Blood products.Blood products.Preparation of blood Preparation of blood

componentscomponents

Whole bloodWhole blood

plasma Backed Red Cells

90% water RBC10% plasma material

Fresh frozen plasma

Platelet concentrate

Cryoprecipitate – VIII = AHF

albumin

Fibrinogen

Immunoglobulin

Others

Blood bagsBlood bags

Single blood bag:Single blood bag: Whole bloodWhole blood

Double bags:Double bags: Backed red cellsBacked red cells plasmaplasma

Triple bags:Triple bags: Backed cellsBacked cells PlasmaPlasma plateletsplatelets

Quarterly bags:Quarterly bags: Backed cellsBacked cells PlasmaPlasma PlateletsPlatelets Plasma factors Plasma factors

Special bags:Special bags:Frozen blood upto 2 years and store under Frozen blood upto 2 years and store under

(– 70- 90 c) (– 70- 90 c) The bags should be sterile = no The bags should be sterile = no

contamination.contamination. Patient information's:Patient information's:

No of patients.No of patients.Name.Name.Others.Others.

CentrifugationCentrifugation This is the first step of blood preparationThis is the first step of blood preparation Depend on 2 factors:Depend on 2 factors:

Relative centrifugation factor (RCF).Relative centrifugation factor (RCF). Duration of centrifugation.Duration of centrifugation.

1.1. Heavy spinHeavy spin 5000 /g / 7min = leukocyte-poor RBC, or cell free plasma.5000 /g / 7min = leukocyte-poor RBC, or cell free plasma. 5000/g / 5min = backed cell and platelet concentrate.5000/g / 5min = backed cell and platelet concentrate. 4170/ g / 10min = cryoprecipitate4170/ g / 10min = cryoprecipitate2. 2. Light spinLight spin 4170 /g/2min = platelet rich plasma.4170 /g/2min = platelet rich plasma.Centrifugation temp.Centrifugation temp. Platelet = at 22cPlatelet = at 22c Others = 1-6cOthers = 1-6c

1 -Whole Blood:

ContentsRBC’sWBC’sPlateletsPlasmaClotting factors

IndicationsAcute loss of whole blood

2 -Packed Red Cells

ContentsRBC’s20% Plasma

IndicationsReplace O2 carrying capacity with less

volumeSevere anemia, slow blood loss, CHF

2 -Packed Red Cells

- Preparation: Blood should be drawn in double bags.Usually 225 ml of plasma is removed.The Hct is about 70-80%.The blood should be used within the

expiration date of the bags.Packed RBCs are ordinarily the

component of choice with which to increase Hb.

22 - -Packed red cellsPacked red cells Indications depend on the patient. O2-carrying Indications depend on the patient. O2-carrying

capacity may be adequate with Hb levels as low capacity may be adequate with Hb levels as low as 7 g/L in healthy patients, but transfusion may as 7 g/L in healthy patients, but transfusion may be indicated with higher Hb levels in patients be indicated with higher Hb levels in patients with decreased cardiopulmonary reserve or with decreased cardiopulmonary reserve or ongoing bleeding. ongoing bleeding.

One unit of RBCs increases an average adult's One unit of RBCs increases an average adult's Hb by about 1 g/dL and his Hct by about 3% of Hb by about 1 g/dL and his Hct by about 3% of the pretransfusion Hct value. the pretransfusion Hct value.

When only volume expansion is required, other When only volume expansion is required, other fluids can be used concurrently or separately.fluids can be used concurrently or separately.

33 - -Washed red cellsWashed red cells

It’s convenient but expensive.It’s convenient but expensive. Washed RBCs are free of almost all traces of Washed RBCs are free of almost all traces of

plasma, most WBCs, and platelets. plasma, most WBCs, and platelets. They are generally given to patients who have They are generally given to patients who have

severe reactions to plasma (eg, severe severe reactions to plasma (eg, severe allergies, paroxysmal nocturnal allergies, paroxysmal nocturnal hemoglobinuria, or IgA immunization). hemoglobinuria, or IgA immunization).

In IgA-immunized patients, blood collected In IgA-immunized patients, blood collected from IgA-deficient donors may be preferable from IgA-deficient donors may be preferable for transfusion.for transfusion.

44 - -Leukocyte-poor red cells orLeukocyte-poor red cells or WBC-depleted RBCsWBC-depleted RBCs::

Are prepared with special filters that remove ≥ Are prepared with special filters that remove ≥ 99.99% of WBCs. 99.99% of WBCs.

The majority of febrile non-hemolytic reactions The majority of febrile non-hemolytic reactions (FNH), can be alienate by transfusion leukocyte-(FNH), can be alienate by transfusion leukocyte-poor red cells, so they are indicated for patients poor red cells, so they are indicated for patients who have experienced nonhemolytic febrile who have experienced nonhemolytic febrile transfusion reactions, and possibly for the transfusion reactions, and possibly for the prevention of platelet alloimmunization.prevention of platelet alloimmunization.

33 - -Leukocyte-poor red cells orLeukocyte-poor red cells or WBC-depleted RBCsWBC-depleted RBCs::

Can be prepared by several techniques:Can be prepared by several techniques:Double centrifugeDouble centrifugeHeavy spin.Heavy spin.Filtration: passing the blood through a nylon Filtration: passing the blood through a nylon

filter which is an efficient method for removal filter which is an efficient method for removal of granulocytes. Heparin is the anticoagulant of granulocytes. Heparin is the anticoagulant used for this procedure. In Europe the used used for this procedure. In Europe the used the cotton for removal lymphocytes and the cotton for removal lymphocytes and granulocytes.granulocytes.

33 - -Leukocyte-poor red cells orLeukocyte-poor red cells or WBC-depleted RBCsWBC-depleted RBCs::

Sedimentation: this method provides 90% of Sedimentation: this method provides 90% of red blood cells and 10% of original no of red blood cells and 10% of original no of platelet and leukocyte. platelet and leukocyte.

Washing: is provides a good recovery of Washing: is provides a good recovery of erythrocyte with low no of WBC and platelet.erythrocyte with low no of WBC and platelet.

Frozen deglycerolized red cells: when Frozen deglycerolized red cells: when maximally leukocyte poor red blood cells maximally leukocyte poor red blood cells needed.needed.

5 -Fresh frozen plasma (FFP)

ContentsClotting factorsFibrinogenProthrombin AlbuminGlobulins

5 -Fresh frozen plasma (FFP) Indications

Volume expansion : FFP can supplement RBCs when whole blood is unavailable for exchange transfusion, but FFP should not be used simply for volume expansion.

Fresh frozen plasma (FFP) is an unconcentrated source of all clotting factors deficiency, so indications also include correction of bleeding secondary to factor deficiencies for which specific factor replacements are unavailable, multifactor deficiency states (eg, massive transfusion, disseminated intravascular coagulation [DIC], liver failure)

5- Fresh frozen plasma (FFP)5- Fresh frozen plasma (FFP) Preparation:Preparation: Can be prepared by:Can be prepared by:

Single heavy spin.Single heavy spin. Double centrifugation to prepare platelet conce. At Double centrifugation to prepare platelet conce. At

the same time.the same time. Each unit contains about 225 ml of plasma.Each unit contains about 225 ml of plasma. Can protect bags within 6h. After collection by placing it Can protect bags within 6h. After collection by placing it

in a dry ice-alcohol path or in freezer at -30c or below.in a dry ice-alcohol path or in freezer at -30c or below. FFP bags should be frozen in a horizontal position and FFP bags should be frozen in a horizontal position and

store at vertical position.store at vertical position. Shelf life is 12 months when store at -18c or less.Shelf life is 12 months when store at -18c or less. When required FFP can be thawed with agitation in 37c When required FFP can be thawed with agitation in 37c

in water path and used within 2h.in water path and used within 2h.

66 - -Platelet concentratePlatelet concentrateContentsContents

PlateletsPlatelets WBC’sWBC’s PlasmaPlasma

IndicationsIndicationsLow platelet counts (bleeding) . Platelet concentrates are Low platelet counts (bleeding) . Platelet concentrates are

used to prevent bleeding in: used to prevent bleeding in: asymptomatic severe thrombocytopenia (platelet count asymptomatic severe thrombocytopenia (platelet count

< 10,000/μL)< 10,000/μL) For bleeding patients with less severe For bleeding patients with less severe

thrombocytopenia (platelet count < 50,000/μL)thrombocytopenia (platelet count < 50,000/μL) For bleeding patients with platelet dysfunction due to For bleeding patients with platelet dysfunction due to

antiplatelet drugs but with normal platelet countantiplatelet drugs but with normal platelet count For patients receiving massive transfusion that causes For patients receiving massive transfusion that causes

dilutional thrombocytopeniadilutional thrombocytopenia And sometimes before invasive surgery.And sometimes before invasive surgery.

66 - -Platelet concentratePlatelet concentrate

Preparation:Preparation:Platelet-rich plasma is separated by Platelet-rich plasma is separated by

light spin from erythrocyte.light spin from erythrocyte.Platelet conc. is then obtained by a Platelet conc. is then obtained by a

heavy spin of platelet rich plasma.heavy spin of platelet rich plasma.Centrifugation should be done at 22c.Centrifugation should be done at 22c.Separation should be done within 4h. Separation should be done within 4h.

After the blood is drawn.After the blood is drawn.Plasma portion can be frozen as FFP.Plasma portion can be frozen as FFP.

66 - -Platelet concentratePlatelet concentrate

Plasma should be frozen within 2h of separation at -Plasma should be frozen within 2h of separation at -30c or less.30c or less.

When needed, Frozen plasma should then be When needed, Frozen plasma should then be thawed between 1-6c over night in a refrigerator or thawed between 1-6c over night in a refrigerator or more quickly in a water path at 4c.more quickly in a water path at 4c.

One platelet concentrate increases the platelet One platelet concentrate increases the platelet count by about 10,000/μL, and adequate count by about 10,000/μL, and adequate hemostasis is achieved with a platelet count of hemostasis is achieved with a platelet count of about 10,000/μL in a patient without complicating about 10,000/μL in a patient without complicating conditions and about 50,000/μL for those conditions and about 50,000/μL for those undergoing surgery. Therefore, 4 to 6 random undergoing surgery. Therefore, 4 to 6 random donor platelet concentrates are commonly used in donor platelet concentrates are commonly used in adults.adults.

66 - -Platelet concentratePlatelet concentrate

Platelet concentrates are increasingly being Platelet concentrates are increasingly being prepared by automated devices that harvest the prepared by automated devices that harvest the platelets (or other cells) and return unneeded platelets (or other cells) and return unneeded components (eg, RBCs, plasma) to the donor. components (eg, RBCs, plasma) to the donor.

This procedure, calledThis procedure, called cytapheresiscytapheresis, provides , provides enough platelets from a single donation enough platelets from a single donation (equivalent to 6 random platelet units) for (equivalent to 6 random platelet units) for transfusion to an adult, which, because it transfusion to an adult, which, because it minimizes infectious and immunogenic risks, is minimizes infectious and immunogenic risks, is preferred to multiple donor transfusions in preferred to multiple donor transfusions in certain conditions.certain conditions.

66 - -Platelet concentratePlatelet concentrateCertain patients may not respond to platelet Certain patients may not respond to platelet

transfusions, possibly because of splenic transfusions, possibly because of splenic sequestration or platelet consumption due to HLA or sequestration or platelet consumption due to HLA or platelet-specific antigen alloimmunization. These platelet-specific antigen alloimmunization. These patients may respond to multiple random donor patients may respond to multiple random donor platelets (because of greater likelihood that some platelets (because of greater likelihood that some units are HLA compatible), platelets from family units are HLA compatible), platelets from family members, or ABO- or HLA-matched platelets.members, or ABO- or HLA-matched platelets.

Alloimmunization may be mitigated by transfusing Alloimmunization may be mitigated by transfusing WBC-depleted RBCs and WBC-depleted platelet WBC-depleted RBCs and WBC-depleted platelet concentrates.concentrates.

77 - -Cryoprecipitated anti hemophilic Cryoprecipitated anti hemophilic factor ( AHF )factor ( AHF )

ContentsContentsFactors VIII and XIII, Fibrinogen and von Willebrand Factors VIII and XIII, Fibrinogen and von Willebrand

factor (vWF)v. It also contains fibronectinfactor (vWF)v. It also contains fibronectin

IndicationsIndicationsHemophilia AHemophilia AFibrinogen deficiencyFibrinogen deficiencyFactor XIII deficiencyFactor XIII deficiency

Disseminated intravascular coagulation Disseminated intravascular coagulation Rare factor XIII deficiency.Rare factor XIII deficiency.

Preparation: Preparation: Cryoprecipitate is a concentrate prepared from Cryoprecipitate is a concentrate prepared from

FFP, it should be frozen within 4h and stored at FFP, it should be frozen within 4h and stored at -18c or less.-18c or less.

A bag of cryoprecipitate should be contain on A bag of cryoprecipitate should be contain on the average about 80-100 units of AHF/unit. the average about 80-100 units of AHF/unit.

The shelf life is 12 month, when store at The shelf life is 12 month, when store at -18c -18c or low.or low.

When requested, cryo precipitate may be When requested, cryo precipitate may be thawed in a 37c water path and then should be thawed in a 37c water path and then should be maintained at room temp. And used as soon as maintained at room temp. And used as soon as possible or within 6h after thawing.possible or within 6h after thawing.

77 - -Cryo-precipitated anti hemophilic Cryo-precipitated anti hemophilic factor ( AHF )factor ( AHF )

66 - -Cryo precipitated anti hemophilic Cryo precipitated anti hemophilic factor ( AHF )factor ( AHF )

In general, it should not be used for other In general, it should not be used for other indications.indications.

A bag of cryo precipitate should be contain on A bag of cryo precipitate should be contain on the average about 80-100 units of AHF/unit. the average about 80-100 units of AHF/unit.

The shelf life is 12 month, when store at The shelf life is 12 month, when store at -18c or -18c or lower.lower.

When requested, cryo precipitate may be When requested, cryo precipitate may be thawed in a 37c water path and then should be thawed in a 37c water path and then should be maintained at room temp. And used as soon as maintained at room temp. And used as soon as possible or within 6h after thawing.possible or within 6h after thawing.

88 - -WBCsWBCs::Granulocytes:Granulocytes: ContentsContents

WBC’sWBC’s20% Plasma20% Plasma

IndicationsIndicationsLife-threatening decreases in WBC countLife-threatening decreases in WBC countGranulocytes may be transfused when sepsis Granulocytes may be transfused when sepsis

occurs in a patient with profound persistent occurs in a patient with profound persistent neutropenia (WBCs < 500/μL) who is neutropenia (WBCs < 500/μL) who is unresponsive to antibiotics.unresponsive to antibiotics.

88 - -WBCsWBCs::

Important Notes:Granulocytes must be given within 24 h of

harvest; however, testing for HIV, hepatitis, human T-cell lymphotropic virus, and syphilis may not be completed before infusion.

Because of improved antibiotic therapy and drugs that stimulate granulocyte production during chemotherapy, granulocytes are seldom used.

99 - -Immune globulinsImmune globulins : :

Rh immune globulin (RhIg), given IM or IV, Rh immune globulin (RhIg), given IM or IV, prevents development of maternal Rh antibodies prevents development of maternal Rh antibodies that can result from fetomaternal hemorrhage. that can result from fetomaternal hemorrhage.

Other immune globulins are available for Other immune globulins are available for postexposure prophylaxis for patients exposed to a postexposure prophylaxis for patients exposed to a number of infectious diseases, including number of infectious diseases, including cytomegalovirus, hepatitis A and B, measles, cytomegalovirus, hepatitis A and B, measles, rabies, respiratory syncytial virus, rubella, tetanus, rabies, respiratory syncytial virus, rubella, tetanus, smallpox, and varicella.smallpox, and varicella.

10 -Plasma Protein Fraction:

Contents5% Albumin/Globin in saline

IndicationsExpand volume in burnsHemorrhageHypoproteinemia

11 -Albumin:

Contents5% or 25% albumin

IndicationsReplace volume in shockBurnsHypoproteinemia