Blood and Blood Components. Goals Of Blood Collection . Maintain viability and function Prevent physical changes Minimize bacterial contamination. Anticoagulants Preservative Solutions. Anticoagulants prevent blood clotting Preservatives provide nutrients for cells Heparin
Maintain viability and function
Prevent physical changes
Minimize bacterial contamination
Anticoagulants prevent blood clotting
Preservatives provide nutrients for cells
Rarely if ever used anymore
Transfuse within 48 hours, preferably 8
Primary bag with satellite bags attached.
One bag has additive solution (AS)
Unit drawn into CPD anticoagulant
Remove platelet rich plasma within 72 hours
Add additive solution to RBCs, ADSOL, which consists of:
Extends storage to 42 days
Final hematocrit approximately 66%
Shelf life = expiration date
At end of expiration must have 75% recovery
At least 75% of transfused cells remain in circulation 24 hours AFTER transfusion
Biochemical changes which occur at 1-6C
Affects oxygen dissociation curve, increased affinity of hemoglobin for oxygen.
Low 2,3-DPG, increased O2 affinity, less O2 released.
pH drops causes 2,3-DPG levels to fall
Once transfused RBCs regenerate ATP and 2,3-DPG
Few functional platelets present
Viable (living) RBCs decrease
Helps release oxygen from hemoglobin (once transfused, ATP & 2,3-DPG return to normal)
Significant for infants and massive transfusion.
Other biochemical changes
Plasma hemoglobin increases
Collect unit within 15 minutes to prevent activation of coagulation system
Draw into closed system – primary bag with satellite bags with hermetic seal between.
If hermetic seal broken transfuse within 24 hours if stored at 1-4C, 4 hours if stored at 20-24C
Centrifuge – light spin, platelets suspended
Remove platelet rich plasma (PRP)
Centrifuge PRP heavy spin
Remove platelet poor plasma
Freeze plasma solid within 8 hours
Thaw plasma at 1-4C – precipitate forms
Centrifuge, express plasma leaving cryoprecipitate. Store both at -18C
RBCs – CPD – 21 days, ADSOL – 42 days – 1-6C
Summary – One unit of whole blood can produce:
Fresh frozen plasma (FFP)
Single donor plasma (SDP) – cyro removed
Platelets – terms PC (platelet concentrate) OR RD PC (random donor platelet concentrate)
Fresh frozen plasma
Sterile docking device joins tubing
Used to add satellite bags to maintain original expiration of component
May be used to pool components
Blood separated into components to specifically treat patients with product needed
Advantages of component separation
Allow optimum survival of each component
Transfuse only component needed
Transfusion requires doctor’s prescription
All components MUST be administered through a filter
Infuse quickly, within 4 hours
D (Rh) neg require D neg cellular products
ABO identical preferred, ABO compatible OK
“Universal donor” – RBCs group O, plasma AB
Fresh Whole Blood
Blood not usually available until 12-24 hours
Newborns needing exchange transfusion
Patients requiring leukoreduced products
Summary of storage temperatures:
Liquid RBCs 1-6C
Platelets, Cryo (thawed) and granulocytes 20-24C (room temperature)
ANY frozen plasma product ≤ -18C
ANY liquid plasma product EXCEPT Cryo 1-6C
Red blood cell products
Clinical indications for use of WB are extremely limited.
Used for massive transfusion to correct acute hypovolemia such as in trauma and shock, exchange transfusion.
RARELY used today, platelets non-functional, labile coagulation factors gone.
Must be ABO identical.
Symptomatic deficit of oxygen-carrying capacity
Hemolytic disease of new born
Acute chest syndrome in sickle cell crisis
Anemias that can be corrected with specific medications such as iron, vitamin B12, folic acid, or erythropoietin
To improve oncotic pressure, wound healing and sense of well being
Leukocytes can induce adverse affects during transfusion, primarily febrile, non-hemolytic reactions.
Reactions to cytokines produced by leukocytes in transfused units.
Other explanations to reactions include: immunization of recipient to transfused HLA or granulocyte antigens, micro aggregates and fragmentation of granulocytes.
Historically, indicated only for patients who had 2 or more febrile transfusion reactions, now a commonly ordered, popular component.
“CMV” safe blood, since CMV lives in WBCs.
Most blood centers now leukoreduce blood immediately after collection.
Bed side filters are available to leukoreduce products during transfusion.
Washing removes plasma proteins, platelets, WBCs and micro aggregates which may cause febrile or urticarial reactions.
Patient requiring this product is the IgA deficient patient with anti-IgA antibodies.
Prepared by using a machine which washes the cells 3 times with saline to remove and WBCs.
Two types of labels:
Washed RBCs - do not need to QC for WBCs.
Leukocyte Poor WRBCs, QC must be done to guarantee removal of 85% of WBCs. No longer considered effective method for leukoreduction.
e. Expires 24 hours after unit is entered.
Blood is frozen to preserve: rare types, for autologous transfusion, stock piling blood for military mobilization and/or civilian natural disasters.
Blood is drawn into an anticoagulant preservative.
Plasma is removed and glycerol is added.
After equilibration unit is centrifuged to remove excess glycerol and frozen.
If frozen, 10 years.
After deglycerolization, 24 hours.
high glycerol -65 C.
low glycerol -120 C, liquid nitrogen.
Thaw unit at 37C, thawed RBCs will have high concentration of glycerol.
A solution of glycerol of lesser concentration of the original glycerol is added.
This causes glycerol to come out of the red blood cells slowly to prevent hemolysis of the RBCs.
After a period of equilibration the unit is spun, the solution is removed and a solution with a lower glycerol concentration is added.
This procedure is repeated until all glycerol is removed, more steps are required for the high glycerol stored units.
The unit is then washed.
A special solution is added to expired RBCs up to 3 days after expiration to restore 2,3-DPG and ATP levels to prestorage values.
Rejuvenated RBCs regain normal characteristics of oxygen transport and delivery and improved post transfusion survival.
Expiration is 24 hours or, if frozen, 10 years
Single donor platelets >3.0 x 1011per bag(250ml) (derived by apheresis)
Random derived platelets >5.5 x 1010 per bag(50ml)
4-10 RDPs are pooled for one adult transfusion
Stored up to five days at 20-24°C (room temperature).
Continually agitated to prevent clumping. Storage is limited to five days due to the risk of bacterial contamination
Bleeding due to critically decreased circulating platelet count or functionally abnormal platelets
Prevention of bleeding from marrow hypoplasia (platelet count <10,000/μL)
Selected cases of postoperative bleeding (platelet count <50,000/μL)
Plasma coagulation deficits
Some conditions with rapid platelet destruction (eg, ITP, TTP) unless life-threatening hemorrhage
Used to prevent spontaneous bleeding or stop established bleeding in thrombocytopenic patients.
Prepared from a single unit of whole blood.
Due to storage at RT it is the most likely component to be contaminated with bacteria.
Therapeutic dose for adults is 6 to 10 units.
Some patients become "refractory" to platelet therapy.
Expiration is 5 days as a single unit, 4 hours if pooled.
Store at 20-24 C (RT) with constant agitation.
D negative patients should be transfused with D negative platelets due to the presence of a small number of RBCs.
One bag from ONE donor
Need 6-10 for therapeutic dose
6-10 units transferred into one bag
Expiration = 4 hours
Used to decrease donor exposure, obtain HLA matched platelets for patients who are refractory to RD-PC or prevent platelet refractoriness from occurring.
Prepared by hemapheresis, stored in two connected bags to maintain viability.
One pheresed unit is equivalent to 6-8 RD-PC.
Store at 20-24 C (RT) with agitation for 5 days, after combining, 24 hours
D negative patients should be transfused with D negative platelets due to the presence of a small number of RBCs
One bag (unit) from one donor
One unit is a therapeutic dose
Volume approximately 250 ccs
Primary use is for patients with neutropenia who have gram negative infections documented by culture, but are unresponsive to antibiotics.
Therapeutic efficacy and indications for granulocyte transfusions are not well defined.
Better antimicrobial agents and use of granulocyte and macrophage colony stimulating factors best for adults, best success with this component has been with babies
Daily transfusions are necessary.
Prepared by hemapheresis.
Expiration time is 24 hours but best to infuse ASAP.
Store at 20-24 C.
Active bleeding or risk of bleeding due to deficiency of multiple coagulation factors,
Severe bleeding due to warfarin therapy, or urgent reversal of warfarin effect
Massive transfusion with coagulopathic bleeding.
Bleeding or prophylaxis of bleeding for a known single coagulation factor deficiency for which no concentrate is available.
Thrombotic thrombocytopenic purpura.
Rare specific plasma protein deficiencies, such as C1- inhibitor.
Increasing blood volume or albumin concentration
Coagulopathy that can be corrected with administration of vitamin K.
Normalizing abnormal coagulation screen results, in the absence of bleeding.
Used to replace labile and non-labile coagulation factors in massively bleeding patients OR treat bleeding associated with clotting factor deficiencies when factor concentrate is not available.
Must be frozen within 8 hours of collection.
frozen - 1 year stored at <-18 C.
frozen - 7 years stored at <-65 C.thawed - 24 hours
frozen -18 C, preferably -30 C or lower
thawed - 1-6 C
Thawed in 30-37C water bath or FDA approved microwave
Must have mechanism to detect units which have thawed and refrozen due to improper storage.
Must be ABO compatible
Used to treat patients with stable clotting factor deficiencies for which no concentrate is available or for patients undergoing therapeutic plasmapheresis.
Prepared by separating the plasma from the RBCs on or before the 5th day after expiration of the whole blood.
Once separated can:
Freeze, store at -18 C for 5 years
If not frozen, called liquid plasma, store at 1-6 C for up to 5 days after expiration of WB.
Once FFP is one year old can redesignate as Plasma, expiration is 5 years.
Most recently licensed product.
Prepared from pools of no more than 2500 units of ABO specific plasma frozen to preserve labile coagulation factors.
Treated with chemicals to inactivate lipid-enveloped viruses.
Contains labile and non-labile coagulation factors but lacks largest Von Willebrand’s factor multimers.
Used same as FFP.Safety concerns
Decreases disease transmission for diseases tested for.
Doesn’t inactivate viruses with non-lipid envelopes: parvo virus B19, hepatitis A, and unrecognized pathogens
Cold insoluble portion of plasma that precipitates when FFP is thawed at 1-6C.
Cryoprecipitate contains high levels of Factor VIII and Fibrinogen, used for treatment of hemophiliacs and Von Willebrands when concentrates are not available.
Used most commonly for patients with DIC or low fibrinogen levels.
A therapeutic dose for an adult is 6 to 10 units.
Can be prepared from WB which is then designated as "Whole Blood Cryoprecipitate Removed" or from FFP
Plasma is frozen.
Plasma is then thawed at 1-6 C, a precipitate forms.
Plasma is centrifuged, cryoprecipitate will go to bottom.
Remove plasma, freeze within 1 hour of preparation
Cryoprecipitate (VIII, vW) Factor (AHF)
Thaw at 30-37°C Store at RT 4 hrs
Plasma cryoprecipitate, reduced (TTP, FII, V, Vii, IX, X, XI)
Frozen within 8 hours
Refrozen with 24 hrs of separation Store at ≤18°C 1 yr
5 day expiration at 1-6°C
Frozen -18 C or lower
Thawed - room temperature
Frozen 1 year
Thawed 6 hours
Pooled 4 hours
Best to be ABO compatible but not important due to small volume
Bleeding associated with fibrinogen deficiencies (<100mg/dl) and Factor XIII deficiency esp if FFP cannot be given due to volume overload
Indicated in hemophilia A or von Willebrand’s disease (vWD) when appropriate Factor VIII concentrates or Factor VIII concentrates containing FVIII:vWF are not available.
Do not transfuse cryoprecipitate unless laboratory studies confirm deficiency of a specific clotting protein for which this component is indicated (e.g. fibrinogen).
Cellular blood components are irradiated to destroy viable T- lymphocytes which may cause Graft Versus Host Disease (GVHD).
GVHD is a disease that results when immunocompetent, viable lymphocytes in donor blood engraft in an immunocompromised host, recognize the patient tissues as foreign and produce antibodies against patient tissues, primarily skin, liver and GI tract. The resulting disease has serious consequences including death.
GVHD may be chronic or acute
Patients at greatest risk are:
receive blood donated by relatives, or
fetuses receiving intrauterine transfusions
Irradiation inactivates lymphocytes, leaving platelets, RBCs and granulocytes relatively undamaged.
Must be labeled "irradiated".
Expiration date of Red Blood Cell donor unit changes to 28 days.
May be transfused to "normal" patients if not used by intended recipient.
It is required that donor units be inspected periodically during storage and prior to issuing to patient.
The following may indicate an unacceptable unit:
Red cell mass looks purple or clots are visible.
Zone of hemolysis observed just above RBC mass, look for hemolysis in sprigs, especially those closest to the unit.
Plasma or supernatant plasma appears murky, purple, brown or red.
A greenish hue need not cause a unit to be rejected.
Inspect platelets for aggregates.
Inspect FFP and CRYO for signs of thawing, evidence of cracks in bag, or unusual turbidity in CRYO or FFP (i.e., extreme lipemia).
Segment closest to unit is hemolyzed.
May indicate bacterial contamination
If a unit's appearance looks questionable do the following:
Quarantine unit until disposition is decided.
Gently mix, allow to settle and observe appearance.
If bacterial contamination is suspected the unit should be cultured and a gram stain performed.
Positive blood cultures usually indicative of:
Inadequate donor arm preparation
Improper pooling technique
Health of donor - bacteremia in donor
If one component is contaminated, other components prepared from the same donor unit may be contaminated.
Reissuing blood cannot be done unless the following criteria is met:
Container closure must not have been penetrated or entered in any manner.
Most facilities set 30" time limit for accepting units back, warming above 6-10C even with subsequent cooling increases RBC metabolism producing hemolysis and permitting bacterial growth.
Blood must have been kept at the appropriate temperature.
One sealed segment must remain attached to container.
Records must indicate that blood has been reissued and inspected prior to reissue.
WB and RBC
Sturdy well insulated cardboard and/or styrofoam container, wet ice in ziplock bag to cool, temperature must be monitored.
Mobile collection units should transport blood ASAP and leave at RT if platelets are to be made.
In-house transport place in cooler with wet ice and thermometer, monitor temperature every 30 minutes.
Temperature must be maintained at or below required storage temperature.
Use dry ice in well insulated container.
Platelets and granulocytes
Maintain at 20-24 C.
Transport in well insulated containers without ice.
Commercial coolers available to maintain at 20-24C.
Handling donor units
Should not remain at RT unnecessarily, when blood is issued it should be transfused as soon as possible.
When numerous units are removed from fridge, remove fluid filled container with a thermometer at same time as blood, when temperature reaches 6 C return to fridge.
Must be made concurrently with each step of component preparation, being as detailed as possible for clear understanding.
Must be legible and indelible.
Must include dates of various steps and person responsible.
Viral ( hepatitis, HIV, CMV, HTLV)
Parasitic and bacteremia (especially platelets)
Severity of the reaction depends in the amount of blood given
“Because of the Risks Associated With Transfusion, Physicians Should Remain Familiar With Currently Recognized Alternatives to Transfusion. Autologous Transfusion Techniques (Such As Perioperative Collection and Preoperative Donation) Should Be Considered, When Indicated, to Reduce the Need for allogeneic Transfusion With Its Attendant Risks of Disease Transmission and Immune Reactions.”