blood component and uses
TRANSCRIPT
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BLOOD COMPONENTS STORAGE AND USESAkor EmmanuelDept. of Haematology and Blood TransfusionJos University Teaching Hospital
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2 Outline
Introduction General Principles Blood Collection Anticoagulant/Preservative Solutions Blood Components
Storage conditions Blood Replacement products: Recommended uses and
effects in adults
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9 Definition
BLOOD PRODUCTS Any therapeutic substance prepared from human
blood through physical and or chemical means.
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11 BLOOD COMPONENTS
Red cell concentrates Platelet concentrates Granulocyte concentrates Fresh frozen plasma cryoprecipitate
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12 Terms to know:
Whole blood: blood collected before separation into components
Components: parts of whole blood that are separated
Closed system: a sterile system of blood collection Open system: when the collection is exposed to air,
decreasing expiration date
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Collection basics
Blood is collected in a primary bag that contains anticoagulant-preservatives
Satellite bags may also be attached, depending on what components are needed
Anticoagulant-preservatives minimize biochemical changes and increase shelf life
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Blood Component Preparation
Components of whole blood are centrifuged: “light spin” – short time, low RPM (1500 for
10mins) “heavy spin” – longer spin, high RPM (5000rpm for
20mins)
Centrifuge must be at 40C
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Plasma hemoglobinPlasma K+
Viable cellspHATP
2,3-DPGPlasma Na+
Helps release oxygen from hemoglobin
(once transfused, ATP & 2,3-DPG return to
normal)
K+Na+
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17 Whole Blood
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18 Whole Blood
Consists of RBCs, WBCs, platelets and plasma (with anticoagulant)
Indications Patients who are actively bleeding and lost >25% of
blood volume Exchange transfusion
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Whole Blood
Component Requirements Stored: 1-6° C Shipping: 1-10° C 21 or 35 days depending on preservative (CPD, CP2D,
or CPDA-1)
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Red Blood Cells
RBCs 1-6° C (stored); 1-10° C (shipped) 21, 35, or 42 days depending on preservative or additive Hematocrit should be ≤80% One unit increases hematocrit 3% Once the unit is “opened” it has a 24 hour expiration date! 24 hours
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21 Red Blood Cells
RBCs (frozen) ≤ -65°C for 10 years
RBCs (deglycerolized or washed) Good at 1-6°C for 24 hours
RBCs (irradiated) 1-6°C for 28 days
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22 Red Blood Cells
RBCs are usually given because of their hemoglobin content
They increase the mass of circulating red blood cells in situations where blood loss occurs
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23 INDICATIONS FOR RBC
Conditions include: Oncology patients (chemo/radiation) Trauma victims Cardiac, orthopedic, and other surgery End-stage renal disease Premature infants Sickle cell disease ( Hgb A)
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RBC Types Leukocyte-Reduced RBCs are for:
patients who receive a lot of transfusions to prevent antibody production toward WBC antigens
Patients transfused outside of a hospital Patients who have reacted to leukocytes in the past
Final unit must have less than 5 x 106 WBCs
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25 Leukocyte Reduction Filters (maintains closed system)
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Frozen RBCs Glycerol is added to cryoprotect the unit Glycerol prevents cell lysis Why? •Freezing RBCs preserves rare units or
extends to life of autologous units
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27 Deglycerolized RBCs
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.
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28 Washed RBCs
Not effective in reducing WBCs For patients (with anti-IgA) that may react with
plasma proteins containing IgA Reactions may be allergic, febrile, or anaphylactic
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29 Irradiated RBCs
Prevents T-cell proliferation that may cause transfusion-associated graft versus host disease (GVHD)
GVHD is fatal in 90% of those affected Produced by subjecting RBC to high dose radiation
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30 INDICATIONS
Donor units from a blood relative HLA-matched donor unit Intrauterine transfusion Immunodeficiency Premature newborns Chemotherapy and irradiation Patients who received marrow or stem cells
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PLATELETS
Important in maintaining hemostasis Help stop bleeding and form a platelet plug (primary hemostasis)
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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
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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
Single donor platelet from apheresis is equivalent to 6-8 random platelet units which makes up the therapeutic dose
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34 INDICATIONS
Cancer patients Bone marrow recipients Postoperative bleeding ITP
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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 3x1011 minumum
HLA matched – for those with HLA antibodies Leukocyte reduced - used to prevent febrile non-hemolytic reactions
and HLA alloimmunization
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Fresh Frozen Plasma (FFP) Plasma that is frozen within 8 hours of
donation
-18°C or colder for 1 year
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Fresh Frozen Plasma (FFP) FFP is thawed before transfusion 30-37°C water bath for 30-45 minutes Stored 1-6°C and transfused within 24 hours Needs to be ABO compatible
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38 INDICATIONS
Provides coagulation factors for Bleeding disorders Abnormal clotting due to massive transfusion Patients on warfarin who are bleeding Treatment of TTP and HUS Factor deficiencies ATIII deficiency DIC when fibrinogen is <100 mg/dL
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Cryoprecipitate Cryoprecipitated antihemophilic factor (AHF) or “Cryo” is the
precipitated protein portion that results after thawing FFP Contains: von Willebrand’s factor (plt. adhesion) Fibrinogen
150 mg in each unit Factor VIII
About 80 IU in each unit Fibrinonectin
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40 Cryoprecipitate
Same storage as FFP (cannot be re-frozen as FFP once it is separated); -18 for 1 year
If thawed, store at room temp 4 hrs The leftover plasma is called cryoprecipitate reduced
or plasma cryo or cryo supernatant Good for thrombocytopenic purpura (TTP)
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41 INDICATIONS FOR CRYO
treatment for Factor VIII deficiency (Hemophilia A) treatment for von Willebrand’s Disease Congenital or acquired fibrinogen deficiency FXIII deficiency “Fibrin Glue” applied to surgical sites
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44 GRANULOCYTE CONCENTRATE
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45 INDICATIONS/CRITERIA
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46 PLASMA DERIVATIVES
Plasma proteins prepared from large pools of human plasma under pharmaceutical manufacturing conditions.
Albumin Coagulation factors immunoglobulins
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47 CONCLUSIONS
A good knowledge of component therapy is vital to minimize wastage of a scarce life saving tissue and also limit the complications arising from its use as only required component is administered.
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48Thank you
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49 references
John P.G wintrobes clinical hematology,twelfth edition;Vol 1;ch 23,pg 672-712
http://emedicine.medscape.com/article/202030-clinical#a0217. Hannah olawunmi a lecture on blood component preparation and uses
for WACP update curse 2015