Preparation & Clinical Use of Blood Components | Dr. Abrar Kabir Shishir

This presentation provides a comprehensive overview of blood component therapy — from the history of transfusion to modern-day preparation, clinical use, and quality control. It covers whole blood, red cell concentrates, platelets (RDP, SDP), plasma products (FFP, cryoprecipitate), and special preparations such as leukocyte-depleted and irradiated blood.
Ideal for medical students, transfusion medicine specialists, and healthcare professionals involved in blood banking and transfusion services.

📍 Topics include:

Component preparation (centrifugation, apheresis, fractionation)

Indications and contraindications of each product

Irradiation and leukoreduction techniques

Quality control parameters

WHO and AABB guidelines

👨‍⚕️ Author: Dr. Abrar Kabir Shishir, MBBS, MD (Transfusion Medicine)
🏥 Ahsania Mission Cancer & General Hospital, Uttara

1. PREPARATION AND PP
CLINICAL USE OF BLOOD:
COMPONENTS

Dr. Abrar Kabir Shishir
MBBS, MD (Transfusion Medicine)

2. * 1818 — First human-to-human transfusion (Blundell, UK)
* 1930s-40s — Blood storage & blood banks started

* 1970s — Glass bottles replaced by plastic bags, enabling
safe component therapy

Blood collection using glass
bottles (used until 1970s)

3. IMPORTANCE OF COMPONENT THERAPY

Ensures optimal survival of each
component.

Provides only the specific blood
product the patient needs.

Avoids unnecessary or
contraindicated components.

One. donor can help several patients,
maximizing each unit.

Triple bag used for component therapy

4. BLOOD COMPONENTS.

1. Cellular Component:
+ RBC- Red Cell Concentrate (RCC)/ Packed Red Blood Cell (PRBC)
+ WBC- Granulocyte Concentrate
« Platelet - Random Donor Platelet (RDP)
- Single Donor Platelet (SDP)/ Apheretic Platelet (AP)

2. Plasma Component: - Fresh plasma
-Fresh frozen plasma
-Cryoprecipitate

3. Plasma Derivatives (separated from plasma by fractionation process):
« Albumin, Immunoglobulins, Coagulation Factors etc.

5. Centrifugation
Apheresis
Fractionation
Filtration
Sedimentation

Freezing and thawing

Apheresis machine

6. Whole blood | Centrifuge machine

Separated RCC & PRP <

(Platelet Rich Plasma)

Plasma extractor

Centrifuged Blood

7. Separated RCC & PRP
(Platelet Rich Plasma)

Platelet (RDP) & Fresh Plasma

Plasma extractor

Centrifuged PRP

Plasma

Platelet

8. Thraw at 1-

| plasma
12 hours,
overnight

+ Cryopoor plasma is discarded, while 10-20 mL of
cryoprecipitate is collected

+ Contains Fibrinogen, Factor VIII, Factor 13, VWF

Transfused within 6 hours of thawing.

| Cryoprecipitate

[ee]
> Cryoprecipitate

N

9. Donor connected via venipuncture
Blood drawn into machine
Centrifugation separates blood components

Required component collected (e.g., plasma,
platelets, stem cells)

Remaining components returned to donor

Plateletpheresis procedure in AMCGH

10. — WAOLEBLOOD ss

Q Objectives:
* To correct volume loss
* To T O, carrying capacity of blood

Q Indications:
+ Acute blood loss:
v Trauma- RTA, stab injury
Y” Major surgery- severe Gl bleeding, rupture esophageal
varices, hematemesis, melena, obstetric cause etc.

+ ¿Exchange transfusion

11. Q Contraindications:

+ Risk of volume overload in patients with:
o Severe Chronic anemia
o Cardiac failure

+ Where there is Platelet or FFP indicated, because in WB:
o No functional platelets (after storage for >24 hours)
o Nolabile coagulation factors (V and VIII)

12. Q Objective: To À O, carrying capacity of blood

Q Indication:
* Chronic blood loss — PUD, hemorrhoids, hookworm
« Refractory anemia — Iron deficiency not responding to therapy
* Hemoglobinopathies — Thalassemia, SCA
* Chronic disease anemia — CKD, RA
+ Malignancy — Breast, cervix, leukemia

Q Contraindications:
* Nutritional anemia (unless need for increased oxygen-carrying capacity)
« “Not for: well-being, healing, infection prevention, volume expansion, or
future anemia

13. PLATELET

Q Preparations :
+ Random Donor Platelet
(RDP): Prepared from whole
blood donations

+ Single Donor Platelet (SDP):
Collected by apheresis
machine !

14. SDP (Single Donor Platelets)

RDP (Random Donor Platelets)

Allo-immunization y,
TIN

Leukoreduced Platelet
Good yield

Easy to arrange 1 donor

1 Unit 200-400 mL 50-70 mL
Contain >3x10*! Platelet Contain >5.5x10% Platelet
Can T30K-60K/uL Can T5K-10K/uL
Dose Adult: 1 U Adult: 4-6 U/1 Pooled
Child: <15 kg: 10-20 mL/kg Child: <10 kg - 5-10 mL/kg
>15 kg: 1U >10 kg - 1U/10 kg
Or, 10-15 mL/kg Or, 10-15 mL/kg
Advantage Contamination (Bac, RBC) | Cheaper

Monitoring not needed for 2 hr.
Expert hand not needed
Appropriate vein is not required
PI count of donor not seen.

15. PLATELET

Q Objective: To maintain adequate hemostasis

Q Indication:

+ Therapeutic:
+ PI<50,000/uL in the presence/of diffuse microvascular bleeding.
+ Butif <5,000/ uL, but no’bleeding > Indicated (to prevent ICH)

< Prophylactic:
+ <10,000/pL—Cancer/chemo/BM failure (to prevent ICH)
+ <20,000/uL- BM failure + risk factors (fever, DIC, sepsis)
+ <50,000/uL — Most surgeries
* <1,00,000/uL — High-risk surgeries (ocular/neural)

16. PLATELET

Q Contraindication: Contraindicated unless there is significant bleeding
or an invasive procedure planned

Situation Why routine platelets are avoided
+ TTP/HUS Adding platelets may “fuel” microthrombi
+ HIT Risk of worsening thrombosis
+ ITP Platelets are rapidly destroyed
+ Sepsis / DIC Platelets rapidly consumed, no benefit, exposes patient to risks
+ Hypersplenism | Transfused platelets sequestered, minimal increment

17. FFP AND CRYOPRECIPITATE

Q Objective: To correct clotting factor deficiency

Q Indication of FFP:
* Congenital — Hemophilia A & B, vWD, factor deficiencies.
* Acquired — DIC, liver disease, massive transfusion, TTP, plasma exchange.

Q Indication of Cryoprecipitate:
* Fibrinogen deficiency, Hemophilia A, vWD, F-XIII deficiency

18. FFP AND CRYOPRECIPITATE

+ Not for volume expansion/protein replacement > safer: albumin,
colloids, saline.

+ Emergency: if FFP unavailable > fresh plasma can be used.

+ Cryoprecipitate > FFP in some cases: higher factor concentration, less
volume, J fluid overload.
Example: 70-kg hemophilia A (needs 1400 U VIII) > FFP ~1000 mL vs Cryo
~300 mL.

19. + Saline Washed Red Cell

+ Leukocyte Depleted Blood Product

+ Irradiated Blood Product

20. SALINE WASHED RED CELL

Q Procedure:
Y” Done with 0.9% NaCl solution

Q Indications:

« IgA deficiency with anti-lgA antibodies
* Patients with severe allergic/anaphylactic reactions

(But now, saline washing is generally avoided due to the high risk of bacterial
contamination)

21. LEUKOCYTE DEPLETED BLOOD PRODUCT

Q Definition: A unit of blood from which at least
70% of leukocytes are removed

Q Methods:
* Centrifugation
« Filtration
+ Washing

Q Types:
+ Pre storage
« - Bedside Leukoreduction filter

22. LEUKOCYTE DEPLETED BLOOD PRODUCT

Q Advantages:

Reduces Febrile Non-Haemolytic Transfusion Reactions (FNHTR)
Prevents HLA alloimmunization & sensitization

Decrease Platelet Refractoriness

Reduce Transfusion Related Acute Lung Injury (TRALI)

Lowers risk of CMV transmission

Minimizes Transfusion-Related Immunomodulation (TRIM) > lowers
post-op infection, cancer recurrence, graft rejection etc.

23. Q Important facts:

* Bedside leukoreduction may not prevent FNHTR in
stored blood > cytokines (IL-1, IL-6, TNF) released from
WBGCs during storage can pass through filters.

Solution: use fresh blood. or pre-storage leukoreduction.

* Patient who takes ACE inhibitor can cause hypotension

Pre storage leukoreduction

24. IRRADIATED BLOOD PRODUCT

Q Source:
+ Gamma ray & X ray by:

Y” Cesium-137
Y” Cobalt-60
Y” Linear Acceleration

Irradiation of blood product

25. Viable T Lymphocytes activate, Proliferated T lymphocytes of
\ Lymphocyte multiply and proliferate donor attack host tissues

Figure: Irradiation preventing TAGVHD

Q Irradiation damages the nucleic acid of the donor T lymphocytes and
therefore makes them unable to proliferate and cause disease.

26. INDICATIONS OF IRRADIATION

Prematurity, low birthweight (<1200 g), erythroblastosis fetalis‘in newborns

Hematologic malignancies or solid tumors (neuroblastoma, sarcoma, Hodgkin
disease)

Peripheral blood stem cell/ marrow transplantation

Components that are crossmatched or HLA matched, or donation from
family members (blood relatives)

Fludarabine therapy

27. IRRADIATED BLOOD PRODUCT

Q Important facts:

* Irradiation can cause hemolysis.
Solution:
v Use fresh RBCs (avoid near-expiry units)
Y” Apply correct, uniform radiation dose
Y” Limit storage time after irradiation

* Irradiated blood > K* leak into plasma > hyperkalemia risk.
Solution: At risk > remove plasma before transfusion

28. OO QUALITY CONTROL

Component Volume Other
Whole Blood 450mL+10% | Hct 30-40%
RCC/ PRBC 200-250 mL Hct 70 + 5%
RDP 50-70 mL + pH6.2 + Platelet >5.5x101 [+ WBC 8.3 x10°
SDP 200-400 mL + pH6.2 + Platelet 23x10" [+ WBC5 x10®
FFP 200-300 mL °, FVII: 0.7.U/mL

+ FIX: Present

* Fibrinogen: 200-400 mg

* Stable coagulation factors: 200 U of each factor
Cryoprecipitate | 10-20 mL + FVII: 80-120 U

* FXIII: 20-30%

+ Fibrinogen: 150-250 mg

* vWF: 40-70%

29. * Use the right component for the right need
* Targeted therapy > better efficacy & fewer reactions

« Safe handling, storage & leukoreduction improve outcomes

30. REFERENCE

AABB Technical Manual, 20th Edition
Modern Blood Banking & Transfusion Practices, 7th Edition
Mollison’s Blood Transfusion in Clinical Medicine, 12th Edition

WHO: Blood Components — Preparation, Storage & Distribution (2017)