Blood Preservation and Storage

Blood component

refers to fractions of whole blood separated and prepared in blood bank or hospital

Oxygen carrying components - human derived

RBC

• washed

• leukoreduced

• frozen

• autologous

Platelet products

• random (pooled)

• single donor

• cold store

Plasma products

• FFP

• rapid thaw plasma

• FP24

• cryoprecipitate

Non-human synthetic blood

perfluorocarbons - carbon and fluorine (not as good)

Whole blood collection

collect 450-500 mL of whole blood into collection bag - processed and additives added (10 minutes)

• exchange transfusion for neonates

• autologous

• mass trauma (low titer O)

Apheresis collection

• whole blood is separated into components during collection with centrifugation

• desired products removed

• remaining products returned to donor

Apheresis products

• single donor platelets (apheresis platelet rich plasma)

• granulocytes

• single donor FFP

• stem cells

Plasma derivatives - oncotic agents

• 5% or 25% albumin

• 5% plasma protein fraction

Plasma derivatives - coagulation factor concentrates

• antihemophilic - factor 8

• 9 complex - 2, 7, 9, 10

Plasma derivatives - immune plasma globulins (ISG)

• RhIg

• HbIg

Primary use of transfusion therapy

• giving patients what they need when they need it

• risk management (selecting least risk products)

• maintain cost effectiveness

RBC product collection, volume, effects

obtained from soft spin of whole blood

RBC circulatory overload effects

RBCs minimize circulatory overload

• reduced AC and electrolytes - high potassium = cardiac arrest

RBC product volume

250 mL - 350 mL with additives

Shipping RBC conditions

• 1-10 C

• ice on top

• monitored

Washed RBC storage conditions

• stored at 1-6 C

• outdate 24 hours after wash

Irradiated RBC storage conditions

• stored at 1-6 C

• outdate 28 days

  • or original outdate

  • whichever is earlier

Deglycerolized RBC storage conditions

• stored at 1-6 C

• outdate 24 hours

RBC frozen with glycerol

• stored at <65 C

• outdate 10 years or longer

Acid citrate deztrose (ACD), citrate phosphate dextrose (CPD), and CP2D (citrate phosphate double dextrose) outdates and hematocrits

• 21 days outdate

• 55-60% Hct

CPDA-1 (citrate phosphate dextrose adenine) outdate and hematocrit

• 35 days outdate

• 70-80% Hct

AS-1, AS-3, AS-5 (additive solutions) outdate and hematocrit

• 42 day outdate

• 55-65% Hct

RBC indications

• increase Hgb content and O₂ carrying capacity in normovolemic patients

  • oncology, end stage renal disease, preemies, hemolysis, hemoglobinopathies

• increase mass of circulating RBC in blood loss

  • trauma, surgery, or 10-20% blood loss

  • transfusion guidelines

    • most patients - Hgb <7 g/dL

    • trauma - Hgb <8 g/dL

One unit of RBC should increase Hgb and Hct by—

• Hgb increases by 1 g/dL

• Hct increases by 3%

• pediatric - 4 mL/kg achieves same result

RBC contraindications

• anemia due to deficiency of iron, folate, or vitamin B12

• anemia due to decreased RBC - epogen (prescribed EPO)

• volume expansion only

Fluid compatibility for RBC

• 0.9% NS

• ABO compatible plasma

• 5% albumin

• anything else is incompatible

Leukoreduced RBC procedure

99% leukocyte free product - almost all RBC products are leukoreduced

filter, centrifuge, separate, add AS-5

Leukoreduced RBC outdate

42 days

Leukoreduced RBC - WBC count and RBC retention

<5 × 10⁶ WBC count

85% RBC maintained

Leukoreduced RBC risk reduction

• prevent alloimmunization of HLA antigen

• decrease risk of CMV infection

• prevent FNHTR

• prevents transfusion related immunomodulation

Irradiated products procedure

• no irradiation id previously frozen

• Ce 137 used to irradiate

• RBC and platelets only irradiated, not plasma

• inactivates and prevents WBC reproduction

Irradiated platelets outdate

no change to original outdate

irradiated products - risk reduction

reduces TA-GVHD risk

• in immunocompetent or 1^o relatives

• delayed fever - 2-30 days

• rash, damage to epidermis, GI, liver portal

• wipes out BM - hypocellular and fibrotic

Deglycerolized frozen RBC - advantages

• decrease lymphocytes

  • decrease HLA stim

  • decrease hepatitis exposure

  • no transfusion reactions

• group O is universal donor

• long storage

• rare donor units or auto can be stored

• no microaggregate material

• DPG levels maintained

Deglycerolized frozen RBC - disadvantages

• high cost of product

• not readily available

  • thaw and deglycerolizing time

Washed RBC

• remove plasma = no plasma proteins

• for patients with anaphylaxis risk and IgA deficiency

• cannot wash plasma

• wash plt or RBC

  • 20% RBC yield and 33% plt yield

FFP volume, content, INR

• 200-250 mL

• 93% water, albumin, stable clotting factors, labile clotting factors (5, 8), fibrinolytic proteins, Igs, other plasma proteins, little to no RBC or plt

• 1.1 INR

FFP storage conditions

<-18 C for 1 year

<-65 C for 7 years if frozen within 8 hours

FP24

frozen plasma longer than 8 hours, less than 24 hours

doesn’t contain as much labile factors

can’t be made into cryo

FFP preparation

thaw in water bath at 37 C for 30-45 minutes

Thawed FFP storage and outdate

• 1-6 C storage

• 24 hour outdate

Thawed plasma storage and outdate

thawed FFP relabeled

• storage at 1-6 C

• keep for additional 4 days - total 5 day outdate

Plasma cryoreduced used for —

can be used in refractory TTP

Liquid plasma definition and use

never frozen plasma separated within four hours of collection

used in massive trauma to bridge to FFP

Plasma indications

• liver disease with bleeding

• reversal of coumadin (warfarin)

• MAHA - DIC, TTP

• clotting factor deficiency - only when no coag factor concentrates available or multiple deficiency with mass trauma

Plasma contraindications

• volume expansion

• clotting factor replacement with available concentrates

• reversal of heparin - use protamine sulfate

• INR greater than 1.8 - INR not designed for transfusion guideline

• general surgical prophy

• source for Ig or hypogammaglobulinemia - give grans instead

Plasma dosage

• 10-20 mL/kg for adults

• 10-15 mL/kg for neonates

• common practice is 2 units per adult

Cryoprecipitate definition, volume, compatibility

• proteins portion of FFP when thawed at 1-6 C, centrifuged, collected, and refrozen within 1 hour

• 15 mL per unit and 100 mL per pool of 5 units

• Rh is irrelevant but ABO is preferred, not required

Cryo contents

• 80-120 units vWBF

• >1250 mg fibrinogen

• >80 IU factor 8

• 40-60 IU factor 13

• fibronectin

Cryo storage conditions

• <-18 C for 1 year

• cannot be refrozen

Cryo preparation

• thaw at 30-37 C for 30 mins

• do not refreeze

• 6 hours outdate if single

• 4 hours outdate if pooled

• store at RT - 22-24 C

Cryo indications

• fibrinogen problem

  • hypofibrinogenemia during active bleeding, risk of bleeding, consumptive coagulopathies

  • dysfibrinogenemia

• factor problem

  • uremic bleeding no responsive to DDAVP

  • factor 13 deficiency

  • vWF deficiency with no available concentrates

  • factor 8 deficienc with no available concentrates

Cryo contraindications

vWF disease or hemophilia A with available concentrates

Random donor platelets definition, volume, compatibility

• whole blood derived platelet concentrates are pooled

• 50-65 mL

• should be ABO specific when possible (Rh also for neonates)

  • RBC contamination - sensitization

Random donor platelets storage conditions

• stored at RT

• agitated

• 5 day outdate

• when pooled - must be given within 4 hours

• same storage as SDP

Random donor platelets minimum count per bag

5.5 × 10¹⁰ platelets

1 unit of random donor platelets should raise platelet count by —

5,000-10,000/uL

Single donor platelets definition, compatibility, yield, volume

• platelets collected with apheresis

• ABO and Rh specific donor if possible

• 6-10x random donor yield

• 180-250 mL

Single donor platelet minimum platelet count

3 × 10¹¹ platelets

Cold storage platelets

• for smaller hospitals that can’t use platelets within date

• same as random donor but extended to 14 day outdate stored at 1-6C with no agitation

Platelet indications

• thrombocytopenia or active platelet related bleeding

  • BM failure, chemo, cardiopulmonary bypass

• dysfunctional platelet disorders

  • Glanzmann’s, Bernard-Soulier

  • prophy

  • patients on anti-platelet meds (NSAIDS, aspirin, plavix)

  • procedures

    • CVC replacement - 20-40,000/uL

    • most surgeries/bleeding - <50,000/uL

    • enclosed surgery (CNS, ophthalmic)

  • non bleeding patients - <10,000/uL

Each apheresis unit (6x random) should raise platelet count by—

30,000-50,000 in adults

Platelet contraindications

• thrombocytopenia due to plt destruction in ITP or TTP, MAHA, and PTP

• heparin induced thrombocytopenia

• platelet count over 100,000/uL without platelet dysfunction

• cirrhosis with massive splenomegaly

• bleeding unrelated to thrombocytopenia or platelet dysfunction

• multiple units without testing for response with absence of bleeding

• transfusion night before planned procedure

Factors affecting platelet transfusion effectiveness

• splenomegaly - platelet sequestration = decreased platelet increment

  • platelet increment PI = post transfusion platelet - pre transfusion platelet count

• hyperthermia - decrease platelet survival

• sepsis - decrease platelet survival

• allo-platelet antiantibodies anti-HLA - markedly decreased PI and requires HLA matched platelets to result in satisfactory transfusion PI

• auto-platelet antibodies - no PI response

PI response effectiveness

24 hours post transfusion - no increase = accelerated usage problem (DIC)

1 hour post transfusion - no increase = platelet Ab, splenomegaly, sepsis, hyperthermia

Platelet refractoriness

• repeat failure to achieve hemostasis or expected PI

• associated with bleeding, splenomegaly, MAHA, fever, sepsis, recent stem cell transplant, drugs, GVHD, poor platelet quality

• suspected with two separate occasions of poor PI

granulocyte collection, volume, donor stimulation, donor selection

apheresis collection

volume is 250-300 mL

donor is mobilized with corticosteroids with or without G-CSF

donors are pedigreed from platelet donor pool

emergency release before infectious disease testing