BLOOD BANKING

1- BLOOD PRODUCTS

2- AUTOLOGOUS TRANSFUSION

M. H. ShaheenMaadi Armed Forces Hospital

BLOOD COMPONENTS

I- Red Cells: For oxygen carrying capacity

II- Plasma : For coagulation proteins

III- Platelets: For microvascular bleeding

RED CELL COMPONENTS

1- Whole blood

2- Red cell concentrates (Packed RBC)

3- Washed red cells

4- Leukocyte depleted red cells

5- Frozen red cells

WHOLE BLOOD

• Anticoagulant:

CPDA-1• Shelf Life:

35 days At 1-6 * C• Volume:

450 ml blood Plus

63 ml CPDA=

510 ml

Cont… WHOLE BLOOD

• Poor in coagulation proteins & platelets

• Corrects oxygen carrying capacity and volume simultaneously

• Indicated for the management of trauma and extensive blood loss

• One unit of whole blood increases Hct by 3% and Hb level by ~ 1 gm

FRESH WHOLE BLOOD

• Less than 5 days old

• Indications:

- Exchange transfusion

- Major surgery with massive blood loss

- Liver transplantation

- Open heart surgery in infants

2- RED CELL CONCENTRATES(Packed red cells)

• Production:

from whole blood; Plt. & plasma are produced

• Shelf life: 35 days

+ nutrient= 42 days• Volume: ~ 200 ml

Cont…. Packed Red Cells

Indications:

• Correction of oxygen carrying capacity

• Chronic anemia

• Before major surgery

• Trauma and emergency transfusion

3- Leukocyte Depleted Red Cells

• Preparation: Nylon wool filters

• Indication: Non-hemolytic febrile reactions

4- Washed Red Cells

• Manual and automated washing systems

• Must be transfused before 24 hours

• Washing removes plasma proteins and reduce allergic transfusion reactions

• indicated in recurrent an/or sever reactions

4- Frozen Red Cells• Production: Red cells + Cryoprotective • Storage: Liquid nitrogen or Freezers• Preparation prior to transfusion: Thawing washing and

addition of glucose• Transfusion: Within 24 after preparatoin• Indications:

- Rare blood groups

- Subgroup antibodies

Appropriate Transfusion Practiceof Red Cell Products in various surgical settings

• One unit of red cells : 3% increment in Hct

increases Hb level by ~ 1gm

• Do not measure Hb &/or Hct before 2 hours

• Factors adversely affecting the benefit from transfused red cells:

- Continued blood loss

- Hemolysis; immune mediated & mechanical

- Suppression of erythropoiesis

Red Cell Transfusion in Acute Blood Loss

• Blood loss of < 10% of total blood volume:

No replacement therapy

• Loss Up to 20% : Replace by crystalloids

• Loss > 25% : Require red cell transfusion

• Preoperative Hb < 10 gm: Historical gold standard for red cell transfusion

• Each case must be evaluated individually

II- PLATELET PREPARATIONS

1- Platelet Concentrates

2- Apheresis Platelet Units

Appropriate Transfusion practice

of Platelet Concentrates• Unit of Platelet Transfusion:

- Conventional requirement is 6 units of

pooled platelet concentrate

- Apheresis platelet unites are largely

dependent on donor parameters

• Single donor (apheresis) platelets have low risk to recipients than do pooled platelets

Platelet Transfusion Dose

• Apheresis Platelets contains 3 x 10^11 Plts

• Six units of pooled platelet concentrate=

6 ( 5.5 x 10^10) Plts

• Appropriate transfusion requirement for normal size individual

• Post-transfusion increment of ; 5 - 8 x 10^9 /L

Cont… Platelet Transfusion Dose

• Approximately one unit of platelet concentrate for each 10 kg body weigh

• Objective in the preoperative period:

Platelet count > 60,000 x 10^6 /L

• Post-transfusion platelet survival:

6 - 8 days

III- PLASMA DERIVATIVES

• Plasma products commonly requested:

1- Fresh Frozen Plasma (FFP)

2- Cryoprecipitate

3- Fibrin Glue

• Plasma and its derivatives represent a valuable source in transfusion practice

• Plasma production:

Manually, Aphersis, Industrial fractionation

1- Fresh Frozen Plasma (FFP)

• Storage: 18 * C for up to 1 year

• Transfusion: Thawed over 20 - 30 min

• Validity: 24 hours after thawing

Indications of FFP1- Multiple acquired coagulation defects:

• Liver disease

• Massive transfusion

• DIC

• Rapid reversal of warfarin effect

2- Plasma Infusion or exchange:

• TTP

• HUS

3- Congenital coagulation defects

2- Cryoprecipiate

• Production: FFP thawed at 4* C

• Storage:

At 18 * C for 1 year

• Properties:

contains fibrinogen, F VIII and vWF

• Indication:

Fibrinogen deficiency & hemophilia A

3- Fibrin Glue• Topical hemostatic blood product

• Production:

1- Cryoprecipitate

2- Thrombin

• Cut , tailored and pasted

• Indication:

Hemostatic and sealant in cardiac , vascular and other surgical procedures

AUTOLOGOUS BLOODTRANSFUSION

• HISTORY:

- Remote: 100 years ago

- Recent: HIV In 1980 th.

ADVANTAGES• Eliminates transfusion transmitted diseases

(Hepatitis and HIV)

• Prevention of transfusion immunologic reactions

• Enhanced recovery from postoperative anemia

• High cost benefit

LIMITATION:• Risk of blood donation in some cardiac patients

Methods of Collection of Autologous Blood Donations

1- Preoperative

2- Intraoperative blood salvage

3- Intraoperative hemodilutionn

1- Preoperative Autologous Transfusion

• Autologous donation once a week

- Normal erythropoiesis

- Adequate iron supply• Large volume if cryopreservation is available• Well tolerated even in by some high risk donors• Limitation: Anemia developing during the donation

interval (Erythropoietin may help)• In USA , less than 2% require allogeniec blood for

elective surgery

2- Intraoperative Blood Salvage

1- Systems without washing:

- Modified suction devices

- Simple and cheap

2- Washing systems:

- combined suction device and continuos flow

centrifugal system

- Processing of large blood volume

- Save ~ 50% of allogeneic blood requirements

3- Intraoperative Hemodilution

• Collection of autologous blood just before the start of surgery

• Value in open heart surgery:

- Saving of platelet number and function

- Reduction of red cell loss

- Improves tissue perfusion and oxygenation

- Less expensive than preoperative donations