This document provides information about blood and blood component therapy. It discusses the types of blood components that can be derived from whole blood donations, including packed red blood cells, platelet concentrates, and fresh plasma. It also outlines guidelines for choosing appropriate blood components for different patient populations and clinical situations, such as neonates, pediatric patients, and those with diseases like sickle cell anemia or thalassemia that require chronic transfusion support. Selection of blood type and volume for transfusion is discussed based on factors like the patient's symptoms, hemoglobin level, and underlying conditions.

1. BLOOD AND BLOOD
COMPONENT
THERAPY Dr Rakesh Verma
Guided by
Dr Santosh Singh 1
Nelson
Cloherty handbook
Ghai Essential Paediatrics
Meherban Singh Care of Newborn
AIIMS Newborn protocol
Nathan and Oski children and infant Haematology

2. -
• The routine separation of donor blood into
components and plasma fraction has made it
possible for blood banks to provide the
specialized blood products required for the
support of patients in multiple treatment
modalities.
• The infusion of blood component is called
component transfusion or blood component
therapy.
2

3. However, in most cases blood components are
preferred because each component has specific
optimal storage conditions and component therapy
maximizes the use of blood donations.
Removal of 10 ml from 1500gm neonate equals
400ml of adult (= 8% blood volume)
As many as 70% - 80% LBW require atleast 1
transfusion
3

4. Fresh Whole Blood
Packed Red Cells
Light spin, 22oC(within 8 hrs)
Platelet Rich Plasma
Heavy spin,22oC
Platelet Concentrate Fresh Plasma
Store at 22oC Freeze(FFP)
4

5. TYPES
Blood-
• Fresh Whole Blood
• Reconstituted whole blood
• From one unit of whole blood
one can make = Blood components
• PRBC
• Platelet pack(random donor)
• Fresh plasma
• Granulocyte pack
• Fresh plasma →frozen at -30°C→FFP
• Pooled plasma→ components

Cryoprecipitate

Albumin

Immunoglobulins
5
Before transfusion consider
Whether required
How much required
Actual component required
Time of duration of transfusion

6. WHOLE BLOOD
Duration of preservation varies according to
preservative (CPD,CPDA, SAGM)
Reconstituted whole blood lacks significant
quantities of platelets and clotting factors
1 unit increases Hgb 1 g/dL and Hct 3%
Indications.
• Exchange transfusions.
• Surgery
• Acute blood loss (>20% blood volume)
• Can be used as a substitute for blood components.
6

7. Packed Red Blood Cells (PRBCs)
After centrifugation of 350 ml whole blood, the RBC
component has a volume of about 200 ml and Hct of
about 80 %.
Genarally 100 to 110 mL of a nutrient additive
solution is added back to the packed RBCs, creating
an “additive RBC” product that has a final hematocrit
of 55% to 60%.
These solutions prolong the shelf life of the RBC
product from 21 days (packed RBCs in CPD) to 35 days
in (CPDA) to 42 days (additive RBCs).
• Once the unit is “opened” it has a to be used in 24
hours 7

8. ABO group selection for RBC Transfusion
Recipient ABO
Group
Component ABO Group
1st Choice 2nd Choice 3rd Choice 4thChoice
A A O None None
B B O None None
AB AB A B O
O O None None None
8

9. Available forms of RCCs
• RBC concentrates.
• RBC concentrates deprived of the buffy coat.
• RBC concentrates with additive solutions.
•Washed RBC.
• Leucodepleted RBC.
• Frozen RBC.
• Apheretic RBC.
• Irradiated RBC.
9

10. 1. Leucodepleted/ Leucoreduced RCCs
Most plasma & 70-80% WBC(buffy coat)
removed & 100 ml of Additive Solution added.
Indications
• Prevention of febrile non-haemolytic
transfusion reactions (FNHTRs)
• - patients with recurrent FNHTR;
• - patients who need prolonged
transfusion support.
• Reduction of the incidence of CMV
infections and other leukotrophic viruses
• Intrauterine transfusions and transfusions
to premature babies, neonates, and infants
up to 1 year.
• Candidates for renal transplantation. 10

11. 2. Washed RCC
RBC washed with Normal Saline
Washing eliminates antibodies & other plasma
constituents reduce potassium
• recommended for intrauterine transfusions,
• exchange transfusion and
• large volume transfusions
Indication
• Patients with IgA deficiency (presence of
anti-IgA).
• Paroxysmal nocturnal hemoglobinuria
• Allogeneic bone marrow transplant
11

12. 3. Irradiated RCCs
• Irradiation, at the dose of 25–50 Gy Gamma radiation, is for
preventing transfusion-related GvHD. Radiation damages T cells
• Shelf life of RBC decrease to 28 days, hyperkalaemia is risk
Donor units from a blood relative (Directed Donations)
Intrauterine transfusion
Immunodeficiency
Premature newborns, recommended <1200gm baby
Preferable for any transfusions till 4 months of age.
Chemo or Radiotherapy
Solid organ transplant, Bone marrow transplant
12
4. Frozen RCCs
Glycerol is used as preservative
Stored for 10 years, Once thawed should be used in 24 hours
 Autologous transfusion
 Preservation of rare blood group

13. Choice of blood in Emergency
need
• Patient should receive type specific blood
• Time not permissible, then O –ve RBC and AB plasma can be
given
• In males when there is shortage of blood then O +ve RBC
can be given
Choice of blood in Massive transfusion
• Greater than 1 blood volume within 24 hours
• For alloimmunised tested patients, blood not tested for
antigen may be used during an acute bleeding period and
antigen negative blood reserved for late transfusion
13

14. Autologous blood transfusion
• For autologous blood transfusion children should have Hb >11gm%, and
Hct >33%.
• Collection before 4-5 weeks before surgery.
• Oral iron supplement
• Erythropoietin may be used
Choice of blood for fetus
• For intrauterine transfusion group O Rh(D-) should be used
• To prevent GVHD blood is irradiated and to prevent CMV; CMV
antibody negative blood or leukocyte reduced blood should be
used
14

15. Choice of blood for neonate
• CMV antibody negative blood or leukocyte reduced blood should be used especially
in less than 1200gm
• Leukocyte reduced blood also prevent GVHD which is more common in low birth
weight babies
• For exchange transfusion for HDN, RBC must be negative for implicated antibody
• In term of ABO group selection, group O RBC and plasma of infant’s ABO are used
15
Directed Donations
A directed donation occurs when a patient's family or friends donate blood for
their children
Transfusion-associated GVHD can occur in these recievers
It can also occur in situations in which the blood donor is homozygous and the
recipient
is heterozygous for an HLA haplotype.
It is associated with higher mortality (80-90%).
It is almost entirely preventable by controlled irradiation of blood products

16. Choice of blood in Sickle cell anemia
• PRINCIPLE ARE
1. Avoidance of excessive viscosity:
• PRBC of high haematocrit should be used cautiously;
• Cautious transfusion when haematocrit is >30%
2. Prevention of sensitization of Red cell antigen
Approach Antigens matched
1. Provide fully antigen matched blood
before patient makes antibodies
Matched for D, C, E, c, e, K, Fy, Jk
antigens
2. Provide partially antigen matched
blood
Matched for D, C, E, K antigen
3. Treat like other patient Avoid antigens to which patient has
made antibody
16

17. In sickle cell anemia Hb should be maintained at 10-12 gm/dl
with <30% Hb S
Transfusion therapy is not normally indicated in patients with
Hb values > 7 g/dL
• Type of blood transfusion
1. erythrocytapheresis,
2. manual exchange transfusions
3. simple transfusion.
17

18. Choice of blood in Thalassemia
• Goal of therapy are
• Prevention of anemia
• Maintenance of Hb level sufficient to supress endogenous
erythropoiesis
• Maintenance of pretransfusion level of 9-10g% is
sufficient
• Red cell alloantibodies are not a significant problem
in most cases, probably because transfusion is
usually initiated at early age when tolerance may
develop
18

19. Choice of blood transfusion in
allogeneic marrow transplant
Major ABO incompatibility Minor ABO incompatibility
Recipient has antibody against donor RBC Donor has antibody against recipient RBC
When there is major ABO incompatibility
Recipient Donor Red cell
A O O
A B O
A AB O or A
B O O
B A O
B AB O or B
Recipient Donor Red cell
AB O O
AB B O or B
AB A O or A
O A O
O B O
O AB O
In minor ABO incompatibility plasma is removed before infusion
19

20. Factors other than hemoglobin concentration to be
considered in the decision to transfuse RBCs include:
• Patient's symptoms, signs, and functional capacities,
• The presence of cardiorespiratory, vascular, and
central nervous system disease
• The cause and anticipated course of the anemia
• Alternative therapies, such as recombinant human
erythropoietin (EPO) therapy, which is known to
reduce the need for RBC transfusions and to improve
the overall condition of children with chronic renal
insufficiency and preterm infants.
20

21. Disease requiring intermittent or chronic blood
transfusion in childhood
• Thalassemia
• Sickle cell disease
• Aplastic anaemia
• Chronic renal dysfunction
21

22. Guideline for chronic transfusion
• Aggressive management of the underlying disease
dialysis or erythropoietin therapy for renal
impairment
• Leukocyte reduced RBC (to prevent FNHTR)
• PRBC in such amount to prevent symptomatic
anaemia and allow normal growth
• Monitor iron, ferritin, TIBC, liver iron store
22

23. Chronic Anaemia
• Transfusion should be considered in a asymptomatic child with
a Hb level of less than 4 g/dL.
• Transfusion should be considered in a child with a Hb level of
less than 5 g/dL with clinical signs of cardiac or respiratory
distress.
• Children with a Hb level of 5 g/dL or greater should NOT be
transfused indiscriminately, but the cause of their anaemia
should be investigated.
• Transfusions must be given slowly (over a 4 hour period. At the
rate of 2-3 ml/kg/hr).
23

24.  Patients with iron-deficiency anemia are often treated
successfully with oral iron alone, even at hemoglobin levels of
<5 g/dL.
 Treat the cause as infection, nutritional and mild blood loss
anaemia with specific therapeutic agents as indicated (iron,
folic acid, B12).
• Premature babies are comfortable at Hb 6.5 - 7
gm%.
• Healthy asymptomatic neonate will self correct
anemia, provided iron should be adequate
• BT in neonate when asymptomatic Hct <21% or
reticulocyte count < 2%
24

25. CHILDREN AND ADOLESCENTS
• Acute loss of >25% at circulating blood volume
• Hemoglobin of <8.0 g/dL in the perioperative period
• Hemoglobin of <13.0 g/dL and severe cardiopulmonary disease
• Hemoglobin of <8.0 g/dL and symptomatic chronic anemia
• Hemoglobin of <8.0 g/dL and marrow failure
(Nelson)
25

26. INFANTS WITHIN THE FIRST 4 MO
OF LIFE
 Hemoglobin of <13.0 g/dL and severe pulmonary disease
 Hemoglobin of <10.0 g/dL and moderate pulmonary disease
 Hemoglobin of <13.0 g/dL and severe cardiac disease
 Hemoglobin of <10.0 g/dL and major surgery
 Hemoglobin of <8.0 g/dL and symptomatic anemia
26

27. Blood component therapy in newborn
• The total blood volume of neonates is small,
although the volume is higher per kg of body
weight than that of older children or adults.
(85 ml/kg for full-term and 100 to 105 ml/kg
for pre-term). .
27

28. Guidelines for packed red blood cells (PRBCs) transfusion thresholds
for preterm neonates
Symptomatic anemia as defined by more than 9 apneic and bradycardic episodes in 12 hours or 2
or more requiring bag and mask ventilation in 24 h while on adequate methylxanthine therapy or
HR>180/min or RR >80/min sustained for 24h or weight gain less than 10 g/day for 4 days on 28
100
kcal/kg/day or requiring surgery

29. • Blood transfusion in pre-term infants, is often given for the
anaemia of prematurity, associated with delayed renal
production of erythropoietin due to decreased sensitivity
to lower haematocrit levels.
• These neonates may require multiple transfusions,
increasing the risk of infectious disease transmission,
through multiple donor exposures alloimmunization
• Studies have shown that multiple transfusion from multiple
donor in preterms is associated with increased risk of ROP
and BPD.
• Multiple donor exposures in small and sick neonates can be
prevented by reserving a bag of fresh PRBC for up to 7 days
for a newborn and withdrawing small aliquots required as
and when needed
29

30. Choosing the blood group for neonatal transfusions
• Mother’s sample should be tested for blood group
and for any atypical red cell antibodies.
• ABO compatibility.
Though ABO antigens may be expressed only
weakly on neonatal erythrocytes, neonate’s serum may
contain transplacentally acquired maternal IgG anti-A
and/or anti-B.
30

31. Choosing the blood group for neonatal transfusions.
c. Blood should be of newborn’s ABO and Rh group.
It should be compatible with any ABO or atypical red cell
antibody present in the maternal serum.
d. In exchange transfusions for hemolytic disease of newborn-,
blood transfused should be compatible with mother’s serum.
If the mother’s and the baby’s blood groups are the same, use
Rh negative blood of baby’s ABO group.
In case mother’s and baby’s blood group is not compatible,
use group O and Rh negative blood for exchange transfusion.
31

32. Volume and rate of transfusion:
Vol of PRBC = Blood volume (mL/kg) 퐗
desired − actual hematocrit
hematocrit of transfused RBC
• Blood volume in term= 80, preterm 110
• The dose is 5 to 20 mL/kg transfused at a rate of
approximately 5 mL/kg/hour.
• In chronic anemia and cardiovascular compromise
dose is 5ml/kg at the rate of 1-3ml/kg/hr.
32

33. • It has been seen that transfusion with PRBC at a dose
of 20 mL/kg is well tolerated and results in an overall
decrease in number of transfusions compared to
transfusions done at 10 mL/kg in preterm and VLBW
infants.
• In Infants and newborn, one unit of RCC( 10 ml/kg)
increases Hb by 3g/dl.
• In children, the transfusion of RCC 10 mL/kg
increases the Hb concentration by about 2 g/dL.
33

34. PLATELET TRANSFUSION
• Platelets are stored at 20°C to 24°C using continuous gentle
horizontal agitation in storage bags specifically designed to
permit O2 and CO2 exchange to optimize platelet quality.
• It should be transported quickly and infused rapidly over 20-30
minutes to prevent loss of platelets due to aggregation.
• Should use only ABO/Rh identical compatible donor.
• In emergency one can use incompatible donors though the
efficacy may be less than expected
34

35. • Types – SDP and RDP
• The storage time from collection to transfusion of
platelets (RDPs) is 5 days.
• SDPs can be stored for up to 7 days.
Random donor platelet
(RDP)
Platelet atleast
5.5x1010
1unit/10kg
Raise 30,000-
50,000/cumm
Single donor platelet (SDP) Platelet atleast
3x1011
1 collection equals 6RDP
35

36. Types of platelets
• RANDOM DONOR
• SINGLE DONOR
• PLASMA DEPLETED PLATELETS
• WASHED PLATELETS
• WBC FILTERED
• UV OR GAMMA IRRADIATED
• PLATELETS FROM SPECIFIC DONOR:
CMV NEGATIVE OR HLA-MATCHED DONOR.
36

37. Patient’s
ABO
Group
Platelet Product Group
First
Choice
Second
Choice
O O
A A B
B B A
AB AB B or A
37

38. Recommandation for platelets use
• Platelets should never be filtered through a
micropore blood filter before transfusion.
• Should be ABO compatible.
• The usual recommended dose of platelets for
neonates is 1 unit of platelets per 10 kg body weight,
which amounts to 5 mL/kg.
• The predicted rise in platelet count from a 5-mL/kg
dose would be 20 to 60,000/cubic mm.
38

39. CHILDREN AND ADOLESCENTS
• PLTs < 50 × 109/L and bleeding
• PLTs < 50 × 109/L and an invasive procedure
• PLTs < 20 × 109/L and marrow failure with
hemorrhagic risk factors
• PLTs < 10 × 109/L and marrow failure without
hemorrhagic risk factors
• PLTs at any count, but with PLT dysfunction plus
bleeding or an invasive procedure
39

40. INFANTS WITHIN THE FIRST 4 MO OF LIFE
oPLTs < 100 × 109/L and bleeding on ECMO
oPLTs < 50 × 109/L and an invasive procedure
oPLTs < 50 × 109/L and clinically unstable
oPLTs < 20 × 109/L and clinically stable
oPLTs at any count, but with PLT dysfunction plus
bleeding or an invasive procedure
40

41. Indications for platelet transfusion in nonimmune
thrombocytopenia in newborn: AIIMS
1. Platelet count less than 30,000/cubic mm: transfuse
all neonates, even if asymptomatic
2. Platelet count 30,000 to 50,000/cubic mm: consider
transfusion in
a. Sick or bleeding newborns
b. ELBW or less than 1 week of age
c. Previous major bleeding tendency
d. Newborns with concurrent coagulopathy
e. Requiring surgery or exchange transfusion
3. Platelet count more than 50,000 to 99,000/cubic
mm: transfuse only if actively bleeding
41

42. Plasma-Derived Blood Components
FFP
Plasma separated from a unit of whole blood and
frozen within 8 h of collection is designated fresh
frozen plasma (FFP) .
 The usual volume of FFP is about 225 ml. FFP supplies
all of the constituents of fresh plasma, including the
labile coagulation factors, albumin and globulin.
Plasma contains about 1 unit/mL of each of the
coagulation factors
42

43. Indications
• Severe clotting factor deficiency (including DIC) with
bleeding
• Severe clotting factor deficiency patient undergoing
an invasive procedure
• Vitamin K deficiency with bleeding
• Dilutional coagulopathy with bleeding
• Severe anticoagulant protein deficiency
• Reconstitution of packed RBC for exchange
transfusion
44

44. FFP use in newborn
• Plasma should be transfused only after reference to normal
values adjusted for the birthweight and age of the infant
• 1. Sick neonate with unspecified coagulation disorder due to
sepsis, DIC, NEC etc.
• 2. Vitamin K deficiency bleeding
• 3. Inherited deficiencies of coagulation factors
It should not be used for prevention of intraventricular
hemorrhage, and in supportive treatment of sepsis
45

45. Cryoprecipitate:
It is prepared from FFP by thawing at 2 – 4C.
Contains approximately 100 u of factor VIII and von
Willebrand factor,
75 u of factor XIII, and
250mg of fibrinogen
in a volume of 20 ml.
It is transfused usually at 5ml/kg over 30 min.
46

46. Indications for use of cryoprecipitate:
• Afibrinogenemia,
• Von Willebrand factor deficiency,
• Congenital antithrombin III deficiency, hemophilia.
• It is also used for reconstitution of blood for
exchange transfusion.
47

47. Granulocyte Transfusions
Granulocyte concentrates are collected from single
donors by use of a blood cell separator.
Each concentrate contains approximately 1010
granulocytes.
Granulocytes has to transfused as soon as possible no
longer than 24 h.
When needed give 1000-2000 granulocytes/kg in
volume of 15-20ml/kg.
The desired count must be maintained for 48 hours for
therapeutic benefits
48

48. Guidelines for Pediatric Granulocyte Transfusions
CHILDREN AND ADOLESCENTS
• Neutrophils of <0.5 × 109/L and bacterial infection
unresponsive to appropriate antimicrobial therapy
• Qualitative neutrophil defect and infection (bacterial or fungal)
unresponsive to appropriate antimicrobial therapy
INFANTS WITHIN THE FIRST 4 MO OF LIFE
• Neutrophils of <3000/cumm (1st wk of life) or <1000 cumm (>
1st wk of life)
• Bone marrow having <10% nucleated neutrophils or peripheral
blood having >70% immature polymorphs
49

49. Blood component therapy
Component Constituent Indications Dose
FFP All clotting factors Many coagulation
factor deficiency
state
15ml/kg (gives 20-
30%)
Cryoprecipitate I, VIII, XIII, vWF Corresponding
deficiencies
5ml/kg
Random donor
plateletI (RDP)
Platelet atleast
5.5x1010
Thrombocytopenia 1unit/10kg
Raise 30,000-
50,000/cumm
Single donor platelet
(SDP)
Platelet atleast
3x1011
Thrombocytopenia 1 collection equals
6RDP
Whole blood All Acute blood loss Severe trauma
50

50. 51