Blood Component Preparation and Therapy PDF

[MLS 416-LEC] Immunohematology - Lecture F3: Blood Component Preparation and Therapy Professor: Bea Angelli Laude, RMT Date: May 1, 2024 INTRODUCTION Blood and its components are utilized NOW as part of the treatment regimen of patients, in what we call as the process of HEMOTHERAPY Each unit of who...

[MLS 416-LEC] Immunohematology - Lecture F3: Blood Component Preparation and Therapy Professor: Bea Angelli Laude, RMT Date: May 1, 2024 INTRODUCTION Blood and its components are utilized NOW as part of the treatment regimen of patients, in what we call as the process of HEMOTHERAPY Each unit of whole blood can be separated into different components, depending on what is necessary to be transfused to the patient This process of blood preparation is going to MAXIMIZE the usage of blood in which component transfusion is going to be much more safer than the use of WHOLE BLOOD Goals of Blood Collection Maintain viability and function ○ Once the blood is being transfused to the patient, it is still going to function and aid in the recovery process of the patient. Prevent physical changes ○ We have to ensure that we have added additive solutions & anticoagulants in order to PREVENT further physical changes that have occured on the blood component upon storage Minimize bacterial contamination ○ Less occurrence of transfusion-associated infections → over time, there were a lot of blood transfusion procedures performed and were considered to be unsuccessful Thanks to the advancement of technology (Discovery of plastics vs. glass) These help in the storage life of blood components Equipment Manufacturing Quality Control Blood bags → collect & store blood components ○ Anticoagulants and additives present Filtration → ensures no contamination from one component to another Centrifuge → most important - made component separation possible → Allows MedTechs to follow CGMP (Current Good Manufacturing Practices) Collection of methods used in the facility/controls used for the manufacture, processing, packing, or holding of a blood product to ENSURE that it meets the safety, purity, and potency standard. Storage Freezers Refrigerators Plated agitator machines Documentation Capture the critical steps in the blood manufacturing process: Personnel Equipment used Date and time → These records will be retained and must be protected from destruction as these are REQUIRED by the Department of Health (DOH) during inspection. All blood banks will be under DOH US Blood Banks are under FDA and AABB Other countries have the BECS (Blood Establishment Computer System) ○ Able to identify blood that are not tested with infectious diseases ○ Able to identify blood required to be quarantined → considered to be UNACCEPTABLE blood components → Philippines : perform manual recording, some are encoded in the computer systems → Other countries : have barcodes Blood Collection and Storage Anticoagulants are responsible for preventing clotting process; maintains blood in fluid state Additive solutions → allows us to store blood on a specific number of days depending on the type of solution that is contained in the blood bag → Must be maintained in a closed system Ensures that we have maintained sterility Recall that we should minimize bacterial contamination Once exposed to air (in the tubing, blood bag itself, top/bottom, entry of air): now considered to be an open-system ○ Example: Transfer of blood component in a particular blood bag to another blood bag ○ ALLOWABLE STORAGE TIME FOR OPEN SYSTEM → reduced Why? Because bacteria might contaminate it → discard! Copy for: HAW, SPENCER Y. | 1 Single Bag ONLY WHOLE BLOOD will be collected (cannot be separated into diff components) Double Bag Plasma and packed red cells Quadruple bags Packed RBCs, platelet concentrate, plasma, cyroprecipitate Anticoagulant Preservative Solutions and Storage Lesions FDA (Food and Drug Administration) : Storage limits and temperature criteria for preservative solutions ○ able to support at least 75% of original RBCs in the recipient's circulation for atleast 24 hours after transfusion, with less than 1% hemolysis STORAGE LESIONS – all biochemical changes that occur in the blood upon storage (collectively known as) INCREASED Triple bags Packed RBCs, platelet concentrate, plasma Hemoglobin Freed when there is hemolysis Potassium Released Visible cells Cells present in the blood bank could be senescent or newly matured cells Some of them are going to be destroyed during storage, some will stay (can survive for 120 days) DECREASED pH Becomes acidic due to the buildup of lactic acid as a byproduct of glucose metabolism in order to produce the energy utilized by the red cells Sodium Possibly from gradual breakdown of rbcs during storage and eventual release of cellular contents that includes sodium Copy for: HAW, SPENCER Y. | 2 ATP 2,3-DPG Red blood cells continue to use ATP for various cellular functions even during storage. However, unlike in the body, stored blood lacks a constant supply of oxygen and glucose, which are essential for ATP production. This limited supply leads to a depletion of ATP stores within the RBCs. Cells are going to be inactive and there will be depletion of the glucose sources Additive solutions tend to contain glucose that would enable the cell to survive for a particular number of days, depending on the preservative solution incorporated in the blood bank Necessary for the oxygen release of the red cells ○ Hgb has high affinity to oxygen → OXYGEN cannot be released MOST IMPORTANT BIOCHEMICAL CHANGE – DECREASED 2,3-DPG, DECREASED OXYGEN RELEASE ○ In newborns undergoing exchange transfusion, it is necessary to make use of FRESH BLOOD (fresh whole blood or freshly separated packed RBCS from whole blood) ○ This is to ensure 2,3-BPG is not entirely separated in which it is in enough amount to serve its function for oxygen release For adults, the doctor may require it – but for newborns it is required to have enough amounts of 2,3-DPG present on the blodo component plasma – in order to generate ATP, once taken out of the body and separated from the plasma, its glucose source is going to be depleted Adenine Acts as substrate for red cell ATP synthesis Citrate Prevents coagulation by chelating calcium Protects the red cell membrane from hemolysis Sodium biphosphate Prevents excessive decrease in pH Acts as a buffer Remember: one of storage lesions is the drop of pH due to the accumulation of lactic acid ○ Red cells are also going to be destroyed if the environment is going to be very acidic Mannitol Osmotic diuretic acts as a RBC membrane stabilizer to avoid hemolysis Anticogulant/Preservative Solutions incorporated in blood bags Anticoagulant/Preservative Preservative Solutions Chemical Dextrose Purpose Source of sugar so red cells [are] Support[ed] with ATP generation via glycolytic pathway Remember: ATP is its main source of energy Recall: Red cells are dependent on the glucose content of Number of Days ACD (Acid Citrate Dextrose) Rarely used because of the acid (should not react w/ lactic acid; makes red cells more prone to hemolysis) 21 CPD (Citrate-Phosphate-Dextrose) 21 CP2D (Citrate-Phosphate-Double-Dextrose) 21 CPDA1 (Citrate-Phosphate-Dextrose-Adenine) 35 AS- 1/AS-5 (dextrose, adenine, mannitol, saline) Mannitol as the membrane stabilizer 42 AS-7 (dextrose, adenine, mannitol, saline) 42 AS- 3 (dextrose, adenine, saline, citrate, phosphate) Citrate and Phosphate are the membrane stabilizers 42 Additive solutions are added to the red cells/packed red cells in order to add more nutrients so it could extend its shelf life Copy for: HAW, SPENCER Y. | 3 Despite its disadvantage, it is valuable for preserving autologous units and red cells with the rare phenotypes Blood Component Preparation → a lot of factors can affect blood component preparation, including temperature and time constraint Specific components of blood are affected Remember that components are going to be separate from whole blood Prior to separation, ○ → If we are to add additive solutions in the packed RBC, more plasma can be removed mainly because the additive solution is ADDED to maintain red cell metabolism during storage → Normally if there is no additive solution, a small amount of plasma will be retained in the packed red cell so it is going to act as a diluent and additional glucose source apart from the preservative solution → MORE PLASMA will be extracted because the additive solution will act as diluent, and provide more sugar source in order to produce ADP → will minimize storage hemolysis to