Lecture 6-7: Blood Components in Transfusion Medicine PDF

# LECTURE 6-7: BLOOD COMPONENTS IN TRANSFUSION MEDICINE I ## Course: Blood transfusion & transplantation (373413-3) ### Dr Maha Bakhuraysah * Assistant Prof. Immunology and Stem Cell Transplantation * College of Applied Medical Sciences * Email: [email protected] ## Objectives By the end of this...

# LECTURE 6-7: BLOOD COMPONENTS IN TRANSFUSION MEDICINE I ## Course: Blood transfusion & transplantation (373413-3) ### Dr Maha Bakhuraysah * Assistant Prof. Immunology and Stem Cell Transplantation * College of Applied Medical Sciences * Email: [email protected] ## Objectives By the end of this lecture, a student should be able to: * Identify the different blood components used in the blood bank. * Be familiar with the methods used in the separation of different blood components. * Be familiar with using different blood components in transfusion therapy. ## HISTORY * The first blood collection bag was invented by Dr. Carl Waldemar Walter. * He has been called a "pioneer in the transfusion and storage of blood". ## Blood Bags * They are designed for the collection, processing, and storage of whole blood and blood components. * They help in providing an aseptic condition for the separation of blood components. * They act as a closed system reducing the chances of contamination. ### Goals of blood collection: * Maintain viability and function. * Prevent physical changes. * Minimize bacterial contamination. ## Cont. blood bags ### Construct of blood bags: * They are made with high molecular weight polyvinyl chloride (PVC) to ensure better strength. * They use a validated sterilization process. * Triple filtration of anticoagulant is done and is filled in the bags automatically to ensure accuracy. * Advance and standardization coiling method is used to prevent kinks, which ensure a free flow during collection and separation. ## Types of blood bags | Type | Description | |---|---| | Single bag | Whole blood collection | | Double bag | Separate blood components into plasma and packed RBCs | | Triple bag with SAGM | Separate blood components into plasma, packed RBCs, and platelets | | Quadruple bag with SAGM | Separate blood components into plasma, packed RBCs, and platelets - Through buffy coat method | | Other blood bags | | ### Other blood bags: * Umbilical cord blood collection bag (150 mL with 22 mL of CPD). * Blood transfer bag for pooling of blood and blood components. * Top and bottom bag. * Top and bottom bag with leukocyte filter for CBC. ## Additive Solution (AS) * An additive solution can be defined as a solution packaged in a blood bag. * They have a primary bag with satellite bags attached. * One bag has an additive solution (AS). * Unit drawn into citrate phosphate dextrose (CPD) anticoagulant. ## Blood Components ### I. Cellular * Red blood cell products * Platelets * Granulocytes ### II. Plasma * Fresh frozen plasma FFP * Cryoprecipitate ## Preparation of Components * One unit of whole blood can produce: * Packed RBCs - only RBCs with a minimal amount of plasma * Fresh Frozen Plasma (FFP) - plasma containing most of the coagulation factors * Cryoprecipitate (CRYO) - prepared from plasma and contains clotting proteins, fibrinogen in particular. (Precipitate of plasma contains Factor VIII and VWF) * Single donor plasma (SDP) - cryo removed: Plasma or platelets collected by Apheresis machine * Platelets ## Blood Component General Information * Blood is separated into components to specifically treat patients with the needed product. ### Advantages of component separation: * Allow optimum survival of each component. * Transfuse only the component needed. ### 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 ## CELLULAR COMPONENT ## Whole Blood * Clinical indications for the use of WB are extremely limited. * It's used for massive transfusion to correct acute hypovolemia, such as in trauma and shock or exchange transfusion. * It's rarely used today because: * Platelets are non-functional. * Labile coagulation factors are gone. * It must be ABO identical. ### Expiration: * CPD bag: 21 days * CPDA-1 bag: 35 days * SAGM bag: 42 days ## Red Blood Cells (RBC) ### Indication: * Used to treat symptomatic anemia and routine blood loss during surgery. * Hematocrit is approximately 80% for non-additive (CPD), 60% for additive (ADSOL). * Allow WB to sediment or centrifuge WB, remove supernatant plasma. ### Mechanism: 1. Use double blood bag. 2. Use cooling centrifuge. 3. Remove supernatant plasma. ## RBCs Leukocyte Reduced * Leukocytes can induce adverse effects during transfusion, primarily febrile, non-hemolytic reactions. * Reactions to cytokines produced by leukocytes in transfused units. * "CMV" safe blood, since CMV lives in WBCs. * Bedside filters are available to leukoreduce products during transfusion. * Prepared by using leukocyte depleted filter. ## 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 WBCs. ## Frozen RBCs; Deglycerolized RBCs Blood is frozen to preserve rare types and for autologous transfusion. * Blood is drawn into an anticoagulant preservative. * Plasma is removed and glycerol is added. ### Expiration: * If frozen, 10 years. * After deglycerolization, 24 hours. ### Storage temperature * High glycerol: -65 C. * Low glycerol: -120 C, liquid nitrogen. ## 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 * 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. * 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. ### Expiration: 5 days ## Platelet agitator (Shaker) ## Preparation of platelet concentrate ## Pooling Platelets * 6-10 units transferred into one bag. * Expiration = 4 hours. ## Apheresis Platelet Concentrate * **Apheresis:** refers to the process of separating the cellular and soluble components of blood using a machine. * One bag from ONE donor. * One unit is a therapeutic dose. * Volume approximately 250. ## Apheresis * **Target finished products:** * Blood components (platelets and red cells) for transfusion. * Plasma for pharmaceutical manufacturing. ## Granulocytes ## Granulocytes * Primary use is for patients with neutropenia who have gram-negative infections documented by culture, but are unresponsive to antibiotics. * Use a triple bag - use cooling centrifuge. * Collect the whitish layer between RBCs and plasma (buffy coat) or by Apheresis. * Expiration time is 24 hours, but best to infuse directly. * Store at 20-24 C. ## PLASMA COMPONENT ## Fresh Frozen Plasma (FFP) * Used to replace 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 * Thawed - 24 hours. ## Cont. FFP * **Storage temperature:** * Frozen - 18 C * Thawed - 1-6 C * Thawed in 30-37C water bath. * Must be ABO compatible. ## Cryoprecipitated (AHF) * Cold insoluble portion of plasma that precipitates when FFP is thawed at 1-6C. * Cryoprecipitate contains high levels of Factor VIII and Fibrinogen, used for the treatment of hemophiliacs and Von Willebrands when concentrates are not available. * A therapeutic dose for an adult is 6 to 10 units. * Plasma is frozen. * Plasma is then thawed at 1-6 C, a precipitate forms. * Plasma is centrifuged, cryoprecipitate will go to the bottom. * Remove plasma, freeze within 1 hour of preparation. ## Cont. AHF ## Cryoprecipitate (CRYO), Factor VIII or Anti-Hemophilic Factor (AHF) * **Storage Temperature:** * Frozen - 18 C or lower. * Thawed - room temperature. ### Expiration: * Frozen 1 year. * Thawed 6 hours. * Pooled 4 hours. * Best to be ABO compatible, but not important due to the small volume. ## Irradiation of Blood Components ## Irradiation of Blood Components * Cellular blood components are irradiated to destroy viable T-lymphocytes which may cause Graft Versus Host Disease (GVHD). * GVHD is a disease that results when immunocompetent viable lymphocytes in donor blood engraft in an immunocompromised host, recognize the patient tissues as foreign and produce antibodies against patient tissues, primarily skin, liver, and GI tract. * The resulting disease has serious consequences including death. * GVHD may be chronic or acute. ## Irradiation of Blood Components * **Patients at greatest risk are:** * Severely immunosuppressed. * Immunocompromised. * Receive blood donated by relatives. * Fetuses receiving intrauterine transfusions. * Irradiation inactivates lymphocytes, leaving platelets, RBCs, and granulocytes relatively undamaged. * **Must be labeled "irradiated".** * Expiration date of Red Blood Cell donor unit changes to 28 days. * May be transfused to "normal" patients if not used by intended recipient. ## Donor Blood Inspection and Disposition * It is required that donor units be inspected periodically during storage and prior to issuing to the patient. * The following may indicate an unacceptable unit and need to be discarded: * Red cell mass looks purple or clots are visible. * Zone of hemolysis observed just above RBC mass, look for hemolysis in sprigs, especially those closest to the unit. * Plasma or supernatant plasma appears murky, purple, brown, or red. * A greenish hue need not cause a unit to be rejected. * Inspect platelets for aggregates. ## Cont. Inspection of Donor Blood * Inspect FFP and CRYO for signs of thawing, evidence of cracks in the bag, or unusual turbidity in CRYO or FFP (i.e., extreme lipemia). * Segment closest to the unit is hemolyzed. * May indicate bacterial contamination. ## ANY QUESTIONS?