Blood components and plasma products helpful in surgery

1. Blood Components and Plasma
Products
Dr. V. S. ChauhanDr. V Singh Chauhan

2. Introduction
• Blood can be separated into various components
by different speed centrifugal techniques
• This allow for effective use of donated blood and
lowers the exposure risk of the transfused patient
• The clinical requirement of a patient determines
which blood product should be transfused
Dr. V Singh Chauhan

3. Some definitions
• Whole Blood
– One unit of donor blood collected in a suitable
anticoagulant/preservative that contains blood cells and
plasma
• Blood Component
– A constituent separated from whole blood by
centrifugation of one donor unit
• Blood Derivatives
– Product obtained from multiple donor units of plasma by
fractionation
Dr. V Singh Chauhan

4. Dr. V Singh Chauhan

5. Dr. V Singh Chauhan

6. Blood Components
Dr. V Singh Chauhan

7. Preparation for Blood Components
• Collection Bags
• Refrigerated centrifuge
• Plasma extractor
• Cooling water bath
• Freezer -18oc – 18oc
• Blood refrigerator 1-6oc
• Platelet incubator
• Insulator container for blood transport
Dr. V Singh Chauhan

8. Centrifugation
• Principle
– Sediment of blood cells depend on their SIZE and
difference in DENSITY from that of the
surrounding fluid
– Also depends on viscosity of medium, flexibility of
cells that are temperature dependent.
Dr. V Singh Chauhan

9. Methods of separation
• Gravity Separation
• Low & High Speed refrigerated centrifugation
• Apheresis by cell separator
– Blood from a donor is passed through an apparatus that separates out one
particular constituent and returns the remainder back to circulation
Dr. V Singh Chauhan

10. Gravity Separation
• Old method, Time consuming, Crude but
cheaper method.
• Steps
– Blood collected in collection bags
– Blood kept hanging overnight for at least 12-16 hrs
• Forms clear plasma above & Red cells below
– Supernated plasma is expressed into satellite bag leaving behind
80-100ml of plasma
– Plasma collected a.k.a Single Donor Plasma
• Can be stored for 24-26 days at 4-6oc or 1 yr at -20oc
Dr. V Singh Chauhan

11. • Low speed refrigerated centrifugation
– Used to prepare platelet rich Plasma (PRP)
• High speed refrigerated centrifugation
– For Platelet concentrate (PC), FFP and
Cryoprecipitate.
Dr. V Singh Chauhan

12. Processing of Blood Components
Dr. V Singh Chauhan

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14. Dr. V Singh Chauhan

15. Dr. V Singh Chauhan

16. Red Cell Concentrates
• Obtained by centrifugation and removal of plasma.
• Contain the oxygen carrying molecule haemoglobin.
• A solution of citrate, phosphate, dextrose-adenine (CPD-A)
is used as anticoagulant in the blood unit.
– Citrate prevents blood from clotting by removing Ca2+.
– Adenine is required to maintain the metabolic activity of red
cells in the blood pack.
• Red cell concentrates in CPD-A are kept @ 2-6 C and shelf
life = 35 days.
• As the blood ages, the 2,3-DPG levels and the oxygen
carrying capacity are reduced.Dr. V Singh Chauhan

17. Leucocytes Depleted concentrate
• Leucocytes in the blood units may cause infections and
non-haemolytic transfusion reactions to the recipients.
• Therefore, leucocytes are removed from blood components
by:
– Centrifugation
• Easiest, Cost effective. WBC decrease (70-80%), RBC vol decrease
(20%)
– Filtration
• Easy, quick, expensive, highly efficient, WBC decrease (>99.9%). Little
loss of RBC
• Examples of infections transmitted by leucocytes in blood
products: Creutzfeldt-Jakob disease (CJD) and CMV.
Dr. V Singh Chauhan

18. Granulocyte concentrates
• Obtained either by differential centrifugation
or by Leucopharesis.
– Leucopharesis preferred since it yields more
granulocytes that can further be enhanced by
corticosteroids
• Contains 1.0 x 1010 granulocytes
• Stored at 24oc
• Infuse within 24 hrs of collection since they
are fragile
Dr. V Singh Chauhan

19. Platelet Concentrates
• Platelets essential for px blood loss by forming the platelet plug at
the site of damaged vessel wall.
• Patients lacking platelets prone to bruising & bleeding.
• Platelets concentrates are prepared from platelets rich plasma by
aspiration into another satellite pack.
• 4 packs pooled to provide one adult unit.
• Platelets units can also be collected by plasmapheresis.
• Platelets are stored @ RT for 5 days.
• Platelets units should be leucodepleted before transfusion.
Dr. V Singh Chauhan

20. Plasma Derived Components
• Fresh Frozen Plasma
• Frozen Plasma – Aged plasma
• Cryoprecipitate
• Cryo poor precipitate
Dr. V Singh Chauhan

21. Dr. V Singh Chauhan

22. Fresh Frozen Plasma
• Is plasma along with anticoag preservative
• Prepared from blood within 8 hours of
donation
• Vol – 250 – 300ml
• Temperature of centrifuge adjusted to 4-6oc
and bags subjected to high spin
centrifugation for approx 5 min
Dr. V Singh Chauhan

23. • Has
– Labile and Non labile clotting factors V, VIII, II
Protein c & s, complement and Immunoglobulins
– Also has proteins (Albumin and Globulin)
• Good for 24hrs post thaw then can be stored
for 5 days as liquid plasma
• Shelf Life – 1yr at -20oc, 5yrs at -70 – 80oc
Dr. V Singh Chauhan

24. Frozen Plasma
• Plasma separated from whole blood at any
time during storage
• Contains all non-labile coagulant factors
• Indicated for treatment of stable coagulation
deficiency
Dr. V Singh Chauhan

25. Other types of Plasma
• Single Donor Plasma
– Prepared from stored blood
– Poor in coag factors hence cant be used to correct
coagulation factor deficiencies
– Effective as a volume expander
• Donor retested single donor plasma
• Ig A deficient FFP
• Solvent detergent Plasma
Dr. V Singh Chauhan

26. Cryoprecipitate
• Is the cold insoluble portion of plasma that ppts when
FFP is thawed between 1-6oc
• Has ppt portion of plasma rich in Factor 8 & Fibrinogen
obtained from FFP prepared within 6 – 8 hrs of
collection
• Indication – Correction of Factor 8 deficiency
(Haemophilia A, vWF)
• Must be infused within 6 hrs of thawing
• Advantage
– Large amounts of Factor 8 can be administered without
overloading recipient (esp in paeds)Dr. V Singh Chauhan

27. Cryo-poor Precipitate
• Is the Supernatant remaining from production
of cryoprecipitate from FFP
• Relatively deficient in Hmwt forms of vWF but
retains normal levels of vWF cleaving
metalloproteinases
• Use
– Treatment of chronic relapsing thrombotic
thrombocytopenic purpura
Dr. V Singh Chauhan

28. Plasma Derivatives
• Factor 8
• Factor 9
• Anti-thrombin 3
• Albumin
• Immunoglobulins
• Rh Immunoglobulin
Dr. V Singh Chauhan

29. Albumin
• Is a binding protein with critical function in providing
osmotic activity and maintaining blood in blood vessels
• Produced from plasma and heat treated to prevent viral
transmission
• Available in 5% & 25% solutions
• Half life – 16 hrs
• Used for hypovolemia & Hypoprotenemia
• Can be given without regard to ABO blood type & cross
matching Dr. V Singh Chauhan

30. Immunoglobulins
• Produced from standard donation or
apheresis
• Can be stored for 12 months at 4 – 6 oc
• Indicated for patients with immunodeficiency
conditions (SCID)
Dr. V Singh Chauhan

31. How long can blood be stored
• RBC 35 days – 42 days depending on
anticoag
• Plts 5 days at RT
• Cryo 12 months at -18oc
4-6 hrs after thawing
• Plasma 12 months at -18oc
24 hrs after thawing
Dr. V Singh Chauhan

32. Dr. V Singh Chauhan