Chapter 15 Component Preparation 343

BOX 15–3

Procedure for Production of Cryoprecipitate

1. The venipuncture must be nontraumatic.
2. The whole blood can be cooled before and during production be-
cause platelets are not usually produced along with cryoprecipitate.
The volume of plasma required to remain on the RBCs and the
platelet concentrate would reduce the amount of plasma available
for cryoprecipitate production enough to significantly reduce the
final AHF activity in the precipitate. At least 200 mL of plasma
(205 g) should be used to ensure that the final product will contain
at least 80 AHF units.
3. The plasma must be stored at –18°C or below within 8 hours of
collection and within 1 hour from the time freezing was initiated.
4. The second stage of cryoprecipitate preparation begins by allowing
the frozen plasma to thaw slowly in the refrigerator at 1° to 6°C .
This takes 14 to 16 hours when plasma is thawed in a standard
blood bank refrigerator. If a circulating cryoprecipitate thaw bath
(4°C water bath) is used, the thawing time is reduced to about
2 to 4 hours. The endpoint is when the plasma becomes slushy.
5. Centrifuge the plasma at 1° to 6°C for a hard spin.
6. Express the supernatant plasma into the attached satellite bag. The
cryoprecipitate will be a small white mass in the original plasma
bag. Leave only 10 to 20 mL of plasma on the precipitate.
7. If preparing prestorage pooled cryoprecipitate, identify compatible
components for pooling and combine at this time.
8. Refreeze the cryoprecipitate immediately. Time elapsed should be
no more than 1 hour at room temperature. A delay in refreezing or
exposure of the unit to elevated temperatures during processing
will significantly decrease the factor VIII activity level in the final
product. The centrifuge temperature must be at 1° to 6°C, and it is
better if the centrifuge cups are well chilled.
9. The final product should be placed in a protective container be-
cause of the brittle nature of the plastic bag at freezer tempera-
tures. Store at –18°C or colder up to 12 months from the date of
whole blood collection.
10. If the supernatant plasma is refrozen at –18°C, it must be labeled
as “plasma cryoprecipitate reduced.”

Table 15–2 Blood Component Characteristics

Storage
Component Shelf Life Temp. Quality Control Volume Dosage
Whole blood (WB) CPD 21 d 1°–6°C N/A 450–500 mL hgb 1 g/dL
CPDA-1 35 d hct 3%
CP2D 21 d
Whole blood irradiated Original expiration or 1°–6°C 25 Gy to center of canister 450–500 mL hgb 1 g/dL
28 d post-irradiation
hct 3%
RBCs CPD 21 d 1°–6°C No additive: hct 80% 250–300 mL hgb 1 g/dL
CPDA-1 35 d hct 3%
CP2D 21 d Additive: N/A
ACD 21 d
AS 42 d
RBC aliquots Closed system: same 1°–6°C varies 10 mL/kg
Open system: 24 hr hgb 2 g/dL
RBC irradiated Original outdate or 1°–6°C 25 Gy to center of canister 250–300 mL hgb 1 g/dL
28 d post-irradiation
hct 3%
RBC leukoreduced Closed system: same 1°–6°C <5 106 WBCs 85% RBC 250–300 mL hgb 1 g/dL
recovery
Open system: 24 hr hct 3%
Washed RBCs 24 hr 1°–6°C hct 70–80% 180 mL hgb 1 g/dL
hct 3%
Frozen RBCs 10 years –65°C
RBC deglycerolized 24 hr 1°–6°C 80% RBC recovery 180 mL hgb 1 g/dL
<1% glycerol hct 3%
Platelets, whole-blood 5–7 d 20°–24°C 5.5 1010 plts 50–70 mL 5k–10k/ L
derived (RD)
pH 6.2
Continued
344 PART III Transfusion Practices

Table 15–2 Blood Component Characteristics—cont’d

Storage
Component Shelf Life Temp. Quality Control Volume Dosage
Platelets, apheresis (SD) 5–7 d 20°–24°C 3 1011 plts 200–400 mL 30k–60k/ L
pH 6.2
Platelets, irradiated 5d 20°–24°C 25 Gy to center of canister Same Same
Platelets, pooled 4 hr 20°–24°C pH 6.2 Varies Varies
Platelets, leukoreduced 5d 20°–24°C pH 6.2 RD: 40–70 mL RD: 5–10k/ L
RD: <8.3 105 WBCs SD: 200–400 mL SD: 30–60k/ L
SD: <5 106 WBCs
FFP 1 yr –18°C 200–380 mL Factor 20%–30%
7 yr –65°C 200–1,000 mL 10–20 mL/kg
AFFP 1 yr –18°C
PF24 1 yr –18°C 200–380 mL Same
7 yr –65°C
LP 5 days after WB 1–6°C 200–380 mL Not well
expires liquid characterized
Cryoprecipitate Frozen: 1 yr –18°C FVIII: 80 IU 10–25 mL Fibrinogen
Fibrinogen: 150 mg 5–10 mg/dL
Thawed: 6 hr 20°–24°C
Pooled (open): 4 hours
Cryo-reduced plasma 1 yr 18°C 200–380 mL
Granulocytes 24 hr 20°–24°C 1.0 1010 200–600 mL 1–2 1010/infusion
four daily doses
Granulocytes, irradiated 24 hr 20°–24°C 1.0 1010 200–600 mL Same

hgb = hemoglobin; hct = hematocrit; plts = platelets; WB = whole blood; SD = single donor; RD = random donor

system and subsequently proliferate and mount an immune
response against the patient’s tissues. In immunocompro-
mised patients, donor T lymphocytes escape destruction
because the patient’s immune system lacks the resources nec-
essary 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 and
therefore not express antigens that would trigger the patient’s
immune system to recognize the donor cells as foreign. Irra-
diation damages the nucleic acid of the donor T lymphocytes
and therefore makes them unable to proliferate and cause
disease.
Both the FDA and AABB recommend a minimum dose of
gamma irradiation of 25 Gy to the central portion of the
blood unit, with no less than 15 Gy delivered to any part
of the blood unit.28 Irradiation may be achieved by using
either a radioactive source (cesium-137 or cobalt-60) or
x-ray. To confirm a product was irradiated, a radiochromic
film label is affixed to the component before it is placed into
the metal canister of the irradiator. Darkening of the film
confirms irradiation requirements. Irradiation devices also
require semiannual or annual dose delivery verification using
an outside source. To determine dose delivery, a detection
device is sent through an irradiation cycle, and the minimum
and maximum radiation dose is determined. For irradiation
devices using a radioactive source, the amount of exposure
time required to achieve the minimum radiation exposure
increases as the radioactive source decays.
Each facility should have a protocol and procedure for
irradiating blood components, training of personnel using
the irradiator, and issuing of irradiated components. The
expiration date of irradiated RBCs is 28 days from the time
of irradiation or the original outdate, whichever is sooner.
The expiration date of platelets and granulocytes are not
impacted by irradiation.
Washing
Red blood cells prepared using the methods previously
described in this chapter are stored for up to 42 days
suspended in a solution that contains additive solution (in-
cluding saline, amino acids, and sugars) in addition to a
small volume of residual plasma and anticoagulant that is
not removed during manufacturing. Platelets are also
stored in a mixture of donor plasma and anticoagulant
solution, with or without additive. The process of removing