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Dr.

Sanjay Upreti Assistant Professor Department of Pathology

What is Blood component

Whole Blood vs Components


Whole blood- red cells suspended in a protein solution Wastage More side effects Not available in western countries Components Specific Therapy More patients can be benefitted Increased shelf life

Whole blood

Red cells

Granulocytes

Plasma

Platelets

(Fresh frozen plasma (FFP) F Vlla*

Fractionated products

Immune Globulin F Vlll*

Cryoprecipitate

Cryo supernatant plasma (CSP) F lX*

Albumin

* Now available as recombinant products

Blood Products
Whole blood Red cell component Platelet component Plasma products Component Fresh frozen plasma (FFP) Liquid plasma derivatives Albumin

Red blood cell Single donation conc./suspension unit (PC) (PRBC) Washed Red Cells Conc. Pooled unit

Coagulation factors immunoglobulins

Leucocyte Single donor Cryoprecipitate depleted red cells apheresis platelets (SDAP) Frozen red cells - irradiated PRBC - irradiated PC Cryo poor plasma Viral inactivated plasma

Red Cell Components

Composition
Preparation

Whole blood

Red cell concentrate (PRBC)


Separate plasma at 260C under gravity/centrifugation

Red cell suspension


Separate plasma and add additive soln. e.g. ADSOL 1-1.5% 150-200 42 days-ADSOL Low viscosity, more shelf life Expensive

1 unit increase Hb by Volume (ml) Maximum storage time at 2-60C Advantages Disadvantages

1gm% 350-450 35 days : CPDA

1-1.5gm% 150-200 35 days: CPDA Easier to prepare Higher viscosity

PRBC
Indications-

Component of choice for virtually all patients with a deficit of oxygen carrying capacity, e.g., blood loss or anemia. Transfusion Trigger>10 gm/dl- Probably no transfusion required 7-10 gm/dl- Transfusion may be requierd <7 gm/dl- Transfusion is usually required

Storage lesions
Viability
2-3 DPG Levels Potassium plasma Hb

REVERSIBLE No or very little clinical significance

Washed RBC
Washed with NS
Removes 99% of plasma proteins, electrolytes and

antibodies No significant leukoreduction. 20% cells lost Use within 24 hours.

Washed RBCs
Indications IgA Deficient individuals Repeated allergic reactions Intrauterine transfusion Pts with T activated cells Very occassionaly- severe autoimmune hemolytic anaemia

Leukodepleted RBC
< 5 x 10 6Leukocyte/unit
Reduce the risk of

1. Febrile non hemolytic reactions 2. CMV Transmission 3. HLA Allo-immunization leading to platelet refractoriness.

Leukodepleted RBC
1. Filteration Prestorage leukodepletion Leukodepletion at time of issue Bedside leukodepletion 2. Buffy Coat Removal

Irradiated Blood Components


Indication- To prevent TA- GVHD Usually due to use of fresh whole blood from related donors/ immunocompromised pts Pathophysiology- escape of donor T lymphocytes present in cellular blood components in the recipient & subsequent clonal expansion of these cells with immune destruction of host tissues.

s/s- fever,dermatitis, erythroderma, hepatitis,

enterocolitis, pancytopenia, hypocellular marrow, Instrument- Blood irradiator Dose- 25Gy Irradiation indicated for1. all relative donors 2. immunocompromised patients 3. neonates undergoing exchange transfusion 4. Pts with Hodgkins disease 5. Pt of CLL receiving fludarbine phosphate

Platelets Transfusion
Indications Bleeding d/t thrombocytopenia/abnormal platelet functions Prophylactically- 10,000/cumm instable pts. Platelet transfusion trigger -50,000/cumm for most surgeries. Neurosurgery/ophthalmic surgery- 100,000/cumm

Effectiveness of platelet transfusion


1 unit of platelet concentrate will increase the platelet

count by 5-10K in the average adult; Dose:1 unit platelet concentrate per 10 kg body weight or 1 unit apheresis platelets Patients repeatedly transfused - alloimmunized and refractory to platelet transfusion-HLA matched or cross-matched platelets may be required

Platelets Transfusion
Contraindications ITP Platelet refractoriness TTP Heparin induced thrombocytopenia