CLS 306 (BB) - Lecture 8: Blood Components

• Leuko reduced

• Non LR

Whole blood (2)

• Non LR RBCs

• LR-RBCs (most common)

• Washed-RBCs

• Frozen / Deglycerolized RBCs

RBCs / Packed Cells (4)

• Non-LR

• LR

Platelets (PLTs) (2)

• Platelet concentrates (from WB donation; “Random”)

• Plateletpheresis (collected by apheresis machine)

• Cold-stored platelets

Types of Platelet Products (3)

• Fresh Frozen Plasma

• Plasma frozen w/in 24 hrs of collection

• Freeze dried plasma

• Cryoprecipatate

Plasma Products (4)

• CPD

• CP2D

• ACD

• CDPA-1

• Additive solutions

5 types of anticoagulant preservatives used in blood collection bags

• AS-1 (Adsol)

• AS-3 (Nutricel)

• AS-5 (Optisol)

Additive solutions in blood collection bags (3)

• CPD CP2D ACD - 21 days

• CDPA-1 - 35 days

• Additive Solutions - 42 days

• LR RBCs - 42 days

Expiration Dates for RBC components (4)

• ↓ Glucose

• ↓ ATP (↑ Hb O2 affinity)

• ↓ 2,3 DPG (↑ Hb O2 affinity)

• ↓ pH

• ↑ K+ in supernatant and free Hb

Biochemical changes of RBCs in storage lesion (5)

• Irreversible shape deformity

• ↑ Osmotic fragility

Morphological changes of RBCs in storage lesion (2)

• ↓ Glucose

• ↓ pH

• ↑ Lactate dehydrogenase (LDH)

Biochemical changes of platelets in storage lesion (3)

• Degranulation

• Clumping (without continuous rotation)

• Discoid/spherical deformity

• Decreased in-vivo recovery/function

Morphological changes of platelets in storage lesion

No changes

Morphological changes in plasma storage lesion

Deterioration of heat-labile coagulation factors (FV, FVIII)

Biochemical changes in plasma storage lesion

• RBC - 120 days

• Platelets - 10 days

• WBCs - 1-3 days

• Coag Factors - hours

Blood element lifespan inside the body (4)

• Coagulation factors

• lyophilized or liquid

Plasma (——) can be further manufactured into separate pharmaceutical products; these blood derivatives can be either (— or —) forms; must have a prescription to be used

Fresh frozen plasma

Blood component that corrects a deficiency in coagulation factors or treats shock due to volume loss from burns or massive bleeding

Platelets

Blood component used to treat or prevent bleeding

Cryoprecipitate

Blood product used to treat fibrinogen deficiencies

• Acute hemorrhaging - trauma / massive bleed

• Volume replacement - hypovolemia

• Increase ox-carrying capacity to vital organs

Whole Blood Indications (3)

• Volume: 400-500 mL

• Storage: 1-6°C

• CPD/CP2D = 21 days; CPDA1 = 35 days

• Quality control: none

Whole blood characteristics (Volume, Storage, Expiration, Quality control)

• Volume: 400-500 mL

• Storage: 1-6°C

• CPD/CP2D = 21 days; CPDA1 = 35 days

• Quality control: A and B hemagglutinin < 1:256, labeled “low titer”

LTOWB characteristics (Volume, Storage, Expiration, Quality control)

• Acute hemorrhaging (trauma or massive bleed)

• Volume replacement (hypovolemia)

• Increased O2 carrying capacity to organs (brain, heart, lungs, kidneys, etc)

LTOWB indications (3)

• Volume: 400-500 mL

• Storage: 1-6°C

• CPD/CP2D = 21 days; CPDA1 = 35 days

• Quality control: <5×10⁶ WBCs, ≥85% recovery of 95% total units

Leuko-reduced whole blood characteristics (Volume, Storage, Expiration, Quality control)

• Anemia (inc O2 carrying capacity to vital organs)

• Low volume

RBC indications (2)

• Volume: 250 mL

• Storage: 1-6°C

• CPD/CP2D = 21 days; CPDA1 = 35 days

• Quality control: HCT ≤ 80% for non-additive products

Non-additive RBC characteristics (Volume, Storage, Expiration, Quality control)

• Raise Hb 1 g/dL

• Raise HCT 3%

What is the effect of 1 unit of RBCs on a patient’s Hb and HCT

• Volume: 300 mL

• Storage: 1-6°C

• Expiration: 42 days

• QC: None (HCT 55-65% with solution)

Additive RBCs characteristics (Volume, Storage, Expiration, Quality control)

• Same as RBC (anemia, hypovolemia)

• Reduces febrile transfusion rxn and transfusion acute lung injury (TRALI)

• Reduce patient immune response against WBCs and PLTs

LR RBC Indications (3)

• Volume: 300 mL

• Storage: 1-6°C

• ExpirationL 42 days

• QC: <5×10⁶ WBCs; ≥85% RBC recovery in 95% units

LR-RBC characteristics (Volume, Storage, Expiration, Quality control)

• Same as RBCs and LR-RBCs (Anemia, hypovolemia)

• Removes plasma proteins (IgA IgG)

• Removes other accumulated substances (K+)

W-RBC Indicators (3)

• Volume; 180-200 mL

• Storage: 1-6°C

• Expiration: 24 hours (open system, needs sterility maintenance)

• QC: HCT 70-80%

W-RBC characteristics (Volume, Storage, Expiration, Quality control)

Donut shaped bag

What do W-RBCs look like when stored

• Same as W-RBCs (remove plasma proteins and accumulated substances)

• Rare phenotypes frozen for future (hr” neg, O_h, U neg)

• Autologous blood

F-RBC Indications (3)

• Volume: 250-300 mL

• Cryoprotective agents: High glycerol (40%) and low glycerol (15-20%)

• Limitation: frozen within 6 days

• Expiration: 10 years

• QC: none

F-RBC characteristics (Volume, cryoprotective agents, limitation, expiration, QC)

• HG ≤ -65°C in mechanical BB ultra low freezer

• LG ≤ -165°C liquid nitrogen

• LG ≤ -196°C liquid nitrogen tank

F-RBC storage temperature (2)

• Rapid thaw F-RBCs in 37°C water bath

• Deglycerolization (Remove cryoprotective agent by dilution of saline + dextrose) → deglycerolzied RBCs

F-RBC Transfusion Process (2)

• Volume: 250 mL

• Storage: 1-6*C

• Expiration: 24 hours (open system)

• QC: ≥80% RBC recovery, <1% residual glycerol

Deglycerolized RBC characteristics (Volume, Storage, Expiration, QC)

• Low PLTs

• Petechiae/ecchymosis

• Platelet function test or Clot retraction test abnormal (PLT disorder)

• Bleeding/oozing

• Hemorrhage

Platelet Product Indications (5)

Amotosalen (psoralen) + UVA light phototherapy

Pathogen reduction technology is used with platelet products to prevent nucleic acid replication for bacterial, viral, and parasitic pathogens'; FDA-approved treatment involves (——)

Raise PLT to 5,000 µL

What is the effect of platelet concentrate on a 70 kg patient

• PLT Ab

• HLA Ab

• Passive immunity

Immune cause of platelet refractoriness (3)

• Sepsis

• Splenomegaly

• Aplasia

• Cirrhosis

• Drugs/Antibiotics

• Bleeding

• DIC

Non-immune causes of PLT refractoriness

• 10-60 min

• Normal: 7,500µL (>4,500µL at 24 hr)

• Abnormal: ≤5,000 µL

Correct Count Increment measures platelet refractoriness based on the number of platelets transfused and the BSA of the patient. It is performed (——) after PLT transfusion with normal values being (——) and abnormal values being (——)

• Volume: 50-70 mL

• Storage: 20-24°C

• Expiration: 5 days (pooled = 4 hours)

• Quality control:

  • ≥5.5×10¹⁰ PLTs

  • pH ≥ 6.2

  • No visible aggregates

PLT concentrate chatacteristics (Volume, Storage, Expiration, QC)

• Volume: 50-70 mL

• Storage: 20-24°C

• Expiration: 5 days (pooled = 4 hours)

• Quality control:

  • ≥5.5×10¹⁰ PLTs

  • pH ≥ 6.2

  • No visible aggregates

  • < 8.3×10⁵ WBCs in 95% of units

LR Platelet concentrate characteristics (Volume, Storage, Expiration, QC)

Made from whole blood collection by low RPM differential centrifugation

How is PLT concentrate made

• Replacement of all coag. factors

  • FV = 12 hr half-life, FVIII = 10 hr half-life

• Massive hemorrhage - hypovolemia

  • group A on any trauma

• Re-establish normal coagulation scheme

Fresh Frozen Plasma indications (3)

• Volume: 200-250 mL

• Storage: ≤ -18°C frozen, 1-6°C thawed

• Expiration: 1 yr frozen, 24 hr thawed

• QC: none

FFP Characteristics (Volume, Storage, Expiration, QC)

Factors II, VII, IX, X, XI

PF24 is frozen within 24 hours of collection but is only used as liquid plasma because the heat-labile coagulation factors are essentially gone. The more stable coag factors (—5—) are still present

• Volume: 200-250 mL

• Storage: ≤ -18°C frozen (1-6°C thawed)

• Expiration: 24 hours after thaw

• QC: None

PF24 characteristics (Volume, Storage, Expiration, QC)

• Volume: 260-270 mL (700mL apheresis)

• Storage: RT

• Expiration: 2 years

• QC: not known

Freeze Dried Plasma Characteristics (Volume, Storage, Expiration, QC)

• Store at room temp

• Reconstitution (Quick process)

• Maintain inventory of AB plasma in rural hospital

• Use in field trauma

FDP Advantages (4)

• Replacement of Factor VIII / Fibrinogen / vWF

• Raise fibrinogen lvl 5-10 mg/dL

• Make biologic fibrin glue to stop ooze bleeding

Cryoprecipitate Indications (3)

• Volume: 15-25 mL

• Storage: ≤ 18°C frozen (20-24°C for transfusion)

• Expiration: 6 hr individual, 4 hr open pooled, 6 hr closed pooled

• QC: ≥ 80 IU FVIII; 150mg fibrinogen

Cyroprecipitate characterics (Volume, Storage, Expiration, QC)

• Treat/control bleeding (massive hemorrhage, fibrinogen deficiency, etc.)

• Replacement of fibrinogen, vWF, or FXIII

• Cannot be used for replacement of FVIII

Fibrinogen Complex Indications (3)

Pooled cryoprecipitate (up to 4 identical ABO) using pathogen-reduction filtration system

How are fibrinogen complex components made

• Volume: 60-100 mL

• Storage: ≤ -18°C frozen (20-24°C thawed)

• Expiration: 1 yr frozen (5 days thawed)

• QC: 150 mg Fibrinogen

Fibrinogen complex characteristics (Volume, Storage, Expiration, QC)

• Larger in volume

• Increased quantity of cellular elements

• Use less manipulation in processing

• Can collect non-LR and LR products without additional filtration

Apheresis product characteristics (4)

• 4-6 PLT concentrates

• 40,000/µL in 70kg pt

Plateletpheresis product is equivalent to (——) PLT concentrates and can raise a patient’s post-transfusion PLT count to (——)

• Volume: 200-300 mL

• Storage: 20-24°C w/ constant agitation

• Expiration: 5 days (7 days w/ PRT)

• QC:

  • ≥3.0×10¹¹ PLTs

  • pH ≥ 6.2

  • No visible a

Plateletpheresis Characteristics (8)

• Volume: 200-300 mL

• Storage: 20-24°C w/ constant agitation

• Expiration: 5 days (7 days w/ PRT)

• QC:

  • ≥ 3.0×10¹¹ PLTs

  • pH ≥ 6.2

  • No visibel aggregates

  • < 5×10⁶ WBCs in 95% of units

LR plateletpheresis characteristics (Volume, Storage, Expiration, QC)

• Cold-storage platelets

• discoid → spherical with appendages

• Bacterial proliferation

Some US trauma services/helicopter services carry (——) because it has been clinically shown that it stops bleeding almost “immediately” due to the change in its morphology (——). This makes it able to quickly adhere to the wound site and enhance their ability to participate in the hemostatic process. It also reduces the potential of (——)

• Volume: 200-400 mL

• Storage: 1-6°C NO AGITATION

• Expiration: 3 days

• QC: Can be stored 20-24°C, ensure proper storage temp and expiration

Cold stored Plateletpheresis characteristics (Volume, Storage, Expiration, QC)

RBC Apheresis

TBC products that are collected in either a single product or a double product depending on the donor’s pre-donation Hb and HCT values

• Volume: 300 mL

• Mean collection ≥ 60g Hb (180 mL RBC) per unit

• QC: > 50g Hb (150 mL RBC) for 95% units

RBC apheresis characteristics (Volume, mean collection values, QC)

• Volume: 300 mL

• Mean collection ≥ 60g Hb (180 mL RBC) per unit

• QC

  • Mean collection of ≥ 51g Hb (153 mL RBC) per unit

  • < 5×10⁶ residual WBC

  • > 42.5g Hb (128 mL RBC) in 95% units

LR RBC apheresis (Volume, mean collection values, QC)

300 mL

Frozen plasma apheresis products follow the same indications and characteristics as WB derived FFP and PF24, EXCEPT the volume is usually (——)

• Electrolytes

• Glucose

• Plasma proteins (Lactated Ringer’s, Plasma-Lyte, Normosol)

Crystalloids are isotonic aqueous solutions containing… (3)

• Macromolecular weight particles (proteins and hydroxyethyl starch (HES))

• Albumin Dextran

Colloids are isotonic aqueous solutions containing (——) suspended in a crysalloid solution (——)