2. Introduction
In the past whole blood was the only preparation that could be
administered to replace red cells, platelets, coagulation factors .
In addition to what patient required, This cause unnecessary
administration of unwanted cells or plasma constituents.
Large volume of whole blood needed to achieve satisfactory
replacement of a particular component.
A significant advance in transfusion medicine was made when
techniques became available for separation of blood in a closed
system and patient could be administered specific replacement
therapy.
One unit of donor’s blood can be utilized for preparation of
different components and thus can be benefit more than one
patient.
3. Now a days , whole blood can be separated into
various blood components and further derivatives can
be obtained from plasma by fractionation.
Specific replacement therapy as per patient’s
requirement is permissible to administer and avoid
transfusion of unwanted constituents of blood.
One unit of blood can benefit more than one patient
after its separation into plasma, red cell and platelet
components.
4. HISTORY
1628- Sir William Harvey described venous circulation
1665- Richard Lower performed first animal to animal
blood transfusions in a dog in london
1667- Jean-Baptiste Denis in France reported successful
transfusions of lamb’s blood to humans
5. History
1818 - James Blundell, a British obstetrician,
performed the first successful transfusion of human
Blood for the treatment of postpartum hemorrhage.
Considered to be Father of Autotransfusion
He also devised various instruments for performing
Blood transfusions.
6. Further Developments
1901 –Karl Landsteiner, an Austrian physician, documented
the first three human blood groups A, B and O.
1902 - A fourth main Blood type, AB was found by A.
Decastrello and A. Sturli.
1914 - Long-term anticoagulants, among them sodium
citrate, were developed, allowing longer preservation of
Blood.
1926 - The British Red Cross instituted the first human
Blood transfusion service in the world.
7. 1940 - Freeze dried plasma was developed.
1940 - Edwin Cohn developed a cold ethanol fractionation
proces. Albumin, Gamma globulin and Fibrinogen were
isolated and became available for clinical use.
1950 - Glycerol cryoprotectant for freezing red blood cells.
1950 - Carl Walter and W. P. Murphy introduced the plastic
bag for blood collection.
8. 1954 – The blood product Cryoprecipitate was developed for
people suffering from hemophilia.
1960 - A. Solomon and J. L. Fahey reported the first
therapeutic plasmapheresis procedure.
1972 - Apheresis was used to extract one cellular component.
1979 - A new anticoagulant preservative, CPDA-1, which
extends the shelf life of whole Blood and red Blood cells to 35
days is introduced.
9. Blood Products
Blood Products
Whole Blood
One unit of donor blood collected in a suitable anticoagulant-
preservative solution and which contain blood cells and plasma.
Blood Components
A constituent separated from whole blood, by differential
centrifugation of one donor unit or by apheresis.
Blood Derivatives
A product obtained from multiple donor units of plasma by
fractionation.
11. Whole blood
Red cells Granulocytes Plasma Platelets
Fractionated
(Fresh) frozen
products
plasma (F(FP)
F Vlla* Immune
Globulin
F Vlll*
Cryo Albumin
Cryoprecipitate
supernatant
plasma (CSP)
F lX*
* Now available as recombinant products
12. Types of blood components
Whole Blood
Packed Red Cells
Leukocyte Reduced Red Blood Cells
Fresh Frozen Plasma
Frozen Plasma
Platelet Concentrate
Cryoprecipitate
13.
14.
15. Types of Blood Components
Blood component preparation is an essential part of the
blood transfusion services. These days, it has been
realized that the increasing demand for this precious and
scarce fluid. Blood needs can only be met by separating it
into various components. Thus component separation
and administration will help us in rationalizing use of
blood.
Blood components are prepared using physical
properties of blood for e.g. centrifugation whereas blood
derivatives use a chemical (e.g. ethanol) in varying
concentration and temperature for its separation.
Primary goal of component therapy is to provide right
component to the right patient in right quantity at the
right time in right quality.
16. Human blood contains many major as well as minor
components but broadly from blood bank component
separation point of view, it can be divided into:
Human blood
a) Cellular elements - Packed red cells, granulocytes and
platelets (PRP and PC)
b) Plasma : Single donor plasma, fresh frozen plasma,
cryoprecipitate and cryo-poor plasma
18. Preparation of Blood Components
EQUIPMENTS
Collection Bag :- Double, Triple, Quadruple Bag
Refrigerated centrifuge
Plasma Extractor
Cooling water bath
Freezer -180C, -800C
Blood Refrigerator 1 - 60C
Platelet incubator
Insulated container for blood transportation
19. Centrifugation
Principle
Sediment of blood cells depend on
their size as well as the difference of their d
ensity from that of the surrounding fluid, visc
osity of medium, flexibility of the cells which
are temperature dependent
20. Methods of preparation
There are various methods to separate these components
and the yield and quality of component depends upon the
method applied. Various methods used are; -
(a) Gravity separation
(b) Low and high speed refrigerated centrifugation
(c) Apheresis by cell separator.
(a) Gravity separation
It is an old time, crude but cheaper method to
separate plasma from whole blood
21. Steps
3. The blood is collected in a double or triple bag system.
4. Blood is kept hanging overnight at least for 12-16 hours.
There is clear plasma above and packed red cells below.
5. The supernatant plasma is expressed into the satellite bag,
leaving behind, 80-IOOml of plasma.
6. Plasma thus collected is called single donor plasma and
can be stored for 24-26 days at 4 - 6°C or for 1 year at
-20°C or below.
(b) Low speed refrigerated centrifugation:-
It is used for preparing Platelet Rich Plasma (PRP)
(c) High speed refrigerated centrifugation:-
It is used for preparing Platelet Concentrate (PC), Fresh Frozen
Plasma (FFP) and Cryoprecipitate (CP).
22. Details
High performance centrifuge
from Beckman Coulter, type
Avanti J-201 with rotor
JLA-8.1000.
Application: separation or
preparation of subcellular
components, proteins,
precipitates, viruses, nucleic
acids, mammalian/insect cells,
blood components and
elutriation.
Technical specifications: 380
V. Technical specifications rotor:
fixed angle, maximum 8000 rpm,
nominal capacity: 6 x 1000 ml,
buckets size (ø)x(H): 95 x 191
mm.
23.
24. Whole Blood
450 ml of blood
63 ml of anticoagulant solution.
Hct-36-44%
No components have been removed.
Store at 1-6 oC
Shelf life-
Citrate-Phophate-Dextrose (CPD) - 21 days
CPDA-1 (adenine) - 35 days
AS-1, AS-3, AS-5 – 42 days
Administer through standard blood filter (150-280 micron)
Infuse within 4 hours of issue
25. Whole Blood
Drawbacks:
After storage for >24 hours, platelets and WBC are non-
functional
Factor V and VIII (labile factors) decrease with storage
Fluid overload
Indications:
Acute blood loss > 25% TBV
26. Whole Blood
Indication
- Acute , active blood loss with hypovolaemia
- Exchange transfusion
Contraindication
- Risk of volume overload : Chronic anemia
Incipient cardiac failure
27. WHOLE BLOOD
Administration
- Must be ABO and RhD compatible
- Never add medication to a unit of blood
- Use blood administration set
Dosage
1 unit Hct 3 % or Hb 1 g / dL
28. Packed Red Cell
units with red blood cells and some plasma
- with Anticoagulant ACD / CPD / CPDA –
1
- Hct ~ 75 – 80 %
29. Preparation of Packed RBCs
Principle:
RBCs are obtained by removal of supernatant plasma from
centrifuged whole blood.
Preparation:
Centrifuge whole blood unit in refrigerated centrifuge containing the
parameters RPM-3850. Acc-4, Decc-5, Time-5 Min, Temp- 40C
Express the supernatant plasma with the help of plasma expressor.
Double seal the tubing between the primary and satellite bag.
Check that the satellite bag has the same donor number as that on the
primary bag and cut the tubing between the two seal.
Advantages:
Oxygen carrying capacity equal to that of whole blood in half the volume.
Significantly decrease levels of isoagglutinins, metabolites and
electrolytes.
30. Preparation of Packed RBCs
Shelf life: (If CPDA1 anticoagulant) -35 days
Storage temp. : 40C (Range is 2-60C)
QC Requirements: PCV 80% (Range is 65-80%)
Volume: 250- 300 ml.
CONTENTS: Red cells- 65-80%
Plasma – 20-35%
Some platelets, white cells storage lesion by
products and anticoagulant preservative solutions.
Transfusion Criteria's: ABO/Rh specific and compatible
Indications: Restore oxygen carrying capacity symptomatic
anemia and surgical blood loss.
Effect: 1 unit RBCs should raise HCT -3%, Hb 1 g/dl
31. Packed Red Cells ( in plasma)
Indication
- Replacement of red cells in anemic patients
- Use with crystalloid or colloid solution in acute
blood loss
Dosage 10 - 15 ml / kg
PRC 1 unit Hct 3 % or Hb 1 g/dL
32. ASA Guidelines for
Transfusion of Packed Red Cells in Adults
Transfusion for patients on cardiopulmonary bypass with hemoglobin
level ≤6.0 g/dL is indicated.
Hemoglobin level ≤7.0 g/dL in patients >65 years and patients with
chronic cardiovascular or respiratory diseases justifies transfusion.
For stable patients with hemoglobin level between 7 and 10 g/dL, the
benefit of transfusion is unclear.
Transfusion is recommended for patients with acute blood loss more
than 1,500 mL or 30% of blood volume.
Evidence of rapid blood loss without immediate control warrants
blood transfusion.
*Ann Thorac Surg
2007;83:S27–86
33. Red cell aliquots
For babies
10-25 mL units.
5 mL/kg will raise Hb by ~1 gm/dL.
34. Irradiated Red Cells
Gamma-radiated to kill the lymphocytes.
The lack of T-cells prevents graft-vs-host disease.
Use for
Severely immunocompromised patients
Lymphoma patients
Stem-cell / marrow transplants
Intrauterine transfusion
Units from close “blood relatives”
Neonates undergoing exchange transfusion or ECMO
Hodgkin’s Disease
36. Leukocyte poor red blood cell
Unit of red blood cells with some plasma,
anticoagulant and additive solution
Hct ~ 55 – 65 %
37. Leukocyte poor red blood cells
Centrifugation method
- easiest and least cost
- least efficient
- reduce WBC only 70 - 80%
RBC volume ~ 20%
38. Leukocyte depleted red blood cells
Filtration method
easy, quick, but more expensive
high efficient
remove WBC more than 99.9%
( third generation )
little loss of RBC volume
38
39. Leukocyte reduced red cells
Indication
- Minimizes white cell immunization in patients
- Prevention of FNHTR (Febrile Non-Hemolytic Transfusion Reaction )
- Reduces risk of CMV transfusion
Contraindication
- Not prevent graft –vs- host disease
Dosage
- same as Packed Red Cell
Administration
- same as Whole Blood
40. Granulocyte Concentrate
Obtained by apheresis from family members for
administration to cancer patients.
Contain 1.0 x 1010 granulocytes
Pre-treatment with recombinant G-CSF and
dexamethasone can yield 4-8 x 1010 granulocytes
Stored at 24o C
Infuse within 24 hours of collection
41. Criteria
ANC <500
Fever
Documented infection (bacterial or fungal) for 24-48
hours
Unresponsive to appropriate antibiotics
Reasonable hope of marrow recovery
42. Platelet Rich Plasma (PRP)
It is prepared from the whole blood within six-hours of collection,
preferably stored at room temperature of 20-24°C.
43. Steps
1. The blood is collected in-CPDA-1 double or triple bag system.
2. The blood bags are weighed on a weighing balance and bags
weighing equal are placed opposite to each other in the buckets of
centrifuge.
3. Temperature of the centrifuge is adjusted between 20 -24°C
4. The speed of the centrifuge is calculated according to the radius of
the arm of the centrifuge rotor.
5. The calculated speed for platelet preparation is 1750 rpm for 11 min.
in PGI
6. After centrifugation, the bags are taken out from centrifuge
chamber with minimal disturbance and the PRP is expressed from
the primary bag into the satellite bag with the help of a plasma
expresser. After placing proper knots, labeling the blood group and
ensuring the screening status the satellite bag is detached from the
primary bag.
44. 7. The PRP for storage can be kept at 22-24°C in a, platelet
incubator with constant agitation for a maximum of
48-72.hours (at our centre in PGI).
8. As a part of internal quality control 1% of the random
components units over a month are tested for pH and
yield. For PRP the pH should always be > 6.2 and yield 4.5
x 1010 / bag (Drugs and Cosmetics Act) and 5.5 x 1010/ bag
(AABB Technical Manual) and one bag of PRP generally
raises the platelet count in the recipient by 5000-10000 /
µl.
Note: Aspirin and related analgesics affect the platelet
function, so the donor for platelets is accepted after 3 days
of ingestion of these drugs.
45.
46. Platelets Concentrate (PC)
This supplies the same amount of platelets as PRP, but in lesser
volume (40 - 50ml).
Principle:
Platelets are harvested from whole blood following ‘light spin‘ centrifugation. The
platelets are concentrated by 'heavy spin' centrifugation with subsequent removal
of supernatant plasma.
Steps
1. Blood is collected in the triple bag system only
2. PRP is prepared by following the above mentioned steps
3. After detaching the satellite bags from the primary bag, the PRP in again spun at
4000 - 5000 rpm (high spin) for 4 to 5 minutes.
4. A platelet button is formed at bottom and platelet poor plasma is expressed from
the 1st satellite bag to the 2nd satellite bags, leaving behind 40 - 50 ml plasma
for platelet button suspension.
5. The platelet concentrate in stored at 20°C-24°C for a maximum of 3 days (at PGI)
with constant agitation.
47. Platelets Concentrate (PC)
Shelf life: 3 days in platelet incubator & agitator.
24 hrs if no storage cabinet
Storage temp.: 20°C - 24°C
Q.C. Requirements: To be prepared within 8 hrs after collection,
pH should be 6.2 or more at the end of
storage time. Platelet count > 5.5 x 1010 /unit.
Volume: 30 to 50 ml
Contents: Platelet - 5.5 x 1010 /bag
Plasma - 30 to 50 ml and some white cells
Transfusion Criteria: ABO / Rh specific and compatible
Indications: Severe thrombocytopenia, qualitative platelet
defects
Effect: Increases in platelet count 10,000 / ul per unit
48. CCI (Corrected Count Increment) should be done at 1 hour and 20 hours post
transfusion. It compares observed versus expected increase in platelet count.
CCI = platelet increment x body surface area (m2)
number of platelets transfused x 1011
Percentage platelet recovery (PPR)
PPR = platelet increment x weight (kg) x blood volume (75 ml/kg) x 100
number of platelets transfused x volume of product (ml)
Platelet refractoriness: is defined as poor increment in platelet count following
2 consecutive platelet transfusion. It is also calculated as follows
CCI < 7500 at 1 hour
CCI < 4500 at 20 hours
49. PLATELET CONCENTRATE
Dosage
1 unit of PC / 10 kg B.W.
Increment will be less in
- Spleenomegaly
- DIC
- Septicemia
1 unit of PC Platelet 5000-10,000 / ul
50. PLATELET CONCENTRATE
Administration should be ABO & Rh compatible
After pooling, should be infused as soon as possible
Use blood administration or platelet infusion set
Must not be refrigerated before infusion
52. Platelet concentrate
(Random Donor Platelets)
Differential centrifugation from freshly drawn blood
units
Volume- 60ml
Store at 20-24 o C with constant & gentle agitation
Use within 5 days
Bacterial contamination a problem
1unit raise the platelet count by 5k-10k/microliter.
ABO matched platelets preferable
54. Single-donor platelets
Obtained by plateletpheresis technique.
6 - 8 times as many platelets as in a random-donor unit.
Larger volumes and HLA-compatibility results in an
increase of 30k-60k.
Leukoreduced because of apheresis collection
ABO matched platelets preferable
Rh negative receive Rh negative platelets
55. Single Donor Platelet
Indication
same as random PC
special requirement obtain from selected donor
Dosage
Usually 1pack of SDP = 1 therapeutic dose
56. Single Donor Platelet
Vol ~ 300 ml
Administration
same as random PC , but ABO compatible is more important
Vol ~ 50 – 70 ml
57. PLATELET CONCENTRATE
Indications
Treatment of bleeding due to
Thrombocytopenia
Platelet Dysfunction
Prevention of bleeding
Contraindication
prophylaxis of bleeding in surgical patients
58. Apheresis platelets:
This component is equivalent to six random donor platelet units.
One unit contains 3 x1011 Platelets.
Advantages:
1. Large dose from single exposure
2. Repeat procedure after 72 hours is possible
3. HLA matched platelets can be given
4. Decreases chances for allo-immunisation and transfusion
transmitted diseases
Disadvantages:
1. Expensive
2. Time consuming
61. Fresh Frozen Plasma
Plasma along with anticoagulant preservative
Volume ~ 250-300 ml
Prepared from blood within 8 hrs of donation
Maximum level of labile and non-labile clotting factors
(about 1 IU per ml) V & VIII, proteins C and S, complement,
and immunoglobulins.
Good for 24 hours post thaw
Then it can be stored for 5 days as liquid plasma (labile
factors V and VIII decreased)
Shelf life: 1 year
62. Fresh Frozen Plasma (FFP)
It is prepared from the whole blood collected in a CPDA-1 double or triple bag system
within 6-8 hours of its collection.
Principle:
Plasma is separated from cellular blood elements and frozen to preserve the activity of
labile coagulation factors.
Steps
1. Blood is collected in a CPDA-1 double or triple bag system.
2. The blood bags are weighed in a weighing balance and bags weighing equal are placed
opposite to each other in the buckets of the centrifuge.
3. The temperature of the centrifuge is adjusted at 4 - 6°C.
4. The bags are subjected to a high spin (3850 rpm) centrifugation for 5 min.
5. After the centrifuge stops, the blood bags are taken out with minimal disturbance and
supernatant plasma is expressed into the satellite bag, with the help of a plasma
expressor, leaving behind 80-90ml.
6. After labeling the group and ensuring screening status, the plasma is stored
at -20°C or below. The storage shelf life is one year at -20°C and 5 years at -70 to-80°C
63. Fresh Frozen Plasma contains coagulation factors and other
plasma protein (per unit or bag)
Volume - 200-250 ml
Factor VIII - 0.6 IU / ml
Factor IX - 0.9 IU / ml
Fibrinogen - 250-300 mg / bag
Proteins - Albumin, globulin, etc.
1 IU / kg of factor VIII or factor IX raises the factor VIII levels in
plasma by 2% and factor IX levels by 1% respectively.
Shelf life: One year
Storage temp.: -20°C or below
Q. C, Requirements: The entire proems of preparation and
freezing should be completed within 8 hrs after collection.
Volume: 50 to 200 ml
64. Indications for FFP Transfusion
Clinically significant deficiency of Factors II, V, X, XI
DIC
Plasma exchange
Immunodeficiencies
Massive transfusion of stored blood.
Liver disease
Urgent reversal of warfarin therapy
Correction of known coagulation factor deficiencies for which specific
concentrates are unavailable
Correction of microvascular bleeding in the presence of elevated (> 1.5
times normal) PT or PTT
Correction of microvascular bleeding secondary to coagulation factor
deficiency in patients transfused with more than one blood volume
and when PT and PTT cannot be obtained in a timely fashion
65. FFP
Dose
10-15 ml/kg of FFP
For warfarin reversal, 5-8 ml/kg of FFP
Contraindication
Volume expansion
Immunoglobulin replacement
Nutritional support
Wound healing
66. FRESH FROZEN PLASMA
Precaution
Acute allergic reaction are common
Anaphylactic reaction may occur
Hypovolemia alone is not an indication for use
Dosage
Initial dose of 15 - 20 ml / kg
67. FRESH FROZEN PLASMA
Administration
Must be ABO compatible
Infuse as soon as possible after thawing ( within 6
hrs )
using standard blood administration set
68. FROZEN PLASMA
Plasma which separate from whole blood at any time
during storage.
Contain all non-labile coagulation factors.
Indication
Treatment of stable coagulation deficiencies
Contraindication
same as FFP
70. Single Donor Plasma
Prepared from stored blood
Poor in coagulation factors
Cannot be used to correct coagulation factor
deficiencies
Effective as volume expander
71. Solvent- Detergent Plasma
Plasma from multiple donors is pooled
Added a mixture of solvent (tri-n-butyl phosphate) &
detergent (Triton X-100)
Inactivate lipid enveloped infectious agents
Disadvantages:
Risk of contamination of nonenveloped agents
Expensive
72. Other Types
Donor Retested Single Donor Plasma
IgA Deficient Fresh Frozen Plasma
74. Cryoprecipitate (C.P)
Cryoprecipitate contains precipitated proteins of plasma,
rich in factor VIII and fibrinogen, obtained from FFP
prepared within 6-8 hours of collection, subsequent
thawing at 4- 60 C and removal of supernatant.
Also the advantage of Cryoprecipitate is that we can
administer large amount of factor VIII without
overloading the recipient, especially in pediatric patients.
Principle: Coagulation factor VIII can be concentrated by
cryoprecipitation of freshly collected plasma.
Cryoprecipitation is accomplished by rapid freezing of
plasma and slow thawing at low temperature.
76. Cryoprecipitate (C.P)
Cryoprecipitate contains (1 unit)
Volume - 10-20 ml
Factor VIII-C - 80-120 IU
Factor VIII R: Ag - high levels
Factor VIII vWF - high level
Fibrinogen - 150-200mg / bag
Factor XIII - 20-30% of original level
77. Cryoprecipitate (C.P)
Shelf life: Frozen - 1 year
Thawed - 6 hours
Storage temp: Frozen - -20°C or less
Q. C. Requirements: Thaw at 37°C
Factor VIII: C-80 units/bag
Volume: 10 to 20'ml
Contents: Factor VIII: C - 80 to 150 units/bag
Fibrinogen - 150 to 250 mg/bag
Factor Xlll - 20 - 30% of whole blood
von Willebrand factor - 40-70% of whole blood
Transfusion Criteria: ABO compatibility not required
Indications: Correction of factor VIII deficiency
(Hemophilia A, von Willebrand disease).
78. Cryoprecipitate
Indication
Quantitative and Qualitative Fibrinogen Deficiency : DIC
von Willebrand Disease
Factor XIII deficiency
Uremic Coagulopathy
Fibrin Glue
Factor VIII ( haemophilia A )
79. CRYOPRECIPITATE
Administration
Dose of Cryo is based on the desired target level of the
specific factor to be replaced
ABO compatible if possible no compatibility testing
required
After thawing & pooling, infuse as soon as possible through
blood admin. Set
must be infused within 6 hours of thawing
80. Fresh Whole Blood
Heavy spin,4oC(within 8 hrs)
Packed Red Cells Fresh Plasma
o
Stored in 1- 6 C Freeze -80oC immediately
o
Stored at < -18 C
81. Fresh Whole Blood
Light spin, 22oC(within 8 hrs)
Packed Red Cells Platelet Rich Plasma
Heavy spin,22oC
Platelet Concentrate Fresh Plasma
Store at 22oC Freeze(FFP)
82. Fresh Frozen Plasma
Thaw at 4oC & heavy spin
Cryoprecipitate Cryoremoved Plasma
-Refrozen within 1 hr Freeze -80oC immediately
o
-Store at < - 18 C
Stored at < -18oC
83. Component Storage
Red blood cells: 1-6°C
Platelets: 22-24°C, with continuous agitation
Plasma:
FFP: ≤ -18°C (after thawing ~ 1-6°C for 24 hours)
FP: ≤ -18°C (after thawing ~ 1-6°C for 24 hours)
CSP: ≤ -18°C (after thawing ~ 1-6°C for 24 hours)
Cryoprecipitate: ≤ -18°C (after thawing ~ 20°C for 4 hours)
84. How long can Blood Components
be Stored?
Red cells: 42 days, collected in CP2D/AS-3
35 days, collected in CPDA-1
Platelets: 5 days with continuous agitation
Cryo: 12 months at -18°C or
4 hours after thawing
Plasma: 12 months at -18°C or (FFP/FP/CSP)
24 hours after thawing
85. Left:
Freezer filled with
FFP and Cryo.
Upper Right:
Refrigerator with
RBC units.
Lower Right:
Platelet Storage.
87. Frozen Deglycerolized Red Cells
RBCs are glycerolized and frozen < -65 o C for as long as 10
years
Good only for 24 hours after thawing
Deglycerolization washes away plasma and WBC
Reduces FNHTR, allergic reactions and CMV risk
Advantages
Blood of rare types can be stored for long periods
Reduce risk of transfusion hepatitis
Safer in massive blood transfusion
Prompt tissue oxygenation
Does not prevent GVHD
88. Plasma Derivatives
Factor VIII Concentrate
Factor IX Concentrate
AT-III Concentrate
Factor XIII concentrate
Albumin
IV Immunoglobulin
Rh Immunoglobulin
89. Albumin
Prepared from large pool of plasma reconstituted in
isotonic electrolyte solution
96% albumin and 4% globulin and other proteins
Heat treated to prevent viral transmission
Available as 5% or 25% solutions
T1/2=16 hours
Used for Hypovolemia or hypoproteinemia
Can be given without regard to ABO blood type &
cross match
90. CMV- Negative Blood Products
For Pregnant women
Newborns
Immunocompromised.
91. Quality control of blood components
At least 1% of total components prepared are subjected to quality control at
random. The individual parameters to be assessed are as follows and should
be fulfilled by at least 75% of the components tested.
1. Platelet rich plasma & Platelet concentrates
Platelet rich plasma Platelet concentrates
Volume 250 ± 20ml 50±10ml
Total platelet count/bag 4.5-5.5x1010 4.5-5;5x1010
pH during storage ≥6.2 ≥6.2
and on the day of
expiry (3rd day)
Gross appearance swirling present, no swirling present, no
evidence of any evidence of any
discoloration/turbidity discoloration/turbidity
92. 2. Single donor apheresis concentrates
Volume is 200ml approximately
Total platelet count ≥ 3 x 1011/ bag
pH > 6.2 at end of storage.
3. Fresh Frozen plasma and Cryoprecipitate
Factor Vlll concentration is measured by factor'VII' assays using'
commercial available factor VIII deficient plasma.
Factor Vlll level should; to.e 0.6 l.U. per ml; in case of Fresh
Frozen Plasma more than 80 I.U. per bag in case of
cryoprecipitates
Fibrinogen is measured by dry clot weight method. Fibrindgen
level should be 250-300 mg/bag in FFP and 150 mg/bag in case
of cryoprecipitates.
123. Apheresis (Hemapheresis)
The word apheresis is derived from a Greek word
which means separation. Apheresis also known as
hemapheresis is removal of whole blood from donor /
patient, separation into components, retention of
desired or unwanted components and reinfusion of
remaining constituents to the donor or patient.
124. Indications
A. Collection of components from healthy donors
Plateietpheresis
Plasmapheresis
Erythrocytapheresis (2 RBC procedure)
Neocytapheresis
Leucapheresis
Peripheral blood stem cells (PBSC)
B. Removal of pathological components from patients
i. Therapeutic plasma exchange
ii. Therapeutic leucapheresis
iii. Therapeutic thrombocytapheresis
iv. Therapeutic red-cell, exchange ' - -
Techniques
1. Manual method
2. Cell separators
Manual method
It is performed using refrigerated centrifuges and specialized plastic bag systems. Blood which is collected in the
primary bag is centrifuged to separate the desired component which is retained in the satellite bag and the remainder
is infused through the same vein back to the donor.
Advantages: Simple and less expensive method
Disadvantages: The amount of component prepared per procedure is less than that collected from cell separators.
The risk of returning red cells to the wrong patient if stringent donor identification is not done.
125. Cell separators
Apheresis machines using centrifugal force and differing densities of various blood
components is used for separation of desired components.
Types
a) Intermittent flow centrifugation (IFC) - Hemonetics V-50, S-30, MCS.
b) Continuous flow centrifugation (CFC) - Fenwal CS 3000, Fenwal CS 3000 plus,
Amicus, COBE Spectra.
Donor selection for apheresis procedure
Plateletpheresis donors
• Donors should be healthy individuals meeting the standard criteria for normal blood
donation as mentioned in chapter 1.
• Donor should have a minimum platelet count of 1.5x 105 / ul.
• The interval between two procedures should be at least 48 hours and the amount of
red cell loss should not exceed 25 ml / week.
• The donor should not have taken salicylates and anti-platelet drugs for last 72 hours.
• The validity of mandatory tested infectious disease markers is taken upto 3:
days, if a repeat procedure is done in that time frame.
126. Plasmapheresisdonors
• Serial plasmapheresis donors (donating at interval of less than 48 hours)
shou :
preferably be less than 50 years of age and have had given blood previously c-
one or two occasions.
• Occasional plasmapheresis donor (no more than once in 4 weeks) are
accepted on the same criteria as mentioned for whole blood donation in
chapter 1.
• Total blood count and total serum proteins should be within normal range.
• The maximum amount ofplasma which an individual can donate in one
sitting should not exceed 500 ml if the weight is between 50-65 kg and no
more than 900 ml if the weight is more than 65 kg.
• Adequate replacement fluid should be given to donor if more than 500 ml of
plasma is drawn.
• If the red cells are not reinfused back to the donor, the donor should be
deferred for 12 weeks.
• No more than two procedures should be done in one week.
127. Leucapheresis
Leucapheresis is defined as the removal of white cells with
the return of red cells, plasma and platelets to the donors.
The granulocyte concentrate must contam' minimum of
1.0 x 1010 granulocytes in atleast 75% of the units tested.
The product should be transfused as soon as possible
-after collection. The maximum shelf life is 24 hours. The
granulocyte collection yield by apheresis procedure (cell
separator) can be increased by:
• Increasing the granulocyte count of the donor .by giving
steroids or haematopoietic growth factors.
• By improving the separation with addition of red cell
aggregating agents. e.g. hydroxyethyl starch (HES).
128. Neocytapheresis
In patients requiring repeated transfusions e.g.
Thalassemia major, the administration of relatively young
cells .(Neocytes) would improve the management of such
patients, by decreasing the frequency of transfusion and
the rate of iron loading. The neocytes for transfusion
purposes are prepared by the use of automated cell
separator on the principle that young, larger and less
dense red cells are expressed
earlier than older cells. Neocytes obtained in such a
manner show improved survival but are expensive and
take approximately 3-4 hours of donor time.
129. Erythrocytapheresis / 2 RBC collection procedure
For collection of negative RBC units, e.g. O negative
Advantages:
1. Standardized RBC mass collection is possible.
2. Metered anti-coagulantobviatesmixing during collection,
thus reducing clot formation.
3. Reduces the risk of hypovolemia to the donor.
4. On line separation of RBC and plasma is possible.
5. Anti-coagulant to whole blood ratio is 1:16, thus decreases
citrate foxicity.
6. Use of smaller gauge needle is possible. ^ Deferral Period:
After 2 RBC procedure, the donor is deferred for 16 weeks.
130. Adverse effects of Apheresis
Citrate toxicity may occur in the form of numbness
and tingling sensation around the mouth if the
amount of citrate infused exceeds the body's ability to
metabolize it. This problem can be solved by
decreasing the rate Of i
nfusion of anti-coagulant or by giving exogenous
calcium to the donor.
The other side effects are similar to that of normal
blood donation.
131. Therapeutic Apheresis
Therapeutic plasma exchange and plasmapheresis
If 500 ml of plasma is removed without any
replacement fluid, the term plasmapheresis is used.
For e.g. to prepare anti Rh immunoglobulin, donors
are hyper-immunized to Rh antigen. If more than the
above amount is removed the lost plasma proteins is
replaced by crystalloid and colloidal solution.
Replacement fluids for plasma exchange
Exchange volumes vary between 1-1.5 times the
plasma volume of the patient
132. Replacement Advantages Disadvantages
AdvantagesLow cost
Crystalloid • and disadvantages of replacement fluids
• No coagulation factors
• No risk of disease • No immunoglobulins
transmission • Hypo-oncotic
•
Albumin • No risk of disease • No coagulation factors
transmission • No immunoglobulins
• Iso-oncotic • Costly
Plasma Protein • Less expensive than • Induction of some hypotensive
Fractions (PPF) albumin reaction
Fresh Frozen • Maintains normal level of • Disease transmission if not
Plasma (FFP) coagulation factors tested properly
• Immunoglobulin & plasma • Citrate overload
protein
