This document provides an introduction to blood transfusion. It begins with definitions of key terms like blood bank and blood donor. It then provides a brief history of blood banking, noting important developments like the use of anticoagulants and refrigerated storage. The document outlines the collection and processing of whole blood into components like red blood cells, plasma, platelets and cryoprecipitate. It discusses the storage and management of these blood products, including shelf lives and temperatures. It also defines red blood cell storage lesion and discusses efforts to minimize its effects. In summary, the document introduces students

1. INTRODUCTION TO BLOOD
TRANSFUSION
Hussein A. Abid
B. Sc. M. Clin. L. T. (ASMM, ASBMBM)
Middle Technical University
Ba’aquba Medical Technical Institute
Medical Laboratory Technology Department
Blood Transfusion Course
Lecture: 1

2. Pre-test
• Define blood bank?
• What are the major elements of blood?
• How to preserve blood for longer time?
• What are the main functions of blood?
• Is blood transfusion dangerous for
donor or recipient?
• Who is need a blood transfusion?

3. Objectives
3
• A student after completion this lecture, will be able to:
1. Define “blood bank”
2. Write short notes about history of transfusion practice.
3. Know how to preserve blood
4. Enumerate blood products
5. Define apheresis
6. Define RBC lesion
7. Write detailed notes about blood storage.

4. Definitions
• Blood bank: is a cache or bank of blood
or blood components, gathered as a
result of blood donation, stored and
preserved for later use in blood
transfusions.
• The term "blood bank" typically refers to a
division of a hospital where the storage of
blood product occurs and where proper
testing is performed (to reduce the risk of
transfusion related adverse events).
4

5. Definitions
• Blood donor: is a person who donates (gives) blood
voluntarily.
• Blood recipient: is a patient who receipt (receives) blood,
for therapeutic purposes.
• Aim of understanding or teaching blood transfusion is to get
a full information about what occurs due to transfusion and
donation of blood, along with the acquired diseases, which
might transmitted from donors to recipients.
5

6. HISTORY
• An early development leading to the
establishment of blood banks occurred in
1915, when Richard Lewison of Mount Sinai
Hospital in New York City initiated the use of
sodium citrate as an anticoagulant.
• This discovery transformed the blood
transfusion procedure from direct (vein-to-vein)
to indirect.
• In the same year, Richard Weil demonstrated
the feasibility of refrigerated storage of
anticoagulated blood.
6

7. HISTORY
• The introduction of a citrate-glucose solution by Francis
Peyton Rous and JR Turner two years later permitted
storage of blood in containers for several days, thus
opening the way for the first "blood depot" established in
Britain during World War I.
• Oswald Hope Robertson, a medical researcher and U.S.
Army officer who established the depots, is now recognized
as the creator of the first blood bank.
7

8. HISTORY
• By the mid-1930s, the Soviet Union had set up a system of at
least sixty large blood centers and more than 500 subsidiary
ones, all storing "canned" blood and shipping it to all corners of
the country.
• News of the Soviet experience traveled to America, where in
1937 Bernard Fantus, director of therapeutics at the Cook County
Hospital in Chicago, established the first hospital blood bank in
the United States.
• In creating a hospital laboratory that preserved and stored donor
blood, Fantus originated the term "blood bank". 8

9. HISTORY
• Within a few years, hospital and community blood banks
were established across the United States.
• Willem Johan Kolff organized the first blood bank in Europe
(in 1940).
• An important breakthrough came in 1939-40 when Karl
Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson
discovered the Rh blood group system, which was found to
be the cause of the majority of transfusion reactions up to
that time.
9

10. HISTORY
• Three years later, the introduction by J.F. Loutit and Patrick L.
Mollison of acid-citrate-dextrose (ACD) solution, which reduces
the volume of anticoagulant, permitted transfusions of greater
volumes of blood and allowed longer term storage.
• Carl Walter and W.P. Murphy, Jr., introduced the plastic bag for
blood collection in 1950.
10

11. HISTORY
• Replacing breakable glass bottles with durable
plastic bags allowed for the evolution of a
collection system capable of safe and easy
preparation of multiple blood components from a
single unit of Whole Blood.
• An anticoagulant preservative, CPDA-1 was
introduced in 1979. It decreased wastage from
expiration and facilitated resource sharing among
blood banks. Newer solutions contain adenine
and extend the shelf life of red cells to 42 days.
11
CPDA-1
Citrate
Phosphate
Dextrose
Adenine

12. COLLECTION AND PROCESSING
• In the U.S., certain standards are set for the collection and
processing of each blood product.
• "Whole blood" (WB) is the proper name for one defined product,
specifically unseparated venous blood with an approved
preservative added.
• Most blood for transfusion is collected as whole blood.
• Autologous donations are sometimes transfused without further
modification, however whole blood is typically separated (via
centrifugation) into its components, with red blood cells (RBC) in
solution being the most commonly used product.
12

13. COLLECTION AND PROCESSING
• Units of WB and RBC are both kept refrigerated at 33.8
to 42.8 °F (1.0 to 6.0 °C), with maximum permitted storage
periods (shelf lives) of 35 and 42 days respectively.
• RBC units can also be frozen when buffered with glycerol,
but this is an expensive and time-consuming process, and
is rarely done.
• Frozen red cells are given an expiration date of up to ten
years and are stored at -85 °F (-65 °C).
13

14. COLLECTION AND PROCESSING
• Blood plasma made into a variety of frozen components, and is
labeled differently based on when it was frozen and what the
intended use of the product is.
• If the plasma frozen promptly and is intended for transfusion, it is
typically labeled as fresh frozen plasma (FFP).
• If it is intended to be made into other products, it is typically
labeled as recovered plasma or plasma for fractionation.
• Cryoprecipitate can be made from other plasma components,
these components must be stored at 0 ºF (-18 ºC).
14

15. COLLECTION AND PROCESSING
• Buffy coat: is the layer between
the red cells and the plasma, which
is some time removed to make
platelets for transfusion.
• Platelets are typically pooled
before transfusion and have a shelf
life of 5 to 7 days, stored at room
temperature (72 ºF or 22 ºC).
15

17. COLLECTION AND PROCESSING
• Some blood banks also collect products by apheresis (is a
medical technology in which the blood of a donor is passed
through an apparatus that separates out one particular
constituent and returns the remainder to the circulation).
• The most common components collected is plasma via
plasmapheresis, red blood cells and platelets can be
collected by similar methods.
• These products generally have the same shelf life and
storage conditions as their conventionally-produced
counterparts. 16

18. STORAGE AND MANAGEMENT
• Routine blood storage is 42 days or 6 weeks for stored
packed red blood cells (also called "StRBC" or "pRBC"), by
far the most commonly transfused blood product, and
involves refrigeration but usually not freezing.
• There has been increasing controversy about whether a
given product unit's age is a factor in transfusion efficacy,
specifically on whether "older" blood directly or indirectly
increases risks of complications.
17

19. STORAGE AND MANAGEMENT
• Studies have not been consistent on answering this question,
with some showing that older blood is indeed less effective but
with others showing no such difference; nevertheless, as storage
time remains the only available way to estimate quality status or
loss, a first-in-first-out inventory management approach is
standard presently.
• It is also important to consider that there is large variability in
storage results for different donors, which combined with limited
available quality testing, poses challenges to clinicians and
regulators seeking reliable indicators of quality for blood products
and storage systems. 18

20. STORAGE AND MANAGEMENT
• Transfusions of platelets are comparatively far less
numerous, but they present unique storage/management
issues. Platelets may only be stored for 7 days, due largely
to their greater potential for contamination, which is in turn
due largely to a higher storage temperature.
19

21. RBC STORAGE LESION
• Insufficient transfusion efficacy can result from red blood cell
(RBC) blood product units damaged by so-called storage lesion
[a set of biochemical and biomechanical changes which occur
during storage].
• With red cells, this can decrease viability and ability for tissue
oxygenation.
• Although some of the biochemical changes are reversible after
the blood is transfused, the biomechanical changes are less so,
and rejuvenation products are not yet able to adequately reverse
this phenomenon. 20

22. RBC STORAGE LESION
• Current regulatory measures are in place to minimize RBC
storage lesion-including a maximum shelf life (currently 42 days),
a maximum auto-hemolysis threshold (currently 1% in the US),
and a minimum level of post-transfusion RBC survival in vivo
(currently 75% after 24 hours).
• Many physicians have adopted a so-called "restrictive protocol"-
whereby transfusion is held to a minimum-due in part to the noted
uncertainties surrounding storage lesion, in addition to the very
high direct and indirect costs of transfusions, along with the
increasing view that many transfusions are inappropriate or use
too many RBC units. 21

23. LONG TERM STORAGE
• "Long-term" storage for all blood products is relatively
uncommon, compared to routine/short-term storage.
• Cryopreservation of red blood cells is done to store rare
units for up to ten years.
• The cells are incubated in a glycerol solution which acts as
a cryoprotectant ("antifreeze") within the cells. The units are
then placed in special sterile containers in a freezer at very
low temperatures.
22

24. 23

25. Post-test
24
1. Define “blood bank”.
2. Write short notes about history of transfusion practice.
3. How to preserve blood?
4. Enumerate blood products.
5. Define apheresis.
6. Define RBC lesion.
7. Write detailed notes about blood storage.

26. Hussein A. Al-tameemi