BLOOD COMPONENTS

BLOOD COMPONENTS AND

PLASMA DERIVATIVES

A. BLOOD COMPONENTS :

1. Whole blood 6. Granulocyte pheresis

2. Red blood cell 7. Platelet conc. (random donor)

3. Leukocyte – reduced RBC 8. Platelet pheresis

4. Washed red blood cell 9. Leukocyte- reduced platelet

5. Frozen / deglycerolized RBC 10. RBC – adenine saline added

B. PLASMA DERIVED COMPONENTS:

1. Fresh frozen plasma 5. Factor IX concentrate

2. Plasma 6. Anti- inhibitor coagulation complex

3. Cryoprecipitate 7. Immune globulin

4. Factor VIII concentrate 8. Albumin/plasma protein factor

DIFFERENT SPEEDS USED IN THE PREPARATION OF BLOOD COMPONENTS|:

HARD SPIN OR HEAVY SPIN :

5000 g - 5 minutes ( PRBC & PC)

5000 g - 7 minutes ( CRYOPPT, LP-RBC, OR

CELL FREE PLASMA)

LIGHT SPIN OR SOFT SPIN :

2000 g - 3 minutes ( PRP)

Preparation of Platelet Concentrate : centrifugation at

RT

Other blood components centrifugation at 1-6 0

WHOLE BLOOD

* For oxygen carrying capacity & volume replacement

* For massive bleeding

* No viable platelets or WBC

* Decreased labile coagulation factors (Factors V & VIII)

* Not an efficient utilization of blood

PACKED RED BLOOD CELLS

* Treatment symptomatic anemia where

oxygen carrying capacity is needed

* For patient who cannot tolerate an increased

blood volume

RBC ALIQUOTS

* For neonates

* For the treatment of anemia caused by :

* spontaneous fetomaternal hemorrhage

* obstetric accidents

* internal hemorrhage

LEUKOCYTE REDUCED RED BLOOD

CELLS

* average unit of RBC contains 2X109 leukocytes

* a reduced leukocyte content to less than 5X 108

prevents repeated non- hemolytic febrile trans. rxns.

* less than 5X106 – prevent HLA sensitization

* reduces immunosuppression of recipient by donor WBC

* decreases post- operative surgical infections

due reduced immunosuppession

* reduced CMV transmission

* does not prevent graft versus disease

WASHED RED BLOOD CELLS

* AIHA

* Paroxysmal nucturia hemoglobinuria

* for the rare patients with IgA deficiency

FROZEN RED BLOOD CELLS

* used for :

* rare blood types for patients with

multiple antibodies

* autologous blood for a postponed

operation

(GAMMA) IRRADIATED RBC s

* RBCs & platelets are exposed to gamma

irradiation at 25 rads for 4.5 minutes

* inactivates T lymphocytes in the donor unit &

prevents graft versus host disease in an

immunocompromised recipient

FRESH FROZEN PLASMA (FFP)

* 200- 250 ml. of plasma frozen at - 180 C C

within 8 hours of collection

* no platelets available

* contains all coagulation factors

* an unconcentrated source of fibrinogen

( use cryo to correct a low fibrinogen level)

* needs 20-30 mins. lead time to thaw prior to

use

* used in patients with multiple coagualtion factor

deficiencies :

* liver disease * Vit. K deficiency

* DIC * warfarin toxicity

* massive transfusin

* indicatated when PT /PTT are >17/55 sec.

* not used if non bleeding or for volume

replacement

CRYPRECIPITATED AHF OR

CRYOPRECIPITATE

* the cold insoluble portion of plasma that

precipitates when FFP has been thawed bet.

1-6 0C.

* volume is 10- 15 ml.

* 30 mins. is needed for thawing & pooling

* used primarily for the replacement of fibrinogen

which is indicated among patients with :

* liver failure

* DIC

* massive transfusion

or among those with congenital fibrinogen

deficiency.

* can also be a source of :

* Factor VIII

* Factor XIII

* Von Willebrand factor

* No longer considered a product of choice

for FVIII deficiency or Von Willebrand’s

disorder. These conditions are better

treated with :

* Factor VIII concentrate or

* with desmopressin acetate: DDAVP

( 1- deamino[ 8- D – arginine]-vasopressin)

Quality Control:

1 U cryoprecipitate = 80-120 IU Factor VIII

150-250 mg fibrinogen

40-70% Von Willebrand factor

20-30% factor XIII

Storage : 1 year if frozen at – 18 0C

6 hours if thawed at 20-24 0 C

4 hours if pooled

Application 1 : Cryoprecipitate transfusion for correcting

Fibrinogen level .

NOTE:

1.(Given weight in kilogram) x 70 ml/ kg.body weight= estimated

blood.volume ( mL)

2. Estimated blood volume x ( 1.0- hematocrit) = estimated plasma

volume (mL)

Required amount of fibrinogen =

[ Desired final fibrinogen ( mg/mL) – Initial Fibrinogen (mg/ml] x

plasma volume

[ If concentration is expressed in mg/dL , simply divide by 100 to

convert to mg/L.]

1 U cryoprecipitate = 150 mg fibrinogen or

1 U cryoprecipitate = 250 mg fibrinogen

Application 2 : Cryoprecipitate transfusion for correcting FVIII level.

1.(Given weight in kilogram) x 70 ml/ kg.body weight= estimated

blood.volume ( mL)

2. Estimated blood volume x ( 1.0- hematocrit) = estimated plasma

volume (mL)

3. Required amount of FVIII=

[ Desired Final FVIII ( Units/ mL) – Initial FVIII (Units/ mL] x plasma

volume

( If concentration is expressed in % , simply drop of % sign and write

units/ dL

To convert it to Units/mL., move 2 decimal places to the left.

1 U cryoprecipitate = 80 U FVIII

-

PLATELET CONCENTRATE

* Platelets are essential in primary hemostasis.

* Maybe prepared by processing unrefrigerated WB

within 6-8 hours after phlebotomy or through apheresis.

* Used among bleeding patients suffering from thrombocytopenia as a result of problem in platelets:

* defective production or decreased function

* induced destruction as a result of radiation and chemotherapy.

QUALITY CONTROL:

* Random Donor Platelets ( RDP) : 5.5 x 10 10 platelets

* Single donoa Platelets (SDP) : 3.0 x 1011 platelets

* Storage : 20-24 0C ( RT or aircon temperature ) with constant

agitation

* Shelf Life : 3-5 days ( if pooled platelets within 4 hours of pooling

* ph 6.0

• Each unit of platelet is expected to provide the following increase in

• platelet count: ( Assume a typical 70 kg human)

• RDP : 5,000 = 10,000/ uL

• SDP : 20,000- 60,000/uL ( same effect with 4-6 pools of RDP)

Assesstment is made by calculating Corrected Count Increment (CCI)

* CCI RDP = ( Posttransfusion PC – Pretransfusion PC x BSA

number of RDP transfused x 0.55

* CCI SDP = ( Postransfusion PC – Pretransfusion PC x BSA

number of SDP transfused x 3

Interpretation: > 10,000/uL (after 1 hr. posttransfusion) good increment

,< 5,000/uL (after 1 hr. posttransfusion) refractoriness

GRANULOCYTE CONCONTRATE/ LEUKOCYTE

CONCENTRATE

* prepared by cytapheresis

* each product contain 1.0 x 1010 granulocytes if

steroids or HES or both are used

* granulocyte concentrate contain 200-600 mL of plasma

stored at 20-24 0C without agitation

• Granulocyte transfusions are done in :

• cases of fever

• septicemia or bacterial infection unresponsive

• to antibiotic

• reversible bone marrow hypoplasia

• reasonable chance for patient survival

• neonates with impaired neutrophil function

• severe neutropenia

PLASMA * Formerly known as a liquid plasma or cryoprecipitate

poor plasma

* Has small amounts of Factors V and VIII

* Not recommended for patients with deficiency of either

of these clotting factors

* Recommended for :

the treatment of stable coagulation deficiency esp.

Factor XI

source of plasma for pts. undergoing plasma

exchange

FACTOR VIII CONCENTRATE

* prepared by pharmaceutical firms by fractionation and

lyophilization of pooled plasma

* derived from plasma obtained by plasmapheresis

* stored at refrigerated temperature and is reconstituted

with saline at the time of infusion

* used to treat patients with hemophilia A or FVIII

deficiency

CRYOSUPERNATE

* Plasma left after separation from WB of the

cellular components and cryoprecipitate

* Used for the treatment of :

bleeding disorders other than hemophilia

hypofibrinogemia

hypovolemia

AUTOLOGOUS TRANSFUSION

• Use of patients own blood, particularly useful in elective

• surgery

• Accounts for 5% of transfusions in USA

• Reduces need for allogeneic BT

• Reduces risk of postoperative complications

• (e.g. infection, tumor recurrence)

FOUR DIFFERENT TYPES OFAUTOLOGOUS

TRANSFUSION 1. Preoperative collection

2. Acute normovolemic heimodilution

3. Intraoperative collection

4. Postoperative collection

Duration of autologous transfusion:

Donor- patient may donate blood every 3 days but not

within 72 hrs. surgery ( to allow the patient plasma to

return to normal before surgery)

• 320 mg ferrous sulfate or ferrous gluconate is given 3X

• daily as iron supplement if several units are required

• within a few weeks.