Blood and its components

1. BLOOD AND ITS COMPONENTS ,
WHEN AND HOW TO USE ?
Dr Pranveer Singh Rao
Department of Pathology
AIMS & RC

2. Objectives
• Definitions
• Blood Components
• Clinical Use
• Examples

3. Definitions
• Blood Product: Any therapeutic substance
prepared from human blood.
• Whole Blood: Unseparated blood collected
into an approved bag.
• Blood component: A constituent of blood,
separated from whole blood.
• Plasma derivative: Human plasma proteins
prepared under pharmaceutical
manufacturing conditions.

5. Blood components
Component Separation from Whole
Blood
Apheresis

9. The required components can give
maximum benefit to a patient with
minimum risk.

16. WHOLE BLOOD
• A 450 ml whole blood
donation contains:
• 450 ml donor blood
• 63 ml anticoagulant-
preservative solution
• Haematocrit 35%–45%
• No functional platelets
• No labile coagulation
factors (V and VIII)

17. Whole Blood-Indications
• Seldom used in modern transfusion practice.
• Exchange transfusion
• Patients needing red cell transfusions where red cell
concentrates or suspensions are not available.

18. Contraindications
Risk of volume overload in patients with:
• Chronic anaemia
• Incipient cardiac failure

19. RED CELL CONCENTRATE (PRBC)
• 150–200 ml red cells from which most of the
plasma has been removed
• Haemoglobin approximately 20 g/100 ml (not
less than 45 g per unit)
• Haematocrit 55%–75%

20. PRBC-Indications
• Replacement of red cells in anaemic patients.
• Use with crystalloid replacement fluids or
colloid solution in acute blood loss.

21. PRBC-DOSE AND EXPECTED RESULTS
• In non-urgent settings, transfuse one unit at a
time.
• For infants, 5 to 10 ml/kg can be given.
Expected result: One unit will increase the
hemoglobin approximately 1 g/dl and the
hematocrit by 3 percent in a 70 kg adult.

22. RBC TRANSFUSION GUIDELINES —
ADULTS
• hypovolemia unresponsive to crystalloid or
colloid infusions
• hemoglobin <8 g/dl and impending surgery
with expected blood loss.
• Symptomatic chronic anemia

23. PRBC-How to Use
• Must be ABO and RhD compatible with the
recipient
• Never add medication to a unit of blood
• Complete transfusion within 4 hours of
commencement.
• To improve transfusion flow, normal saline
(50–100 ml) may be added using a Y-pattern
infusion set

24. RED CELL SUSPENSION
• RBCs
• 150 ML
• Residual
• Plasma
• SAG-M
• 100ml

25. RED CELL SUSPENSION
Better flow rates are achieved than with red cell
concentrate or whole blood.

26. LEUCOCYTE-DEPLETED RED CELLS
• < 5 million WBC.
• Risk of CMV Transmission is reduced.
• Reduced risk of WBC immunization.
• Reduced incidence of FNHTR.

28. PLATELET CONCENTRATES (prepared
from whole blood donations)
• Single donor unit in a volume of 50–60 ml of
plasma
• At least 55 x109 platelets
• <1.2 x109 red cells
• <0.12 x109 leucocytes

29. • Single donor unit: platelets prepared from
one donation
• Pooled unit: platelets prepared from 4 to 6
donor units ‘pooled’ into one pack to contain
an adult dose of at least 240 x109 platelets

30. Indications
• Treatment of bleeding due to:
• — Thrombocytopenia
• — Platelet function defects
• Prevention of bleeding due to
thrombocytopenia, such as in bone marrow
failure.

31. Not indicated in:
• Idiopathic autoimmune thrombocytopenic
purpura (ITP).
• Thrombotic thrombocytopenic purpura (TTP).
• Untreated disseminated intravascular
coagulation.
• Thrombocytopenia associated with
septicaemia, until treatment has commenced.
• Hypersplenism.

32. Expected Results
Transfusing a pool of 5 concentrates
or a plateletpheresis should increase the platelet
count
by 25,000 to 50,000 μl in an average adult, in the
absence of consumption.

33. Increment will be less if there is:
— Splenomegaly
— Disseminated intravascular
coagulation
— Septicaemia

34. PLATELET CONCENTRATES
• MUST NOT BE REFRIGERATED
• Give ABO compatible wherever possible.
• Infused in 30 minutes.

35. Complication
• FNHTR
• Urticaria

36. PLATELET CONCENTRATES (collected
by plateletpheresis)
• Volume 150–300 ml
• equivalent to 3–10 single donations
• ABO compatibility is more important

37. PLATELET TRANSFUSION GUIDELINES
• Platelet count <10,000/μl
• Platelet count <50,000/μl:
– a. Severe active bleeding.
– b. Major surgery
– c. Coagulopathy, including DIC.
– d. Newborn <1 month of age, or preterm infant.
– e. Patients with severe infections.

38. PLATELET TRANSFUSION GUIDELINES
• Platelet count <100,000/μl
– a. Following cardiopulmonary bypass surgery.
– b. Neurologic or ophthalmologic surgery.

39. FRESH FROZEN PLASMA (FFP)
• Contains normal plasma levels of stable
clotting factors, albumin and immunoglobulin
• Factor VIII level at least 70% of normal fresh
plasma level
• 200–300 ml

40. FFP- DOSE AND EXPECTED RESULTS
• Dose: 10 to 20 ml/kg body weight.
Expected result: In a 70 kg adult, each
unit will increase the activity of plasma
clotting factors by about 4 to 5 percent,
and fibrinogen by about 10 mg/dl.

41. FFP TRANSFUSION GUIDELINES
• APTT > 45 SECONDS
• INR > 1.5
• Prophylacticaly in patients with factor
deficiency before surgery
• Newborns with septicaemia and coagulopathy

42. Indications
• Replacement of multiple coagulation factor
deficiencies: e.g.
— Liver disease
— Warfarin (anticoagulant) overdose
— Depletion of coagulation factors in patients receiving
large volume transfusions
• Disseminated intravascular coagulation (DIC)
• Thrombotic thrombocytopenic purpura (TTP)

43. Precautions
• Acute allergic reactions are not uncommon,
especially with rapid infusions.
• Severe life-threatening anaphylactic reactions
occasionally occur
• Hypovolaemia alone is not an indication for
use

44. use within 6 hours of thawing

45. CRYOPRECIPITATE
Prepared from fresh frozen plasma by collecting the
precipitate formed during controlled thawing at +4°C
and resuspending it in 10–20 ml plasma.

46. Indications
• As an alternative to Factor VIII concentrate in
the treatment of inherited deficiencies of:
— von Willebrand Factor (von Willebrand’s disease)
— Factor VIII (haemophilia A)
— Factor XIII
• As a source of fibrinogen in acquired
coagulopathies:
 e.g. disseminated intravascular coagulation (DIC)

47. • If possible, use ABO-compatible product
• No compatibility testing required
• After thawing, infuse as soon as possible
through a standard blood administration set
• Must be infused within 6 hours of thawing

50. Storing blood products prior to transfusion
• Once issued by the blood bank, the
transfusion of whole blood, red cells and
thawed fresh frozen plasma should be
commenced within 30 minutes of their
removal from refrigeration.

51. Storing blood products prior to
transfusion
• If the transfusion cannot be started within this
period, they must be stored in an approved
blood refrigerator at a temperature of 2°C to
6°C.
• The temperature inside every refrigerator
used for blood storage in wards and operating
rooms should be monitored and recorded
daily to ensure that the temperature remains
between 2°C and 6°C.

52. Storing blood products prior to
transfusion
• The upper limit of 6°C is essential to minimize the
growth of any bacterial contamination in the unit of
blood.
• The lower limit of 2°C is essential to prevent
haemolysis, which can cause fatal bleeding problems
or renal failure.

53. • Platelet concentrates that are held at lower
temperatures lose their blood clotting
capability; they should never be placed in a
refrigerator

54. Checking the blood pack

62. Reference
• Clinical Use Of Blood – WHO
• AABB Technical Manual
• Practical Transfusion Medicine- Murphy
• Principles of Transfusion Medicine- Rossi

63. Thank you