Blood Component Preparation

Difference between open and closed systems

• open systems

  • blood components exposed to air during blood component preparation

• closed systems

  • blood components prepared in a sterile environment without exposure to air, allows for maximum storage time

What are some common changes to RBCs during storage?

• glucose, ATP, plasma pH, and 2,3-DPG decrease

  • ATP and 2,3-DPG return to normal within 12-24 hours of transfusion

How do the chemicals dextrose, adenine, and citrate preserve RBCs during storage?

• dextrose

  • supports ATP generation

• adenine

  • acts as a substrate for ATP synthesis

• citrate

  • prevents coagulation by chelating calcium

How long can you store CPD (citrate, phosphate, dextrose) RBCs?

21 days

How long can you store CPDA (citrate, phosphate, dextrose, adenine) red cells?

35 days

How long can you store RBCs with the additives AS-1, 3, 5, or 7?

42 days

What are the benefits of storing leukocyte-reduced platelets with buffered salt solutions instead of plasma?

• increased platelet viability

• allows more plasma to be used for other purposes

• possible reduction of allergic reactions (no plasma proteins)

How are units of RBCs pathogen reduced? How are platelets pathogen reduced?

• RBCs

  • UV radiation and amotosalen damage nucleic acids in pathogens

• PLTs

  • psoralen

  • reduces WBCs and kills viruses, bacteria, and parasites

Platelets need to be separated within __ hours of whole blood collection

8

How are platelets removed from whole blood?

1. whole blood is centrifuged at a light spin

   1. platelet-rich plasma is expelled into a separate bag

   2. additives are added to the red cells

2. the platelet-rich plasma is centrifuged at high speed

   1. platelets are separated and placed on a platelet agitator

   2. plasma can be further processed into FFP and cryo

How long can whole blood with CPD be stored? CPDA-1?

• with CPD

  • 1-6 C for 21 days

• with CPDA-1

  • 35 days

RBC transfusions are indicated for what patients?

• radiation or chemo patients

• trauma victims

• surgery patients

• end-stage renal disease

• premature infants

• sickle cell patients

One unit of RBCs increases Hgb by ___g/dL and HCT by ___%

1, 3

What is the shelf life of red cells with adenine and saline?

42 days

• drops the HCT between 55% and 65%

List one thing that leukoreduced red cells can prevent

creation of HLA antibodies that can trigger platelet refractoriness

Does leukoreduction decrease the risk of GVHD?

No

Final units of apheresis RBCs must have? (Hgb, volume, WBCs)

• at least a Hgb of 51 g/dL

• volume of 153 mL

• less than 5 × 10⁶ WBCs

What are the two methods of freezing RBCs? At what temperature are these red cells stored and for how long?

• high glycerol: uses 40% glycerol

• low glycerol: uses 20% glycerol

• storage

  • -65 C for up to 10 years

How are RBCs deglycerolized?

• after thawing, units are washed with saline to remove glycerol

• dextrose is added

• if open system: expiration date is 24 hours after

• closed system: stored for 14 days at 4 C

RBCs and platelets must be irradiated if:

• the unit is from a blood relative

• it is HLA matched

• is for intrauterine transfusion

• if the patient is immunocompromised

How long are irradiated RBCs good for?

28 days from the date of irradiation

Rejuvenated RBCs

• additive solutions that extend the unit’s expiration date

• unit expires 24 hours after rejuvenation

• used to extend the life of rare donor units

Platelets are indicated for:

• chemo or radiation patients

• post-hematopoietic stem cell transplant patients

• post op bleeding

• organ transplant

How are platelets stored?

at room temperature (20-24 C) with gentile agitation

What is the shelf life of platelets?

5 days after collection

Pooled platelets in an open system are stored at ___ C and expires after ___ hours

20-24 C

4

Platelets must have a pH of

6.2

What can be added to platelets to maintain their function during storage?

platelet additive solution (PAS)

replaces about 65% of plasma in the unit

What is platelet refractoriness and what are some causes?

• when platelets transfusions do not lead to an adequate increase in PLT count

• causes

  • HLA alloantibodies

  • platelet alloantibodies

  • autoantibodies

When is FFP used? Cryo?

• FFP

  • for multi-factor deficiencies

• Cryo

  • fibrinogen and factor VIII deficiencies

  • for hemophilia A and vwD

Storage requirements for FFP

• -18 C for up to 12 months

  • once thawed, product is stored at 1-6 C and has to be used within 24 hours

How long can refrozen cryo be stored for? At what temperature?

-18 C for 1 year

What is in cryoprecipitate and what is its primary clinical use?

• contains fibrinogen, vWF, factor VIII, and factor XIII

• use

  • patients with factor deficiencies

  • however, specific factor concentrates are more useful for patients with vWD or hemophilia

At what temperature are apheresis granulocytes stored? For how long?

20-24 C for 24 hours

Freezers, refrigerators, and platelet incubators must have:

• recording devices to monitor temperature

• audible alarms and alarm checks

• emergency procedures for power failure

• emergency back up power

Whole blood and RBCs are transported between ___ C

1-10

What temperature are platelets shipped at?

20-24 C

During administration of blood components, what information is documented?

• the medical order for transfusion

• recipient consent

• name or type of component administered

• donor unit number

• date and time of transfusion

• vital signs of patient taken pre, during, and post transfusion

• amount transfused

• ID of transfusionist

• any adverse events