Blood Component Therapy MCC

7/26/2019 Blood Component Therapy MCC

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Blood ComponentTherapy

Dr. M. Mohandoss

Assistant Professor

Transfusion Medicine

Malabar Cancer Centre, Thalaserry


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Outline

Whole Blood

Blood Components

Apheresis

Special Blood Components

21/03/15MALABAR CANCER CENTRE


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Blood n !istory

Richard Lower is credited with

performing, in 1665, the first

authentic blood transfusion

(animal to animal)


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!uman to !umanTransfusion

In 1818, James Blundell -Attempted human-to human transfusion


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Modern Transfusion Therapy.means component therapy



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Whole blood in True sense.



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Whole blood is not

Whole! After "#hrs of stora$e WB essentially becomes red

cells suspended in a protein solution

Changes in PlateletsWB stored at #%C & platelets rapidly lose 'iability

Granulocytes & Monocytes & function reduced

(ithin )hrs and disinte$rates (ithin "#hrs

Microaggregatesincrease in number FVIII, FV & le'els decreases



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Component Therapy

*. Optimal preser'ation of in 'itro function of blood

". +cient utili-ation of blood donations



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COMPONENTS STORAGETEMPERATURE

Packed red blood cells PRBC! "2 #o $%C

Pla#ele#s PLTS! "22 #o "2&%C '(derco(s#a(# a)*#a#*o(

+res, -ro.e( lasa ++P! 30%C or beloCrorec**#a#e CR4O! 30%C or belo


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Blood Ba$s



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Methods of Component

Preparation

Whole Blood Apheresis

Platelet ichPlasmaMethod

Bu/y CoatMethod

ManualMethod

Automation



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Platelet Rich Plasma (PRP) method

Whole blood

Soft spin within

(1800 rpm 6 hrs x 9 min at 22oC)

Red cells Platelet rich plasma (PRP)

Hard spin(000 rpm

x ! min at 22oC)

Plasma Platelet Conc.

(RDP)

PRP

RBC

PRP

PCFFP



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PP Method

Manual plasma expresser



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Buy Coat method

Whole blood

Hard spin within

(000 rpm 6 hrs x 9 min at 22oC)

Red cells Buy coat plasma

Soft spin(1800 rpm x ! min at 22oC)

Platelet Conc. WBC !ith fe! RBC

Plasma

RBC



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Bene0ts of Bu/y coat

method Platelet yield impro'ed a lot

educed WBCs in product

BC contamination drasticallydecreased



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eparation using component extraction

"uadruple Ba#(Top $nd Top Ba#s)

Top and Bottom Ba#(T$B)



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Blood Component

+1tractor

Se(sors

Sealers

Se(sor

Sealer

Press



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Platelets

* unit of DP raises P2Tcount by 34445*4,44467l

Adult dose re8uires 6

units of RDP increase

P2T count by 94,4445

:4,44467l

Paced "ed #lood

Cells

* unit of PBC contains

appro1 34$ of !b

One unit of PBC

transfused in adult

; raises

!b by *$6dl

Dosa$e


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Cryoprecipitate

Adults

1unit/10kg body wt

nfants

single unit (10-15ml)

Fresh Fro$enPlasma

* unit of ??P increases

each factor by "59@ in

adult

Dose

10-20ml/kg

1unit/10kg body

wt

Dosa$e


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Apheresis

%o tae a'ay( or %Withdra'(

Process in (hich blood is remo'ed from a

subect and continuously separated intocomponent parts, allo(in$ a desiredcomponent ;s> to be retained (hile theremainder is returned to the subect



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Principle Centrifu$ation

Separation eciency & based on $5force and d(ell time ;inlet Eo( rate>



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Principle of Apheresis

Plasma

Platelets

2ymphocytes

Franulocytes

+rythrocytes

Blood components separated bycentrifu$ation and selecti'ely

remo'ed

Wholeblood

Wholeblood

;'ein> ;'ein>

Anticoa$ulantadded

emainin$ bloodcomponents

recombined and

returned



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Principle of Apheresis



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Apheresis Modalities

PlasmapheresisPlasa reoal or

e6c,a()eCe(#r*-')al/+*l#ra#*o(

ss#e!

CytapheresisCell reoal or e6c,a()e

Ce(#r*-')al ss#e!

Donor Red cellcollection

7o'ble '(*#!

PlateletpheresisS*()le do(or

la#ele#s!

%ranulocytecollection

8&tem cells

Plasmapheresis



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Donor for Apheresis

Similar to normal donation criteria

Wei$ht G :4 H$

Preferably a repeat donor 5 mi$ht ha'e $i'enblood *5" times earlier

Ienous access & peripheral line

?irst de$ree relati'e donors are deferred to

pre'ent ris= of F'!D



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Multicomponent blood

apheresis Collection of t(o or more identical or

di/erent blood components by apheresis

RCC "RCC 9 2 RBC RCC" ++P RCC" la#ele#

RBC" ++P" PC

PC" PC 9 2PC PC" ++P

++P " ++P " ++P

$##ressi'eMulticomponent$pheresis

A#leas# 3 coo(e(#sare collec#ed: *(cl'd*()

a#leas# o(e S7P: a(do(e PRBC



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Apheresis

Sin$le Donor Platelets

$pheresisPlatelets

Whole bloodderi'ed

platelet21/03/15MALABAR CANCER CENTRE


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SDP Vs RDPDecreased chances of TTI and alloimmunization

number of donor support required

Lesser Donor reactions

Ensures adequate dose

ABO matched platelet support

Consistent and standardized yield

RDP RDPRDPRDPRDP RDP

SDP

= 1 adult dose

3x 1011/ unit)

! 1 adult dose(4 x 1010/unit)


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Plateletpheresis or

)P Platelet count J *34 1 *4K6l ;preferably G"34

1 *4K6l>

Lsually not more than" procedure in a (ee=

#) hours must elapse bet(een t(oprocedures

Ma1imum of "# procedures 6 year

)ouble Product

Platelet Count of J 944 1*4K6l



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Ad'anta$es of Apheresis BloodComponents

Patients

Reduced donor exposure : full transfusion dose

Matching donor to patients

afet! enhancement for patient

Donors

"re#uent repeat donor

Reduced donor reactions

$igh donor acceptance

Products

$igher #ualit! products

%onsistent and standardi&ed products

'ouble !ield or multiple component collections 21/03/15MALABAR CANCER CENTRE


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Special Blood

Components 2eu=oreduced Blood Components

rradiated Blood components

Saline Washed Components ;edCells6Platelets>

Minor Phenotype Matched Components



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What is 2eu=oreduction

A process in (hich the residual leu=ocyte countof the components is reduced to a 'ery lo(le'el, so that the deleterious e/ects of

leu=ocytes are minimi-ed or pre'ented



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*d+erse eect o- .euocytes in bloodcomponents

rile non/hemolytic trans-usion reactions 0F12"3

immuni$ation to 2.*4.euocyte antigens

telets re-ractoriness3

s-usion related immunomodulation 0"IM3+2) 0ransplant re5ection3

s-usion related acute lung in5ury 0"*.I3

CMV

2.V/6

7#V

Immunological eects )isease ransmissio



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Why 2eu=oreduction

NOf many ad'erse transfusion reactions,

0'e are associated (ith leu=ocytes.These 0'e comprise o'er K4@ of allreported reactions associated (ithtransfusion of blood components.



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storage time

passenger leuoc!tes

Cytokine generation in stored

PC

Circulatin# cyto*ine

+,-TR

hreshold

!"ceeded

IL - 1

IL 6

IL 8

TNF-

RANTES

TGF-

GRO-

ransfused Leuoc!tes

Cytokine production in

#i#o


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Me#,ods o- Le'kored'c#*o(

%entrifugation "ree&ing

*ashing

creen "iltration+uff! %oat Remoal

-pheresis


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2eu=ocyte Content of

Iarious Blood Components

W#C Content per8nit

Whole Blood *4K

ed Cells "53 1*4K

ed Cells, 2 *53 1*4:

Apheresis Platelets, 2 *53 1*4:

Bu/y Coat Platelets *4)

Bu/y Coat Platelets, 2 *53 1*4:

.euoreduction 0."3 labelingre9uirements8 : ; x 6


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Component processing



storage

storage

storage

storage

transfusion

transfusion

transfusion

transfusion

Pre processfiltration

In process

filtration

Post process

filtration

Pre storage

Post storage

.euocyte depletion > +arious stages



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2e'els of 2eu=oreduction

@ WBC remo'al

K4@

KK@

KK.K @

KK.KK @

2o$ eduction

2o$ * ; *4)>

2o$ " ; *4

2o$ 9 ; *4:>

2o$ # ; *43>



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rradiated Blood Products

.rradiation of cellular components with ioni&ing radiation

results in the inactiation of /l!mphoc!tes

he damage to /l!mphoc!tes '0- preents post infusion

proliferation that abrogates the potential for 2$'

Minimum dose15/ 35!

Reduced shelf life (34 da!s)


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oni-in$ adiation


r nc p e o rra at on


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r nc p e o rra at onbiophysics

Action of Gamma rays

Direct Indirect

Nuclear DNA

strands broken

Disruption of cell division

cell death

Interact with cell water

Oxidative inury

!ree radical production



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#lood components 'hichshould be irradiated

*ll components thatcontain +iable cells

Whole blood

PBC6 2P5PBC

SDP6 DP

Franulocyte conc

?resh plasma

?ro-en

de$lyceroli-ed redcells

1ot recommended

??P

Cryoprecipitate

fractionated plasmaproducts ;clottin$

factor concentrates,albumin and IF>



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rradiated Blood

ComponentsIndications/

BMT 6Stem cell ecipients

elati'es blood usa$e

!2A Matched Platelets

ntra uterine transfusions

Transfusions ne(born6infant



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Instrumentation



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Washed Componentsemo'al of Plasma ;residual protein 4.3$6unit>

Most of WBC

Fe' indications

eactions to plasma proteins

ed cells for $A de0cient patients (ith Ab.

2imits shelf life ;Open Is Closed System>

is= of contamination

Delay in issuin$21/03/15MALABAR CANCER CENTRE


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Minor Phenotype Matched

Alloimmuni-ation to red blood cell ;BC>blood $roup anti$ens



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A-#er #ra(s-'s*o( or re)(a(c: a erso( akes

a(#*bod #o red cell a(#*)e(: ,e or s,e lacks

Ree6os're *#, correso(d*() A)

Indicated inepeat bloodtransfusion

ThalassemiaSic=le cell diseaseAutoimmune hemolyticanemia


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Minor Phenotype Matched


"h #N$s % &ewis &utheran 'ell Duffy 'idd ()a

D * + c e f , ,$ *w # N $ s %- &ea

&eb

&ua

&ub ' k 'pa .sa !ya !yb .ka .kb ()a

%atient / / 0 / / / 0 0 0 / / / 0 0 / 0 / / 0 / 0 0 / / / / /

Donor - / / 0 / / 0 0 0 / / / 0 / / / 0 0 / 0 / 0 0 / 0 / / /

Donor 1 / / 0 0 / 0 0 0 0 / / 0 / / 0 / 0 / / / 0 0 0 / 0 / /

Donor 2 / 0 / / O 0 0 3 0 / 0 0 / / 0 0 0 / 0 / 0 0 0 0 / 0 /


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Conclusion

Whole blood has limited use in the currentera.....

Component therapy has re'olutioni-edtransfusion medicine

Standardi-ed blood components help to assessthe outcome of the component therapy.

Apheresis collection units ;more feasible>

Other procedures as leu=o0ltration, rradiationof blood Q phenotype matched blood shouldbe employed (hen e'er possible



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han ?ou


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Patho$en nacti'ation of

blood



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Methods Patho$en

nacti'ation



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Patho$en nacti'ation

Documents

Blood Component Therapy MCC