PREPARATION, STORAGE & USAGE OF BLOOD COMPONENT edit.pptx

PREPARATION, STORAGE & USAGE OF BLOOD COMPONENT

1. PREPARATION, STORAGE & USAGE OF BLOOD COMPONENTS Nur Aqilah Tajul Lile Nurul Fahmiza Tumiran

2. Outline Whole blood collection Component processing Blood components - Whole blood - Red cell concentrates (including its modifications) - Platelets - Plasma - Cryoprecipitate - Cryosupernatant

3. Blood Components Plasma derivatives Red cell concentrates Platelet concentrates Fresh frozen plasma Cryoprecipitate Cryosupernantant Coagulation factor concentrates Factor VIII concentrates Factor IX concentrate Albumin Immunoglobulin Blood Components vs Plasma Derivative Blood component :A product separated from a single unit of whole blood Plasma derivative : A blood product separated from a large volume of pooled plasma by a process called fractionation

4. Two methods in which blood and blood products are collected: Whole blood - a process where whole blood is collected into a multi bag system which allows for the production of specific cellular and plasma components Apheresis - a process by which blood being removed from a subject and continuously separated into component parts , to allow a desired component to be retained while the remainder is returned to the subject

5. W HOLE B LOOD C OLLECTION  Blood is collected in a primary bag that contains an anticoagulant-preservative mixture.  The entire blood collection set (including integrally attached satellite bags and tubing) is sterile and considered a closed system .  The sterile system becomes an open system when administration ports or other areas are exposed to air, and the allowable storage time is reduced because of potential bacterial contamination. Primary Bag Satellite Bags

6. • Single Bag • Whole Blood • Allows 450 mls of blood (and contains 63 mls of CPDA-1) • Double Bag • Red cell concentrate + FFP • Allows 350 mls of blood (and contains 49 mls of CPDA-1) • Triple Bag • RBC with additive solution + FFP + platelets/ RBC+Cryoprecipitate+cyrosupernatant • Allows 450 mls of blood (contains 63 mls of CPD in primary bag, 100 mls of SAGM in one satellite bag) • Quadruple bag + one inline filter • RBC with additive solution + FFP + platelets • Allows 450 mls of blood (contains 63 mls of CPD in primary bag, 100 mls of SAGM in one satellite bag) • Allows prestorage leucodepletion B LOOD B AGS COMMONLY USED

7. Sodium Citrate, citric acid Monobasic sodium phosphate Dextrose Adenine Chelates calcium; prevents clotting Maintains pH during storage; necessary for maintenance of adequate levels of 2,3-DPG Substrate for ATP production; supports ATP generation by glycolytic pathway Substrate for red cell ATP production th A NTICOAGULANT -P RESERVATIVE S OLUTIONS  ACD – acid-citrate-dextrose (shelf-life:21 days) CPD – Citrate-phosphate-dextrose (21 days) CP2D- Citrate-Phosphate-Double Dextrose (21 days)  CPDA-1 – citrate-phosphate-dextrose-adenine. (35 days) Harmening DM (2012). Modern blood banking and Transfusion Practices. 6 ed.

8. Normal Saline Adenine Dextrose Mannitol Further increase the levels of ATP Osmotic diuretic; acts as a membrane stabiliser to reduced RBC lysis during storage R ED B LOOD C ELL A DDITIVE S OLUTIONS  Enhance red cell survival and function by increasing the shelf life of blood.  SAGM – saline, adenine, glucose and mannitol 1. extends shelf life of RBC to 42 days 2. allows the harvesting of more plasma and platelets 3. produce a packed RBC with lower viscosity that is easier to infuse

9. Platelets White Cells Red Cells Plasma C OMPONENT P REPARATION AND S EPARATION  Based on the principle that different components of whole blood have different specific gravities.  Using centrifugation to spin the donated unit, the components separate into layers in the blood bag, with the heaviest component settling to the bottom.  Variables that affect yield of product   Speed of centrifuge (revolutions per minute, RPM) Length of time of centrifugation

10. o 2. “Soft ” spin – 2500 RPM for 5 mins at 22 C o 5. “Hard ” spin – 3800 RPM for 12 mins at 22 C 1. Whole blood is in Bag A (primary bag). Bag B and C are satellite bags. 3. Whole blood is separated into components in the primary bag. Platelet-rich plasma at the top, and red blood cells at the bottom. 4. Platelet-rich plasma is forced into bag B; red blood cells (RBC) remain in the bottom of Bag A. Additive solution is then added from Bag C to Bag A. Bag A is separated from Bags B and C. 6. Plasma and platelets are separated in Bag B. Plasma rises to the top; platelets move to the bottom. 7. Plasma is separated into bag C, leaving about 50-70 mls of platelets in Bag B. Bags B and C are separated. F LOW C HART OF C OMPONENT P REPARATION Bag A: CPD Bag C: SAGM Bag B: Empty

11. o Fresh Frozen Plasma: Rapid freeze the plasma containing secondary bag in a blast freezer to achieve complete freezing to -30 C within an hour. This should be done within 12 hours of collection. o Centrifuge at 3680 RPM for 17 min at 4 C For Cryoprecipitate Production o Separate the supernatant and the cryoprecipitate (leaving about 10-15 mL of supernatant in the cryoprecipitate bag). Rapidly re-freeze both bags in a blast freezer to achieve complete freezing to -30 C within 1 hour (for cryoprecipitate) or within 24 hours (for cryosupernatant). FFP Cryoprecipitate Cryosupernatant o F LOW C HART OF C OMPONENT P REPARATION Thaw at 2-6 C over 16 hours.

12. Storage lesion Multiple changes can occur during storage of blood that altered its physiological properties. In vitro RBCs changes during storage; Depletion of metabolic substrates; Adenosine triphosphate (ATP) 2,3-diphosphoglyerate (2,3-DPG) Slow progressive leakage of potassium Changes in red cell morphology The pH of blood decreases with storage, but most recipients can handle the acid load during transfusion without ill effect.

13. Storage lesions Plasma lactic acid Plasma potassium levels Plasma haemoglobin Plasma ammonia •Viable red cells • pH •RBC adenosine triphosphate (ATP) •RBC 2, 3 diphosphoglycerate •Red cell deformability •Plasma sodium levels

14. Changes occur in vitro of stored blood 1. pH Glycolysis results in the production of lactate and decrease in pH Day 0 (CPD) pH = 7.20 Day 21 (CPD) pH = 6.84 Glycolysis is slowed at temperature of 1 to 6’C 2. ATP ATP is closely a/w red cell viability  Loss results in rigidity and decrease deformability ATP is also needed for Na /K -ATPase pump Eg: ATP levels on day 35 of storage is 45% in CPDA-1 3. 2,3-DPG levels Decrease in pH of stored blood  low 2,3-DPG levels With low levels, there will be left shift of oxygen dissociation curve & increase affinity of oxygen • After transfusion the levels return to normal values within 24 hours

15. 4. Na+ and K+ levels Na+/K+ leak through the red cells  Cells lose potassium and gain sodium 5. Plasma Hemoglobin Hemolysis  raised plasma Hb 6. White cells Granulocyte = lost phagocytic and bactericidal properties (4-6 hours of collection) But it do not lose antigenic properties & capable of sensitising recipient and caused non haemolytic febrile transfusion reaction

16. 7. Platelets Lost haemostatic function within 48 hours 8. Coagulation factors F V and F VIII lost their coagulant activity (50%) within 48 to 72 hours of storage 9. Micro- aggregates Aggregates of aged platelet, leucocytes, fibrin strands formed causing transfusion related lung injury (TRALI)

17. BLOOD COMPONENT 5 main blood component : Whole blood Red cells Platelet Fresh frozen plasma Cryoprecipitate, cryosupernatant

18. o o o o W HOLE B LOOD Topic Description Definition Blood taken from a suitable donor and collected into a pyrogen-free anticoagulant bag without further processing Contents Red and white blood cells, plasma (haematocrit 0.35-0.45) Usually does not contain viable platelets or coagulation factor Volume 400-500 +/- 50 ml 1 unit WB : 450 mls + 63 mls a nticoagulan t, collected from donor with minimum 38% hematocrit Criteria for preparation No further preparation required Storage temperature 2-6 ° C Modification Can be volume reduced to yield pack red cells or prepared specifically for neonatal exchange transfusion. Can undergo leucoreduction, washing or be irradiated. Shelf-life Depends on anticoagulant/preservative: Citrate-Phosphate-Dextrose (CPD), acid-citrate-dextrose formula A (ACD-A),citrate-phosphate-double dextrose (CP2D) : 21 days Citrate-Phosphate-Dextrose-Adenosine-1 (CPDA-1): 35 days

19. W HOLE B LOOD Topics Descriptions Quality Control (frequency = 1% of all units with a minimum of 4 units per month) Volume 450 ml bag – 450 ml +/- 10% 350 ml bag – 350 ml +/- 10% 250 ml bag – 250 ml +/- 10% Haemoglobin 450 ml bag - >45g/unit 350 ml bag - >35g/unit 250 ml bag - >25g/unit Haemolysis at the end of storage <0.8% of red cell mass Sterility at the end of the shelf-life No growth Note: At least 75% of the units sampled should have the relevant parameters fall within the specification indicated in the table.

20. Indication: Clinical indications for use of WB are extremely limited , rarely used today except in certain situation . Benefit: able to replace the loss of both RBC mass and plasma volume at same time . Must be ABO Identical 1. Exchange transfusion in neonate for haemolytic disease of new born (fresh WB < 5 days old) 2. Acute hypovolemia (haemorrhagic shock)/ Lost of blood more than 30% of blood volume Contraindication : Chronic anemia - R educed amount of RBCs but have compensated by increasing their plasma volume to restore their total blood volume. - Risk of volume overload: patient may developed pulmonary edema and heart failure. More likely to occur in patient with kidney failure or preexisting heart failure . WHOLE BLOOD – CLINICAL USES

21. o o o R ED C ELL C ONCENTRATE Topics Description Definition A component obtained by removing most of the plasma from whole blood. May contain additive solution (e.g. Saline Adenine Glucose Mannitol, SAGM) Volume 250-300 ml Haematocrit • Without additive: 0.65-0.80 • With additive: 0.55-0.65 Criteria for preparation Whole blood volume within 10% of the range as specified for the type of bag used. Plasma (200ml) is removed from whole blood after centrifugation. Pre-processing transport Transport in temperature monitored insulated carrier with core bag temperature maintained between 4-10 C Modification Can undergo leucodepletion, washing or irradiation. Storage temperature 4 ° C +/- 2 ° C Shelf life • CPD is used: 21 days • CPDA-1 is used: 35 days • Additive included: 42 days

22. R ED C ELL C ONCENTRATES – C LINICAL U SES  Indications:   Symptomatic anaemia or critical deficit of oxygen carrying capacity SHOULD NOT be based on haemoglobin oxygen concentration alone. Should take into account:  Rate of blood loss or drop of haemoglobin level  Patient ’s ability to tolerate the degree of anaemia  Marrow reserve and capability to replenish red cells  Oxygen carrying capacity of patient ’s haemoglobin  Tissue oxygen delivery and extraction capacity  Effect of RBC transfusion (in an average 70kg adult):   Increases haemoglobin by 1 g/dL Increases haematocrit by about 3%

23. Types of Red cells Concentrate 1. Red cells, leucocyte-depleted 2. Red cells, leucocyte-depleted for paediatric transfusion (PAEDIPACK) 3. Red cells, buffy coat removed, in additive solution 4. Red cells, washed 5. Red cell, cryopreserved/deglycerolised 6. Red cells, irradiated

24. RED CELLS, LEUKOCYTE-DEPLETED C omponent Red Cells, Leukocyte-depleted Definition A component obtained from red cells by removing the leukocytes to a residual leukocyte content of less than 1 x 10 6 per unit with at least 85% of the original RBC mass Criteria for preparation Red cell concentrate and red cell in additive solution within the volume range as specified for the type of bag used. Preparation Filtration technique is used to produce red cells , leukocyte-depleted. Leukocyte depletion should be done within 48 hours after donation , usually prior to processing . Storage temperature 4 + 2 ºC. Shelf life 35 to 42 days depending on the anticoagulant/ additive solution used. Benefit reduce incidence of febrile non-haemolytic transfusion reactions, HLA alloimmunisation, prevent transmission of CMV infection & nvCJD .

25. Indication: Patients requiring repeated red cell and/or platelet transfusions Patient with recurrent febrile non-hemolytic transfusion reaction Transplant candidates (e.g. haematopoietic stem cell, renal) to reduce risk of rejection Neonates : neonatal intensive care, exchange transfusion Two categories : Prestorage : using inline filters to remove leucocytes prior to storage,within 48-72 hours Poststorage: bedside leucocyte reduction filter when the unit is transfused

26. special filters multiple layers of polyester or cellulose acetate non-woven fibers that trap leukocytes and platelets but that allow RBCs to flow through. pre-storage leukoreduction involved biological response modifiers (BRMs) released from leukocytes during storage of the component that were found to promote febrile transfusion reactions. Examples of BRMs include proinflammatory cytokines (interleukin-1, interleukin-6, and tumor necrosis factor) complement fragments (C5a and C3a)

27. RED CELLS, LEUKOCYTE-DEPLETED FOR PAEDIATRIC TRANSFUSION (PAEDIPACK) Component Red Cells, Leukocyte-depleted for Paediatric Transfusion ( Paedipack ) Definition A unit of leukocyte-depleted red cells alliquoted into smaller volumes of 25-100ml per pack. Criteria for preparation Prepared from blood of regular donors. Preparation The prepared red cell concentrate is transferred into several small unit volume packs which contain a residual content of leukocyte count of less than 1 x 10 6 per unit. A closed system preferably an aliquot blood bag system shall be used to ensure sterility during transfer of the red cells. Storage temperature 4 + 2°C Shelf life 35 to 42 days depending on the anticoagulant / additive solution used.

28. RED CELLS, BUFFY COAT REMOVED, IN ADDITIVE SOLUTION Definition Removal of plasma & buffy coat layer from whole blood with subsequent addition of additive solution. Criteria for preparation Whole blood volume shall be within 10% of the range as specified for the type of bag used. Preparation Centrifuge whole blood  20-60ml of the buffy coat layer removed  suspension of the red cells in additive solution. Leukocyte count should < 1.2 x 10 9 cells per unit. Storage temperature 4 + 2°C Shelf life 28 to 42 days depending on the anticoagulant / additive solution used.

29. RED CELLS, WASHED Definition Red cells/whole blood through sequential washing in an isotonic solution , followed by re-suspension of the red cells in additive or saline solution ( process of removing the extracellular solution and replacing it with normal salin e; to remove WBCs, platelet & plasma protein / allergen) Criteria for preparation Whole blood , red cell concentrate and red cell in additive solution within the volume range specified for the type of bag used. Preparation Whole blood or red cells are s uspended in the isotonic solution  remove supernatant containing protein ( total protein of the final supernatant shall be less than 0.5g per unit) Storage T emp . 4 + 2 ºC. Shelf life Shelf life is 24 hours using open system. Closed system is subject to local validation.

30. 3 main indication for washed process 1. Allergic reaction: Preventing anaphylactic transfusion reaction Recurrent severe allergic transfusion reaction not prevented by pre-transfusion histamine & corticosteroid IgA deficiency with circulating anti-IgA antibodies 2. Removal of antibodies: prevent exposing the recipient to additional antibody in cases of hemolytic disease of the fetus and newborn; the mother is antigen-negative RBCs or platelet neonatal alloimmune thrombocytopenia; the mother’s RBCs or platelets lack the required antigen but contain high concentration of antibody. 3. Removal of other substance of clincal concern to remove potassium (leakage in RBC component) ; avoid hyperkalemic cardiac arrhythmias/arrest Extracellular potassium levels increase in stored RBC after 32 days of storage & in irradiated RBCs after 2days

31. RED CELLS, CRYOPRESERVED/DEGLYCEROLIZED Definition a component derived from thawing frozen red cells, where most of the cryoprotectant (glycerol) removed. Criteria for preparation Whole blood/red cell concentrate ( ± additive) can be used as starting materials. Freezing ( glycerolization ) of red cells is carried out within 7 days of donation. Preparation Red cells frozen in cryoprotectant using low or high glycerol technique . Washing / deglycerolization procedure is required (* Free of leukocytes, platelets and plasma) Storage temperature Red cells, cryopreserved: Below -65°C. Deglycerolized red cells: 4 + 2°C. Shelf life Red cells, cryopreserved: 10 years. Deglycerolized red cells: max 14 days.

32. RED CELLS, CRYOPRESERVED/DEGLYCEROLIZED 2 categories of Cryoprotectant agents: Penetrating: i.e glycerol small molecules that cross cell membrane into cytoplasm The osmotic force of the agent prevents water from migrating outward (as extracellular ice is formed) & preventing intracellular dehydration. used to cryopreserving red blood cell units Nonpenetrating : i.e hydroxyethyl starch, dimethylsulfoxide large molecules that doesn ’t enter cell but form shell around cell  preventing loss of water and subsequent dehydration used to freeze hematopoietic progenitor cells

33. RED CELLS, CRYO-PRESERVED/DEGLYCEROLIZED Indicated for patients with: Rare phenotype Autologous use Paroxysmal nocturnal hemoglobinuria IgA deficiency with circulating anti-IgA antibodies

34. RED CELLS, IRRADIATED Definition Red cells that have been irradiated to inactivate lymphocytes to prevent T ransfusion A ssociated -G raft V ersus H ost D isease . Irradiation damages nucleic acid of the donor T lymphocytes  unable to proliferate and cause disease Criteria for preparation Can be irradiated anytime up to 14 days after collection. All irradiated units shall be labelled as such using appropriate barcode labels. Preparation Unit shall be labelled with irradiation indicator tag to indicate successful irradiation process. FDA and AABB recommend a minimum dose of gamma irradiation of 25 Gy to the central portion of the blood unit & minimum 15 Gy delivered to any part of the blood unit ; using either a radioactive source or x-ray. Storage temperature 4 + 2 ºC. Shelf life Maximum of 14 days after irradiation or up to the expiry date of the blood, whichever is earlier.

35. Indication To prevent development of transfusion-associated graft-versus-host disease (TA-GVHD) in: Immunocompromised patients who received bone marrow /stem cell transplant Fetus undergoing intrauterine transfusion Recipient of components collected from blood relative or HLA-matched donors In GVHD, donor T lymphocytes escape destruction by host immune system proliferate & induce immune response against patient’s tissue In immunocompromised patients, donor T lymphocytes escape destruction because the host immune system lacks the resources necessary to detect and destroy the foreign cells. When a patient receives blood from a relative or an HLA-matched donor, the donor cells may be haploidentical to the patient cells → not express antigens that would trigger the patient’s immune system to recognize the donor cells as foreign

36. Platelet concentration, random Component Plateletpheresis Derived from whole blood containing majority of the original platelet content, suspended in plasma *pooled 4-6 units of ABO-identical platelet concentrate Definition A component which contains platelet in a therapeutically effective dose suspended in plasma obtained from a single donor by apheresis technique using automated cell separation equipment Duration of bleeding <12 minutes. Storage temperature prior preparation is 20-24 °C & preparation within 24hours of collection. Preparation Platelets harvested directly from whole blood via apheresis machine 22° + 2°C under consistent agitation throughout storage Storage temperature 22° + 2°C under consistent agitation throughout storage 5 days Shelf life 5 days >60 x 10 9 per unit (50-70ml) Platelet content contain a minimum of 200 x 10 9 platelets/unit

37. Platelet agitator Facilitate oxygen transfer for oxygen consumption by platelet Oxygen for the maintenance of pH of platelet component -when pH is reduced, the shape will change from disc to spheres (irreversible)

38. Dosing: for an adult is a pool of 6 whole blood derived platelets or one apheresis platelet ( raise the platelet count by 30,000-60,000/uL in a 70 kg patient ). Transfused platelets have a short life span ( need to be re-dosed within 3-4 days if given for prophylaxis. Contraindication: in Thrombotic Thrombocytopenic Purpura (TTP)/ Hemolytic Uremic Syndrome (HUS) and Heparin Induced Thrombocytopenia (HIT) because they are pro-thrombotic and transfusion of platelets may exagerrated if transfused as prophylaxis in the absence of significant bleeding. In autoimmune destruction of platelets ( e.g. ITP ) : no transfusion in the absence of bleeding because the transfused platelets will quickly removed similarly to the patient’s own platelets

39. FRESH FROZEN PLASMA Definition A component which consists of dissolved proteins, clotting factors and other constituents, for transfusion or fractionation. Plasma is prepared from fresh whole blood or collected by apheresis method. This plasma is then immediately frozen. Criteria for preparation Plasma should be prepared within 24 hours of whole blood collection, preferably within 12 hours ( Use of whole blood >12 hours of collection result in FFP with lower concentration of Factor VIII) Preparation The plasma obtained (after centrifugation or by plasmapheresis) need immediately frozen to achieve complete freezing within 1 hour to a temperature of less than minus 30°C (blast freeze) Storage temperature 36months at or below -25°C Shelf life 3 months at -18°C to -25°C

40. FRESH FROZEN PLASMA – Content Contains all coagulation factors labile (Factor V and VIII) Stable (Factor II, VII, IX, X) Other electrolytes: Na+ K+ Glucose Citrate Fats Proteins Thawed in water bath ( at 37ᵒC) & place in protective lining Transfused ASAP at a tolerable rate because labile factors degrade rapidly Once thawing is complete, the product may be stored at 2° to 6°C for up to 24 hours. If not transfused within 24-hour, the thawed plasma may be stored up to 5 days, but must label as “thawed plasma”

41. FRESH FROZEN PLASMA – Indications Single factor deficiencies; Specific/combined factor concentrate is not available Reversal of warfarin effect (immediate) DIVC with multiple coagulation deficiencies Thrombotic thrombocytopaenic purpura (TTP) Inherited coagulation inhibitor deficiencies; High risk procedures Specific/combined factor concentrate is not available Bleeding/abnormal coagulation parameters; Massive transfusion Cardiac bypass surgery Liver disease patients

42. Choice of blood group for FFP transfusion FFP should be ABO compatible to avoid potential haemolysis caused by donor anti-A or anti- B , but cross matching is not required. Can be given without regard to Rh . FFP is cell-free product, so unlikely to cause RhD sensitisation. Therefore Anti-D prophylaxis is not required if an RhD negative recipient is transfused with RhD positive plasma.

43. CRYOPRECIPITATE & CRYOSUPERNATANT Component Cryoprecipitate Cryosupernatant Definition A component containing the cryoglobulin fraction obtained by thawing and further processing of FFP ( re-centrifuged using a hard spin ) A by-product from the preparation of cryoprecipitate. Acceptance criteria Duration of whole blood donation shall not exceed 15 minutes. Plasma should be prepared within 24 hours of whole blood collection, preferably within 12 hours. Preparation Prepared by slow thawing of plasma at 2°C to 6°C overnight. After thawing, the component is re-centrifuged using a hard spin at the same temperature. The supernatant, cryo -poor plasma is then partially removed while the remaining cryo -poor plasma is used for resuspension. The resulting cryoprecipitate is then rapidly frozen. Storage temperature and shelf life 36months at or below -25°C 3 months at -18°C to -25°C

44. CRYOPRECIPITATE – Content Factor VIII Factor XIII Fibrinogen vWF Should be ABO compatible , cross-matching is not required

45. CRYOPRECIPITATE – Indication Rarely given except in cases with evidence of low fibrinogen level or cases of hypo /afibrinogenaemia : Clinical bleeding Invasive procedure DIVC As an alternative therapy in certain situation: von Willebrand Disease bleeding pre-op VWF concentrate not available Replacement of factor XIII deficiency Haemophilia A Factor VIII concentrate not available

46. CRYOSUPERNATANT Content : low levels of factor VIII(greatly reduced), von Willebrand factor, factor XIII, fibronectin and fibrinogen (can up to 70% of original level) INDICATION: 1. Plasma exchange: Thrombotic thrombocytopenic purpura Hemolytic Uremic Syndrome Preferred for plasma exchange, because lack of vWF factor(high molecular weight) 2. Substitute with FFP/ Fresh plasma when unavailable

47. Storage and transportation temperatures Component Temperature Transport Boxes Storage Transportation Red cell (all types) 2 – 6 °C 2 – 10 °C Insulated box with coolant pack Direct contact with coolant is AVOIDED Platelet 20 – 24 °C 20 – 24 °C Insulated box with NO ICE Frozen products: Fresh frozen plasma Cryoprecipitate Cryosupernatant Below -25°C Below -25°C Insulated box If temperature rises above -25°C , shelf life shortened to 3 months Thawed: Fresh frozen plasma Cryoprecipitate Cryosupernatant To be issued out immediately 2 – 10 °C Insulated box with coolant pack Direct contact with coolant is AVOIDED

48. https://oncohemakey.com/blood-transfusion/ Plasma-containing components & platelet, should be ABO compatible with the patient’s RBC when possible to prevent passive immune hemolysis from antibodies in the plasma

49. https://www.goodhousekeeping.com/health/a33438096/how-to-find-out-blood-type-chart/

50. REFERENCES Denise M Harmening, Modern Blood Banking & Transfusion Practices, 7 th Edition National Blood Center MOH, Transfusion Practice Guidelines for Clinical and Laboratory Personnel, 4 th Edition National Blood Center MOH, Guidelines for the rational use of blood and blood products