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Blood components
One unit of whole blood can be separated into various blood components through centrifugation and other processing steps. This allows each component to be stored optimally and transfused only as needed by patients. Red blood cells can be stored for 21 days in CPD or 42 days when added to ADSOL. Platelets are stored at room temperature while plasma products like FFP and cryoprecipitate must be frozen and thawed as needed. Whole blood is rarely used today due to non-functional platelets and labile coagulation factors after collection.
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Blood components
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- 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 Storagetime 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
- 9. Plasma hemoglobin Plasma K+ Viable cells pH ATP 2,3-DPG PlasmaNa+ Helps release oxygen from hemoglobin (once transfused, ATP & 2,3- DPG return to normal) K+Na+ 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
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- 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
- 20. Blood Components • Cellular – Red blood cell products – Platelets – Granulocytes • Plasma – FFP – Cryoprecipitate KAWITA BAPAT
- 21. Products With Red Cells 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
- 23. Changes in Stored Blood 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
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- 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
- 28. Cell Washer to Prepare Washed Cells KAWITA BAPAT
- 29. Frozen Blood KAWITABAPAT
- 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
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- 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
- 35. Prepara;on of platelet concentrate RBCs PRP Plasma Platelet concentrate 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
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- 41. Platelets Pheresis • One bag (unit) from one donor • One unit is a therapeu;c dose • Volume approximately 250 ccs KAWITA BAPAT
- 42. Granulocytes Lymphocyte Monocyte Neutrophils Eosinophils Basophils 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
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- 45. Fresh Frozen Plasma – Volume 200-‐250cc 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
- 51. FFP Frozen within 8 hours Thawed FFP Cryoprecipitate (VIII, vW) Plasmacryoprecipitate, reduced (TTP, FII, V, Vii, IX, X, XI) Thaw at 30-37°C Store at RT 4 hrs Refrozen with 24 hrs of separation Store at ≤18°C 1 yr 5 day expiration at 1-6°C 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
- 53. Cryoprecipitate – volume 15ccs KAWITA BAPAT
- 54. Irradia;on of Blood Components 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
- 57. Irradia;on of Blood Components 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
- 63. Safe-‐T-‐Vue Temperature Monitor 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
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