Storage of Blood Components- equipments, effects of improper storage, transport with latest AABB and NACO guidelines

Introduction
Equipments required
Harmful effects of improper storage
Storage of various blood components- AABB guidelines
NACO guidelines for storage
Storage during transport
Storage in frozen state
Physical and chemical changes in stored blood

1. A seminar on- Storage of Blood and its Components Presenter- Dr. Shiny Moderator- Dr. Nidhi Bansal

2. INDEX Introduction Equipments required Harmful effects of improper storage Storage of various blood components- AABB guidelines NACO guidelines for storage Storage during transport Storage in frozen state Physical and chemical changes in stored blood

3. INTRODUCTION Transport and storage requirements must be followed when blood components are transferred from the collection site to the processing facility, from the supplier to the blood bank, or from the blood bank to the patient. Failure to adhere to these storage and expiration requirements can result in decreased product potency and/or safety. Blood is collected at body temperature, i.e. +37°C. But in order to maintain its vital properties, it must be cooled to below +10° C to be transported , and stored at refrigeration temperatures of around +4°C until use.

4. Temperature requirements during transport of blood components differ from those during storage. When blood components are issued from the blood bank to the patient care area, maintenance of appropriate temperature requirements allows for the possibility of returning the component to inventory if it is not transfused .

5. EQUIPMENTS REQUIRED Refrigerators, freezers, and platelet incubators equipped with continuous-temperature-monitoring devices to allow detection of temperature deviations before products are affected. Automated electronic monitoring devices include: weekly pen and chart recorders sets of hard-wired or radio-frequency temperature-recording devices centralized temperature-monitoring systems.

6. If an automated temperature-recording device is not used, temperatures of the blood storage environment must be recorded manually every 4 hours. Because platelets must be gently agitated during storage, typically using horizontal flatbed or elliptical rotators; alarm systems should also emit alerts when the platelet agitator has malfunctioned.

7. Harmful effects of Improper Storage If blood is stored or transported outside of these temperatures for long, it loses its ability to transport oxygen or carbon dioxide to and from tissues respectively upon transfusion. Other factors of serious concern are the risk of bacterial contamination if blood is exposed to warm temperatures. Conversely, blood exposed to temperatures below freezing may get hemolysed and can lead to a fatal transfusion reaction.

8. STORAGE OF VARIOUS BLOOD COMPONENTS (AABB guidelines)

9. NACO GUIDELINES FOR STORAGE

10. WHOLE BLOOD AND RED CELLS

11. PLASMA

12. PLATELET CONCENTRATES

13. IMPORTANT POINTS FOR STORAGE Avoid fluctuations in temperature No food/drinks in storage refrigerators Blood units in upright position Separate areas for unprocessed blood, processed blood, cross-matched blood Alternative power supply in case of frequent power cuts

14. STORAGE DURING TRANSPORTATION Temperature 2-8 o C Cold boxes or insulated carrier boxes surrounded by ice packs. Eg - Blood transport containers from Electrolux or REMI Measure the temperature of blood bags after arrival Check for any evidence of hemolysis

15. PHYSICAL CHANGES IN STORED BLOOD Change in shape of RBC from disc to spherical Loss of lipid in red cell membrane, which causes decrease in deformability Decrease in critical hemolytic volume (CHV) in parallel with membrane lipid content. Critical haemolytic volume is the largest volume to which red cells swell before hemolysis

16. Contd.. Increase in osmotic fragility Blood stored for more than 24 hours loses viable platelets and granulocytes Heat labile coagulation factors i.e. Factor V and Factor VIII decreases on storage, 50% in first 48-72 hours. Viable lymphocytes persist throughout the storage period.

17. BIOCHEMICAL CHANGES IN STORED BLOOD Dextrose level and pH levels drop as the red cells undergo anaerobic glycolysis to generate ATP. Decrease in 2,3-DPG Decrease in cells’ ability to release oxygen to the tissues Loss of potassium from red cells into plasma Passage of sodium from plasma to red cells Increase in plasma ammonia levels

18. The sum of physical & chemical lesions – STORAGE LESIONS But these changes have little or no significance in transfusions as patient’s body compensates for them, except compromised patients and neonates, in whom blood less than 7 days old is preferred.

19. STORAGE OF BLOOD IN FROZEN STATE The storage of red cells can be extended upto 10 years or more by freezing cells after adding glycerol (cryo-protective agent). The deglycerolized blood is comparable to freshly drawn blood in volume, hematocrit and functioning of red cells. HIGH GLYCEROL-SLOW FREEZE LOW GLYCEROL-RAPID FREEZE At -80 C using mechanical freezing At -196 C using liquid nitrogen

20. References AABB Technical manual 18 th edition Makroo Principles & Practices of Transfusion Medicine NACO guidelines for Blood storage

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