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In the United States, much of the nation's Blood supply of whole Blood is drawn from volunteer
Blood donors and is given at such places as hospitals and community Blood banks. Most of the
whole Blood collected is separated, before it is sold, into Blood products (Blood components)
including red Blood cells, Blood platelets, Blood plasma and other human Blood clotting agents.
All of these Blood products are transfused into patients needing just that particular part (fraction) of
the whole Blood that is donated. A number of Blood donors also donate platelets by apheresis (a
procedure in which Blood is drawn from a Blood donor and separated into its components, some of
which are retained, such as plasma or platelets, and the remainder of the Blood is returned, by
transfusion, to the Blood donor; also called hemapheresis). Blood plasma, the fluid in which red
Blood cells, Blood platelets and other Blood clotting factors are suspended, also can be collected
by apheresis. For this process, whole Blood is drawn, Blood plasma is removed, and the red Blood
cells are transfused back into the Blood donor. This Blood plasma collection process normally takes
one to two hours to complete. Blood plasma is often collected from donors by a variety of entities,
particularly commercial for-profit organizations that sell it to companies for manufacture into a
variety of Blood products. These Blood products often undergo a purification process to make them
safer. Some of these Blood products provide, among other things, clotting factors for people who
suffer from abnormal bleeding disorders (hemophilia, etc.) Blood Products
Rather than using whole Blood transfusions, doctors are increasingly using individual Blood
components such as red cells, white cells, platelets, and plasma. Plasma is fractionated into an
increasing number of Blood products, including albumin, gamma globulins, blood-typing sera,
clotting factors for people with hemophilia, and more. Umbilical Cord Blood and Free Cord Blood
Registry products.
Blood and Blood component products, like any other use of intrusive medicine, should be used only
in critical conditions. All around the world, most countries have stopped giving whole Blood to the
patients for the following reasons:
Whole Blood is a more likely carrier of transfusion transmitted diseases;
Keeping in mind the frequency of serious shortages of quality Blood, it is considered
imprudent to use whole Blood;
Most patients require only one particular component of whole Blood. Better patient
management is achieved by giving only the desired and/or essential component;
Utilizing normal Blood storage techniques, Blood products have a greater shelf life than
whole Blood;
Blood filtration and other techniques help to make Blood safer; and,
Blood products can often be infused regardless of ABO Blood group.
Following here is a brief, though at times technical, commentary and definition set of common
products made from donated Blood. There are others, however, these are the ones that are most
often are needed in the United States.
Whole Blood Products
Whole Blood
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ml) of red cells, 100ml of Optisol, and approximately 30ml (range 10 to 50 ml) of plasma. As an
average, in the United States, the total volume of a RBC unit is 310 ml (range 270 to 350 ml). Blood
Products
A unit of RBC is prepared from a whole Blood collection using a closed sterile system. Blood is
drawn into a bag containing the anticoagulant CPD. Most of the platelet rich plasma is separated
with a centrifuge and separated into an attached container. 100 ml of an additive nutritive solution
(Optisol) is added to RBC. Optisol is a crystalloid solution containing sodium, dextrose, adenine
and mannitol. The Optisol supports red cell survival and extends the shelf life of the unit to 42
days. The added fluid volume of the Optisol also reduces the unit's hematocrit to ~57% (range 50
to 65%), thereby improving the flow characteristics of the component. Optisol is also known as
AS-5.
All RBC transfusions must be ABO/Rh compatible with the recipient. Packed red Blood cells do not
provide viable platelets or neutrophils, nor do they provide clinically significant amounts of
coagulation factors. RBC must be stored between 1 to 6C.
Indication - Red Blood cells are indicated for patients with symptomatic anemia that is not treatable
with specific therapy such as iron, vitamin B12 or with folic acid.
Therapeutic Effect - In a 155-pound adult, one unit of RBCs can be expected to increase the
hematocrit by approximately 3% or the hemoglobin by 1 gm/dl.
Washed Red Blood Cells Blood Products
Description - Washed red Blood cells are red Blood cells washed with normal saline to remove
most of the plasma. Washed red Blood cells should not be considered leukoreduced. Because the
bag must be entered to introduce the saline, washed red cells must be given within 24 hours of their
preparation.
Indication - Washed red cells can be considered for patients who have had repeated
hypersensitivity reactions to Blood or components despite prophylactic administration of
antihistamines. It should be kept in mind, however, that the red cell washing procedure may not
reduce the proteins enough to prevent hypersensitivity reactions (e.g. hypersensitivity to IgA).
Controversial indicators for washed red Blood cells include complement mediated immune
hemolysis and paroxysmal nocturnal hemoglobinuria. Blood Products
Therapeutic Effect - A unit of washed red Blood cells will raise the hematocrit less than will a unit
of red Blood cells because of an approximate 20% loss of red cells from the unit during the washing
process.
Leukoreduced Red Blood Cells
Description - Leukoreduced red Blood cell units contain leukocytes in a specifically reduced
amount. In the United States, Blood processing centers use filtration to make leukoreduced red
Blood cell units. Blood Products
Indication - The most common indication for leukoreduced red Blood cells is for patients who have
experienced two or more non-hemolytic febrile transfusion reactions. Leukoreduced red cells are
usually effective in preventing non-hemolytic febrile transfusion reactions for most patients.
Leukoreduced red Blood cells are also effective in prevention of CMV transmission or HLA
alloimmunization. Blood Products
Therapeutic Effect - Leukoreduced red Blood cells will have a slightly lower therapeutic effect than
red cells that have not been leukoreduced. Depending on the filter used, there is a 10 to 15% loss
of red cells with leukoreduction by filtration.
Pediatric/Divided RBC Units
Description - Pediatric/Divided red Blood cell units are prepared by separating a CPD
anticoagulated (containing no Optisol) packed red Blood cell unit into four bags. Each pedi-pack
contains approximately 45 to 50 ml of red Blood cells and approximately 15 ml of plasma. This
processing minimizes wasting Blood when only small volume transfusion is required. In addition, it
may reduce the recipient's donor exposure because four units for transfusion are available from one
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unit of donated Blood. Divided red cell units are issued when they are less than six days old. This
helps ensure adequate amounts of 2,3 DPG for optimal delivery of oxygen to the tissues and
relatively low plasma potassium levels when stored a shorter period of time. All divided units are
routinely prepared from units which have been screened and found negative for HgbS. All divided
units are irradiated. They may or may not be serologically negative for CMV, but all divided units are
leukoreduced. Studies indicate leukoreduction by filtration is equivalent to CMV screened negative
for prevention of CMV transmission by transfusion.
Because of the small number of these Blood products (components) requested and for inventory
management purposes, divided RBC units are only available as type O. These units may be
transfused to any ABO type recipient in any clinical circumstance, including intrauterine transfusion
when the fetus ABO type may be unknown, as well as for exchange transfusion in neonates when
fetal-maternal ABO incompatibility may be involved. Blood Products
Divided red Blood cells units have a higher hematocrit, approximately 72%, higher than standard
Optisol preserved RBC units. Unprotected and unprepared divided Blood units expire 21 days after
collection. Blood Products
Indication - Divided red Blood cell units are indicated for infants who require small amounts of red
cells. Blood Products
Therapeutic Effect - A divided red Blood cell unit will increase the hematocrit/hemoglobin the same
as a standard red Blood cell unit when corrected for the weight of the child and the volume infused.
Platelets
Description - Platelets are cells essential for the coagulation of Blood. Platelet products also
contain plasma (coagulation factors), some red cells and some white cells (leukocytes). Platelet
products are usually cloudy and yellowish in color but may occasionally have a pink tone because
of the presence of residual red cells. Platelets are stored at 68 to 75 Fahrenheit (room
temperature) and require continuous gentle agitation. They can be stored at the Blood center for up
to five days. When received for transfusion, both pooled and apheresis platelets will expire in less
than four hours. Since preparation for transfusion involves processes such as pooling, volume
reduction and leukoreduction which require entry into the component, a four hour expiration is
placed on the platelets once preparation is started at the Blood center to avoid bacterial growth.
A Whole Blood Platelet Concentrate is prepared from whole Blood by an initial soft centrifugation to
separate the red cells from the platelet rich plasma. A second harder centrifugation is used to
concentrate the platelets that are then resuspended in 60 ml of residual plasma. Each unit contains
a specific ratio/quantity of platelets. To provide an adequate dose of platelets for an adult, four to six
platelet concentrates of the same Blood type are pooled at the Blood center prior to issue. Pooled
platelets are generally issued ABO type compatible, but other types may be substituted. One
should avoid, if possible, giving type A platelets to an O recipient. If the O recipient happens to have
a high titer of anti-A, the post transfusion platelet increment will be reduced. Platelets products
contain an insufficient number of red cells to cause an incompatibility reaction. There are sufficient
numbers of red cells, however, for an Rh negative person to be sensitized (develop Rh antibodies) if
they receive Rh positive Blood. There is very little risk of the patient having an incompatibility
reaction because the plasma in a pooled unit is combined from different donors thereby reducing
the possibility that isoagglutinins (anti-A and/or anti-B) would be present in high titer. Due to the
smaller Blood volumes of infants and small children, ABO compatible or reduced volume ABO
incompatible platelets must be given.
Apheresis Platelets are obtained from one donor with the use of an apheresis machine. Blood is
drawn from a donors arm into a self contained, single use Blood tubing/collection set which has
been inserted into the apheresis machine. Blood does not come into contact with the apheresis
machine itself. Anticoagulant is added to the Blood as it is drawn from the donor. The platelets are
separated from the red cells, leukocytes and most of the plasma by centrifugation. The red cells,
leukocytes and plasma are returned to the donor through his or her other arm, and the platelets are
retained in a collection bag for later transfusion to a patient. The procedure takes approximately 60
to 90 minutes.
The majority of apheresis platelets collected contain less than a specific amount of leukocytes and
are labeled as leukocyte reduced.
One apheresis collection of platelets generally contains 200 to 400 ml of plasma. Because of the
possibility of a high titer of ABO antibodies in the donor plasma, the unit is volume reduced in cases
of minor ABO incompatibility. Apheresis platelet concentrates can be collected from unselected
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community donors. This yields a product known as a Random Apheresis Platelet (RAP). Alternately
the platelets may be drawn from a family or community donor who has been specifically matched to
the patient on the basis of HLA (Human Lymphocyte Antigen) typing. This yields a product known
as a Matched Apheresis Platelet (MAP).
Random Apheresis Platelets are available in two doses: Standard and Large. The standard dose
contains a smaller average count of platelets (approximately equivalent to four units of pooled
platelets). The standard dose is generally ordered for smaller patients, for those in whom a high
platelet count is not required, and for patients who respond well to transfusion. The large dose
contains, as the name would indicate, a greater average number of platelets, approximately
equivalent to six units of pooled platelets. The large dose is generally ordered for larger and heavier
patients, for those in whom a high platelet count is desired, and for those who do not respond well
to transfusion.
As many platelets as possible are collected from HLA matched apheresis donors, therefore it is not
necessary to specify dose when ordering these platelets.
Indications - Platelet transfusions are indicated for patients with bleeding due to either
thrombocytopenia, platelet dysfunction or some combination of the two conditions. The point at
which bleeding may occur varies depending on the patients condition. The majority of patients with
normal platelet function will not experience bleeding until the platelet count drops below a certain
point. In patients with abnormal platelet function, usually caused by drugs (e.g. aspirin or
semi-synthetic penicillin), uremia or elevated split products of fibrinogen/fibrin, bleeding may occur
with higher platelet counts. In patients undergoing surgery, bleeding may occur with relatively low
platelet counts. Blood Products
In addition to evaluating platelet count and patient condition, bleeding time may also be used in
determining the need for platelet transfusions. A bleeding time twice the upper normal limit may be
an indication for a platelet transfusion in a bleeding patient. HLA Matched platelets are indicated for
patients who are refractory (demonstrate a poor post-transfusion platelets increment) to random
donor platelets due to alloimmunization.
Patients with auto-immune thrombocytopenic purpura (ITP) should not receive platelet transfusions
unless bleeding is significant or life threatening. Platelet transfusions given to patients with ITP will
be rapidly removed from circulation by the patients anti-platelet antibodies and thus will be, at most,
only of transient benefit.
Therapeutic Effect - Each unit of platelets prepared from donated whole Blood contains a certain
number of platelets and can be expected to increase the platelet count of a 155-pound patient by a
known approximate amount by one hour after transfusion. Since the usual dose for adults with
platelet related bleeding is a pool of four to six units of platelet concentrates from whole Blood or
one standard sized unit of apheresis platelets, an increase in the platelet count by one hour after
transfusion is expected. Blood Products
Effect of Platelet Product and Patient Weight on Platelet Increment*
Patient weight (in
pounds)
Single whole
Blood platelet
concentrate
Large apheresis or
six pooled whole Blood
platelets
50
17,600
70,400
105,600
100
8,800
35,200
52,800
150
5,900
23,500
35,200
200
4,400
17,600
26,400
Patients demonstrating two consecutive platelet count increases of less than a known standard
range at one hour after transfusion of four to six units of pooled platelets (or one unit of apheresis
platelets) are considered refractory. Failure to achieve hemostasis or the expected increment in the
platelet count may signify a refractory state. A refractory state to platelets may be caused by fever,
sepsis, DIC, or splenomegaly or an immune response to the platelets also referred to as platelet
alloimmunization. In patients with alloimmunization, HLA matched platelets may be necessary to
control bleeding due to thrombocytopenia.
Granulocytes (Neutrophils)
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treatment.
The use of cryoprecipitate for the preparation of fibrin glue is increasing as applications in
neurosurgery, orthopedic and ENT surgeries are expanding. Autologous units can be collected
ahead of time and processed into Cryo to be used for fibrin glue. Blood Products
Therapeutic Effect - When used for fibrinogen replacement, ten bags should provide enough
fibrinogen to raise the fibrinogen 60 to 70 mg/dl in a 155 pound adult. Therapeutic effect can be
monitored by fibrinogen levels and the patients clinical response.
Note: Cryoprecipitate transfusions may be prepared from a designated donor for some young or
mildly affected patients with hemophilia A or von Willebrand disease to limit potential viral exposure
through transfusions. These single donor Cryo products may have higher concentrations of factor
VIII and von Willebrand factor than regular donor Cryo because of DDAVP used to stimulate the
apheresis donor prior to collection. Multiple bags of high potency Cryo are then prepared from one
collection. Blood Products
A single unit (bag) of Cryo is usually adequate for the preparation of fibrin glue unless more than 10
ml is needed.
Factor VIII Concentrates
Description - Factor VIII concentrates are a commercially prepared, lyophilized powder purified from
human plasma to treat patients with hemophilia A or von Willebrands disease. Alternatively,
recombinant (synthetic) protein is purified from genetically engineered non-human cells grown in
tissue culture. The quantity of factor VIII coagulant activity is stated on the bottle. One factor VIII
concentrate unit equals the clotting activity in 1 ml of fresh plasma. Factor VIII concentrate is cell
free and is administered without regard to patient or donor ABO or Rh type. It is heat treated and/or
solvent detergent treated to reduce the risk of virus transmission. Current processes appear to have
eliminated the risk of HIV, HBV and HCV transmission. concentrates differ in the purification
procedures. Highly purified factor VIII, e.g., preparations purified over a monoclonal antibody column
or current recombinant factor VIII concentrates, are stabilized by adding 98% of pasteurized human
albumin. Porcine factor VIII concentrate is available for patients with high titer anti-human factor VIII
'allo' or autoantibody inhibitors. Factor VIII concentrates are stored refrigerated at 35 to 45
Fahrenheit for up to two years from the date of manufacture (expiration date will be indicated on
each vial). Some preparations may be kept at room temperature for extended periods. Once
reconstituted, it should not be refrigerated. Factor VIII concentrate should be infused within four
hours of preparation to reduce the risk of bacterial growth. Vials are usually shipped to a hospital
pharmacy, Blood service or nursing unit and mixed there prior to use. Many patients or families
receive them directly for home care. Blood Products
Indication - Factor VIII concentrate is indicated for the treatment of bleeding or imminent invasive
procedures in patients with hemophilia A, (congenital factor VIII deficiency) and for patients with low
titer factor VIII inhibitors. Regular prophylactic doses are often used, as well as daily doses in some
hemophilic inhibitor patients to try to induce immune tolerance. Patients with von Willebrands
disease respond to one specific, pasteurized intermediate purity concentrate in which that factor
activity is relatively preserved.
Therapeutic Effect - Dosage is dependent on the nature of the injury, the degree of factor
deficiency, the weight of the patient and the presence and level or absence of factor VIII inhibitors.
The half life of circulating factor VIII is eight to twelve hours, therefore transfusions may need to be
repeated every 12 to 24 hours to maintain hemostatic levels. Following surgery, it is necessary to
maintain hemostatic levels for up to two weeks to prevent delayed bleeding and promote wound
healing in the hemophilic patient.
Factor IX Concentrates
Description - Factor IX concentrates are a commercially prepared, lyophilized powder purified from
human plasma to treat patients with hemophilia B. Crude preparations, previously referred to as
prothrombin complex concentrates, contain coagulation factors II (prothrombin), IX, X and variable
amounts of factor VII and carry a risk of thrombosis associated with administration. Purified factor IX
concentrates, available since early 1991, essentially contain only factor IX and thus have eliminated
the risk of thrombosis. Since both products are used primarily to treat factor IX deficiencies, the
amount of Factor IX contained in each product is stated on the label. Factor IX concentrates are
heat treated to reduce the risk of disease transmission, particularly HIV and hepatitis, and the
purified forms currently manufactured are treated sufficiently to inactivate hepatitis viruses B and C.
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SUMMARY
BLOOD COMPONENT
CONTENTS
VOLUME SHELF
LIFE**
Whole Blood (autologous Red Blood cells (RBC); plasma. White Blood Cells (WBCs); platelets
not viable after 24 hr. Factors V; VIII significantly decreased after 2
or directed donations)
days. Hct 35%. 450mL Blood; 63 Ml CPDA-1 anticoagulant
520 ml
340 mL 42 days
4o C
Platelet concentrate
50 mL
Platelet pheresis
300 mL 5 days
200 C
225 mL 1 year
18o C
35 days
4o C
5 days
20o C
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Cryoprecipitate
15 mL
1 year
18o C
* Note 1 - these are not "packed" red cells. Packed red cells have a Hct of 70-80%.
** Note 2 - these times do not consider cryo-freezing technologies.
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