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 Rarely if ever used anymore Anticoagulant ONLY Transfuse within 48 hours, preferably 8
Additive Solution Primary bag with satellite bags attached. One bag has additive solution (AS) Unit drawn into CPD anticoagulant
Additive Solution Remove platelet rich plasma within 72 hours Add additive solution to RBCs, ADSOL, which consists of: Saline Adenine Glucose Mannitol Extends storage to 42 days Final hematocrit approximately 66%
Changes Occur During Storage 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
Storage Lesion 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
Plasma hemoglobin Plasma K+ Na+ K+ Viable cells pH ATP 2,3-DPG Plasma Na+ Helps release oxygen from hemoglobin (once transfused, ATP & 2,3-DPG return to normal)
Storage Lesion Significant for infants and massive transfusion. Other biochemical changes ATP decreases Potassium increases Sodium decreases Plasma hemoglobin increases
Preparation of Components 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
Preparation of Components 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
Preparation of Components Summary – One unit of whole blood can produce: Packed RBCs Fresh frozen plasma (FFP) Cryoprecipitate (CRYO) Single donor plasma (SDP) – cyro removed Platelets – terms PC (platelet concentrate) OR RD PC (random donor platelet concentrate)
Components Fresh frozen plasma Cryosupernatant Cryoprecipitate Albumin Immunoglobulin etc Red cells Platelets Whole blood Cellular components Fresh plasma Factor VIII Fibrinogen
Preparation of Components Sterile docking device joins tubing Used to add satellite bags to maintain original expiration of component May be used to pool components
Blood Component General Information 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
Blood Component General Information Transfusion practice 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
Blood Component General Information Fresh Whole Blood Blood not usually available until 12-24 hours Candidates Newborns needing exchange transfusion Patients requiring leukoreduced products
Blood Component General Information 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
Blood Components Cellular Red blood cell products Platelets Granulocytes Plasma FFP Cryoprecipitate
Whole Blood 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.
Packed red blood cells Indications Symptomatic deficit of oxygen-carrying capacity Exchange transfusion Hemolytic disease of new born Acute chest syndrome in sickle cell crisis Contraindications Anemias that can be corrected with specific medications such as iron, vitamin B12, folic acid, or erythropoietin Coagulation deficiency Volume expansion To improve oncotic pressure, wound healing and sense of well being
Leukocyte Reduced Red Cells (LR-RBC) 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.
Washed Red Blood Cells (W-RBCs) 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.
Red Blood Cells Frozen; Red Blood Cells Deglycerolized (D-RBC) 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. Expiration If frozen, 10 years. After deglycerolization, 24 hours. Storage temperature high glycerol -65 C. low glycerol -120 C, liquid nitrogen.
Red Blood Cells Frozen; Red Blood Cells Deglycerolized (D-RBC) 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.
Rejuvenated Red Blood Cells 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
Platelets 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
Transfusion of Platelets:Indications and Contraindications Indications 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) Contraindications Plasma coagulation deficits Some conditions with rapid platelet destruction (eg, ITP, TTP) unless life-threatening hemorrhage
Platelets (PLTS), Platelet Concentrate (PC) or Random Donor Platelet Concentrate (RD-PC) 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.
Preparation of platelet concentrate Plasma RBCs PRP Platelet concentrate
Platelets (PLTS), Platelet Concentrate (PC) or Random Donor Platelet Concentrate (RD-PC) One bag from ONE donor Need 6-10 for therapeutic dose
Pooling Platelets 6-10 units transferred into one bag Expiration = 4 hours
Platelets Pheresis, Apheresis Platelet Concentrate, Single Donor Platelet Concentrate (SD-PC) 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
Platelets Pheresis One bag (unit) from one donor One unit is a therapeutic dose Volume approximately 250 ccs
Granulocytes Lymphocyte Monocyte Neutrophils Eosinophils Basophils
Granulocytes 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.
Indications 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.
Contra-indications 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.
Fresh Frozen Plasma (FFP) 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. Expiration frozen - 1 year stored at <-18 C. frozen - 7 years stored at <-65 C.thawed - 24 hours