or other comorbidities (e.g., hyperglycemia or hypocalcemia) are at risk of hyperkalemia and resulting acute cardiac toxicity • Treatment includes insulin, glucose, calcium gluconate, and furosemide • Prevention includes the use of washed or plasma- reduced RBCCs or a storage age of <7–10 days and the avoidance of RBCCs stored for >24 h after irradiation • Hypothermia • Rapid transfusion of BCs still at 4°C can result in hypothermia and cardiac dysrhythmias • Use of an inline warmer will prevent this complication • For individuals treated with blood component resuscitation, a ratio of 1:1:1 (plasma to platelets to pRBCs) to prevent complications of massive transfusion
- 54.