Blood components

Whole Blood, Blood Components & Blood Derivatives

Dr Shahin Hameed

JR Pathology

AIMS

BLOOD PRODUCTS

Whole bloodOne unit of donor blood collected in a suitable anticoagulant-

preservative solution and which contains blood cells and plasma.

Blood componentsA constituent separated from the whole blood, by differential

centrifugation of one donor unit or by apheresis.

Blood derivativesA product obtained from multiple donor units of plasma by

fractionation.

WHOLE BLOOD

• BLOOD COMPONENTS

– Packed red cells

– Granulocyte concentrate

– Platelet concentrate

– Cryoprecipitate

– Fresh frozen plasma

• BLOOD DERIVATIVES

– F VIII concentrate

– F IX concentrate

– Albumin

– Immunoglobulins

– Prothrombin complex concentrate

WHOLE BLOOD

• One unit of blood collected in a suitable anticoagulant solution.

• Haematocrit 35-45% and haemoglobin 12.0gms/dl.

• Contains no functionally effective platelets and no labile coagulation factors.

• Storage temperature: 2-6oC in appropriate blood bank refrigerator.

• Shelf-life: 35 days (in CPDA-1)

• Indication: Acute massive blood loss, Exchange transfusion, Non-availability of packed red cells

• Risk of volume overload in patients with chronic anaemia and compromised cardiovascular function.

BLOOD COMPONENTS

Red cellsPacked red cells

Red cells in additive soutionLeucocyte-poor red cells

Washed red cellsFrozen red cells

Irradiated red cells

PlateletsPlatelet concentrate

GranulocytesGranulocyte concentrate

PlasmaFresh frozen plasma

Cryoprecipitate

TEMPERATURE AND DURATION OF STORAGE OF BLOOD PRODUCTS

• Whole blood, Packed red cells: 2-6oC for 35 days

• Platelet concentrates: 20-24oC for 3 days with continuous agitation

• Fresh frozen plasma: below -25oC for 1 year

• Cryoprecipitate: below -25oC for 1 year

PACKED RED CELLS (RED CELL CONCENTRATE)

• Red cells from which most of plasma has been removed.

• Haematocrit 55-75% or haemoglobin 20mg/dl.

• Raises haemoglobin by 1 gm% or haematocrit by 3 %

• Storage temperature: 2-6oC and shelf-life 35 days (in CPDA)

• Indication: replacement of red cells in anaemia and in acute and massive blood loss (along with crystalloid or colloid)

• Volume: 250ml

RED CELLS IN ADDITIVE SOLUTION (RED CELL SUSPENSION)

• Commonly used additive solution is SAGM (saline, adenine, glucose and mannitol).

Advantages:• Maximum amount of plasma can be removed for preparation of plasma components.• Shelf life increases from 35 days to 42 days.• Flow of infusion is improved due to reduction in viscosity

Indications similar to those for packed red cells

Contraindication for exchange transfusion in neonates

LEUCOCYTE-POOR RED CELLS

• These are the red cells from which most of the white cells have been removed• By definition, leucocyte depleted red cells should contain less than 5 X 106 white cells per bag

Indications:• To avoid sensitization to HLA antigens• To avoid febrile transfusion reactions in persons who require repeated tansfusions or who have earlier been sensitized to white cell antigens• To reduce the risk of transmission of CMV infection

WASHED RED CELLS

• Packed red cells can be washed with normal saline to remove plasma proteins, white cells and platelets

• IgA-deficient individuals

FROZEN RED CELLS

• Red cells can be stored frozen for up to 10 years

• To prevent haemolysis of red cells during freezing and thawing, a cryoprecipitate agent such as glycerol is added

Indications:• Donor red cells with rare blood groups can be stored frozen for recipients who have developed antibodies against frequently occuring red cell antigens• Red cells can be stored frozen for future autologoustransfusion, if blood group is rare

IRRADIATED RED CELLS

Transfusion of gamma-irradiated red cells is indicated for prevention of graft vs. host disease

PLATELETS

•Obtained either from single donor units of whole blood by centrifugation or by plateletpheresis

•Platelets prepared from whole blood donation are supplied either as a single unit or as a pooled unit (i.e. platelets obtained from 4-6 donor whole blood units are ‘pooled’ together in one bag)

•Platelets obtained from plateletpheresis are supplied as one pack of single donor platelet

•Storage: 20-24oC with constant agitation up to 72 hours

•Common indications : thrombocytopenia due to decreased platelet production and hereditary platelet function defect

PHERESIS

Donor pheresis is a procedure in which a suitable donor is connected to an automated cell separator machine through which whole blood is withdrawn, the desired blood component is retained, and the remainder of the blood is returned back to the donor. Depending on the component that is separated and removed, the procedure is called as platelet pheresis, leucopheresis ..

Therapeutic pheresis consists of removing the undesired blood component and returning the remaining blood portion to the patient’s circulation. The undesirable component is discarded. Examples are therapeutic plasmapheresis in hyperviscosity syndrome in plasma cell dyscrasias, and leucapheresis in hyperleucytosis in AML or CML

GRANULOCYTE CONCENTRATE

• Rarely used

• Granulocytes for transfusion can be obtained either from a single donor unit by differential centrifugation or by leucapheresis.

• Indication:Patient with severe neutropenia with documented bacterial or fungal infection, which is not responding to appropriate antibiotic therapy.

FRESH FROZEN PLASMA

• Plasma separated from whole blood within 6 hours of collection and then rapidly frozen to -25oC or lower

• Contains all the coagulation factors

• Storage: at -25oC or lower up to 1 year

• Volume: 200-300 ml

• Indications: Multiple coagulation factor deficiencies (liver disease, warfarin overdose), disseminated intravascular coagulation, and massive blood transfusion

CRYOPRECIPITATE

• Prepared by slowly thawing 1 unit of FFP AT 4-6oC

• Storage: ??

• Contains F VIII (about 80 units), von Willebrandfactor, fibrinogen, F XIII, and fibronectin

BLOOD DERIVATIVES

• Human albumin solutions

• F VIII concentrate

• F IX concentrate

• Prothrombin complex concentrate

• Immunoglobulins

HUMAN ALBUMIN SOLUTIONS

• Prepared by cold ethanol fractionation of pooled plasma

• Available as 5% and 20% solutions

• Heat-treated (at 60oC for 10 hours) to inactivate any contaminating viruses

• Used as a replacement fluid in therapeutic plasma exchange, and treatment of diuretic-resistant oedemaof hypoproteinaemia

F VIII CONCENTRATE

• Prepared by fractionation from large pools of donated plasma

• Supplied as a freeze-dried powder in vials

• During manufacturing process, it is treated with heat and chemicals to destroy lipid-enveloped viruses like HIV, HBV, HCV and HTLV

• Stored in refrigerator at 2 to 6oC

• Before administration, it is reconstituted as per manufacturer’s directions and given intravenously

Indications for the treatment of: Hemophilia A Severe von Willebrand disease.

PROTHROMBIN COMPLEX CONCENTRATE

• Contains factors II, IX and X, and sometimes also F VII.

Indications:• Inherited deficiency of F II, IX and X• Haemophilia A with inhibitor antibodies against F VIII and who are nonresponsive to F VIII concentrate

IMMUNOGLOBULINS

Prepared by cold ethanol fractionation of pooled plasmaUsed for passive immunization against infections

Two types:Non-specific or Normal immunoglobulins:Prepared from pooled plasma of non-selected donors Composed of antibodies against infectious agents that are prevalent in donor populationIndications:Passive prophylaxis against hepatitis ACongenital or acquired hypogammaglobulinaemiaAutoimmune thrombocytopaenic purpura to temporarily raise platelet count

Specific Immunoglobulins:Prepared from donors who have specific high titer IgG antibodiesIncludes:Specific immunoglobulins for passive prophylaxis against hepatitis BAnti-RhD immunoglobulin.