Blood components & their rational use

1. Blood components
& their rational use
Presented by
Dr. Md. Rifat Hasan
MD(Phase-A)
Resident
BSMMU

2. Blood components
Blood component refers to blood product separated
from single unit of anti co-gulanted whole blood with in
6 hours of collection for clinical use or preservation.

3. Blood components
 Used correctly can be life saving
 Transfusion carries some risks
 Tested & labeled to show ABO, Rh compatible
 Single blood donation to provide treatment for two /three
patients
Safe blood components :Transfusion of safe blood components only to
treat a condition leading to significant morbidity & mortality
that cannot be prevented or managed effectively by other means

4. Concept of Component Therapy

6. Whole Blood
Used for simultaneous replacement of
i. Red cell mass &
ii. Intravascular volume
Disadvantage:
i. Storage lesion.
ii.. Granulocytes & Platelets - deteriorate rapidly.
iii. Factor V, VIII & Complement - markedly reduced.
In massive hemorrhage : Crystalloids & Components are
preferred
Volume: 450 + 63 mL anticoagulant

7. Quality control of Whole Blood
Parameter to Quality Frequency of
be checked requirement control
Volume 450ml/350ml ± 10% All units
Hemoglobin Not less than 9.7% All units
W/V of Hemoglobin

9. Packed Red Blood Cell (PRBC)
Method of preparation:
i. Sedimentation
ii. Centrifugation: rpm - 3190rpm, 3.30 min,
40 / 220 C
Volume: 150-200 mL
Hct: 55 – 75 % (<80 %)
Hb: 20 gm / dL
Red cell mass: 1 unit of WB
Shelf life: 35 days in CPDA 1
Storage: 2 – 60 C

10. Indications:
To replace red cell mass:
 Tissue oxygenation impaired eg. Acute/Chronic
blood loss
 Symptomatic anemia unresponsive to hematinic,
 Anemia of chronic disorders, CRF, Bone marrow
failure
 Hemoglobinopathies - Thalassemia, Sickle cell
anemia
 Those cover all the indications for giving whole
blood

11. Saline Washed Red Cells
* Method of preparation – 3 washing in normal saline.
* 98% Plasma, 92% Platelets, WBCs & 20% RBCs removed
* Should be used within 4 hrs
Indications:
Patients with
• known allergic/ febrile transfusion reactions
• H/O severe urticarial reactions
• IgA deficiency
• Intrauterine transfusion
• Multiple transfusions

12. Fresh Frozen Plasma (FFP)
 plasma prepared from whole blood:
i. Primary centrifugation of WB
ii. Secondary centrifugation of PRP
 Plasma must be frozen within 6 - 8
hrs of collection

13. FFP
 Volume: 200 - 300 mL
 Storage: - 250 C or <
 Thawing: 30 to 370C (administer within 6 hrs)
 Factor VIII: 70% of normal plasma
 Dose: 10 -15 ml/kg
 Monitoring: PT / APTT
 ABO compatible
 Rh compatible at child bearing age
(anti-D Ig: 50 IU /unit of FFP)

14. Indications
Definite Indications:
 Replacement of coagulation factor deficiencies
such as hemophilia.
 Liver disease
 Massive transfusion
 Acute DIC
 TTP

16. Cryoprecipitate
 Cold insoluble portion of plasma when FFP is thawed
between 1 to 40 C
 1 unit: 10-20 mL volume
 Factor VIII: 80 -100 iu/ pack
 Fibrinogen: 150-300 mg
 vWF: 20 - 30% of original
 Storage: -250 C or <
 Thawed at 30-370c & used within 6 hrs

17. Indications…
1. To replace - Factor VIII
vWF
Factor XIII
Fibrinogen
2. To correct abnormal bleeding in DIC
3. To make fibrin glue

18. Platelets
Platelets are small fragments of cytoplasm derived
from a Megakaryocyte
Monumental discovery by Wright
Duke (1910) was the first to realize that platelet transfusion
would relieve hemorrhage in the presence of Thrombocytopenia.
PROBLEMS:
A) BLOOD GROUPS AND TRANSFUSION REACTION
B) EFFECTIVE METHODS OF PREPARATION OF
PLATELETS
C) OPTIMAL PRESERVATION / STORAGE
D) METHODS TO PREVENT ALLOIMMUNIZATION

19. Storage of Platelets
 Closed system: 5 days in specialized pack
 1st generation bag: 3 days
 Open system: 1 day
 20-240 C with continuous gentle agitation
 pH: > 6.2
 No cross-matching: < 5 ml RBCs
 Leucocyte content: < 5 x 106/ unit
 Leucocyte responsible for refractoriness, chill & rigors
 Platelet count: 5 - 10 x 109 / L

20. Indications of Platelet Transfusion
I. Decreased platelet production:
a. Malignancy with cytoreductive drugs
b. Aplasia
II. Platelet loss:
a. Hemorrhage
b. Cardiac surgeries
III. Platelet sequestration:
Splenomegaly
IV. Platelet qualitative defects:
Dengue

21. Platelet Transfusion Reactions
# Febrile non-haemolytic transfusion
reactions (FNHTR)
# Allergic reactions
# Alloimmunization
# Bacterial contamination
# Graft-versus-host-disease (GVHD)

22. LEUCOCYTE DEPLETED BLOOD
COMPONENTS
• < 5 x 106 LEUCOCYTES / UNIT
• PRE - STORAGE LEUCODEPLETION
• INDICATIONS
TO PREVENT FNHTRs
TO REDUCE GRAFT REJECTION
• FETAL/NEONATAL TRANSFUSION
• TO PREVENT VIRAL INFECTION (CMV/nvCJD)
• PLATELET REFRACTORINESS

23. COMPONENT
THERAPY
IS BETTER
REMEDY