Component preparation, storage and effective use of blood products

noleata@iium/bms/07-08

BLOOD COLLECTION

APHERESIS

SEPARATION OF BLOOD COMPONENTS

WHOLE BLOOD

SCREENING & TESTING

STORAGE of BLOOD COMPONENTS (SCREENED AND UNSCREENED)

INDICATIONS FOR TRANSFUSION

TRANSPORT & STORAGE OF SCREENED BLOOD COMPONENTS

Definition:
Blood products: any theraeutic substance prepared from human blood. Whole blood: Unseparated blood collected into an approved container containing an anticoagulantpreservative solution.

Blood components
1. A constituent of blood separated from whole blood,
Red cell concentrate Red cell suspension Plasma Platelet concentrates

2. Plasma or platelets collected by apheresis 3. Cryoprecipitate, prepared from fresh frozen plasma rich in FVIII and fibrinogen.

Plasma derivatives
Human plasma proteins prepared under pharmaceutical manufacturing conditions:
Albumin Coagulation factor concentrates; FVIII,FIX, FVII concentrates. Immunoglobulin.

HTAA Blood Bank

Historical note:1665
Dr, please save my girlfriend, you can take my blood, anything.. You are too young to donate and to have a girlfriend..

Richard Lower, performed the first The first recorded successful successful animal transfusion in 1665, blood transfusion occurs in England when he transferred blood from the carotid artery of one(dogs to dogs) dog to the jugular vein of another.

Historical Note:1667
u, yo e f ld to t sa y e Iv s no ke m ee it ta ..s to ood bl

In November 1667, Lower transfused Mr. Arthur Coga, "a mildly melancholy insane man," with the blood of a lamb. Mr. Coga, described his experience to the Royal Society of Medicine and stated that he was much better. "cracked a little in his head. Denis fourth attempt ended fatally, he was charged with murder

Historical Note
For the next 150 years, there was little interest in transfusion.

Historical Note:1818
JAMES BLUNDELL 1818
interest in transfusion was revived by James Blundell in 1818, it was on the basis of replacement of lost blood in puerperal hemorrhage and after series of experiments.

Historical Note:1818
Blundell failed in his first four desperate attempts to save women on the point of death from postpartal hemorrhage, but he succeeded in five of the next six attempts. Patients selectionearly stage of PPH.

Blood Components Separation

GOALS:

1. To maintain viability & function of relevant constituent. 2. To prevent physical changes detrimental to constituent. 3. Minimize bacterial proliferation.

modern BLOOD PRODUCTS : in plastic bag

Adenosine Energy. Glucose Dextrose. Citrate Anticoagulant. Concentration of anticoagulant and other derivatives have been modified through times optimum value. Closed systemtubing methods. Sterile low risk of contamination.

BEGIN:
Platelet rich plasma Packed RBC

Whole blood

END:

Packed RBC

plasma platelets

Packed RBC

Platelet rich plasma

plasma Packed RBC

platelets

Preparation Of Packed Rbc

Blood is collected as whole blood. Blood destined for component preparation is drawn into bags with integrally attached transfer container (closed system)

Light centrifugation:
for separation of packed RBC & Platelet Rich Plasma (PRP )

SEPARATOR STAND: allows PRP to flow into one of the transfer bag

PRP

Sediment: Packed RBC70-80% plasma removed

Platelet Rich Plasma use for preparation of FFP

Packed RBC
stored as unscreened blood

Preparation Of FFP & Platelet

Heavy centrifugation
To separate plasma & platelet

SEPARATOR STAND: express platelet-poor-plasma into the 3rd attached transfer bag

Plasma place at < -180C within 6 hours after donation to get FFP (stored as unscreened blood)

Platelet stored as unscreened blood on agitator

FFP

platelets

Packed RBC

a single donation of whole blood has supplied three separate components (packed red blood cells, platelets, fresh frozen plasma) that can potentially benefit three different patients.

CRYOPRECIPITATE:
Melt FFP between 1-6oC Cold insoluble portion of plasma remaining is called cryoprecipitate

Platelet collection using apheresis system yield higher concentration of platelets. 1 bag = Equivalent to 46 donors (units)

RECORDS & LABELS

RECORDS Must be made concurrently with each step of component preparation. Must be legible & permanent. Record system such that any unit of blood can be traced from source to disposal.

LABELS 1. Made on each blood bag: Proper name of components ABO blood group & Rh group Unit no. relate unit to donor Expiration date 2. Made on storage system: differentiate unscreened & screened blood

STORAGE OF BLOOD COMPONENTS and SPECIFIC INDICATIONS OF BLOOD COMPONENTS

HISTORICAL NOTES: EARLY 1900 TILL 1950s blood storage in bottle

Back then
Still using bottle

1950

Im using the new plastic bag..COOL!

Inventors: Carl Walter and W.P. Murphy, Jr.

Whole Blood (CPD-Adenine-1)

A 450 ml whole blood donation contains:
510 total volumes 450 ml donor blood. 63 ml anti-coagulant preservative solution Hb ~ 12 g/ml Hct -35%-45% No functional platelets No labile coagulation factors (V and VIII) Storage: Storage +2 C +6o C in approved blood bank refrigerator, fitted with a temperature chart and alarm. Transfusion should be started within 30 minutes after removal fr refrigerator.
o _

Whole Blood (CPD-Adenine-1)

Indications:
Red cell replacement in acute blood loss with hypovolaemia Exchange transfusion Patients needing red cell transfusion where red cell concentrates are not available Contraindications: Risk of volume overload in pts with: Chronic anaemia Incipient cardiac failure
ADMINISTRATION:
Must be ABO and RhD compatible. Never add medication to a unit of blood. Complete transfusion within 4 hours of commencement.

Red Cell Concentrate(packed Red Cells, Plasma-reduced Blood)

150-200ml red cells. 150-200ml red cells. Hb ~ 20g/100 ml Hb ~ 20g/100 ml Hct ~ 55% 75% Hct ~ 55% --75% Storage: Storage: +2oC- 6o C +2oC- 6o C

Indications: Indications:
Replacement of red Replacement of red cells in anaemic cells in anaemic patients. patients. Use with crystalloid Use with crystalloid replacement or replacement or colloid solution in colloid solution in acute blood loss acute blood loss
Administration: Administration: Same as whole blood. Same as whole blood.

Red Cell Suspension (CPD-SAGM)

150-200ml red cells 150-200ml red cells with minimal with minimal residual plasma to residual plasma to which NS,adenine, which NS,adenine, glucose,mannitol glucose,mannitol solution(SAG-M) solution(SAG-M) has been addded. has been addded. Hb ~ 15g/100 ml Hb ~ 15g/100 ml Hct ~ 50% 70% Hct ~ 50% --70% Storage: Storage: +2oC-6ooC +2oC- 6 C

Indications: Indications:
Replacement of red Replacement of red cells in anaemic cells in anaemic patients. patients. Use with crystalloid Use with crystalloid replacement or replacement or colloid solution in colloid solution in acute blood loss acute blood loss

Contraindications: Contraindications:
Not advised for Not advised for exchange transfusion exchange transfusion in neonates in neonates

Standard Blood Bank refrigerator should be fitted with a temperature chart and alarm.

Storage for SCREENED blood components should be separated from the UNSCREENED.

Platelet concentrate
CONTENTS:

Infection risk

Same as whole
blood but for adult dose involves btween 5 6 donor exposures.

Single donor unit

(prepared from whole blood in a volume of 50-60 ml of plasma contain at least 55109 platelets) < 1.2 x 10 9 red cells < 0.12 x 10 9 leucocytes.

Bacterial
contamination: 1% of pooled units. STORAGE: Up to 5 DAYS at 20C 24C(with agitation). Longer storage increases the risk of bact proliferation and septicaemia in the recipient.

150-500 x 109
platelets (from apheresis.

INDICATIONS: INDICATIONS: Treatment of bleeding due to: Treatment of bleeding due to:

Thrombocytopenia Thrombocytopenia Plateletfunction defects. Platelet function defects. Preventionof bleeding d2 Prevention of bleeding d2
thrombocytopenia thrombocytopenia CONTRAINDICATIONS: CONTRAINDICATIONS CONTRAINDICATIONS: Not for prophylaxis of bleeding, Not for prophylaxis of bleeding, unless known to have significant unless known to have significant pre-operative platelet deficiency. pre-operative platelet deficiency. Not indicated in: Not indicated in: ITP ITP TTP TTP UntreatedDIC Untreated DIC Thrombocytopeniaass with Thrombocytopenia ass with septicaemia, until treatment has septicaemia, until treatment has commenced or in cases of commenced or in cases of hypersplenism. hypersplenism.

Platelet concentrate
DOSAGE DOSAGE IIunit of plt conc/10 kg unit of plt conc/10 kg BW in a 60-70 kg adult, BW in a 60-70 kg adult, 4-6 single donor units 4-6 single donor units containing 240 x 10 99plts containing 240 x 10 plts should raise the plt count should raise the plt count by 20-40 x 10 99/L by 20-40 x 10 /L Increment will be less if Increment will be less if there is: there is: Splenomegaly Splenomegaly DIC DIC Septicaemia Septicaemia

ADMINISTRATION ADMINISTRATION
After pooling, plt conc After pooling, plt conc should be infused ASAP. should be infused ASAP. MUST NOT BE MUST NOT BE REFRIGERATED before REFRIGERATED before infusion reduces plt fx. infusion reduces plt fx. Should be infused Should be infused though a fresh standard though a fresh standard blood administration set. blood administration set. Should be infused over a Should be infused over a period of about 30 period of about 30 minutes. minutes. Do not give plt conc Do not give plt conc prepared fr RhD positive prepared fr RhD positive donors to an Rh D negative donors to an Rh D negative female with child bearing female with child bearing potential. potential. Give plt that are ABO Give plt that are ABO compatible whenever compatible whenever possible. possible.

Fresh Frozen Plasma

Contains normal Contains normal plasma levels of plasma levels of stable clotting factors, stable clotting factors, albumin and Ig. albumin and Ig. Fc VIII level at least Fc VIII level at least 70% of normal fresh 70% of normal fresh plasma level. plasma level. UNIT OF ISSUE: UNIT OF ISSUE: Usual volume of pack Usual volume of pack is 200-300 ml. is 200-300 ml.

Fresh Frozen Plasma

INDICATIONS: INDICATIONS:
Replacement of Replacement of multipe coagulation multipe coagulation factor def factor def Liverdise Liver dise DOSAGE: DOSAGE: Initial dose: 15 Initial dose: 15 ml/kg ml/kg

Warfarinoverdose Warfarin overdose DIC DIC TTP TTP Depletionof Depletion of

coagulation factors coagulation factors in pts receiving large in pts receiving large volume transfusion. volume transfusion.

Fresh Frozen Plasma

STORAGE: STORAGE:
At -25C or colder up to 1 At -25C or colder up to 1 year. year. Before use, should be Before use, should be thawed in the blood bank in thawed in the blood bank in water between 30 37C. water between 30 --37C. Higher temperatures will Higher temperatures will destroy clotting factors and destroy clotting factors and proteins. proteins.

Fresh Frozen Plasma

ADMINITSTRATION: ADMINITSTRATION: ABO compatible to avoid ABO compatible to avoid risk of haemolysis in risk of haemolysis in recipient. recipient. No compatibility testing No compatibility testing required. required. Infuse using standard Infuse using standard blood administration set as blood administration set as soon as possible after soon as possible after thawing. thawing. Labile coagulation factors Labile coagulation factors rapidly degrade, use within 6 rapidly degrade, use within 6 hours of thawing. hours of thawing.

Cryoprecipitate
Fac VIII: 80-100iu/pack Fibrinogen: 150-300 mg/pack UNIT OF ISSUE: Usu supplied as a single donor pack or pack of 6 or more single donor units. -involves at least 6 donor exposures.

Cryoprecipitate

STORAGE: AT -25oC or colder for up to 1 year.

Cryoprecipitate
INDICATIONS: INDICATIONS:
Alternative for Fc VIII conc in the tx of inherited Alternative for Fc VIII conc in the tx of inherited def (Haemop A, fc XIII, VWD) def (Haemop A, fc XIII, VWD) As source of fibrinogen in acquired As aasource of fibrinogen in acquired coagulopathies eg DIVC coagulopathies eg DIVC

Cryoprecipitate
Administration: Administration:
compatible. compatible.

Ifpossible: use ABO If possible: use ABO Nocompatibility No compatibility Afterthawing infuse After thawing infuse Mustbe infused Must be infused

testing required. testing required.

as soon as possible as soon as possible .. within 6 hours of within 6 hours of thawing thawing

Effective use of blood products

Blood bank
Proper collection, separation and storage of blood components. Correct legal identification procedure: Donor Blood group ect Quality assurance in every steps. Proper screening procedure Pre-donation. Post-donation. Appropriate release of blood and its products Clear indication. Proper handling of units. Documentatations.

Patients site
Indications must be clear. Check on documentations and avoid mishandling of units. Correct transportation system and storage prior transfusion. Timing of transfusion. Corret use of drif set and branulas. Patients monitoring during and after transfusion. Good Ward-blood bank communication. Blood transfusion reaction. Any queries Ect

Think of your intention to transfuse

Sensible.. Clear indication/s. No other alternatives. is the most appropriate therapy? Can the risk be avoided? Is the patient fully informed? Hazard of components therapy? What is the time frame for decision-making process?