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Chapter 3 The Use of Blood and Blood Components Various blood components and how they function The indications and contraindications for use Red Blood Cells - RBC (LRF) Description:

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The use of blood and blood components l.jpg

Chapter 3

The Use of Blood and Blood Components

Various blood components

and how they function

The indications and

contraindications for use


Red blood cells rbc lrf description l.jpg
Red Blood Cells - RBC (LRF)Description:

  • Whole blood is collected into an anticoagulant then centrifuged to separate the red cells from the plasma.

  • The plasma is then expressed from the whole blood bag and the remaining red blood cells (RBC) are filtered.

  • The filtering process removes all but 5 x 106 white blood cells (WBCs).

  • 85% of the original RBC volume will remain after filtration.

  • A typical unit has a volume of 240-340 mL and a hematocrit of 80%.


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Red Blood Cells - RBC (LRF)Function:

  • Increase the oxygen carrying capacity of the blood by increasing the circulating red blood cell mass.

  • Carry oxygen and nourishment to the tissues and take away carbon dioxide.


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Red Blood Cells - RBC (LRF)Indications:

  • Component of choice for virtually all patients with a deficit of oxygen carrying capacity, e.g., blood loss or anemia.

  • The majority of the WBC are removed thereby decreasing the risk of cytomegalovirus (CMV) infection in immunocompromised patients. This is because the CMV virus is carried in the WBC.

  • Use of RBC (LRF) reduces the risk of the patient forming antibodies against WBC (HLA) antigens. This is especially important for potential organ or bone marrow transplant candidates.


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Red Blood Cells – RBC (LRF)Contraindications:

RBC (LRF) should not be used:

  • when anemia can be corrected with specific medications, e.g., iron, B12, folic acid, erythropoietin, etc

  • for volume replacement


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Platelets – PC (LRF)Descriptions:

  • Platelets are prepared from a random unit of whole blood collected in CP2D anticoagulant solution and filtered to remove leukocytes. PC (LRF) contain less than 8.3 x 106 leukocytes.

  • Platelets are suspended in a small amount of the original plasma. A unit contains at least 55 x 109 platelets suspended in 50-55 mL of plasma.

  • Trace amounts of red blood cells can be present in some units.

  • These will appear pink to salmon colored.

  • Platelets may also be obtained by apheresis


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Platelets - PC (LRF)Function:

  • The primary role of platelets is to prevent bleeding of injured blood vessel walls by forming an aggregate at the site of injury.

  • Platelets also participate in blood coagulation, inflammation and wound healing.

  • The transfusion of platelets to a patient with thrombocytopenia or bleeding should produce a rise in the platelet count and control bleeding.


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Platelets - PC (LRF)Indications:

  • For treatment of patients with bleeding due to severely decreased production or abnormal function of platelets.

  • Treatment of bleeding patients with platelet consumption or dilutional thrombocytopenia (in most instances of dilutional thrombocytopenia, bleeding stops without transfusion).

  • Useful if given prophylacticaly to patients with rapidly falling or low platelet counts, less than 10 x 109/L (10,000/uL), secondary to cancer or chemotherapy.

  • Useful in selected cases of postoperative bleeding with platelet count less than 50 x 109/L (50,000/uL).


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Platelets – PC (LRF)Contraindications:

  • Platelets should not be used if bleeding is unrelated to decreased numbers or abnormal platelet function.

  • Should not be used in patients with consumption of endogenous and exogenous platelets, such as in Thrombotic Thrombocytopenia Purpura (TTP) or Idiopathic Thrombocytopenia Purpura (ITP), unless the patient has a life threatening hemorrhage.


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Platelet Incubator

Stored with constant

agitation


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Fresh Frozen Plasma - FFP (LRF)Description:

  • Fresh frozen plasma is separated from whole blood and frozen within 8 hours of collection. It can be obtained from a whole blood donation (approx. 250 mL) or by apheresis (approx. 500 mL).

  • Fresh frozen plasma contains a normal concentration of fibrinogen and the labile coagulation factors VIII and V.


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Fresh Frozen Plasma – FFP (LRF)Function:

  • Fresh frozen plasma contains the clotting factors that are necessary for hemostasis.

  • Plasma also has volume expansion and oncotic properties.


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Fresh Frozen Plasma – FFP (LRF)Indications:

  • The majority of clinical situations for which FFP is currently used do not require FFP.

  • FFP is indicated for massive transfusion (replacement of the patient’s blood volume in < 24 hours) with a demonstrated deficiency of Factor VIII and V, otherwise frozen plasma is adequate.

  • Fresh frozen plasma is also indicated in exchange transfusion in neonates.


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Fresh Frozen Plasma – FFP (LRF)Contraindications:

  • Fresh frozen plasma should not be used when a coagulopathy can be corrected more effectively with specific therapy, such as vitamin K, cryoprecipitate, or Factor VIII concentrates.

  • Fresh frozen plasma has the same infectious disease risk as whole blood.

  • Fresh frozen plasma should not be used when the blood volume can be replaced with other volume expanders such as 0.9% sodium chloride, lactated ringer’s, albumin or pentaspan.


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Frozen Plasma – FP (LRF)

  • Frozen plasma is prepared from whole blood, collected in CP2D anticoagulation solution.

  • The plasma is separated after cold centrifugation and processed to the frozen state within 24 hours of collection.


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Frozen Plasma – FP (LRF)

  • Frozen plasma contains stable coagulation factors such as Factor IX and fibrinogen in concentrations similar to FFP, but reduced amounts of Factor V

    and VIII.

  • On average, each unit of frozen plasma contains an average of 250 mL (>100 mL) of anticoagulated plasma.

  • The indications and side effects are the same as for FFP, except that FP should not be used to treat coagulation factor deficiencies of Factor V and Factor VIII.


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Fresh Frozen Plasma (FFP)

Unit of FFP

(Approx. 250 mL)

Apheresis FFP

(Approx. 500 mL)


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Cryosupernatant Plasma (CSP)Description:

  • CSP is prepared by thawing fresh frozen plasma at a temperature between 1°C and 6°C. After centrifugation, the plasma is separated from the insoluble cryoprecipitate which is then harvested and frozen. The CSP is frozen.

  • On average, each unit of CSP has a volume of approximately 200 mL.

  • CSP is deficient in the high molecular weight multimers of von Willebrand Factor (vWF) which are found in plasma, and cryoprecipitated AHF. It contains only 20-30% of the plasma Factor VIII.


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Cryosupernatant Plasma (CSP)

Indications:

  • This component is used as an exchange fluid in the treatment of Thrombotic Thrombocytopenic Purpura (TTP) and Adult Hemolytic Uremic Syndrome (HUS).

Contraindications:

  • Do not use for conditions that require von Willebrand or Factor VIII replacement.


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Cryoprecipitate (Cryo)Description:

  • Cryoprecipitate is prepared by thawing fresh frozen plasma at a temperature between 1°C and 6°C. After centrifugation, the supernatant plasma is removed and the insoluble cryoprecipitate is refrozen.

  • On average, each unit of cryoprecipitate contains 80 IU or more Factor VIII (FVIII:C) and at least 150 mg of fibrinogen in 5-15 mL of plasma.


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Cryoprecipitate (Cryo)Function:

  • Cryoprecipitate provides a source of coagulation factors. Factor VIII, Factor XIII and von Willebrand Factor.

  • Fibrinogen and fibronectin are present.


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Cryoprecipitate (Cryo)Indications:

  • Currently the main indication for this component is as a source of fibrinogen or Factor XIII.

  • It may be used as a source of Factor VIII only when inactivated fractionation products or recombinant Factor VIII are not available.


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Cryoprecipitate (Cryo)Contraindications:

  • Cryoprecipitate should not be used unless results of laboratory studies indicate a specific hemostatic defect for which this product is indicated.

  • Specific factor concentrates are preferred, when available, because of their reduced risk of transmissible diseases (because of viral inactivation during manufacturing).

  • Cryoprecipitate can be used to make fibrin glue. Alternatively, virally inactivated commercial products can be purchased for this purpose.


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Cryoprecipitate (Cryo)

Cryoprecipitate

Pooling Cryoprecipitate


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