BLOOD COMPONENTS
BLOOD COMPONENTS AND
PLASMA DERIVATIVES
A. BLOOD COMPONENTS :
1. Whole blood
6. Granulocyte pheresis
2. Red blood cell
7. Platelet conc. (random donor)
3. Leukocyte reduced RBC 8. Platelet pheresis
4. Washed red blood cell
9. Leukocyte- reduced platelet
5. Frozen / deglycerolized RBC 10. RBC adenine saline added
B. PLASMA DERIVED COMPONENTS:
1. Fresh frozen plasma
2. Plasma
3. Cryoprecipitate
4. Factor VIII concentrate
5. Factor IX concentrate
6. Anti- inhibitor coagulation complex
7. Immune globulin
8. Albumin/plasma protein factor
DIFFERENT SPEEDS USED IN THE PREPARATION OF
BLOOD COMPONENTS|:
HARD SPIN OR HEAVY SPIN :
5000 g - 5 minutes ( PRBC & PC)
5000 g - 7 minutes ( CRYOPPT, LP-RBC, OR
CELL FREE PLASMA)
LIGHT SPIN OR SOFT SPIN :
2000 g - 3 minutes ( PRP)
Preparation of Platelet Concentrate : centrifugation at
RT
Other blood components centrifugation at 1-6 0
WHOLE BLOOD
*
For oxygen carrying capacity & volume replacement
For massive bleeding
*
*
*
No viable platelets or WBC
Decreased labile coagulation factors (Factors V & VIII)
Not an efficient utilization of blood
PACKED RED BLOOD CELLS
* Treatment symptomatic anemia where
oxygen carrying capacity is needed
* For patient who cannot tolerate an increased
blood volume
RBC ALIQUOTS
* For neonates
* For the treatment of anemia caused by :
* spontaneous fetomaternal hemorrhage
* obstetric accidents
* internal hemorrhage
LEUKOCYTE REDUCED RED BLOOD
CELLS
* average unit of RBC contains 2X109 leukocytes
* a reduced leukocyte content to less than 5X 108
prevents repeated non- hemolytic febrile trans.
rxns.
* less than 5X106 prevent HLA sensitization
* reduces immunosuppression of recipient by
donor WBC
* decreases post- operative surgical infections
due reduced immunosuppession
* reduced CMV transmission
* does not prevent graft versus disease
WASHED RED BLOOD CELLS
* AIHA
* Paroxysmal nucturia hemoglobinuria
* for the rare patients with IgA deficiency
FROZEN RED BLOOD CELLS
* used for :
* rare blood types for patients with
multiple antibodies
* autologous blood for a postponed
operation
(GAMMA) IRRADIATED RBC s
* RBCs & platelets are exposed to gamma
irradiation at 25 rads for 4.5 minutes
* inactivates T lymphocytes in the donor unit &
prevents graft versus host disease in an
immunocompromised recipient
FRESH FROZEN PLASMA (FFP)
* 200- 250 ml. of plasma frozen at - 180 C C
within 8 hours of collection
* no platelets available
* contains all coagulation factors
* an unconcentrated source of fibrinogen
( use cryo to correct a low fibrinogen level)
* needs 20-30 mins. lead time to thaw prior to
use
* used in patients with multiple coagualtion factor
deficiencies :
* liver disease
* Vit. K deficiency
* DIC
* warfarin toxicity
* massive transfusin
* indicatated when PT /PTT are >17/55 sec.
* not used if non bleeding or for volume
replacement
CRYPRECIPITATED AHF OR
CRYOPRECIPITATE
* the cold insoluble portion of plasma that
precipitates when FFP has been thawed bet.
1-6 0C.
* volume is 10- 15 ml.
* 30 mins. is needed for thawing & pooling
* used primarily for the replacement of fibrinogen
which is indicated among patients with :
* liver failure
* DIC
* massive transfusion
or among those with congenital fibrinogen
deficiency.
* can also be a source of :
* Factor VIII
* Factor XIII
* Von Willebrand factor
* No
longer considered a product of choice
for FVIII deficiency or Von Willebrands
disorder. These conditions are better
treated with :
* Factor VIII concentrate or
* with desmopressin acetate: DDAVP
( 1- deamino[ 8- D arginine]-vasopressin)
Quality Control:
1 U cryoprecipitate = 80-120 IU Factor VIII
150-250 mg fibrinogen
40-70% Von Willebrand factor
20-30% factor XIII
Storage : 1 year if frozen at 18 0C
6 hours if thawed at 20-24 0 C
4 hours if pooled
Application 1 : Cryoprecipitate transfusion for correcting
Fibrinogen level .
NOTE:
1.(Given weight in kilogram) x 70 ml/ [Link] weight= estimated
[Link] ( mL)
2. Estimated blood volume x ( 1.0- hematocrit) = estimated plasma
volume (mL)
Required amount of fibrinogen =
[ Desired final fibrinogen ( mg/mL) Initial Fibrinogen (mg/ml] x
plasma volume
[ If concentration is expressed in mg/dL , simply divide by 100 to
convert to mg/L.]
1 U cryoprecipitate = 150 mg fibrinogen or
1 U cryoprecipitate = 250 mg fibrinogen
Application 2 : Cryoprecipitate transfusion for correcting FVIII level.
1.(Given weight in kilogram) x 70 ml/ [Link] weight= estimated
[Link] ( mL)
2. Estimated blood volume x ( 1.0- hematocrit) = estimated plasma
volume (mL)
3. Required amount of FVIII=
[ Desired Final FVIII ( Units/ mL) Initial FVIII (Units/ mL] x plasma
volume
( If concentration is expressed in % , simply drop of % sign and write
units/ dL
To convert it to Units/mL., move 2 decimal places to the left.
1 U cryoprecipitate = 80 U FVIII
PLATELET CONCENTRATE
* Platelets are essential in primary hemostasis.
* Maybe prepared by processing unrefrigerated WB
within 6-8 hours after phlebotomy or through apheresis.
* Used among bleeding patients suffering from thrombocytopenia as a
result of problem in platelets:
* defective production or decreased function
* induced destruction as a result of radiation and chemotherapy.
QUALITY CONTROL:
* Random Donor Platelets ( RDP) : 5.5 x 10 10 platelets
* Single donoa Platelets (SDP) : 3.0 x 1011 platelets
* Storage : 20-24 0C ( RT or aircon temperature ) with constant
agitation
* Shelf Life : 3-5 days ( if pooled platelets within 4 hours of pooling
* ph 6.0
Each unit of platelet is expected to provide the following increase in
platelet count: ( Assume a typical 70 kg human)
RDP : 5,000 = 10,000/ uL
SDP : 20,000- 60,000/uL ( same effect with 4-6 pools of RDP)
Assesstment is made by calculating Corrected Count Increment (CCI)
* CCI RDP = ( Posttransfusion PC Pretransfusion PC x BSA
number of RDP transfused x 0.55
* CCI SDP
( Postransfusion PC Pretransfusion PC x BSA
number of SDP transfused x 3
Interpretation: > 10,000/uL (after 1 hr. posttransfusion) good increment
,< 5,000/uL (after 1 hr. posttransfusion) refractoriness
GRANULOCYTE CONCONTRATE/ LEUKOCYTE
CONCENTRATE
* prepared by cytapheresis
* each product contain 1.0 x 1010 granulocytes if
steroids or HES or both are used
* granulocyte concentrate contain 200-600 mL of plasma
stored at 20-24 0C without agitation
Granulocyte transfusions are done in :
cases of fever
septicemia or bacterial infection unresponsive
to antibiotic
reversible bone marrow hypoplasia
reasonable chance for patient survival
neonates with impaired neutrophil function
severe neutropenia
PLASMA
* Formerly known as a liquid plasma or cryoprecipitate
poor plasma
* Has small amounts of Factors V and VIII
* Not recommended for patients with deficiency of either
of these clotting factors
* Recommended for :
the treatment of stable coagulation deficiency esp.
Factor XI
source of plasma for pts. undergoing plasma
exchange
FACTOR VIII CONCENTRATE
* prepared by pharmaceutical firms by fractionation and
lyophilization of pooled plasma
* derived from plasma obtained by plasmapheresis
* stored at refrigerated temperature and is reconstituted
with saline at the time of infusion
* used to treat patients with hemophilia A or FVIII
deficiency
CRYOSUPERNATE
* Plasma left after separation from WB of the
cellular components and cryoprecipitate
* Used for the treatment of :
bleeding disorders other than hemophilia
hypofibrinogemia
hypovolemia
AUTOLOGOUS TRANSFUSION
Use of patients own blood, particularly useful in elective
surgery
Accounts for 5% of transfusions in USA
Reduces need for allogeneic BT
Reduces risk of postoperative complications
(e.g. infection, tumor recurrence)
FOUR DIFFERENT TYPES OFAUTOLOGOUS
TRANSFUSION
1. Preoperative collection
2. Acute normovolemic heimodilution
3. Intraoperative collection
4. Postoperative collection
Duration of autologous transfusion:
Donor- patient may donate blood every 3 days but not
within 72 hrs. surgery ( to allow the patient plasma to
return to normal before surgery)
320 mg ferrous sulfate or ferrous gluconate is given 3X
daily as iron supplement if several units are required
within a few weeks.
