Blood Components Lecture Notes PDF

Blood components Lecture 3 Dr. Muneef Aldhafeeri  Blood Components  STANDARD SPECIALIZED  Whole blood Saline-washed Red Cells  Packed Red Cells Frozen Red Cells Irradiated prod...

Blood components Lecture 3 Dr. Muneef Aldhafeeri  Blood Components  STANDARD SPECIALIZED  Whole blood Saline-washed Red Cells  Packed Red Cells Frozen Red Cells Irradiated products  Platelets PRP (Platelet-rich plasma), RDP(Random Donor platelets)  Fresh Frozen Plasma (FFP)  Cryoprecipitate https://youtu.be/fS42C1G OyvM https://youtu.be/UgPtAVB8  Definitions Blood product: Any therapeutic substance prepared from human blood Whole blood: Unseparated blood containing anti-coagulant preservative Blood component (component separation): A constituent of blood, separated from whole blood eg., red cells, platelets, FFP Plasma derivative (fractionation): Human plasma proteins prepared under pharmaceutical manufacturing conditions eg., albumin  Preparation of blood components Whole blood Plasma Packed RBC 90% water Fresh frozen plasma Platelet concentrate Cryoprecipitate + CryosupernatantI = AHF albumin Fibrinogen Immunoglobulin Others  Blood Components Human blood consists of plasma, in which cells are suspended The plasma also contains other specialised substances, which are important for blood clot formation (e.g. clotting factors) Whole blood can be separated at the blood bank into various components Blood Component Production.mp4 5  Centrifugat ion  This is the first step of blood preparation  Depend on 2 factors:  Relative centrifugation factor (RCF).  Duration of centrifugation.  Heavy spin  5000 /g / 7min = leukocyte-poor RBC, or cell free plasma.  5000/g / 5min = Packed cell and platelet concentrate.  4170/ g / 10min = cryoprecipitate  Light spin  4170 /g/2min = platelet rich plasma.  Centrifugation temp.  Platelet = at 22c  Others = 1-6c  Preparation protocol Counter balancing Weighing Centrifugatio n Expression Centrifugation - Principle Blood cells have different Sedimentation Coefficients } Plasma } Buffy Coat } Packed Red Cells  How is blood used? Nowadays, whole blood is rarely used except in cases of sudden and severe blood loss. Instead, it is nearly always separated into its individual components and used for different purposes.  1- Whole Blood:  Contents RBC’s WBC’s Platelets Plasma Clotting factors  Component Requirements Stored: 1-6° C 21 or 35 days depending on preservative (CPD, or CPDA-1)  Indications Acute loss of whole blood like in operations and accidents. In Aplastic anaemia.  Correct anaemia. Kidney dialysis.  2- Packed red cells Contents RBC’s 20% Plasma Indications Replace O2 carrying capacity with less volume  Severe anemia, slow blood loss, CHF(Congestive Heart Failure)  Preparation:  Blood should be drawn in double bags.  Usually 225 ml of plasma is removed.  PRBCs (Packed red blood cells ) stored in CDPA have Hct of 70- 80% and can be stored for35 days, wheres PRBCs stored in additive solutions( AS) have Hct 52-60% and shelf life of 42 days.  RBCs must be stored at 1-6 C (refrigerated)  Packed red cells shelf life up to 42 days  The blood should be used within the expiration date of the bags (CDPA, AS).  Packed RBCs are ordinarily the component of choice with which to increase Hb. Preparation Indications depend on the patient. O2- carrying capacity may be adequate with Hb levels as low as 7 g/L in healthy patients, but transfusion may be indicated with higher Hb levels in patients with decreased cardiopulmonary reserve or ongoing bleeding. One unit of RBCs increases an average adult's Hb by about 1 g/dL and his Hct by about 3% of the pretransfusion Hct value.  3- Washed red cells It’s convenient but expensive. Washed RBCs are free of almost all traces of plasma, most WBCs, and platelets. RBCs washed prepared by using an automated cell washer and centrifugation. RBCs from any unite are mixed with large volumes of physiologic saline The red cell-saline mixture is then centrifuged and the supernatant is removed  3- Washed red cells The procedure removes about 99% of the plasma protein and up to 20% of the red blood cell mass Following completion of the washing process, the RBCs are suspended in 0.85% normal saline. Because the original collection bag must be opened to facilitate the washing process, a washed RBC product has a shelf life of 24 hours from the time of entry. Indications RBCs washed generally given to patients who have severe reactions to plasma (eg, severe allergies, or IgA immunization). One type of patient who is candidate excellent for transfusion with RBCs washed is the IgA-deficient patient. The patient most at risk for anti-IgA development is the IgA-deficient patient who has been previously transfused or pregnant. The rare patient who does develop anti-IgA can experience sever, potentially fatal anaphylaxis when receiving products carring IgA  Indications The patient with anti-IgA has only two choices for transfusion:  Receive products from another IgA-deficient person  Have the IgA- containing plasma removed before transfusion of the products. Because number of IgA-deficient persons is small  4-Frozen RBCs  Glycerol is added to cryoprotect the unit (≤ -65°C for 10 years )  Glycerol prevents cell lysis  Why?  Freezing RBCs preserves rare units or extends to life of autologous units N.B Cryoprotective agent: A chemical agent, such as glycerol, capable of protecting cells from freeze injury.  4-Frozen RBCs Deglycerolized RBCs Good at 1-6°C for 24 hours  RBCs that have had the glycerin removed  Thawed at 37°C  A blood cell processor washes the cells with varying concentrations of saline  Considered “open”, expires in 24 hrs. Terms to know: Closed system: a sterile system of blood collection Open system: when the collection is exposed to air, decreasing expiration date  5- Fresh frozen plasma (FFP) Contents Clotting factors Fibrinogen Prothrombin Albumin Globulins  Plasma that is frozen within 8 hours of donation -18°C or colder for 1 year  Indications Bleeding Abnormal clotting due to massive transfusion Disseminated intravascular coagulation [DIC], liver failure Hypofibrinogenaemia  Preparation: Can be prepared by: Single heavy spin. Double centrifugation to prepare platelet conce. At the same time. Each unit contains about 225 ml of plasma.  Plasma that is frozen within 8 hours of donation  -18°C or colder for 1 year After collection by placing it in a dry ice-alcohol bath or in freezer at -65c or colder.  Preparation:  FFP bags should be frozen in a horizontal position.  Shelf life is 12 months when store at -18c or less.  When required FFP can be thawed with agitation in 37c in water bath. FFP is thawed before transfusion  30-37°C waterbath for 30-45 minutes  Stored 1-6°C and transfused within 24 hours  Needs to be ABO compatible  6-Platelet concentrate Contents Platelets WBC’s Plasma  Important in maintaining hemostasis  Help stop bleeding and form a platelet plug (primary hemostasis)  6-Platelet concentrate cont.  Indications Low platelet counts (bleeding). Platelet concentrates are used to prevent bleeding in: 1.asymptomatic severe thrombocytopenia (platelet count < 10,000/μL) 2.For bleeding patients with less severe thrombocytopenia (platelet count < 50,000/μL) 3.For bleeding patients with platelet dysfunction due to antiplatelet drugs but with normal platelet count 6-Platelet concentrate cont. 4. For patients receiving massive transfusion that causes dilutional thrombocytopenia 5. Sometimes before invasive surgery. 6. Acute leukemia 7. Lymphoma. 8. ITP ( Idiopathic thrombocytopenic purpura) 9. Bone marrow transplant  Preparation: Requires 2 spins: Soft – separates RBCs and WBCs from plasma and platelets  Heavy platelets in platelet rich plasma (PRP) will be forced to the bottom of a satellite bag 40-60 mL of plasma is expelled into another satellite bag, while the remaining bag contains platelet concentrate Storage Temperature  20-24°C for 5 days (constant agitation) Each unit should contain at least 5.5 x 1010 platelets (platelet concentrate) Each unit should elevate the platelet count by 5-10,000 μL in a 165 lb person  Types of platelets  Pooled platelets  Used to reach therapeutic dose  An “open system” occurs when pooling platelets, resulting in an expiration of 4 hours  Platelet, pheresis – therapeutic dose (from one donor) without having to pool platelets  HLA matched – for those with HLA antibodies  Leukocyte reduced - used to prevent febrile non-hemolytic reactions and HLA alloimmunization  7- Cryoprecipitated anti hemophilic factor ( AHF ) Contents Factors VIII and XIII, Fibrinogen and von Willebrand factor (vWF)v. It also contains fibronectin Indications Hemophilia A Fibrinogen deficiency Factor XIII deficiency Disseminated intravascular coagulation Rare factor XIII deficiency. Von Weill brand's disease.  Preparation:  Cryoprecipitate is a concentrate prepared from FFP, it should be frozen within 4h and stored at -18c or less.  A bag of cryoprecipitate should be contain on the average about 80-100 units of AHF/unit.  The shelf life is 12 month, when store at -18c or low.  When requested, cryo precipitate may be thawed in a 37c water bath and then should be maintained at room temp. And used as soon as possible or within 6h after thawing. 8-Antithrombin III (AT III) Antithrombin III (AT III) is a plasma protein which acts as the principal inhibitor of thrombin and is a major modulator of intravascular coagulation. Hereditary deficiency of AT III leads to recurrent episodes of thromboembolism. Acquired deficiency of AT III occurs in persons with a variety of conditions, including severe liver disease and disseminated intravascular coagulation. Replacement of AT III may be important in some deficient persons.  9- Plasma Protein Fraction: Contents 5% Albumin/Globin in saline Indications Expand volume in burns Hemorrhage Hypoproteinemia