4 Blood Products

8/6/2019 4 Blood Products

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Blood products.

Preparation of blood components

Whole blood

Plasma Packed RBC

90%water 10%plasma materialFresh frozen plasma

Platelet concentrate

Cryoprecipitate+ CryosupernatantI = AHF

albumin

Fibrinogen

Others

Immunoglobulin

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Blood bags:

Single blood bag:

Whole blood

Double bags: Packed red cells

plasma

Triple bags:

Packed cells

Plasma

platelets

Quarterly bags:

Packed cells

Plasma

Platelets

Plasma factors

Special bags:

Frozen blood upto 2 years and store under ( 70- 90 c)

The bags should be sterile = no contamination.

Patient information's:

No of patients.

Name.

Others.

Centrifugation

This is the first step of blood preparation

Depend on 2 factors:

Relative centrifugation factor (RCF).

Duration of centrifugation.

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Heavy spin

5000 /g / 7min = leukocyte-poor RBC, or cell free plasma.

5000/g / 5min = backed cell and platelet concentrate.

4170/ g / 10min = cryoprecipitate

Light spin, 4170 /g/2min = platelet rich plasma.

Centrifugation temp.

Platelet = at 22c

Others = 1-6c

How is blood used?

Nowadays, whole blood is rarely used except in cases of sudden and

severe blood loss. Instead, it is nearly always separated into its individual

components and used for different purposes.

1- Whole Blood:

Contents

RBCs

WBCs

Platelets

Plasma

Clotting factors

Indications

Acute loss of whole blood like in operations and accidents.

In Aplastic anaemia.

Correct anaemia.

Kidney dialysis.

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2- Packed red cells

Contents

RBCs

20% Plasma

Indications

Replace O2 carrying capacity with less volume

Severe anemia, slow blood loss, CHF

- Preparation:

Blood should be drawn in double bags.

Usually 225 ml of plasma is removed.

The Hct is about 70-80%.

The blood should be used within the expiration date of the bags.

Packed RBCs are ordinarily the component of choice with which to increaseHb.

Indications depend on the patient. O2-carrying capacity may be adequate with

Hb levels as low as 7 g/L in healthy patients, but transfusion may be indicated

with higher Hb levels in patients with decreased cardiopulmonary reserve or

ongoing bleeding.

One unit of RBCs increases an average adult's Hb by about 1 g/dL and his Hct

by about 3% of the pretransfusion Hct value.

When only volume expansion is required, other fluids can be used

concurrently or separately.

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3- Washed red cells

Its convenient but expensive.

Washed RBCs are free of almost all traces of plasma, most WBCs, and

platelets.

They are generally given to patients who have severe reactions to

plasma (eg, severe allergies, paroxysmal nocturnal hemoglobinuria, or IgA

immunization).

In IgA-immunized patients, blood collected from IgA-deficient donors

may be preferable for transfusion.

4- Leukocyte-poor red cells or WBC-depleted RBCs:

o Are prepared with special filters that remove 99.99% of WBCs.

o The majority of febrile non-hemolytic reactions (FNH), can be alienate

by transfusion leukocyte-poor red cells, so they are indicated for patients who

have experienced nonhemolytic febrile transfusion reactions, and possibly for

the prevention of platelet alloimmunization.

o Can be prepared by several techniques:

1. Double centrifuge

2. Heavy spin.

3. Filtration: passing the blood through a nylon filter which is an

efficient method for removal of granulocytes. Heparin is the

anticoagulant used for this procedure. In Europe the used the cotton for

removal lymphocytes and granulocytes.

4. Sedimentation: this method provides 90% of red blood cells and

10% of original no of platelet and leukocyte.

5. Washing: is provides a good recovery of erythrocyte with low no

of WBC and platelet.

6. Frozen deglycerolized red cells: when maximally leukocyte poor

red blood cells needed.

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5- Fresh frozen plasma (FFP)

Contents

Clotting factors

Fibrinogen

Prothrombin

Albumin

Globulins

Indications

a. Volume expansion : FFP can supplement RBCs when

whole blood is unavailable for exchange transfusion, but FFP should not be used

simply for volume expansion.

b. Fresh frozen plasma (FFP) is an unconcentrated source of

all clotting factors deficiency, so indications also include correction of bleeding

secondary to factor deficiencies for which specific factor replacements are

unavailable, multifactor deficiency states (eg, massive transfusion, disseminated

intravascular coagulation [DIC], liver failure)

c. Hypofibrinogenaemia, or afibrinigenaemia.

Preparation:Can be prepared by:

Single heavy spin.

Double centrifugation to prepare platelet conce. At the same time.

Each unit contains about 225 ml of plasma.

Can protect bags within 6h. After collection by placing it in a dry ice-

alcohol path or in freezer at -30c or below.

FFP bags should be frozen in a horizontal position and store at vertical

position.

Shelf life is 12 months when store at -18c or less.

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When required FFP can be thawed with agitation in 37c in water path

and used within 2h.

6- Platelet concentrate

Contents

Platelets

WBCs

Plasma

Indications

Low platelet counts (bleeding) . Platelet concentrates are used to prevent

bleeding in:

1. asymptomatic severe thrombocytopenia (platelet count < 10,000/L)

2. For bleeding patients with less severe thrombocytopenia (platelet count

< 50,000/L)3. For bleeding patients with platelet dysfunction due to antiplatelet drugs

but with normal platelet count

4. For patients receiving massive transfusion that causes dilutional

thrombocytopenia

5. Sometimes before invasive surgery.

6. Acute leukemia

7. Lymphoma.

8. ITP.

9. Bone marrow transplant

Preparation:

Platelet-rich plasma is separated by light spin from erythrocyte.

Platelet conc. is then obtained by a heavy spin of platelet rich

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Centrifugation should be done at 22c.

Separation should be done within 4h. After the blood is drawn.

Plasma portion can be frozen as FFP.

Plasma should be frozen within 2h of separation at -30c or less.

When needed, Frozen plasma should then be thawed between 1-6c

over night in a refrigerator or more quickly in a water path at 4c.

One platelet concentrate increases the platelet count by about

10,000/L, and adequate hemostasis is achieved with a platelet count of about

10,000/L in a patient without complicating conditions and about 50,000/L

for those undergoing surgery. Therefore, 4 to 6 random donor platelet

concentrates are commonly used in adults.

Platelet concentrates are increasingly being prepared by automated

devices that harvest the platelets (or other cells) and return unneeded

components (eg, RBCs, plasma) to the donor.

This procedure, calledcytapheresis, provides enough platelets

from a single donation (equivalent to 6 random platelet units) for transfusion

to an adult, which, because it minimizes infectious and immunogenic risks, is

preferred to multiple donor transfusions in certain conditions.

Certain patients may not respond to platelet transfusions, possibly

because of splenic sequestration or platelet consumption due to HLA or

platelet-specific antigen alloimmunization. These patients may respond to

multiple random donor platelets (because of greater likelihood that some units

are HLA compatible), platelets from family members, or ABO- or HLA-

matched platelets.

Alloimmunization may be mitigated by transfusing WBC-depleted

RBCs and WBC-depleted platelet concentrates.

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7- Cryoprecipitated anti hemophilic factor ( AHF )

Contents

Factors VIII and XIII, Fibrinogen and von Willebrand factor

(vWF)v. It also contains fibronectin

Indications

Hemophilia A

Fibrinogen deficiency

Factor XIII deficiency

Disseminated intravascular coagulation

Rare factor XIII deficiency.

Von Weill brand's disease.

Preparation:

Cryoprecipitate is a concentrate prepared from FFP, it should be frozen

within 4h and stored at -18c or less.

A bag of cryoprecipitate should be contain on the average about 80-100

units of AHF/unit.

The shelf life is 12 month, when store at -18c or low.

When requested, cryo precipitate may be thawed in a 37c water path and

then should be maintained at room temp. And used as soon as possible or

within 6h after thawing.

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8- WBCs:

Granulocytes:

Contents

WBCs

20% Plasma

Indications

Life-threatening decreases in WBC count

Granulocytes may be transfused when sepsis occurs in a patient

with profound persistent neutropenia (WBCs < 500/L) who is

unresponsive to antibiotics.

Important Notes:

- Granulocytes must be given within 24 h of harvest; however, testing for HIV,

hepatitis, human T-cell lymphotropic virus, and syphilis may not be completed

before infusion.

o Because of improved antibiotic therapy and drugs that stimulate granulocyte

production during chemotherapy, granulocytes are seldom used.

9- Immune globulins:

o Rh immune globulin (RhIg), given IM or IV, prevents development of

maternal Rh antibodies that can result from fetomaternal hemorrhage.

o Other immune globulins are available for postexposure prophylaxis for

patients exposed to a number of infectious diseases, including

cytomegalovirus, hepatitis A and B, measles, rabies, respiratory syncytial

virus, rubella, tetanus, smallpox, and varicella.

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10- Plasma Protein Fraction:

Contents

5% Albumin/Globin in saline

Indications

Expand volume in burns

Hemorrhage

Hypoproteinemia

11- Albumin:

Contents

5% or 25% albumin

Indications

Replace volume in shock

Burns

Hypoproteinemia

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4 Blood Products