1. BLOOD COMPONENTS IN CLINICAL PRACTICE Dr Jaisy Mathai BLOOD TRANSFUSION SERVICES SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES &TECHNOLOGY, THIRUVANANTHAPURAM

2. BLOOD BANK PROCESSES • 1.DONOR REGISTRATION • 2.DONOR SELECTION CRITERIA • ACCEPTANCE &DEFERRAL CRITERIA • HEALTH CHECK • INFORMED CONSENT • 3.BLOOD COLLECTION • DONOR CARE, POST DONATION ADVICE & FOLLOW UP

3. BLOOD BANK PROCESSES-CONTD 4.DONOR SAMPLE TESTING-BLOOD GROUPING, ANTIBODY & TTI SCREENING 5.BLOOD COMPONENT SEPARATION 6.LABELLING 7.BLOOD STORAGE 8.BLOOD ISSUE- PATIENT SAMPLE TESTING, BLOOD GROUPING, ANTIBODY SCREENING & COMPATIBILITY 9.PATIENT FOLLOW UP

4. BLOOD BANK REFRIGERATORS • Uniform 40C Temperature Recovery • Forced Air Circulation system • Audio/ Visual Alarm • Temp. Display

6. WHY BLOOD COMPONENTS ? • TO CORRECT SPECIFIC DEFICIENCY • STORAGE CONSIDERATIONS

7. BLOOD COMPONENT PREPARATION • SEDIMENTATION • CENTRIFUGATION • FILTRATION • CRYOPRECIPITATION • PHERESIS • FREEZING &THAWING • FRACTIONATION

8. S C T I M S T ROLE OF PLASTICS IN BLOOD COMPONENT THERAPY • LIGHT WEIGHT, FLEXIBLE PVC CONTAINERS • SEPARATION OF BLOOD COMPONENTS IN CLOSED SYSTEM • BAGS WITH ADDITIVES • PLATELET STORAGE BAGS • BAGS WITH IN-LINE LEUKOFILTER

9. S C T I M S T BLOOD BAGS FOR DIFFERENT FUNCTIONS

10. BLOOD COMPONENT LAB • BALANCE • REFRIGERATED CENTRIFUGE • PLASMA SEPARATOR • TUBE SEALER • STERILE CONNECTING DEVICE • EQPTS. FOR STORAGE

11. S C T I M S T DIFFERENTIAL CENTRIFUGATION

12. WB LIMITED USE SOURCE MATERIAL INDN. • ACUTE BLEEDING WITH MORE THAN 20-25% BLOOD LOSS • EXCHANGE TRANSFUSION NOT INDICATED IN CHRONIC ANAEMIA NOR IN HYPOVOLAEMIA ALONE STORAGE: 35 DAYS ( CPDA – 1 ) AT 2OC TO 6OC

13. RBC INDN: • SYMPTOMATIC DEFICIT OF OXYGEN CARRYING CAPACITY WITHOUT VOLUME EXPANSION • HAEMOSTATIC FUNCTION ADV. DECREASES • CIRCULATORY OVERLOAD • METABOLITES, HIGH TITRE ANTIBODIES • RISK OF IMMUNISATION

14. I UNIT RBC  Hb BY 1gm / dl STORAGE AND EXPIRY • 2OC TO 6OC FOR 35 DAYS • IN ADDITIVES – 42 DAYS • OPEN SYSTEM – 24 HRS. AT 2OC TO 6OC WASHED CELLSTO  INCIDENCE OF FEBRILE, URTICARIAL AND ANAPHYLACTIC REACTIONS INDICATIONS: • IN MULTI TRANSFUSED PATIENTS WITH IgA DEFICIENCY • ALLERGIC TO PLASMA ANTIGENS

15. PRP Fresh WB PC PLATELETS Apheresis INDN. • BLEEDING DUE TO QUALITATIVE AND QUANTITATIVE DEFECTS • SECONDARY TO CHEMOTHERAPY AND IRRADIATION • MULTIPLE COAGULATION DEFECTS • IMMUNE THROMBOCYTOPAENIA CONTRAINDICATED IN TTP, HIT

16. DOSE: I UNIT OF PC/10 kg wt. STORAGE: 22OC TO 24OC – 72 hrs. ON AN AGITATOR STORAGE EXTENDED IN PLT. BAGS

17. PLASMA FFP • INDN : • REPLACEMENT OF MULTIPLE COAGULATION DEFECTS • IMMEDIATE REVERSAL OF ANTICOAGULANT EFFECT • THROMBOTIC THROMBOCYTOPAENIA NO JUSTIFICATION IN HYPOVOLAEMIA, PROTEIN LOSING ENTREROPATHIES,IMMUNO DEFICIENCY STATES DOSE: 12-15 ml / kg wt EXPIRY : I yr

18. CRYOPRECIPITATE • SOURCE OF FVIII, FIBRINOGEN, VWF, FXIII EACH UNIT-80 IU FVIII,150-300 mg FIBRINOGEN, 20-30 % OF FXIII INDN : • HAEMOPHILIA A, vWD CONGENITAL AND ACQUIRED DEFECTS OF FIBRINOGEN • EXPIRY AND STORAGE : 1 YR AT- 300C CONTD…

19. DOSE • HAEMOSTATIC LEVELS > 50 % DURING MAJOR SURGERY AND MAINTENANCE DOSE OF 30 % DURING CONVALESCESNCE LIQUID PLASMA (RECOVERED PLASMA) INDN • FOR REPLACEMENT OF STABLE CLOTTING FACTORS • FOR PREPARATION OF FRACTIONATED PRODUCTS • EXPIRY 5 YRS IF FROZEN

20. SPECIAL COMPONENTS FOR SPECIAL PATIENTS’ NEEDS • LEUCOREDUCED • APHERESIS • IRRADIATED

21. S C T I M S T LEUCOCYTES TRANSFUSION-IMPLICATIONS • FNHTRS • HLA ALLOIMMUNISATION • TRANSMISSION OF LEUCOTROPIC VIRUS • GVHD • TRALI • TRIM

22. APROXIMATE LEUCOCYTES / UNIT WB 10 9 RBC 10 8 –10 9 BC DEPLETED RBC 10 8 WASHED RBC 10 7 FROZEN DEGLYCEROLISED RBC 10 6-10 7 PCS 10 7 – 10 8 AP- PLTS 10 6 – 10 8 FFP <10 4

23. DYNAMICS OF WBC REDUCTION- USE OF FILTERS RETENSION BY PASSIVE SIEVINGDIRECT ADHESION & ATTACHMENT OF WBCSINDIRECT ADHESION

25. LEUCOCYTE FILTER • TIME OF DEPLETION-PRESTORAGE POST STORAGE BEDSIDE • WBC REDUCTION IN RBC – PLATELETS < 5x106 / unit < 1x106 / unit < 8.3X105 / unit < 0.2x106 / unit • LIMITATION AND ADVERSE REACTIONS • FILTER COST • HYPOTENSION, COMPLEMENT ACTIVATION

27. HAEMAPHERESIS • REMOVAL OF WB, SEPARATION AND RETENTION OF DESIRED COMPONENTS AND RETURN OF REMAINING ELEMENTS BACK TO THE DONOR. USED FOR COMPONENT PREPARATION CYTAPHERESIS PLASMAPHERESIS • ADVANTAGES: • THERPAEUTIC DOSE FROM A SINGLE DONOR • LIMITS DONOR EXPOSURE • LEUKO DEPLETED

28. HEMAPHERESIS Treat your patient… to the best

29. TA-GVHD • UNCHECKED PROLIFERATION OF DONOR LEUCOCYTES IN IMMUNO-COMPROMISED PTs. • VIABILITY OF DONOR LYMPHOCYTES • HLA SIMILARITY BETWEEN DONOR & RECIPIENT

30. S C T I M S T IRRADIATED BLOOD BY GAMMA RAY EMITTING RADIO ISOTOPES- CS137/CO160 LINEARACCELERATORS DOSE: 2500 cGY UNITS INDICATIONS: • I/U TRANSFUSION • MARROW AND ORGAN TRANSPLANTATION • RECIPIENTS OF BLOOD FROM RELATIVES( DIRECTED DONATION) • IMMUNO SUPPRESSED PATIENTS

31. S C T I M S T BLOOD IRRADIATOR

32. FRACTIONATED PLASMA PRODUCTS • .ALBUMIN HUMAN SERUM ALBUMIN PLASMA PROTEIN FRACTION • IMMUNOGLOBULINS IMMUNE SERUM GLOBULIN SPECIFIC Igs (HYPER IMMUNE) • COAGULATION PROTEINS F VIII,IX, VII ACTVATED F IX COMPLEX/ F VIII • PROTEASE INHIBITORS AT III, CI ESTERASE INHIBITOR

33. RECOMBINANT BLOOD PRODUCTS • GENETIC ENGINEERING TO ISOLATE NA SEQUENCES FOR PROTEIN PRODUCTION • TRANSFER INTO VECTORS AND CELL CUTURE SYSTEM • PRODUCTION OF DESIRED PLASMA PROTEINS HUMAN SERUM ALBUMIN F VIII, vWF, ATIII, ALPHA1 PROTEASE INHIBITOR HB VACCINES, r Hb HAEMOPOIETIC GROWTH FACTORS EPO,G-CSF, GM-CSF,TPO,ILS,TNF

34. BLOOD COMPONENTS FOR BETTER PATIENT CARE

35. BLOOD BAG-PROBLEM AREAS • NEEDLE • TUBING • BAG SURFACE • BREAK VALVE • LABEL • LEAKAGE/STICKING

36. Thank you