Blood Bank: Blood Components

• WB collected within 15-20 min

• No clots

• Temp for certain components (PLT 20-24°; Plasma 1-6°)

• Components created within 8 hrs (RBCs anytime within WB expiration)

Requirements to create blood components from WB (4)

• CPD (Citrate Phosphate Dextrose)

• CP2D

• ACD (Acid citrate dextrose)

• CPDA-1 (Citrate phosphate dextrose adenine)

• Additive solutions

5 types of anticoagulant preservatives in blood collection bags

• AS-1 = Adsol

• AS-3 = Nutricel

• AS-5 = Optisol

(Anticoagulants in blood colelction bag) 3 types of additive solutions

• CPD, CP2D, ACD = 21 d

• CPDA-1 = 35 d

• Additive sol = 42 d

Expiration of anticoagulant preservative solutions

Decrease

• Glucose

• ATP (→ high O2 affinity)

• 2,3 DPG (→ high O2 affinity)

• pH

Increase

• K+ in supernatant

• Free Hb

Biochemical changes in RBCs when they are stored

Irreversible shape deformity and increased osmotic fragility

Morphological changes in RBCs when they are stored (2)

• ↓ Glucose

• ↓ pH

• ↑ Lactate dehydrogenase (LDH)

Biochemical changes when platelets are stored (3)

• Fragile (→ fragmentation/degranulation)

• Clumping w/o agitation

• Irreversible shape deformity (discoid → spherical)

• Decreased in-vivo recovery, survival, function

Morphological changes to platelets when they are stored (4)

Deterioration of heat labile coagulation factors (FV anf FVIII)

Biochemical changes of plasma when it is stored

• RBC = 120 d

• PLTs = 10 d

• WBC = 1-3 d

• Coag factor (half-life) = hours

Lifespan of blood elements while inside the body (RBC, PLT, WBC, Coag factors)

• Acute hemorrhaging

• Hypovolemia (volume replacement)

• Inc O2 carrying capacity to vital organs

Indications for WB (3)

• A and B hemagglutinin titer < 1:356

• Labeled “Low Titer”

• Some used for 14 days only (→ spun down for just RBCs)

QC for LTOWB (3)

Mixed field agglutination can be detected

When LTOWB is given to a patient prior to hospital admission, the pt has a high probability of being “mistyepd” due to the transfused blood, so it is better practice to perform ABO/Rh typing using the manual method so that…

• Anemia

• Avoid hypervolemia during Tx

• Increase O2 carrying capacity to vital organs

Indications for RBC Tx (3)

• Hb = +1 mg/dL

• Hct = +3%

How does 1 unit of RBCs affect a pt’s hemoglobin and hematocrit?

• Reduce Febrile Transfusion Reactions and TRALI

• Reduce recipient’s immune response against WBCs and PLTs

LR-RBCs have the same indications as RBCs, but it has additional advantages like… (2)

• Removes plasma proteins (IgA, IgG)

• Removes other accumulated substances in stored blood (K+)

The indications for W-RBCs are the same as RBCs and LR-RBCs, but has additional advantages like… (2)

• Rare phenotypes saved for future Txs

• Autologous blood can be saved

The indications for F-WBCs are the same as W-RBCs but has additional advantages such as… (2)

• 37°C waterbath

• Saline with dextrose

• Deglycerolization

Prior to transfusion, F-RBCs must be rapidly thawed in a (——) before the removal of all the cryoprotective agent is performed using varying dilutions of (——). This removal process is called (—-)

Low RPM then high RPM

Platelet products are made from a whole blood collection using a 2 step differential centrifugation process, i.e., (——)

Treat/prevent bleeding from thrombocytopenia/dysfunction

• Raises PLT to 5,000/µL in 70 kg adult

PLT concentrate indicator

• Replacement of all coag factors

  • FV HL = 12 hrs

  • FVII HL = 5 hrs

  • FVIII HL = 10 hrs

• Hypovolemia (Group A used for trauma)

FFP indications (2)

• Replacement of FVIII, fibrinogen, or vWF

  • Fibrinogen inc 5-10 mg/dL

• Can be used to make biologic fibrin glue in certain surgeries to stop ooze bleeding

Cryoprecipitate indications (2)

Sterile Connecting Device (SCD)

This device can connect 2 separate blood tubing without breaching the integrity of either container/aliquot; a closed system is maintained and this type of environment does not affect the original expiration date of the product

• Treatment/control of bleeding

• Replacement of fibrinogen, vWF, or FXIII

  • (Cannot be used for the replacement of FVIII)

Indications for fibrinogen complex (2)

• Larger volume

• More cellular elements

• Less manipulation in processing

  • Can collect non-LR and LR without added filtration step

Apheresis product characteristics (3)

• 4-6

• 40,000/µL in a 70 kg adult

PLTPH product is equivalent to (——) PLT concentrates and raises the patient PLT count after transfusion to (——)

• Normal > 7,500 µL (>5,000 µL @ 24 hrs)

• Abnormal/Refractoriness < 5,000 µL

Normal and abnormal values for PLT corrected count increment (CCI)

<50% of expected on 2 occasions

If the PLT CCI is (——), the patient is considered refractory and a PLT xmat or HLA ABS is performed. IF either the PLT xmat or HLA ABS is positive, it is considered evidence of alloimmunization

(Absolute PLT increment) * BSA / (# PLTs transfused (10¹¹) ≥ 7,500/µL

PLT CCI formula including expected result

ABO Ags

Which blood group antigens are found on PLT membranes (and therefore incompatibility may cause refractoriness)

Daratumumab

It was seen that the off-label administration of the prescription drug for Multiple Myeloma (——) effectively addressed platelet refractoriness while exhibiting mild and tolerable drug side effects

Cold stored platelets

It has been clinically shown that (——) will stop bleeding quicker than room temperature platelets

• Discoid → Spherical with appendages

• Bacterial proliferation

Cold stored platelets alter the PLT morphology (——) which increases itss ability to quickly adhere to the wound site and enhance their ability to participate in the hemostatic process; additionally has reduced potential for (——)

Profound neutropenia (<500/µL) while unresponsive to bact/fungal infection

Indication for granylocyte apheresis

• Irradiated

• TA-GVHD

Because most recipients of granulocyte apheresis are severely immunosuppressed, the product should be (——) prior to transfusion to prevent (——)

Alphanate (FVIII and vWF)

Pharmaceutical blood derivative that treats hemophilia A and VWD

Konyne (FIX)

Pharmaceutical blood derivative used to treat hemophilia B

Gammagard (Gamma globulin)

Pharmaceutical blood derivative used to treat IgG associated disease