Prep and characteristics of Blood components

platelet poor plasma

8-24 hours labeled PF24 plasma

<8 hours labeled FFP

FFP

Stored frozen colder than -18 C —> (thawed at 30-37C) —> FFP thawed (can give to patient)

OR store at 4C @ >24 hour labeled as thawed plasma (can give it patient) 5day after thawing

homologous donations

CPD - store of 21 days, No. of viable cells 80

CP2D

Autologous donations

CPDA-1

Whole blood store for 35 days, No. of viable cells 79

Red blood cells store for 35 days, No. of viable cells 71

Adheresis

A powerful methodology where the donor/patient’s blood stream is connected to a centrifuge system to remove selected blood elements.

Hyperventilation

Common in young donors; shortness of breath, facial twitching

Paper bag rebreathing trick

Vado-vagal

Hypotension and slowed heart rate

Elevate feet; cold compress on neck

Hypotensive shock

Hypotension and accelerated heart rate

Give volume infusion

Citrate effect

Tingling around mouth; rarely tetany and cardiac arrhythmias

Slow re-infusion of donor’s blood; give calcium

Whole Blood

4C for 35 days

RBC

4C for 42 days can be frozen 10 years

Need for increased O2 carrying capacity

Each unit will increase Hgb ~1 g/dL

Platelets

5 days at 20-24, gentle agitation

Thrombocytopenia

Platelets <10,000/microL

Bleeding/invasive procedures

Platelets <50,000/microL

Plasma

12 months at -18C

Dosage 20 mL/kg to raise coagulation factors 20%

Cyroprecipitate

1 year at < -18C

Dosage ~1 unit/5-10 kg recipient body weight

Leukoreduction (LR )

Prevent FNHTR*, CMV transmission, HLA alloimmunization

Gamma-irradiation (Irr)

Prevent TA-GvHD

Washing

Prevent repetitive/severe allergic/hyper- sensitivity reactions

CMV seronegative

Prevent CMV transmission

HLA-matched platelets

Treat platelet refractoriness

Cross-matched platelets

Treat platelet refractoriness

Leukoreduction

FDA mandated cut off

< 5 x 106 WBCs/blood unit

Equivalent to removal of 99.9–99.99% of WBCs

>85% original RBC retained

Febrile nonhemolytic transfusion reactions (FNHTR)

Common: 0.5 - 2% of transfusions

Transfusion-transmitted CMV infection (TT-CMV)

Cytomegalovirus (CMV) is an opportunistic virus

Can be lethal in immunocompromised recipients

CMV can be transmitted by blood products

Primarily found in WBCs (monocytes)

HLA alloimmunization

Anti-HLA antibodies bind to transfused platelets and eliminate them

Gamma-irradiation

Viable WBCs in blood transfusions can attack the recipient if they are immunocompromised

Leads to TA-GvHD

~95% lethal!

Completely preventable by 25 Gy irradiation before transfusion

Irradiation = TA-GvHD

Accepted for gamma-irradiation

Hodgkin diease

Immunocompromised

Donations from relatives, HLA- matched donors

Intrauterine transfusions

Neonatal exchange transfusion ECMP

Congenital cell mediated immunodeficiencies

Washed platelets

pRBCs and platelets can be washed with saline to remove > 98% of plasma proteins

However....

• Washed RBCs must be used within 24 hrs

• Washed platelets must be used within 4 hrs

• RBC/platelet dose decreased 20% or more

C/T ratio

Only the units transfused would be cross matched ideally C/T ratio = 1

The goal (and regulatory standard) is a C/T of < 1.5

Elevated C/T is problematic

Removes RBCs from inventory that then have to be returned

Wastes resources (time, effort, reagents)

Can complicate inventory management

Emergency transfusion

O Rh (D) negative blood give to women of child bearing age in male wont make a difference

blood administration

Monitor patient closely for first 15 minutes

This is the time period during which most of the most significant adverse events occur

Regularly monitor thereafter

Complete transfusions within 4 hours

Coagulation factors factor VIII

Hemophilia A

Coagulation factors factor IX

Hemophilia B

Coagulation factors Factor VIIa (Novoseven)

Various bleeding situations

albumin

Volume expanders, typically for plasma exchange

Therapeutic apheresis

Therapeutic apheresis is the removal of a single blood component to treat an underlying disease

Blood flow rates up to 120 mL/min.

Either peripheral or central lines can be

used for access to the patient’s circulation

Citrate used for anticoagulation