Blood components

a presentation giving a general idea about basic machinery of blood bank.

1. Blood components & Rationale of use Presented by: Dr. Himani rai Moderator: dr. sonal gupta

2. A blood donor donates the product known as whole blood, from which components are prepared. The ability to separate various components from whole blood is desirable for the following reasons: 1.Separation of blood into components allows optimal survival of each constituents. 2. Component preparation allows transfusing only specific blood component that the patient requires.

3. 3. Transfusion of only the specific constituent of the blood needed avoids the use of unnecessary component, which could be contraindicated in a patient . 4. By using blood components, several patients can be treated with the blood from one donor, giving optimal use of every unit of donated blood.

4. Blood components & Plasma derivatives Cellular components Red cell concentrate Platelet concentrate Leucocytes-reduced red cells Leukocytes-reduced platelet concentrate Granulocytes, apheresis Plasma components Fresh frozen plasma Single donor plasma Cryoprecipitate Cryo -poor plasma Plasma derivatives Albumin plasma protien fractions Factor VIII concentrate Immunoglobulins Fibrinogen Other coagulation factors

5. Preparation of blood components is possible due to : • Multiple Plastic packs system • Refrigerated centrifuge •Different specific gravity of cellular components: 1)Red cells specific gravity 1.08 - 1.09 2)Platelet specific gravity 1.03 - 1.04 3) Plasma specific gravity 1.02 - 1.03

6. Whole blood 350-450 ml of blood 49-63ml of anticoagulant solution Hct - 30-40% No components removed Stored at 1- 6 degree celsius Shelf life : • Citrate –phosphate –Dextrose(CPD)- 21days • CPDA (adenine) – 35 days • AS-1, AS-3, AS-5 – 42 days

7. Increase H b by 1 g/dl Rate of blood transfusion -3ml/kg/ hr

8. Functions of whole blood Red cells in whole blood carry O2 to tissues Plasma in whole blood is blood volume expander whole blood is a source of proteins with oncotic properties Is a source of non-labile coagulation factors

9. Indication F or those patients who have hypovolemia with shock. The patients of trauma and for major surgery

10. Whole blood Drawbacks After storage for 24 hours at 1-6 degree celsius platelets and WBC are non functional Factor V and Viii decrease with storage Fluid overload

11. Fresh blood Whole blood or red blood cells concentrates less than 12-24 hours old from the time of collection are considered fresh. P rovides the greatest oxygen-carrying capacity because it has the maximum level of 2, 3 - di- phosphoglycerate (2, 3-DPG) and minimum amount of potassium as compared with older blood. I ndicated in newborns because they have high percentage of fetal hemoglobin, which does not release oxygen to the tissues as well as the adult hemoglobin.

12. Red blood cell (PRC) Shelf life – 35 days with CPDA and 42 days with additive solutions Storage temp- 2 – 6 Degree celsius QC Requirements: PCV 80% (Range 65-80%) Volume- 250- 300 ml Contents : • red cells- 65-80%, • Plasma 20- 35%, • Some platelets, • white blood cell and anticoagulant preservative solutions

13. Indication of prc In decreased bone marrow production conditions leukemia ,aplastic anemia In decreased red cells survival conditions hemolytic anemia ( eg . Thalassaemia ) In bleeding patients surgical bleeding traumatic bleeding

14. Hemoglobin of less than 6.0 g/dl in the absence of disease and between 8 and 10 g/dl with disease need transfusion of red cells. Each unit of transfused red cells prepared from 450 ml of whole blood increase hemoglobin by about 1 g/dl ( hct 3 per cent) in a patient of 70 kg body weight

15. Advantages of transfusion of PRC (over whole blood) Reduce risk of circulatory overload due to less volume of anticoagulant and plasma Lessens severity and incidence of allergic reactions ABO antibodies are reduced, red cells non-ABO identical to patient’s group can be given, if compatible Removed plasma can be used for preparing FFP and cryoprocipitate (factors VIII and V).

16. Contraindications of PRC: To correct protein and coagulation factors deficiency Preoperative transfusion to raise H b above 10 g/dl T o enhance general well being, promote wound healing, prevent infection, expand blood volume when oxygen-carrying capacity is adequate

17. Leukocytes reduced red blood cells Methods of the preparation of leucocyte reduced red cells C entrifugation and removing of buffy coat Filtration Washing of red cells with saline F reezing and thawing of red cells

18. Indications: Multitransfused patients like thalassaemic Leukemia Aplastic anemia Immunosupressed Immunodeficient

19. Continued….. Multiparous women Prevention of recurrent FNHTRs (Febrile non haemolytic transfusion reactions) Prevention or delay of primary alloimmunization to HLA antigen Prevention of CMV transmission in at risk individual

20. Leukocytes in blood components can cause : Non- hemolytic febrile transfusion reaction (NHFTR) Human leukocyte antigen (HLA) alloimmunizaion Transmission of leukotropic viruses (cytomegalovirus(cmv), epstein - barr virus (EBV) and human t-cell lymphotropic virus type 1 (HTLV-1) Transfusion related graft versus host disease Transfusion related acute lung injury (TRALI) Transfusion related immunosuppression

21. WASHED RED CELLS Washing of red cells removes 70 - 95 % of leukocytes and there is concomitant loss of 15 - 20 ml of red blood cells, but it is effective in removal of plasma proteins and microaggregates .

22. Indications Patients having recurrent attacks FNHTRs and urticarial reactions . Patients who have developed antibodies to plasma proteins. IgA deficient patient who has developed anti-IgA (incidence of IgA deficiency is 1 in 700 persons ). Paraoxymal noctural hemglobiuria (PNH), sensitive to complement

23. FROZEN/DEGLYCEROLIZED RED CELLS Indications Storage of rare blood group Autologous units of patients with multiple red cells alloantibodies stored for future surgery. Prevention of non hemolytic febrile transfusion reaction in patients sensitized to leukocytes, platelets or plasma protein. Prevention of sensitization against HLA antigen.

24. Platelet concentrates Shelf life: 1 day if no storage cabinet & 5 days in platelet incubator and agitator Storage temp :20-24 degree celsius Q.C requirements: to be prepared within 6hr of collection and pH should be >6.2 V olume: 30 to 50 ml contents: 5.5x10 10 unit/bag

25. indications Platelet count is < 5000 / µl regardless of clinical condition E ffect: increases platelet count by 5000-10000/ µl per unit Dosage : Adults: 1 Unit of RDP for every 10 kg increases platelet count by approx. 50x10 9 /l (50,000/mm 3 ). Pediatric: 0.2unit/kg of RDP will raise platelet count to 50x10 9 /L (50,000/mm 3 ).

26. Platelet concentrates can be prepared from: 1. Random donor platelet (prepared from 450ml whole blood) 2. Single donor platelet prepared by apheresis .

27. Platelet Apheresis (single donor platelet) Random donor platelet Average >3x10 11 platelet (equal to platelet obtained from 5-6 donations) 5.5x10 10 platelets Leukocytes<5.5x10 6 10 8 in each unit Red cell traces more

28. Single donor platelet Random donor platelet Exposes a patient to one donor Exposes a patient to multiple donor Less exposure to infections More exposure to infections Low risk to alloimunization Relatively more risk to alloimunization HLA or platelet matched donor product can be prepared No t Possible Highly trained person and equipment required Not much

29. Single donor platelet Obtained by plasmapheresis technique 6 to 8 times more platelets as in random donor unit Larger volumes and HLA compatibility results in increase of 30 to 60 k Leucoreduced because of apheresis technique ABO Matched platelets preferred

30. Granulocyte (GC) Granulocyte products available : buffy coat granulocytes, apheresis B uffy coat prepared from 450 ml of blood contains : • 0.60 x 10 9 granulocytes • C ontaminated with red cells, platelets, other leukocytes • 15-20 ml plasma

31. Indications of gc Septicaemia not responding to antibiotics. Infections in patients undergoing chemo / radio therapy for neoplastic diseases N eutrophil count less than 0.50 x 109/L (500 / mm3), having gram-negative infection which fail to respond with antibiotics Temporary bone marrow depression for 1 - 2 weeks.

32. Doses and Administration of Granulocytes • In adult lxl0 10 granulocytes daily e.g. 1 unit of granulocytes prepared by apheresis (equivalent to 18 - 20 units of buffy coat ) • Infected neonates need 0.5 - 0.6 x 10 9 granulocytes daily Granulocytes transfusion should be discontinued when the patient becomes afebrile, or when granuolcyte count exceeds 1.0 x 109/L.

33. FRESH FROZEN PLASMA Fresh frozen plasma (FFP) is plasma that is separated from whole blood and is frozen within 6-8 hours of collection. FFP contains plasma proteins and all coagulation factors, including the labile Factors V and VIII if stored at - 30°C or below

34. Contents of 1 unit of FFP prepared from 450 ml Of whole blood Plasma :175 - 230 ml All coagulation Factors ( including Factors V & VIII) : 1 i.u . / ml of each factor Fibrinogen : 200-400mgm

35. Indications of Fresh Frozen Plasma ƒ Actively bleeding and multiple coagulation factors deficiencies in • Liver diseases • Disseminated intravascular coagulation (D1C) • Coagulopathy in massive transfusion • TTP • When specific disorder cannot be or has not yet been identified

36. 2.Familial Factor V deficiency If concentrated Factor V is not available, FFP can be used as a source of Factor V. 3.Deficiency of Factors II, VII, IX,, and X 4.Antithrombin III deficiency 5.Congenital or acquired coagulation factor deficiency 6.Use of FFP in conjunction with red cells has largely replaced the transfusion of fresh blood

37. Dosage of ffp About 10 ml / Kg of body weight. Post transfusion assessment of levels of aPTT , PT and fibrinogen is done for monitoring the effect of FFP. FFP should be thawed at 30-37°C in circulating water bath. Thawed plasma should be transfused as soon as possible, or within 12 hours, if stored at2-4°C.

38. PLASMA ABO COMPATIBILITY Recipient’s blood group Plasma donor’s blood gop O O, A, B, AB A A, AB B B, AB AB AB

39. Contraindications for the use of fresh frozen plasma Blood volume expander Hypoproteinaemia S ource of immunoglobulins W hen the prothrombin time is < 18 seconds

40. Solvent / Detergent Plasma Plasma is treated with the solvent tri (n-butyl) phosphate (TNPB) and the detergent triton X-100 to inactivate lipid-enveloped viruses such as hepatitis B and C and HIV . Indications for its use are the same as that of FFP. Out date :12 hours at room temperature after thawing, do not refrigerate . Doses and Administration is the same as that for FFP.

41. contraindications • Pregnant women, except at the time of delivery • Neonates • Chronic hemolytic anemia • Sickle cell disease • Patients under going treatment with bone marrow damaging chemotherapy or radiation • Bone marrow transplant patients

42. SINGLE DONOR and CRYOPRECIPITATE-POOR PLASMA Plasma separated from one unit of whole blood on or before the fifth day of the expiration date is called as single donor plasma. Cryoprecipitate-poor plasma is a by product of cryoprecipitate preparation. Both these products lack the labile coagulation factors V and VIII, but contain stable clotting factors II, VII, IX, and X. Cryo -poor plasma lacks fibrinogen also.

43. indications In deficiency of stable clotting factors (e.g. coagulopathies due to warfarin drugs ) Burn Doses : are the same as that of FFP.

44. Cryoprecipitate: Precipitated proteins of plasma rich in factor VII and fibrinogen,obtained from a single unit of fresh plasma by rapid freezing within 6 hrs of collection. Plasma 10-15 ml Factor VIII 80-100 iu Fibrinogen 150-250 mg von- Willebrand Factor 40 - 70% Fibronectin 55 mgm Factor XIII 20 - 30% of the original

45. Indications: Hemophilia A V on Willebrand’s disease Congenital or acquired fibrinogen deficiency Acquired Factor VIII deficiency (e.g. DIC, massive transfusion) Factor XIII deficiency Source of Fibrin Glue used as topical hemostatic agent in surgical procedures and to remove fragmented renal calculi. Factor VIII concentrate, 500 i.u . bottle, available as pharmaceutical product, is the product of choice for most of the hemophiliacs.

46. components composition Approx volume Indications Whole Blood RBC (approx. Hct 40%) WBC & some platelets; Plasma deficient in factors V, VIII 350-450ml Increase red cells and plasma volume Red Blood cells RBC ( approx. Hct 75%) WBC and some platelets, reduced plasma 250ml Increase Red cell mass in symptomatic anaemia .

47. Components Composition Approx volume Indications Leukocytes reduced RBCs RBC>85% of original volume WBC<5x10 8 to < 5x10 6 Few platelets and minimal plasma 225ml Increase red cell mass, reduce FNHTR, decrease HLA immunization and CMV transmission.

48. Components Composition Approx volume Indications Washed RBCs RBC (approx. 75%) WBC<5x10 8 No Plasma 180ml Increase red cell mass, reduce risk of allergic reaction to plasma proteins. RBCs frozen/ Deglycerolized RBC (approx. Hct 75%) WBC< 5x10 6 No platelets and plasma 180 ml Increased red cell mass, minimize febrile or allergic reactions, Used for prolonged RBCstorage .

49. Components Composition Approx volume Indications Platelet, Concentrate (Random donor) Platelets 5.5x10 10 /unit, few RBCs, Wbc , Plasma 50ml Bleeding due to thrombocytopenia or thrombocytopathy Plateletpheresis Platelet>3x10 11 WBC<5.5x10 6 , plasma & minimal RBCs 300ml Same as platelets concentrates, sometimes HLA matched or cross matched platelets are prepared.

50. Components Composition Approx volume Indications Granulocytes pheresis Granulocytes> 1x 10 10 Lymphocytes, some RBCs and Platelets 220ml Used in selected cases with sepsis and severe neutropenia Fresh Frozen Plasma Plasma having all coagulation factors 220ml Coagulation disorders, if PT> 18 sec, aPTT > 60 sec (>1.5 to 1.8 times of controls)

51. Components Composition Approx volume Indicaions Single donor and cryoprecipitate poor plasma Plasma, stable clotting factors, no platelets 220ml Stable clotting factor deficiencies( II, VII, IX, X, XI) Cryoprecipitated AHF ( FactorVII ) Factor VIII, VWF, Fibrinogen 15ml Hemophilia A, VWD, Deficiency of fibrinogen and Factor XIII

52. Thank you