The document provides an overview of blood components and their uses in clinical practice. It discusses the history of blood transfusions and the development of techniques to separate whole blood into components. The key blood components discussed are packed red blood cells (PRBC), which are used to treat symptomatic anemia. PRBC are produced by removing plasma from whole blood and allow for faster correction of hemoglobin levels compared to whole blood. The document also discusses plasma derivatives produced from large pools of donor plasma through fractionation processes. It notes the various screening tests performed on donations and techniques used to reduce risks of transfusion-transmitted infections.

1. USE OF BLOOD COMPONENTS IN CLINICAL
PRACTICE – Part 1
By
Dr.Varughese George

2. INTRODUCTION
• In the past whole blood was the only preparation administered to replace
RBCs, platelets and coagulation factors.
• Unnecessary administration of unwanted cells/ plasma constituents in
addition to what patient required.
• Large volume of blood required to achieve satisfactory replacement of
particular component.
• Techniques became available for separation of blood components in a
closed system and patient could be administered specific replacement
therapy.
• 1 unit of donor's blood can be utililized for preparation of different
components and thus can benefit more than one patient.

3. BLOOD COMPONENTS
HISTORY:
• 1628 - Sir William Harvey described
venous circulation.
• 1665 - First animal-to-animal (dog)
blood transfusion performed at
Oxford by Richard Lower
• 1667- First animal-to-human blood
transfusion by Jean-Bapiste Denis .
• 1818- First human-to-human blood
transfusion was performed by James
Blundell.

4. BLOOD COMPONENTS
HISTORY:
• 1900- The ABO blood grouping
system was classified by
Landsteiner.
• 1907- The first pretransfusion
cross-match was done by
Ottenberg.
• 1940- The system of Rh typing
was invented by Landsteiner
and Wiener.

5. BLOOD COMPONENTS
FURTHER DEVELOPMENTS
• 1950 - Glycerol cryoprotectant for freezing RBCs
• 1950 - Carl Walter & W.P.Murphy introduced the
plastic bag for blood collection.
• 1954 -= The blood product Cryoprecipitate was
developed for people suffering from hemophilia.
• 1960 - A.Solomon and J.L.Fahey reported the 1st
therapeutic plasmapheresis procedure.
• 1972 - Apheresis was used to extract one
cellular component.
• 1979 - A new anticoagulant preservative, CPDA-
1, which extends the shelf life of whole blood
and RBCs to 35 was introduced.

6. • There were no Blood Banks in India before 1942 when first Blood
Bank was established in Calcutta due to perceived threat by
advancing Japanese forces.
• Thereafter Bombay, Lucknow, Pune and Lahore blood bank were
established during world war II.
• Colonel CWG Bird and Colonel SDS Grewal of IMS in British
Indian Army played pivotal role in development of Blood Bank
programme and the production units in AFMC and rest of the
country.
• Veteran transfusion man Professor PD Jolly pioneered development
of Blood Banking Programme in whole of the country from
inception.

7. • There have been major inventions in the
component therapy in the 20th century
e.g. invention of anticoagulant and preservative
solutions, refrigeration, plastic blood bag, etc.
• Transfusion medicine is a separate speciality by
now and MD transfusion medicine courses have
started at many premier institutions at JIPMER,
AIIMS, AFMC, PGIMER Chandigarh, SGPGI
Lucknow and many other centres.

8. REGULATIONS:
• Drugs & cosmetic act 1940 and Drugs &
cosmetic (amendment) rules 1999 – Human
blood is covered under the definition of drugs.
• These regulations give requirements,
processing & distribution of whole human
blood & blood components by the blood banks
and manufacture of blood products.

9. • Blood products are therapeutic substances
prepared from human blood which comprise:
Blood components: Plasma derivatives:
-RBC conc. -Albumin
-Platelet conc. -Coagulation factors
-Granulocytes -Immunoglobulins
-Fresh plasma
-Cryoprecipitates

11. • Advent of component therapy was in 1980 in
U.K by use of factor VIII for Haemophilia
which was prepared by fractionating human
plasma.
• In UK and other western countries, whole blood
is no longer used routinely for transfusion – it is
processed in various components and only that
are specifically needed by the patient are used.
• Donors are chosen to exclude anyone who may
harm the recipient and anyone who may be
harmed by donating blood.
• Acceptable limit - 450 – 500 ml upto 3 times a
year.

12. Blood components
From whole blood Apheresis – only the
after collection. component to be used is
separated out &collected
& rest is returned to the donor.

13. • With development of closed system of PVC bags
with integral tubing, separation of components
could be achieved safely without risk of infection.
• Blood components can be prepared in any licensed
blood bank which has the required space,
specialized equipment, storage facility and trained
personnel.

14. Essential equipments in a blood bank
Essential equipments are:
-A steady flow of voluntary blood
donors
-Testing facility for transfusion
transmitted infections
-Refrigerated blood bank centrifuge
-Integral multiple blood bags
-Plasma expressor
-Blood sealer/ aluminium rings
-Blood bank refrigerator
-Deep freezer
-Cryoprecipitate bath
-Platelet agitator
-Laminar flow cabinet for pooling

15. Use of blood products ensures added advantages:
• Maximised use of one unit of blood for a number of patients with
same unit.
• Shelf life of components is longer than whole blood.
• Better patient care with specific components without danger of
overloading/ side effects of other components.
• Cost effective blood bank system wherein cost of processing a unit of
blood is shared by a number of patients rather than one patient if given
as whole blood.

18. Production of blood components &
plasma derivatives

19. Production of blood components &
plasma derivatives
• Whole blood is centrifuged to separate plasma from red cells.
• Concentrated RBCs become too viscous to infuse safely and are depleted in
nutrients, glucose and adenine.
• Following collection, red cells are resuspended & stored in a preservative solution
to keep them in good condition.
•
• Most common solutions used are SAGM – contains
 sodium chloride,
 Adenine
 Glucose
 Mannitol.
 Glucose provides energy source for the metabolic requirements of the cells
 Adenine helps maintain cellular levels of ATP
 Saline and Mannitol provides aqueous medium of appropriate osmolarity and pH.

20. Blood Component Screening
• Blood screening varies across the globe.
In UK, all blood donations are tested for
 Hepatitis B (Surface antigen)
 Human Immunodeficiency Virus (HIV)
 HTLV (Human T Lymphocyte Virus)
 Hepatitis C (Ab & RNA)
 Syphilis (antibody)
• In case, donor has been exposed to infections through travel
 Malaria antibody.
 Trypanosoma Cruzi (Chagas disease) antibody.
 West Nile Virus RNA.
Some blood donations are tested for Cytomegalovirus (CMV) antibody to meet
the needs of specific patient groups.

21. Blood Component Screening
Since October 1999, all blood components used in UK & Ireland have been
leucodepleted ( removal of white blood cells by filtration) in an attempt to
reduce the risk of transfusion transmitted infections & variant Creutzfeldt-
Jakob disease (vCJD) – no test for reliable detection is available.
Each blood donation is also tested to establish ABO & Rh D group of donors’
red cells.

22. Plasma derivatives
• Plasma derivatives are partially purified preparations of human plasma
proteins that are produced in a pharmaceutical process from large
volumes of plasma.
• Thawing , addition of ethanol, exposure to varying temperature, pH &
ionic strengths are combined with filtration, chromatography and
centrifugation to separate the different groups of proteins.
•
• Purification and virus inactivation steps are also performed.
• Final products supplied as solutions or freeze dried powders.
• Pooling of huge number of donations potentially increases the risk of
infective disease transmission.

23. Plasma derivatives
• Since 1999, UK has imported plasma for fraction
from areas reporting low incidence of Bovine
Spongiform Encephalopathy, which is associated
with vCJD.
• The USA supplier only provides plasma from male
donors to reduce the risk of Transfusion Related
Acute Lung Injury (TRALI).
• Women are excluded as they may be a source of
Antibodies that increase risk of TRALI, which are
though to occur during pregnancy.

24. Blood Component Therapy
• Used to correct coagulopathy and
thrombocytopenia once exsanguination has
been stopped by physical means.
• The availability of near patient testing
equipment such as thromboelastography
(TEG) can provide useful information to help
guide component therapy.

25. Blood Component Therapy
Whole blood:
• Accounts for most transfusions in
many countries, rarely used in
developed nations.
• Shelf life :
 CPD - 21 days.
 CPDA – 35 days.
 AS-1, AS-3, AS-5 – 42 days
• 70ml of citrate preservative solution
is added to 420ml of blood.

26. Blood Component Therapy
Whole blood:
• Whole blood/ RBC concentrate less than 12
– 24 hrs from time of collection are
considered fresh, difficult to provide, as
screening is rarely completed within that
period.
• 80 -90 % platelets become non-functional.
• 30-40% labile factors V & VIII lost in 24 hrs
at 4-6⁰C.
• Justified when no facilities for component
separation, sometimes in newborn due to
high fetal Hb.

27. Blood Component Therapy
Indications :
• Acute, active blood loss with
hypovolemia.
• Exchange transfusion.
Contraindications :
Risk of volume overload :
Chronic anemia.
Incipent cardiac failure.

28. Red Cell Components
The objective of red cell components transfusion is to improve oxygen
delivery to the tissues.
Packed Red Cells (PRBC) –
• Produced by removing 150-200ml of citrated plasma from a unit and whole blood.
• 1 unit of PRBC has hematocrit between 60-70%.
Storage :
 Storing RBCs just above freezing temperature allows survival upto 42 days.
 There is gradual loss of 2,3 Diphosphoglycerate (2,3 DPG), leading to increased Hb affinity for
O2.
 Left shift of O2 dissociation curve and reduced O2 delivery to the tissues.
 Gradual loss of cell membrane integrity as cells begin to age.
 Potassium leaks out of cells into suspension fluid and there is gradual buildup of lactate.
 Some cells may eventually die and become haemolysed.
• Giving packed red cells – faster way to increase the O2 delivery capacity of the blood
• 1 unit of packed red cells will roughly increase patient’s hematocrit by 3% and Hb by 1 g/dl.

29. Blood components
Packed Red Blood Cells (PRBC):
-Symptomatic anaemia.
-Decreased BM production – Leukaemia, Aplastic anaemia.
-Decreased RBC survival conditions – Hemolytic anemia,
Thalassemia.
-In bleeding patients – surgical bleeding, traumatic bleeding.
-Suggested levels of Hb warranting transfusion
– 6g/dl in absence of disease
– 8-10g/dl with disease

30. • Each count of RBC from 450 ml of whole
blood is expected to raise Hb level 1g/dl in a
70kg body wt individual, more quick with
RBC than whole blood.

31. Reasons Indications & Replacement fluid
Anaemia -Anaemia associated with incipient/
established cardiac failure.
-Hb value < 6g/dl
-Patients approaching delivery & has Hb
<7g/dl
-In hereditary hemolytic anemia & β
thalassemia major, guidelines are more
liberal.
Reasons Indications & Replacement fluid
Surgery -Patient needs urgent operation and has Hb
<10g/dl
-Anticipated blood loss > 1000ml
Other acute blood loss <20% -None
20-30% - Crystalloids/ colloids
30-40% - RBC & crystalloids
>40% - Whole blood / PRBC & Crystalloids
Broad indications for PRBC transfusion:

32. Advantages of transfusion of red cells:
-Reduce risk of circulatory overload due to less
volume of anticoagulant and plasma.
-Lessen severity and incidence of allergic reactions
-ABO antibodies are reduced, Red cells non ABO
identical to patients group can be given if
compatible.
-Removed plasma can be used for preparing FFP, &
Cryoprecipitate (factor VIII & V)

33. Contraindications of red cell transfusion:
- Well compensated anaemic patients such as chronic
renal failure.
-Nutritional anemia responsive to treatment, unless
signs of decompensation.
-To correct protein and coagulation factor deficiency.
-To prevent infection , promote wound healing,
general well being, etc.

34. Red cell aliquots
• For neonates
• 10-25 ml units
• 5ml/kg will raise Hb by approx. 1 gm/dl

35. Red Cell Components
Microaggregate - free blood
• Used to prevent reactions to leucocytes and platelet antigens.
• Specially designed machines are used to wash RBC.
• Washed RBC are then suspended in sterile saline.
• Washed RBC usually have hematocrit of 70-80% and a volume of
about 180ml.
• Saline washing removes 98% of plasma & reduces concentration of
leucocytes, platelets and cellular debris.
• Washing may be carried out at anytime during the shelf-life of a
unit of blood.
• As washing is in an open system, the resultant RBC can be stored for
24 hrs at 1-6 °C.

36. Irradiated RBCs
• Gamma radiation is used to destroy the lymphocytes
in a unit of packed RBCs that are responsible for
transfusion related Graft V/S Host Disease.
• Used in
 severely immunocompromised patients.
 lymphoma patients.
 stem cell and marrow transplants.
 unborn children undergoing intrauterine infusion.

37. Leucocyte depleted Red cells
• Has 99.9% of white cells removed by freezing or
microfiltration.
• This only reduces but doesn’t eliminate the risk of CMV, EBV,
HTLV infections and febrile reactions.
• Since 1999, all blood components in the UK and Ireland have
leucodepleted red cells in an attempt to decrease potential
risk from transfusion transmitted vCJD.

38. Leucocyte reduced blood components/ RBC’s:
• Approximate residual leucocytes in cellular
blood components in one unit.
-Fresh whole blood 10⁹
-Red blood cell concentrate 10⁸ - 10⁹
-Buffy coat depleted red cells 10⁸
-Red cells leucocyte reduced by <10⁷
filtration
-Washed red cell concentrate 10⁷
-Deglycerolized red cells 10⁶ - 10⁷
-Platelet concentrate ≤10⁷

39. Leucocytes in blood components can cause:
-Non-hemolytic febrile transfusion reaction(NHFTR)
-Human leucocyte antigen (HLA) alloimmunization
-Transfusion of leucotropic viruses – CMV, EBV, HTLV-1
-Transfusion related Graft versus Host disease (GVH)
-Transfusion related Acute lung injury (TRALI)
-Transfusion related immunosuppression.

40. • Febrile Non Hemolytic Transfusion Reaction
(FNHTR):
FNHTR – “rise of body temperature >1⁰C above 37⁰C”
-Antibodies against WBC in patients plasma endotoxins
-Leucocyte cytokines- product storage as in non leucocyte
reduced platelets in warmer climates.
-Antipyretics can be used prior & during transfusion.
-Difficulty in detecting antibodies in vitro.
-Patients with two or more FNHTR should receive
leucocyte reduced blood components – pre-storage
reduced leucocytes for reduced cytokines , Red cell
component – fresh / washed.
-For platelets - residual plasma removed.

41. -Reducing leucocytes to less than < 5 x 10⁸ in one unit
of RBC prevents most of Non-hemolytic febrile
transfusion reactions.
-To prevent CMV transmission or alloimmunisation to
HLA antigen, leucocyte content is reduced to
< 5 x 10⁶ in a unit of RBC.
-Donor lymphocytes reacting against host antigen may
cause GVHD.
-Leucoagglutination in recepient may lead to
Transfusion Related Acute Lung Injury (TRALI) &
pulmonary edema.

42. • Leucocyte reduced Red Blood Cells:
Methods of preparation:
-Centrifuging and removing of buffy coat
-Filtration
-Washing RBC’s with saline
-Freezing and thawing of RBC’s
Can be done at:
-Prestorage – on collection
-After storage – before issue Disintegrated leucocytes & cytokines
may cause FNHTR & HLA alloimmunisation
-Bed side filtration

43. Indications for use:
• Multitransfused patients like thalassemia & other
haemoglobinopathies
• Aplastic anemia
• Immunosuppressed
• Immunodeficient
• Multiparous women
• Prevention of FNHTR
• Prevention/ delay of primary alloimmunisation to
HLA antigen
• Prevention of CMV transmission in at risk
individual.

44. Indications under investigations:
• Prevention of platelet refractoriness due to
alloimmunisation
• Prevention of recurrent FNHTR to platelets
• Prevention of reactivation of latent CMV or HIV
infection.

45. Washed red cells :
-Washing of red cells removes 70 – 95% of leucocytes
and there is concomitant 15 – 20ml of RBC’s but
effective in removal of plasma proteins and
microaggregates.
Indications:
-Patients having recurrent attacks of FNHTR and
urticarial reactions.
-Patients who have developed antibodies to plasma
proteins
-IgA deficient patients who has developed anti IgA
(IgA deficiency prevalent in 1 in 700 persons)

46. FROZEN RED CELLS:
-Frozen red cells in high glycerol can be preserved at
-65⁰C before thawing for 10 years & -120⁰C in low
glycerol for 3 years and both can be used after
thawing for 24 hrs if stored at 2-4⁰C
IRRADIATED RED CELLS:
Gamma radiated to destroy T-Lymphocytes to prevent
GVHD in severely immunocompromised, Stem cells
/Bone marrow transplant Lymphoma & intrauterine
transfusions.