Blood components and plasma derivatives
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Blood Components and Plasma derivatives. Blood Components. Refers to a product separated from a single unit of whole blood The term plasma derivative indicates a blood product separated from a large volume of pooled plasma by a process called fractionation.

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Blood Components and Plasma derivatives

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Blood Components and Plasma derivatives

M. Zaharna Blood Bank Lab. 2009


Blood Components

  • Refers to a product separated from a single unit of whole blood

  • The term plasma derivative indicates a blood product separated from a large volume of pooled plasma by a process called fractionation

M. Zaharna Blood Bank Lab. 2009


  • The anticoagulants and preservatives that are added to blood nowadays enable storage for long periods of time

    • Before acid-citrate-dextrose (ACD) was used- 21 days

  • Aseptic separation of blood into cellular & plasma components by the introduction of plastic collection systems

    • Before glass bottles were used

M. Zaharna Blood Bank Lab. 2009


Blood collection

  • Blood is collected in plastic bag systems with anticoagulant & preservative

  • Whole blood can be stored at 4oC for up to 5 weeks

  • Whole blood contains many components

  • Wasteful to give whole blood if only red cells are needed

M. Zaharna Blood Bank Lab. 2009


Blood Components

  • Human blood consists of plasma, in which cells are suspended

  • The plasma also contains other specialised substances, which are important for blood clot formation (e.g. clotting factors)

  • Whole blood can be separated at the blood bank into various components

M. Zaharna Blood Bank Lab. 2009


BLOOD COMPONENTS

  • Blood separated into different parts:

    • Packed red cells

    • Platelets

    • Fresh frozen plasma

    • Cryoprecipitate

    • Granulocytes

    • Factor IX conc.

    • Factor VIII conc.

  • There are more than 20 different products available

  • M. Zaharna Blood Bank Lab. 2009


    Plasma

    Red cells

    (Fresh) frozen plasma (FFP)

    Immuno-

    globulins

    Platelets

    Stored Plasma

    Cryoprecipitate

    F lX

    Albumin

    Whole blood

    Granulocytes

    Fractionated products

    F Vlla

    F Vlll

    M. Zaharna Blood Bank Lab. 2009


    Whole Blood

    • One unit contains

      • 450 ml of blood

      • & 63 ml of anticoagulant-preservative

    M. Zaharna Blood Bank Lab. 2009


    RBC Anticoagulant/Preservative Solutions

    • Purpose of RBC Preservation

      • Designed to prevent clotting and maintain red cell viability and function during storage.

      • Usual anticoagulant-preservative is CPD-A (Citrate Phosphate Dextrose Adenine )

    • Anticoagulant-Preservative Contents

      • Citrate: anticoagulant (binds plasma calcium and prevent activation of coagulation cascade)

      • Phosphate: provide substrate to help maintain red cell 2,3 DPG levels

      • Dextrose: a sugar, provides substrate for ATP production.

      • Adenine: Acts as a substrate for RBC synthesis of ATP

    M. Zaharna Blood Bank Lab. 2009


    • During storage at 4oC

    • Platelets and WBCs

      • become nonfunctional during hours of collection

  • Red cells

    • 5 weeks in CPD-A have a mean recovery 70%

  • Plasma

    • K+,  H+ →  pH

    • Levels of coagulation factors V & VIII decrease

  • M. Zaharna Blood Bank Lab. 2009


    Blood Components

    • Refers to a product separated from a single unit of whole blood

    • The term plasma derivative indicates a blood product separated from a large volume of pooled plasma by a process called fractionation

    M. Zaharna Blood Bank Lab. 2009


    • Blood components

      • Oxygen carrying components

        • Red cell concentrates (RCC)

        • Leukocyte poor blood

        • Frozen-thawed red cells

    • Platelet products

      • Platelet rich plasma (PRP)

      • Platelet concentrates (PC)

  • Plasma products

    • Fresh frozen plasma (FFP)

    • Frozen plasma (FP)

    • Cryoprecipitate

    • Stored plasma

    • Plasma Derivatives

      • Coagulation Factor concentrates

        • Factor VIII concentrates

        • Factor IX complex concentrates & others

      • Oncotic agents

        • Albumin

        • Plasma protein fraction (PPF)

      • Immune serum Globulin

        • Hepatitis B Ig (HBIG)

        • Varicella-zoster Ig (VZIG)

        • Rh Ig (RhIG)

        • Tetanus Ig (TIG)

    M. Zaharna Blood Bank Lab. 2009


    A- Blood components that carry oxygen

    • 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.

    M. Zaharna Blood Bank Lab. 2009


    1- Red blood cell concentrates

    • Prepared by removing approx. 200 ml of plasma from whole blood after centrifugation

    • RBCs plus 100 ml of residual palsma

    • In CPD-A can be stored for 35 days at 4oC

    M. Zaharna Blood Bank Lab. 2009


    1- Red blood cell concentrates

    M. Zaharna Blood Bank Lab. 2009


    1- Red blood cell concentrates

    • High hematocrit → viscous → infuse slowly

    • Rate of infusion increased by adding saline

    • Other fluids should not used

      • Calcium containg fluids (eg. Ringer’s lactate) should not be added

        • May cause clotting

    • Glucose solutions

      • can cause clumping

  • Only saline can be added to blood

  • M. Zaharna Blood Bank Lab. 2009


    2- Leukocyte poor blood

    • No viable leukocytes

    • WBCs are of no consequence

    • In some patients cause febrile transfusion reaction

    • Should receive leukocytes poor-blood

    • WBCs can be removed by discarding the buffy coat (inverted centrifugation)

    • Or by washing RBCs or by using filters

    Buffy coat

    Red cells

    M. Zaharna Blood Bank Lab. 2009


    3- Frozen-thawed red cells

    • Red cells can be frozen with use of cryopreservation techniques

    • Permit storage for up to 10 years

    • Expensive procedure & recommended only in special circumstances

      • e.g. Individuals with rare blood types

      • For auto-transfusion

    M. Zaharna Blood Bank Lab. 2009


    3- Frozen-thawed red cells

    • The RBC's are first incubated in a 40% glycerol solution which acts as an "antifreeze" within the cells.

    • The units are then placed in special sterile containers in a deep freezer at less than -60 degrees C.

    • Cryopreserved units are thawed and washed free of glycerol prior to use as saline suspended RBC's.

    M. Zaharna Blood Bank Lab. 2009


    4- Synthetic oxygen carrying agents

    • Synthetic oxygen carrying agents

      • Perfluorochemical (e.g. Fluosol-DA )

        • Fluorinated hydrocarbons

        • Readily dissolve oxygen

        • Poor soluble in plasma

        • Side effects:

          • Hypotension

          • DIC

      • Chemically modified hemoglobin

        • Free Hb has a very short half life

        • Chemically modified to:

          • increase intravascular survival

          • and to make it more effective in carrying oxygen

    M. Zaharna Blood Bank Lab. 2009


    B- Platelet Products

    • Platelet Rich Plasma (PRP)

      • Gentle centrifugation of whole blood

      • Supernatant transferred to the 2nd bag

    • Platelet Concentrates

      • Prepared from PRP by a 2nd centrifugation

      • Removal of all but 50 ml of plasma

      • Contain approx. 6X1010platelets

      • 60 – 80% Plts present in whole blood unit

      • Remain 5 days

      • Longer at 22oC with continuous agitation

    M. Zaharna Blood Bank Lab. 2009


    B- Platelet Products

    • Contamination by WBCs & RBCs is usually small

    • But there is enough to induce alloimmunization

    • Plt concentrates from Rh +ve should not be administered to Rh –ve women

    • Storage at 22oC, therefore care to prevent contamination

    M. Zaharna Blood Bank Lab. 2009


    C- Plasma Products

    • Plt poor plasma can be separated into a number of products

      • Fresh frozen plasma

      • Frozen plasma

      • Cryoprecipitate

      • Stored plasma

    M. Zaharna Blood Bank Lab. 2009


    1- Fresh frozen plasma (FFP)

    • Prepared from whole blood within 6 hours of collection

    • Rapid freezing of plasma preserves the labile coagulation factors at maximum levels

    • Donot contain cellular elements

    • 200 ml volume

    • Stored at -30oC for 12 months

    M. Zaharna Blood Bank Lab. 2009


    2- Frozen Plasma (FP)

    • Separated from whole blood within 24 hours of collection

    • Contains at least 50 % of original factor VIII & factor V frozen plasma

    • Adequate source for treatment of mild to moderate coagulation factor deficiencies

    • 200 ml volume

    • Storage at -30oC for up to 12 months

    M. Zaharna Blood Bank Lab. 2009


    3- Cryoprecipitate

    • Produced from freshly separated plasma by freezing at -70oC followed by thawing at 4oC

    • Flocculent precipitate is rich in factor VIII, fibrinogen and fibronectin

    • Once thawed, mixture is centrifuged to sediment the cryoprecipitate & all but 5 to 10 ml of supernatant plasma is removed

    • Contains 250 mg fibrinogen

    • 80 clotting units of factor VIII

    • Stored at -30oC for 12 months

    M. Zaharna Blood Bank Lab. 2009


    3- Cryoprecipitate

    • Increase of 2% of factor VIII level for each bag of cryoprecipitate infused

    • Supernatant plasma removed is called stored plasma

      • Must be used within 5 weeks if stored at 4oC

      • Lasts for 2 years at -30oC

    M. Zaharna Blood Bank Lab. 2009


    4- Stored plasma

    • Plasma separated from whole blood after 24 hours of storage at 4oC

    • Can also be derived from cryoprecipitate production

    • Contain reduced levels of labile coagulation factors V VIII & fibrinogen

    • It is indicated for patients requiring volume expansion or protein replacement when labile clotting factors are not required

    • Plasma products do not require crossmatch prior to use but should be ABO compatible

    M. Zaharna Blood Bank Lab. 2009


    Plasma Derivatives

    M. Zaharna Blood Bank Lab. 2009


    • Certain plasma derivatives can be obtained by fractionating the fresh frozen plasma or stored plasma

    • Fractionation:

      • Allows the processing of large volumes of pooled plasma

      • Pooling of many units increases the risk of viral transmission to the recipient

    M. Zaharna Blood Bank Lab. 2009


    Plasma protein fractionation

    • Plasma proteins are separated according to differences of each protein.

    • Fractionation involves changing the conditions of the pooled plasma (e.g. the temperature or the acidity)

    • Proteins that are normally dissolved in the plasma fluid become insoluble, forming large clumps, called precipitate.

    • The insoluble protein can be collected by centrifugation.

    M. Zaharna Blood Bank Lab. 2009


    • One of the very effective ways for carrying out this process is the addition of alcohol to the plasma pool while simultaneously cooling the pool.

    • This process is sometimes called cold alcohol fractionation or ethanol fractionation.

    • This procedure is carried out in a series of steps so that a single pool of plasma yields several different protein products, such as albumin and immune globulin.

    M. Zaharna Blood Bank Lab. 2009


    Plasma Derivatives

    M. Zaharna Blood Bank Lab. 2009


    1- Coagulation Factor Concentrates

    • Prepared in a freeze-dried form

    • Indicated for patients with congenital coagulation deficiencies

      • Risk of hepatitis is high

    • Should not used for mild acquired coagulation deficiencies

      • Should be treated with FP or FFP

    M. Zaharna Blood Bank Lab. 2009


    Factor VIII Concentrate

    • Commercially prepared, lyophilized powder purified from human FFP

    • Contain also small amounts of fibrinogen & other proteins

    • Can contain blood group Abs

    • Treat patients with hemophilia A

    M. Zaharna Blood Bank Lab. 2009


    Differences of Cryoprecipitate & Factor VIII concentrates

    M. Zaharna Blood Bank Lab. 2009


    Factor IX Concentrate

    • For the treatment Factor IX deficiency or Hemophilia B (Christmas Disease).

    • Have been used to treat patients with acquired inhibitors of factor VIII

      • Have factor VIII bypassing activity

    • Contains also factors II, VII & X in concentrated form

    • Vials containing 500 units of factor IX

    M. Zaharna Blood Bank Lab. 2009


    Factor IX Concentrate & liver disease

    • It is contraindicated in patients with liver disease

      • Have low levels of circulating antithrombin III

      • Activation of clotting factors present in some factor IX concentrates,

      • cause DIC

    M. Zaharna Blood Bank Lab. 2009


    Blood products & treatment of specific clotting factor deficiencies

    M. Zaharna Blood Bank Lab. 2009


    2- Oncotic Agents

    • Albumin: volume expansion

    • Other colloids are available for blood volume expansion

      • Dextran

      • Gelatin

      • Hydroxyethyl starch

      • Polyvinylpyrrolidone

    M. Zaharna Blood Bank Lab. 2009


    Albumin

    • Albumin is prepared by ethanol fractionation of pooled plasma

    • Available in 5% and 25% concentrations.

    • Have physiological sodium content

    • No risk of hepatitis, sterilized during preparation

    • No coagulation factors or blood group Abs

    M. Zaharna Blood Bank Lab. 2009


    Albumin

    • Used for treatment of hypovolaemia and hypoalbuminaemia (result from abnormal synthesis, increased metabolism or loss)

    • It maintains capillary osmotic pressure

    • Carrier protein for drugs, hormones, enzymes & metabolites

    M. Zaharna Blood Bank Lab. 2009


    Plasma protein Fraction

    • Partially purified albumin

    • Contains ≈ 85% albumin & 15% other plasma proteins

    M. Zaharna Blood Bank Lab. 2009


    3- Immune Globulins

    • Contains immune IgG antibodies, prepared from pools of plasma.

    • For disease prophylaxis, hepatitis A, measles, varicella and rubella.

    • For the treatment of hypogammaglobulin-emia and agammaglobulinemia.

    M. Zaharna Blood Bank Lab. 2009


    Immune Serum Globulin (ISG)

    • Primarily IgG Ab

    • Prevention of some viral diseases

    • Hypogammaglobulinemia

    • Congenital immune deficiency

    • Given by IM injection (aggregates of IgG)

    M. Zaharna Blood Bank Lab. 2009


    Hepatitis B Immune Globulin (HBIG)

    • Contains Hepatitis B immune antibodies.

    • From plasma of donors with high titer of Ab to HBsAg

    • Provides passive immunization for HBV.

    • For treatment after exposure to HBsAg.

    • For the prevention of maternally transferred HBV (perinatal exposure).

    M. Zaharna Blood Bank Lab. 2009


    Varicella-Zoster immune globulin (VZIG)

    • Derived from patients had recent Herpes Zoster infections

    • Herpes Zoster infections result in severe fatal infection in immunocompromised individuals

    • Passive administration of VZIG during 72 hours of exposure can prevent or attenuate infection

    M. Zaharna Blood Bank Lab. 2009


    Rh Immune Globulin (RhIG)

    • Derived from Rh -ve individuals

    • Contains IgG antibodies to the D antigen on red blood cells.

    • Given during pregnancy and post-natally to Rh negative mothers to prevent the development of anti-D and hemolytic disease of the newborn (HDN) due to anti-D.

    • Given prophylacticaly following abortion, or invasive maternal procedures (e.g., amniocentesis).

    M. Zaharna Blood Bank Lab. 2009


    Tetanus Immune Globulin (TIG)

    • Prepared from individuals specifically immunized for tetanus toxoid

    • Available for individuals at risk following injury

    M. Zaharna Blood Bank Lab. 2009


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