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BLOOD COMPONENT

MODIFICATION AND USE OF
BLOOD COMPONENTS

SPEAKER
MODERATOR

VIVEK KUMAR DR.
K. K. GUPTA
BLOOD COMPONENT MODIFICATION AND USE OF BLOOD
COMPONENTS

These days effective blood transfusion therapy depends upon on the availability
of different blood components. These components, used separately or in
combinations, can meet most patients transfusion need and keeping the risk of
transfusion to a minimum. A blood donor donates the product known as whole
blood, from which components are prepared. The ability to separate various
components from whole blood is desirable for the following reasons:

• Separation of blood into components allows optimal survival of each
constituent. For example after 24 hours storage of whole blood at 2-6°C, it
has few viable platelets and levels of labile Factors V and VIII decrease,
while after separation platelets can be stored for 5 days at 22°C and
Factors V and VIII can be stored as FFP for 1 year at-30°C or below.
• Component preparation allows transfusing only specific blood component
that the patient requires.
• Transfusion of only the specific constituent of the blood needed avoids the
use of unnecessary component, which could be contraindicated in a
patient. For example, because of the risk of hypervolemia, an elderly
anaemic patient in congestive heart failure may not easily tolerate the
transfusion of two units of whole blood, while the same patient can be
transfused two units of red blood cells easily.
• By using blood components, several patients can be treated with the blood
from one donor, giving optimal use of every unit of donated blood.
• Use of blood components, supplements blood supply - adds to blood
inventory.

Blood components such as red cells, platelets, and plasma are prepared from a
single whole blood donations. Components have tightly regulated preparation
and storage requirements. Blood group compatibility between the component
and the patient is considered during product selection. Each component carries
the same risk of hepatitis, human immunodeficiency virus (HIV) transmission as
the original unit of whole blood.

In contrast, plasma derivatives (fractions) such as albumin, immune serum
globulins, and concentrated coagulation factors etc. are prepared from large
pools of donor plasma. They have more flexible storage requirements and are
given without regard to ABO compatibility. Depending on the manufacturing
process, derivatives may carry a decreased risk of hepatitis and HIV transmission
as compared with components.

The blood plasma components given below can be prepared in blood bank by
conventional methods (e.g. centrifugation, freezing and thawing) for therapeutic
use. The specific gravity of red cells and granulocytes is very similar so the
centrifugation is not efficient method of separation them. While plasma

1.09 • Platelet specific gravity 1.02 .03 . . If any unit takes more than 8 minutes to draw.03 Due to different specific gravity of cellular components. fresh frozen plasma or cryoprecipitate.04 • Plasma specific gravity 1.1.derivatives (fractions) are prepared by biochemical or other manufacturing process under pharmaceutical manufacturing conditions in a well equipped Plasma Fractionation Laboratory. it is not suitable for preparation of platelets concentrate.08 .1. Apheresis Cryoprecipitate Factor VIII concentrate Granulocytes. Preparation of blood components is possible due to : • Multiple Plastic packs system • Refrigerated centrifuge • Different specific gravity of cellular components- • Red cells specific gravity 1. • A correct amount of blood proportionate to anticoagulant should be collected in primary bag that has satellite bags attached with integral tubing’s. Blood Components (Cellular and Plasma) and Plasma Derivatives (Fractions): Cellular components Plasma components Plasma derivatives Red cell concentrate Fresh frozen plasma Albumin 5% & 25% Platelet Concentrate Single donor plasma Plasma Protien Fractions Platelet . they can be separated by centrifuging at different centrifugal force in g for different time. • Monitor the collection of blood with Automatic Mixer/Scale which is used for collecting the desired amount of blood and mixing the blood with the anticoagulant. Apheresis Cryo-poor plasma Immunoglobulins Leucocytes-Reduced Fibrinogen • Red cells Other coagulation factors • Platelet Concentrate Precautions to be observed in preparing components: • Proper selection of donor • Clean and aseptic venipunture site to minimize bacterial contamination • Clean venipunture with minimum tissue trauma and free flow of blood • The flow of blood should be uninterrupted and continuous.

Epstein. The use of additive solutions allows recovery of maximum amount of plasma and red cells viability is enhanced. white blood cells. The plasma is transferred into another satellite bag. Whole blood has a hematocrit of 30-40 per cent. While quad packs system with three attached bags are used for preparing red cells. Platelets should be separated within 6-8 hours from the time of collection of blood. Red blood cells preparations are: Sedimented red cells: They have a PCV of 60-70 per cent.24°C until platelets are separated.. CPDA-1 Whole Blood. platelet concentrate. starting from bottom: red blood cells. 30 per cent of plasma and all original leukocytes and platelets. extending the shelf-life of the red cells to 42 days. The name of the anticoagulant is used with the name of the product e. minimum plasma and all Leukocytes and platelets.• If platelets are to be harvested the blood bag should be kept at room temperature 20. platelet concentrate and fresh frozen plasma. Red cells have higher specific gravity than plasma. and plasma only. the centrifuged products settle in layers. Stored blood has no functional platelets and no labile coagulation factors V and VIII. 15 per cent of plasma and all original leukocytes and platelets.poor plasma. The plasma is transferred into a satellite bag. Double bags are used for making red cells.Barr virus (EBV) and human T-cell lymphotropic virus type 1 (HTLV-1) • Transfusion related Graft versus host disease • Transfusion related acute lung injury (TRALI) . Triple packs system with two attached bags makes it possible to make red cells. Centrifuged red cells: They have a PCV of 70. After separating platelet-rich plasma (PRP) from the red cells. Minimum 70% of transfused red cells should survive in the recipient's circulation 24 hours after transfusion. and platelet rich plasma.80 per cent. the PRP is centrifuged at a heavy spin for a longer time. Leukocyte-Reduced Blood Components Leukocytes in blood components can cause: • Non-hemolytic febrile transfusion reaction (NHFTR) • Human leukocyte antigen (HLA) alloimmunizaion • Transmission of leukotropic viruses (Cytomegalovirus(CMV). PREPARATION OF RED BLOOD CELL CONCENTRATES (PACKED RED CELLS) Red blood cells (packed red cells) are prepared by removing most of the plasma from a unit of whole blood. In a unit of blood. Prepared by Centrifuge at heavy spin (5000 x g) for 5 minutes at 2-6oC. WHOLE BLOOD Whole blood contains 450 ± 45 ml or 350 ± 35 ml of donor blood plus anticoagulant solution.g. Red cells with additive (Adsol or SAG-M): They have PCV of 50-60 percent. cryoprecipitate (factor VIII) and cryo. the red cells settle in the lower portion of bag due to the gravitational settling (sedimentation) or centrifugation. This time platelets settle to the bottom of the bag.

. PREPARTION OF PLATELET RICH PLASMA (PRP) AND PLATELET RICH CONCETRATE(PC) Platelet concentrate can be prepared from: 1.9%) reduction of the WBCs (< 5 x 106). There is very little loss of red cells and the process is quite easy. Microaggregate filters are polyester or plastic screen filters with a pore size of 20-40 micron.• Transfusion related immunosuppression Methods of the preparation of Leucocyte-Reduced Red cells • Centrifugation and removing of buffy coat • Filtration • Washing of red cells with saline • Freezing and thawing of red cells Centrifugation and removing of buffy coat: In the centrifugation method for leuokocyte reduction. which trap most of the microaggregates composed of white cells. They are made of polyester or cellulose acetate and will produce a 2 to 4 log (99- 99. leaving the buffy coat. platelets. Random Donor Platelet It is prepared from 350-450 ml whole blood kept at room temperature (22-22°C) and within 6 to 8 hours of collection. Filtration : Many types of filters are available today that can produce an acceptable leukocyte-reduced product depending on the requirement.g. Random donor platelet (prepared from 350.450 ml whole blood) 2. Single donor platelet prepared by apheresis. Haemonetic cell washing machine. and fibrin threads that form in blood after 5-6 days of refrigerated storage. A unit of platelet concentrate prepared from 450 ml blood contains: . A variation of this method is to spin the red cells in an inverted position so that red cells can be transferred into a satellite bag. and NHFTRs. CMV transmission. platelets and plasma. some red cells and plasma behind in primary bag. It can be done manually or using machine e. Washing of Red Cells for leukocyte reduction: Washing of red cells removes leukocytes. They prevent allommunization to HLA antigens. Newer leukocyte-reducing filters (third generation) use selective absorption of leukocytes or leukocytes and platelets. the buffy coat layer between the red cells and the plasma which appear after centrifugation is drawn off along with plasma and some red cells into a satellite bag. Filtration of this type usually give a 1 -2 log reduction (90-92%) of leukocytes in the unit (< 5 x 108) and recover most of the red cells.

Platelets are stored in bags made of standard polyvinylchloride (PVC) with Di-(2-ethylhexyle ) phthalate (DEHP) plasticizer upto 72 hrs at room temperature (20-24°C). Apheresis Random donor platelet prepared from whole blood • Average > 3 x 1011 platelets 5. Agitator (flat bed) with 1” to 1. Maintenance of pH and function of platelets on storage depends upon permeability of storage bag to oxygen and carbondioxide.matched donor Not possible product can be prepared for the patients . • Pseudopod formation.0 or more Precaution and storage : pH should never fall below 6.Plasma Volume 40-70 ml Platelet Yield 5. SINGLE DONOR PLATELETS A unit of single donor platelet(SDP) usually contains the equivalent to approximately 8-10 units of random platelet concentrates i. maintenance of pH. Relative Merits of Platelet-Apheresis(SDP) and Random Donor Platelet Platelet.5 x 106 108 in each unit Obviate the need of filtration filtration is required to reduce leukocytes • Red cells – Traces more • Exposes a patient to one donor Exposes a patient to multiple donors • Less exposure to infections More exposure to infections • Low risk to alloimmunization Relatively more risk to alloimmunization • HLA . and reduces formation of platelets aggregates.5” strokes at 70 cycles per minutes at 20-24°C.or platelet. A decline in pH causes: • Change in shape of platelets from disc to sphere. The above changes are responsible for low recovery and poor survival of platelets in vivo.e 1-4 x 1011 / pack suspended in 200-300 ml of plasma. Agitation during storage helps the exchange of gases.5 ml pH 6.5 x 1010 platelets (equal to platelets obtained from 5 to 6 whole blood donations) • Plasma volume 200 ml 50-60 ml • Leukocytes < 5. gives good results. New plastic bags made of polyolefin with no plasticizer. • Release of platelet granules.5 x 1010 WBC ≥108 RBC Traces to 0. or thin walled PVC with Tri - (2-ethylhexyl) trimellitate (TOTM) plasticizer maintain pH level and platelet function upto about 7 days but it is recommended to use them within 5 days from the date of collection of blood.

as described under FFP. . Freeze the plasma at -70° C in freezer or in ethanol dry bath. It is rich in factor VIII. Procedure 1. freezing and thawing to preserve their activity. obtained from a single unit of fresh plasma (approximately 200 ml) by rapid freezing within 6 hours of collection. FRESH FORZEN PLASAMA (FFP) FFP is plasma obtained from a single donor either by normal donation or by plasmapheresis and rapidly frozen within 6-8 hours of being collected. FFP is plasma obtained from a single donor either by normal donation or by plasmapheresis and rapidly frozen within 6-8 hours of being collected. If FFP is not used within one year. rich in Factor VIII and fibrinogen. 2. the separation of granulocytes by centrifugation is not satisfactory. freezing and thawing to preserve their activity. it is redesignated as a Single Donor Plasma which can be kept further for 4 years at -30° C or below. Store the bag with croprecipitate at -30°C or lower and bag with Cryo-poor plasma in the second satellite bag is stored at -20°C or below. von-Willebrand factor. 4. Single donor unit 2. To separate the plasma from whole blood centrifuge is done at heavy spin (5000 x g for 5 minutes) at 4°C. Leukapheresis by blood cells separator As the specific gravity of red cells and granulocytes is very similar . CRYO PRECIPITATE Cryoprecipitate are precipitated proteins of plasma. It contains all coagulation factors and great care must be taken during collection of blood.who have become refractory to platelets. It contains all coagulation factors and great care must be taken during collection of blood. for processing into cryoprecipitate. Leukapheresis is a better method. Prepare fresh frozen plasma (FFP). • Sophisticated equipment required Not required • Highly trained persons required Not much GRANULOCYTE CONCETRATE Granulocyte concentrate can be prepared by: 1. fibrinogen (Factor XIII) and fibronectin. 3. • Decreased risk of bacterial contamination More risk of bacterial contamination . Thaw frozen plasma either at 4°C in a cold room (air thaw) or at 4°C in circulating water bath. It has been shown that the most labile coagulation factors are preserved for one year if FFP is kept at -30° C or below.

Reconstituting cryoprecipitate (Thawing and issue of Cryoprecipitate) Cryoprecipitate is reconstituted before issue by placing in an overwrap in a 30°C water bath until the cryoprecipitate has dissolved. Few patients fall into this category. It should not be frozen. single donor plasma may be kept upto 5 years. One bag of cryoprecipitate contains on an average 80-120 units of factor VIII in 15-20 ml of plasm. CRYOPRECIPITATE-POOR-PLASMA It is a by-product of cryoprecipitate preparation. i. A unit of whole blood of 350 ml blood will increase the hemoglobin by about 0. The patients of trauma and for major surgery or exchange transfusion may be considered for whole blood transfusion.Storage and shelf life of croprecipitate : One year at -30°C or below.75 g/dl while a unit of 450 ml will increase Hb by about 1 g/dl in an adult patient of about 70 Kg body weight who is not bleeding. Indications for use : Whole blood is indicated for those patients who have a symptomatic decrease in oxygen-carrying capacity combined with hypovolemia of sufficient degree associated with shock. cryoprecipitate should be kept at 2-6°C and administered within 4 hours. IX and X. THERAPEUTIC USES OF BLOOD COMPONENTS WHOLE BLOOD Functions of whole blood • Red cells in whole blood carry O2 to tissues • Plasma in whole blood is blood volume expander • Whole blood is a source of proteins with oncotic properties • Is a source of non-labile coagulation factors. RED BLOOD CELLS (Packed Red Blood Cells) Red cells are indicated for increasing red blood cells mass in symptomatic anemia who require increased oxygen-carrying capacity. . SINGLE DONOR PLASMA Single donor plasma can be prepared by separating it from red cells any time upto 5 days after the expiration of the whole blood unit. It lacks labile clotting factors V and VIII and fibrinogen. Generally. General principles There is no universal `trigger' for red cell transfusions. VII. a given concentration of haemoglobin at which transfusion of red cells is appropriate for all patients. A prolonged pre-separation storage period increases its contents of potassium and ammonia and at times free hemoglobin.e. it has no labile coagulation activity. Once thawed. It is frozen and stored at -20°C or lower temperature for 5 years. When stored at -20°C or lower. It contains adequate levels of the stable clotting factors II.

8 g/dl. 1999). RBCs & crystalloids > 40% of blood vol. − The correct strategy for transfusion of patients with haemoglobin concentrations between 7 and 10 g/dl is less clear. Whole blood or RBCs & Crystalloids Need for transfusion based on consideration of the concentration of haemoglobin.g.0 g/dl in the absence of disease and between 8 and 10 g/dl with disease need transfusion of red cells. Clinicians often transfuse red cells. e. e. Indications for the use of red cell transfusions 1) Acute blood loss.10 g/dl. In principle. megaloblastic anaemia and autoimmune haemolytic anaemia.7/g/dl.10 g/dl) (Hebert et al. Overtransfusion may increase mortality in this group. The cause of anaemia should be established. 3) Chronic anaemia. when the haemoglobin concentration becomes . Each unit of transfused red cells prepared from 450 ml of whole blood is expected to increase hemoglobin by about 1 g/dl (Hct 3 per cent) in a patient of 70 Kg body weight and who is not bleeding as with whole one unit of whole blood. e.Clinical judgement plays a vital role in the decision to transfuse red cells or not.7 g/dl) than in patients receiving a `liberal' transfusion strategy ( trigger haemoglobin concentration . consider adopting a higher concentration at which transfusions are indicated. red cell transfusions for patients with chronic anaemia should be given at intervals to maintain the haemoglobin just above the lowest concentration that is not .g. − Red cell transfusion is indicated when the haemoglobin concentration is .g. treatment of iron deficiency. Crystalloids/Colloids 30-40% of blood vol. None 20-30% of blood vol. The same target values should be applied as for acute blood loss. unless the anaemia is life threatening. − In patients who may tolerate anaemia poorly. The increase in hemoglobin and hematocrit is evident more quickly with transfusion of 1 unit of red cells than with 1 unit of whole blood. 2) Anaemia in critical care. The concentration of haemoglobin should be considered along with other factors such as the rate of blood loss: − Red cell transfusion is not indicated when estimates of actual and anticipated haemoglobin concentrations are . although available evidence suggests that this is often not justified. However it is suggested that values of hemoglobin of less than 6. and treatment with red cell transfusions should not be given where effective alternatives exist. patients over the age of 65 years and patients with cardiovascular or respiratory disease. Surgery • Patient need urgent operation and has Hb < 10g/dl • Anticipated surgical blood loss > 1000 ml Other acute Loss of blood Replacement Fluid < 20% of blood vol. 30-d mortality was no worse in patients receiving a `restrictive' transfusion strategy ( trigger haemoglobin concentration .

• IgA deficient patient with antibodies to IgA • Its use to prevent FNHTRs has been supplanted by the use of LR-Red Cells. PLATELET TRANSFUSION The production of platelet in a healthy person is approximately 40. • Patients who have developed antibodies to plasma proteins. Platelet transfusions . Platelet transfusions are indicated for the prevention and treatment of haemorrhage in patients with thrombocytopenia or platelet function defects. if compatible.95 % of leukocytes and there is concomitant loss of 15 .associated with symptoms of anaemia. • Removed plasma can be used for preparing FFP and cryoprocipitate (factors VIII andV). sensitive to complement. Indications • Patients having recurrent attacks FNHTRs and urticarial reactions. • Autologous units of patients with multiple red cells alloantibodies stored for future surgery. but it is effective in removal of plasma proteins and microaggregates.20 ml of red blood cells. Advantages of transfusion of red cells • Reduce risk of circulatory overload due to less volume of anticoagulant and plasma • Lessens severity and incidence of allergic reactions • ABO antibodies are reduced. FROZEN/DEGLYCEROLIZED RED CELLS Indications • The provision of rare blood lacking common antigens for patients with corresponding antibodies. red cells non-ABO identical to patient’s group can be given. This production rate balances platelet removal and sustains a normal platelet count as long as steady state conditions are maintained. • IgA deficient patient who has developed anti-IgA • Paraoxymal noctural hemglobiuria (PNH). Leukocytes-reduced red blood cells are indicated in the following conditions: • Multitransfused patients like thalassaemic • Leukemia • Aplastic anemia • Immunosupressed • Immunodeficient • Multiparous women • Prevention of recurrent FNHTRs • Prevention or delay of primary alloimmunization to HLA antigen • Prevention of CMV transmission in at risk individual Leuko-reduced red cells are not indicated to prevent transfusion related GVHD WASHED RED CELLS Washing of red cells removes 70 . but it may be difficult to determine what this concentration is for individual patients.000 platelets / μl per day.

1980). concurrent use of antibiotics or other abnormalities of haemostasis . Rh . depending on the patient’s size and the number of platelets transfused. laparotomy or similar procedures. Administration of ABO incompatible platelets is an acceptable transfusion practice. If the platelet transfusion was given because the patient was bleeding. ABO compatibility between donor and recipient is of minor importance in platelet transfusion in most adults. Risk factors include sepsis. insertion of indwelling lines. but the minimum platelet recovery to define a successful transfusion is considered as > 30% at 1 h post transfusion and > 20% at 20–24 h. liver biopsy. − For lumbar puncture. including: 1. Bone marrow failure (due to disease. Platelet recovery The percentage platelet recovery (R) is calculated from the platelet increment (x 109 ⁄ l) (PI). and a preoperative platelet count should be checked to ensure that the above thresholds have been reached. the platelet count should be raised to 100 X 109 ⁄ l It should not be assumed that the platelet count will rise just because platelet transfusions are given. Responses to a prophylactic platelet transfusion should be assessed by measuring the increase in the platelet count following the transfusion.are not indicated in all causes of thrombocytopenia and may indeed be contraindicated in certain conditions. or a CCI of > 7. transbronchial biopsy. the body surface area of the patient in square metres (BSA) and the dose of platelets transfused (x1011) (PD): _1 CCI = PI x BSA x PD A successful transfusion may produce a platelet recovery of about 67% in a stable patient. gastroscopy and biopsy. the blood volume (BV) in litres and the platelet dose transfused (x 109) (PD): R(%) = PI x BV x PD_1 x 100 2. The possibility of Rh immunization by red cells contained in platelet concentrates should be considered in female patients. the platelet count should be raised to at least 50 X 109 ⁄ l − For operations in critical sites such as the brain or eyes. the clinical response is the most important indication of the effectiveness of the transfusion. Corrected count increment The corrected count increment (x 109 ⁄ l) (CCI) is calculated from the platelet increment (PI).5 x 109 ⁄ l at 1 h and > 4. although serious spontaneous haemorrhage due to thrombocytopenia alone is unlikely to occur at platelet counts above 10 x 109 ⁄ l (Slichter. Prophylaxis for surgery − Bone marrow aspiration and biopsy may be performed in patients with severe thrombocytopenia without platelet support. epidural anaesthesia. cytotoxic therapy or irradiation) − Therapeutic platelet transfusions are unequivocally indicated for patients with active bleeding associated with thrombocytopenia. providing that adequate surface pressure is applied.5 x 109 ⁄ l at 20–24 h. RESPONSE TO PLATELET TRANSFUSIONS Responses to platelet transfusions should be monitored as they will serve as a guide to further platelet supportive care. Various formulas have been used to correct for the variation in the increment of the platelet count. A threshold of 10 x 109 ⁄ l is as safe as higher levels for patients without additional risk factors.

otherwise Rh(D) immune globulin Rhlg should be given in doses of 20 μg for each unit of platelet. still in experimental stage. Contraindications for Platelet Transfusions : 1. Platelet refractory state Patient becomes refractory to platelet transfusion. if increment in platelet count one hour after transfusion is less than 20% of the expected increase in value on two occasions. Idiopathic thrombocytopemia purpura . are • Treatment of platelets with ultraviolet light to abolish the immunogenicity of contaminating leukocytes. • Splenectomy • Removal of antibodies by plasmapheresis • High-dose intavenous immunoglobulin therapy − Graft-Versus-Host Disease :. platelets subsequently administered often fail to produce a therapeutic benefit. Alloimmunization to platelet antigens is common in patients who have received repeated platelet transfusions.matched platelets from family members or unrelated persons. • Platelets-Matched transfusion • Platelet from single donor (prepared by apheresis) • Leukocyte-reduced platelets New approaches to this problem. Thrombotic thrombocytopenic purpura (TTP). • Transfusion of soluble. class 1 HLA antigens to induce active tolerance.(D) negative female patient of child bearing age should be given platelets from Rh (D) negative platelets.This is a rare complication of platelet transfusions that can beprevented by gamma irradiation of concentrates prior to transfusion to patients who have undergone bone marrow transplantation or have other form of immunodeficiency. • HLA. Platelet refractoriness may be due to: Immune-mediated platelet refractoriness − Antibodies against HLA antigen − Antibodies to platelet-specific antigen Non-immune based refractoriness − Sepsis − High fever − DIC − Hyperspleenism Various techniques have been used to improve the effectiveness of platelets in alloimmunized patients. Risks associated with platelet transfusion : − Alloimmunization When platelet-reactive HLA-antibodies are induced by transfusion.

There is no role for prophylactic platelet transfusion in routine primary open heart surgery unless there is: a. Heparin-induced thrombocytopenia. • Adverse effects of granulocytes transfusion However the granulocytes trasfusion are still used at times with success in the following conditions: • Septicaemia not responding to antibiotics.g. Microvascular bleeding (e.230 ml All coagulation Factors 1 i.6 x 109 granulocytes daily Granulocytes transfusion should be discontinued when the patient becomes a febrile.g. unless life-threatening hemorrhage exists. GRANULOCYTES TRANSFUSION The role of granulocytes transfusion has decreased with • The availability of new and better antibiotics • The advent of recombinant granulopoietic growth factors e. including the labile Factors V and VIII if stored at . Surgery or invasive procedures where platelet count is more than 50.5 . / ml of each factor (including Factors V & VIII) Fibrinogen 200 .u.2 weeks.50 x 109/L (500 / mm3). FRESH FROZEN PLASMA FFP contains plasma proteins and all coagulation factors. Microvascular bleeding and platelet function defect 3. 1 unit of granulocytes prepared by apheresis (Equivalent to 18 .000 /μl.400 mg Indications of Fresh Frozen Plasma Actively bleeding and multiple coagulation factors deficiencies in • Liver diseases • Disseminated intravascular coagulation (DIC) • Coagulopathy in massive transfusion . Infections in patients undergoing chemo / radio therapy for neoplastic diseases • Neutrophil count less than 0. having gram-negative infection which fail to respond with antibiotics • Temporary bone marrow depression for 1 . granulocyte stimulating factor (rhG- CSF). Microvascular bleeding and platelet count 50. post-operative chest tube drainage greater than 500 ml within 6 hours) and non-diagnostic coagulation abnormality c. or when granulocyte count exceeds 1. 2.0. Granulocyte products available: • Buffy coat • Granulocytes.000/μl b. Contents of 1 unit of FFP prepared from 450 ml Of whole blood Plasma 175 .(ITP).30°C or below.g.0 x 109/L.20 units of buffy coat) • Infected neonates need 0. Apheresis Doses and Administration of Granulocytes • In adult 1xl010 granulocytes daily e. prophylactic platelet transfusion is not indicated.

Post transfusion assessment of levels of aPTT.B. signs of hemorrhage may require transfusion of FFP in emergency.. However plasma of the same ABO group as that of the recipient is preferred. but contain stable clotting factors II. Cryo-poor plasma lacks fibrinogen also. Compatibility test before transfusion is not necessary. but not necessarily group specific.AB AB AB Rh(D) positive plasma should not be given to Rh(D) negative women in the reproductive age group. Both these products lack the labile coagulation factors V and VIII.A. VII. FFP can be used as a source of Factor V. IX. ■ Cryoprecipitate-poor plasma contains 80% of the amount of Factor V in FFP and can be used as an alternative to FFP.• TTP • When specific disorder cannot be or has not yet been identified ■ Familial Factor V deficiency If concentrated Factor V is not available. PT and fibonogen is done for monitoring the effect of FFP. Inappropriate use of fresh frozen plasma • Blood volume expander • Hypoproteinaemia • Source of immunoglobulins • Reversal of prolonged INR in the absence of bleeding. VII. and X It is due to the absence of vitamin K or the use of drugs such as coumarin.AB B B. . Because several hours are required for vitamin K effectiveness.AB A A. The donor’s plasma should not contain ABO antibodies that might interact with A or B antigen on the recipient’s red blood cells. Cryoprecipitate-poor plasma is a by product of cryoprecipitate preparation. SINGLE DONOR and CRYOPRECIPITATE-POOR PLASMA Plasma separated from one unit of whole blood on or before the fifth day of the expiration date is called as single donor plasma. and X. ■ Deficiency of Factors II. Before transfusion FFP should be thawed at 30-37°C in circulating water bath. ■ Antithrombin III deficiency ■ Congenital or acquired coagulation factor deficiency ■ Use of FFP in conjunction with red cells has largely replaced the transfusion of fresh blood. Plasma should be ABO compatible with the recipient blood. Plasma ABO Compatibility Chart Recipient’s blod group Plasma Donor’s blood group O O. or within 12 hours. Dosage of FFP: About 10 ml / Kg of body weight. IX. if stored at 2-4°C. Administration of vitamin K is preferred to FFP in order to correct Vitamin K deficiency or coumarin over dose. like warfarin sodium and dicumarol that interfere with vitamin K metabolism. Thawed plasma should be transfused as soon as possible.

Fibrinogen 150 . diarrhea. It has long been known that gamma irradiation inactivates lymphocytes in blood. The resulting disease has serious consequences like fever. Doses and Administration of Factor VIII Concentrates Cryoprecipitate may not be ABO identical however ABO compatible croprecipitate is preferred. coagulopathies due to warfarin drugs) • Burn Doses : are the same as that of FFP. a person of 70 kg weight will require 1400 i.15 ml Factor VIII 80 ./ml).g. such as bone marrow transplant patients. of factor VIII. In calculating the dose. all of them can progress to mortality. If 20 units /Kg body weight are required. Recipients at high-risk of GVHD are those who are severely immunsuppressed or immunocompromised. it can be assumed that 1 i.250 mg von-Willebrand Factor 40 .30% of the original Indications : • Hemophilia A • von Willebrand’s disease • Congenital or acquired fibrinogen deficiency • Acquired Factor VIII deficiency (e. if the patient’s base line factor VIII level is 0. neonates who ./ml. hepatitis.u. Data from the first five reports of the Serious Hazards of Transfusion (SHOT) scheme show that transfusion-associated graft-versus-host disease (TA-GVHD) is the most frequent cause of transfusion-associated death (The Serious Hazards of Transfusion Steering Group.4 i. CRYOPRECIPITATE Each bag has approximately: Plasma 10.u. Thus. 2002). The compatibility testing is not necessary. massive transfusion) • Factor XIII deficiency • Source of Fibrin Glue used as topical hemostatic agent in surgical procedures and to remove fragmented renal calculi.100 i.u. CRYO could be used to supply 1400 i. IRRADIATION Since past several years the use of irradiated blood products (primalary red blood cells and platelets) has increased dramatically.u.02 i. but at 80 i. Rh type need not be considered when using this component.Indications • In deficiency of stable clotting factors (e.g. of factor VIII. per bag this would require at least 17-18 bags of cryo.70% Fibronectin 55 mgm Factor XIII 20 ./ml).u. The half-life of factor VIII is 10- 12 hours. skin rashes.u. bone marrow suppression and infection. Viable lymphocytes in blood can be responsible for graft- versus-host disease (GVHD) in the recipient-host. DIC.01 i.u. of factor VIII / Kg body weight will increase the patient’s factor by 2% (0.u.u./Kg body weight would be expected to raise the level to 40% (0. a dose of 20 i.

every 12 hours • Intramuscular hemorrhage 20 . Irradiation should not be performed on bone marrow or peripheral blood progenitor cells prior to their infusion.u. every 12 hours teeth • Tongue or mouth laceration Often not necessary .u. reducing their survival after transfusion. every 8-12 Intracranial hemorrhage hours Major surgery Major trauma • Severe abdominal pain 20 20-25 i. The shelf-life of irradiated blood (RBCs) is 28 days from the date of irradiation or original expiration date of unit. Products such as FFP and cryoprecipitate do not require irradiation because they do not carry viable lymphocytes. every 12 hour • Extraction of permanent 20 20 i. Therefore irradiated red blood cells are given in a reduced storage time. platelets and granulocytes) of the blood.u/k Frequency • Acute hemarthosis Early 10 Seldom required Late 20 20 i. The usual dose is 25 Gray (Gy) to 35 Gy (1 Gray=100 rads).have received intrauterine transfusion and exchange transfusion. Hemophilia A .u. and persons who are recipient of blood from first-degree relatives. u. whichever comes first.u.30 20 i. Studies have shown that irradiation causes a modest leakage of potassium.Recommended Doses of Factor VIII Type of bleeding Doses (Factor VIII i. This dosage inactivates 85 to 95% of lymphocytes in the blood components without any adverse effect on other cellular components (red cells. Indications for Transfusion of Irradiated Blood • Bone marrow transplant or Peripheral blood stem cells recipients • Neonates intrauterine transfusion recipients • Neonatal exchange transfusion recipients • Premature new born s (less than 1200g) • Immunocompromised or immunosuppressed recipients • Recipients of first-degree relative donors blood • Recipients of HLA-selected platelets or platelets known to be HLA homozygous • Patients with Hodgkin's disease or non-Hodgkins's lymphoma • Granulocytes transfusion recipients Mostly either cesium-137 (137 Cs) or Cobalt-60 ( 60 Co ) is used as the source of gamma rays.threatening situation 50 25-30 i. every 12 hours Life .

5 x 106. 250 Increase red cells mass in WBC & some ml symptomatic anemia platelets. s WBC < 5. ml plasma sometimes HLA concentrate. Hct 75%) 180 Increased red cells mass. Platelets 5. ml mass in symptomatic Solution reduced plasma.8 times of controls) . Hct 40%) 500 Increase red cells and WBC & some ml plasma volume platelets. WBC <5 x106 RBCs < 5x 106 . reduced volume . WBC <5 x 108 ml reduce risk of allergic No plasma reaction to plasma proteins RBCs frozen/ RBC (approx.if plasma coagulation Factors ml PT > 18 sec. aPTT >60 seconds (> 1. volum Whole blood RBC (approx.5-1. Granulocytes > 1x1010 220 Used in selected cases apheresis Lymphocytes: some RBCs ml with sepsis & sever and platelets neutropenia (500/μl) Fresh frozen Plasma having all 220 Coagulation disorders. plasma thrombocytopenia or (random thromocytopathy donor) Plateletpheresi Platelet > 3 x 1011/unit 300 Same as platelet.Blood Components and their uses (Summary) Components Composition Appro Indications x.Few platelets & decrease HLA immuni- minimal Plasma zation & CMV transmission Washed RBCs RBC (approx. WBC. Hct 75%). used for prolonged RBCs storage Platelet. 75%) 180 Increase red cells mass. reduced plasma Red RBC (approx.5x1010/unit 50 ml Bleeding due to Concentrate few RBCs. & minimal RBCs matched or platelet cross- matched platelets are prepared Granulocytes.WBC<5x 108 to ml reduce FNHTR. RBC > 85% of original 225 Increase red cells mass. Hct 60%) 330 Increase in red cells cells+Additive WBC & some platelets.100 ml anemia of additive solution Leukocytes. VIII Red blood cells RBC (approx. Plasma deficient in factors V. Deglycerolized WBC < 5x106 ml minimize febrile or no platelets & plasma allergic reactions.

deficiency VIII) of fibrinogen & factor XIII GENERAL TRANSFUSION PRACTICES Filters for blood components Generally two types of filters are used for blood transfusion: a 170-mm filter or a leukocytedeletion filter. stable clotting 220 Stable clotting factor factors.Plasma Plasma. This filter is designed to prevent febrile nonhemolytic transfusion reactions.factor XIII. A standard blood administration filter must be used for transfusion of all blood components. 15 Hemophilia A. If it is not required for transfusion it should be returned immediately to the blood bank with reasons. d Willebrand’s . to prevent or delay the development of HLA antibodies. The 170-mm filter removes clots or cellular debris develop during storage from any blood products and is used in routine administration sets. and to reduce the risk of CMV. von. If the . Before starting transfusion. These time limits have been determined for temperate climates where temperature in hospital building are generally between 22°Cand 25°C. Leukocyte-depletion filters are designed to remove white blood cells (WBCs). IX. Time limits for infusion Whole blood or red cells 1. Administration of blood Products A physician or a qualified nurse should administer blood and blood products. Transfusion should be completed within 4 hours of starting the transfusion. X. no platelets ml deficiencies (II. it is not taken back in the blood bank. 2. After 30 minutes of issuing it from the blood bank. XI) Cryoprecpitate Factor VIII. The administration of whole blood or red cells should be started with in 30 minutes of Issuing from the blood bank. patient identity check should be done at the patient's bed side. Filtration in the blood bank seperatory rather than at the bedside. ml von-Willebrand’s AHF (Factor fibrinogen disease. is more reliable and better for reduction of leukocytes. VII.

Fresh Frozen Plasma 1. 2.Adults receiving multiple transfusion at rates greater than 50 ml/kg/hr 2. 3. Transfusion with 18 gauge needle or cannula is recommended . Patients who may need benefit from warmed blood include: 1. Children receiving transfusion at rates greater than 15 ml/kg/hr. FFP should be infused as soon as possible after thawing to avoid loss of labile clotting factors or thawed plasma stored at 2-4oC should be used within 12 hours. If blood warmers are being used they should be tested before use to ensure that the temperature regulators are operating properly. Should be kept at room temperature 22°C to 24°C. 4. or run blood through an extended tubing or coil in water bath. In adult. Pressure Devices for rapid infusion Pressure devices or pumps are sometimes used to achieve very fast flow rates in rapid transfusion: 1. The temperature of the blood should also be monitored. ■ Do not immerse whole unit of blood or red cells in a water bath. Blood warming procedure ■ It is carried our using approved blood warmer devices. I unit of plasma should generally be infused with in about 15-20 minutes.ambient (room) temperature is very high. Infusion should be completed with in about 15-20 minutes. shorter 'out-of-refrigerator times' should be used. Infants receiving exchange transfusion 4. Platelet concentrate should be administered as soon as they have been received. infusing 2-4 units of refrigrated blood over several hours causes no harm. Thawed or partially thawed plasma is not taken back in the blood bank. Platelet Concentrates 1. 3. Blood Warming Routine warming of blood is not needed. Should be administered with transfusion set with filter 5. if the patient requires ongoing transfusion support. Patients receiving rapid transfusion through central venous catheter 5. such as the Level 1 Hot line. ■ Blood is not warmed above 37°C. Patients with cold agglutinins The rapid and massive transfusion of cold blood (2-6oC) is associated with an increased risk of ventricular fibrillation and cardiac arrest. 2. Do not put in refrigerator. Change the blood administration set after 12 hours. Platelets once issued are not taken back in the blood bank. Excessive warming can cause hemolysis and endanger the patient. 3. 3.

The advantages of single-donor components are: 1. Fewer donor reaction due to . Automated cell-separator machines are used for both component preparation and therapeutic applications .Crystalloids and anticoagulants return of fluid . In apheresis blood is withdrawn from a donor or patient in anticoagulant solution and separated into components. The bag should be inflated to about 200 mm Hg till blood flow through the drip chamber is continuous.Reduced risk of alloimmunization . Ability to match donor to patient Platelet matched or HLA matched 6. Pressure of 300 mm Hg may cause the red cells to hemolyse and the blood bag seams to split.Reduced incidence of transfusion- transmitted diseases 2. With the current available automatic technology now the manual process is seldom used. Purer product leukocytes-reduced products 5. Any one of the components of blood can be removed and the procedures are specified for the Component selected. The issues of safety and quality. Full and effective transfusion dose 3. REFERENCES . It can be done manually or using automated equipment. The process of removing the plasma from red cells is termed plasmapheresis.Reduced multiple donors exposure . Similarly terms are given to the removal of other components. A device of a pressure bag with a sphygmomanometer is required in emergency situation when blood has to be transfused rapidly (about 5 minutes per unit). One (or more) component is retained and the remaining constituents are returned to the individual.2. Higher quality product 4. with fluid from interstitial spaces 7. Apheresis (or hemapheresis) Apheresis (or hemapheresis) is a Greek word that means to separate or remove. It involves great care that the bags are labelled correctly and its contents are returned to ihe correct donor. are met by the use of single-donor apheresis components. Smaller needle technology Venous access injuries are less. which are the basic requirement in blood banking. including platelets (plateletpheresis). Apheresis can be non-therapeutic or therapeutic. red cells (erythrocytapheresis) or leukocytes (leukapheresis).Longer period in apheresis help refilling of intravascular compartment. In manual apheresis whole blood is collected in multiple bags system and centrifuged off-line .

Ministry of Health Services & Family Welfare. Mollison PL. 199.A. Directorate General of Health.GUIDELINES FOR THE CLINICAL USE OF RED CELL TRANSFUSIONS. 24±31. 409±417. S. Dacie. New England Journal of Medicine.T. Contreras Marcela.. Slichter. 117:151-62. 2003. controlled clinical trial of transfusion requirements in critical care. Transfusion Medicine Technical Manual. L. DGHS. Hebert et al. 2001. 2. British Journal of Haematology. 11–28 11. cryoprecipitate and cryosupernatant. K. the Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group (1999) A multicenter. . 10–23 10. Blood Transfusion in Clinical Medicine. Guidelines for the use of fresh-frozen plasma. Sir John V. 20lh Edn.. 31.. Churchill Livingstone. 340. 8. 6th Edn. Standards for Blood Bank and Transfusion services. 3. of India (1987) 6. randomized.. Lane.2004 The British Society for Haematology.INDIA 9. (1980) Controversies in platelet transfusion therapy. British Journal of Haematology. et al.. C.P. T. Goodnough. 122. Services. USA(2000). GUIDELINES FOR THE USE OF PLATELET TRANSFUSIONS. . 4. Engelfriet. Ann Intern Md. Standards of Blood Banks and Transfusion Services. 5. Second Edition 2003.J. Practicle Hematiology. 1993. 1984. Ammerican Association of Blood Banks.. 7.. 126. Govt.C. Annual Reviews of Medicine. 1. 113. Leukocyte reduction in blood component therapy. S. 9th Edn. Anderson. Lewis..M. 509–540.