Blood components and plasma derivatives

whole blood collection

Collect 450-500 ml + additives

Use in exchange transfusion in neonates = prevent clotting

Autologous transfusion (self)

Apheresis collection

Whole blood is separated (centrifuge)

Remove desired component,

return remaining back to pt

Apheresis products

Single donor platelets

Platelet rich plasma

Granulocytes

FFP (single donor over 500ml)

Stem cells

Plasma derivatives

Oncotic agents

Coagulation factor concentrates

Immune plasma globulins (ISG)

Oncotic agent

Plasma derivative

Albumin 5% or 25%

Plasma protein fraction 5%

Coagulation concentrates

Plasma derivatives

Antihemophilic factor - VIII

Factor IX complex - II, VII, IX, X

Immune plasma globulins

Plasma derivatives

Hepatitis B immunoglobulin HBIg

Rh immunoglobulin RHIG

Transfusion therapy uses

Only give needed components

Select least possible risk

Cost effective

Red blood cells

Soft spin into packed PRBC

Volume 250ml (350 ml + additives)

Store 1-6C

RBC storage (ACD, CPD, CP2D) 55-60% Hct

21 days

RBC storage (CPDA-1) 70-80% Hct

35 days

RBC storage (AS-1, AS-3, AS-5) 55-65% Hct

42 days

RBC storage Frozen w/ glycerol (<65C)

10 years

RBC storage washed/deglycerolized (1-6C)

24 hours

RBC storage Irradiated (1-6C)

28 days

Leukoreduced RBCs

99% leukocyte free

WBC less than 5×10^6

85% RBC maintained

+AS5 additive

42 days outdate

RBC indications

Increased Hgb content and O2 carrying capacity

Increase mass of circulating RBCs during blood loss

Amount raised in each RBC unit

Should raise hemoglobin 6/dL and hematocrit 3%

Pediatric dose of 4ml/kg

Transfusion guidelines (TRICC, TRICS, TRISS)

Hgb < 7g/dL = Most

Hgb < 8g/dL = acute coronary syndrome, traumatic brain injury

RBC contraindications

Anemia that can be corrected with iron, folate, vitamin B12

Anemia that can be corrected with Epogen

Volume expansion only

RBC compatible fluids

Normal saline (0.9%)

ABO compatible plasma and 5% albumin

RBC incompatible

D5W, ½ NS, TPN, antibiotics, lactate ringers

RBC leukocyte reduction

Indicated to prevent alloimmunization to HLA antigens

Infections with CMV

Febrile nonhemolytic transfusion RXN

Prevent TRIM

via apheresis

Irradiated products

Cesium 137

RBC and platelets only

Reduce risk of graft vs host

28 days outdate = RBC

No change outdate = platelets

Cesium 137

prevent reproduction of WBCs

Irradiate products indications

Bone marrow transplants

Oncology

Neonates

Suppressed immune system

First degree family

Deglycerolized Frozen RBCs

Pure RBC

Decreased HLA stimulation, hep exposure

No transfusion RXN

Storage 10 years (store rare units)

DPG levels maintained

Deglycerolized Frozen RBCs disadvantage

High cost of product

Not readily available 90 minutes to thaw and deglycerolize

Deglycerolized Frozen RBCs storage

< -65C

10 years or longer

Expiration after deglycerized 24 hours from thaw

RBC washed

Washed with 1-2 L of normal saline remove 98-99% of plasma, platelets, debris

45 mins prep for RBC

3 hours prep for platelets

Platelets cannot be washed

Washed RBC indications

Remove toxic sub from plasma (potassium, adenine)

History of anaphylactic transfusion RXN

IgA deficiency

Must be proven to have IgA deficiency and anti-IgA antibodies

Washed RBC expiration

20% RBC yield and 33% platelet yield may be lost

RBC outdate is 24 hours

Plate outdate 4 hours

Plasma collection

platelet rich plasma (PRP)

Fresh frozen plasma (FFP)

Cryoprecipitated Antihemophilic factor (cryo)

Fresh Frozen Plasma FFP

Volume 200-250ml, Store 1-6C after thaw

All clotting factors present including V and VIII

No cross match, need ABO

Expire 1 year

Fresh Frozen Plasma FFP prep

30-37C for 30-40 minutes

Store at 1-6C after thaw

Good for 24 hours (may store +4 days must be re-labeled)

Must consider ABO group

Fresh Frozen Plasma FFP storage

Storage -18C or colder within 8 hours of collection

Shelf life 1 year at -18C

7 years at -65C or colder

FP24 after phlebotomy

Decreased F-VIII and protein C and S

Used like FFP but cant use to make cryo

Plasma cryoprecipitate reduced (Cryo-poor plasma)

May be used in refractory TTP patients

Liquid plasma

Never frozen

Plasma separated from whole blood within 4 hours

Used in massive transfusion/trauma as a bridge to FFP

Plasma indications

Coag deficiencies

Live disease with bleeding

Reversal of warfarin

TTP

Active bleeding in DIC

Plasma contraindications

Volume expansion

Factor conc exist (FVIII or IX)

heparin reversal use protamine sulfate instead

INR < 1.8

General surgical prophylaxis

Source of immunoglobulin for hypogammaglobulinemia

Plasma dosage

10-20 ml/kg adults

10-15 ml/kg neonates

2 units at a time for adults