The Use of Blood and Blood Components

1. Chapter 3 The Use of Blood and Blood Components Various blood components and how they function The indications and contraindications for use

2. Red Blood Cells - RBC (LRF)Description: • Whole blood is collected into an anticoagulant then centrifuged to separate the red cells from the plasma. • The plasma is then expressed from the whole blood bag and the remaining red blood cells (RBC) are filtered. • The filtering process removes all but 5 x 106 white blood cells (WBCs). • 85% of the original RBC volume will remain after filtration. • A typical unit has a volume of 240-340 mL and a hematocrit of 80%.

3. Red Blood Cells - RBC (LRF)Function: • Increase the oxygen carrying capacity of the blood by increasing the circulating red blood cell mass. • Carry oxygen and nourishment to the tissues and take away carbon dioxide.

4. Red Blood Cells - RBC (LRF)Indications: • Component of choice for virtually all patients with a deficit of oxygen carrying capacity, e.g., blood loss or anemia. • The majority of the WBC are removed thereby decreasing the risk of cytomegalovirus (CMV) infection in immunocompromised patients. This is because the CMV virus is carried in the WBC. • Use of RBC (LRF) reduces the risk of the patient forming antibodies against WBC (HLA) antigens. This is especially important for potential organ or bone marrow transplant candidates.

5. Red Blood Cells – RBC (LRF)Contraindications: RBC (LRF) should not be used: • when anemia can be corrected with specific medications, e.g., iron, B12, folic acid, erythropoietin, etc • for volume replacement

6. Platelets – PC (LRF)Descriptions: • Platelets are prepared from a random unit of whole blood collected in CP2D anticoagulant solution and filtered to remove leukocytes. PC (LRF) contain less than 8.3 x 106 leukocytes. • Platelets are suspended in a small amount of the original plasma. A unit contains at least 55 x 109 platelets suspended in 50-55 mL of plasma. • Trace amounts of red blood cells can be present in some units. • These will appear pink to salmon colored. • Platelets may also be obtained by apheresis

7. Platelets - PC (LRF)Function: • The primary role of platelets is to prevent bleeding of injured blood vessel walls by forming an aggregate at the site of injury. • Platelets also participate in blood coagulation, inflammation and wound healing. • The transfusion of platelets to a patient with thrombocytopenia or bleeding should produce a rise in the platelet count and control bleeding.

8. Platelets - PC (LRF)Indications: • For treatment of patients with bleeding due to severely decreased production or abnormal function of platelets. • Treatment of bleeding patients with platelet consumption or dilutional thrombocytopenia (in most instances of dilutional thrombocytopenia, bleeding stops without transfusion). • Useful if given prophylacticaly to patients with rapidly falling or low platelet counts, less than 10 x 109/L (10,000/uL), secondary to cancer or chemotherapy. • Useful in selected cases of postoperative bleeding with platelet count less than 50 x 109/L (50,000/uL).

9. Platelets – PC (LRF)Contraindications: • Platelets should not be used if bleeding is unrelated to decreased numbers or abnormal platelet function. • Should not be used in patients with consumption of endogenous and exogenous platelets, such as in Thrombotic Thrombocytopenia Purpura (TTP) or Idiopathic Thrombocytopenia Purpura (ITP), unless the patient has a life threatening hemorrhage.

10. Platelet Incubator Stored with constant agitation

11. Fresh Frozen Plasma - FFP (LRF)Description: • Fresh frozen plasma is separated from whole blood and frozen within 8 hours of collection. It can be obtained from a whole blood donation (approx. 250 mL) or by apheresis (approx. 500 mL). • Fresh frozen plasma contains a normal concentration of fibrinogen and the labile coagulation factors VIII and V.

12. Fresh Frozen Plasma – FFP (LRF)Function: • Fresh frozen plasma contains the clotting factors that are necessary for hemostasis. • Plasma also has volume expansion and oncotic properties.

13. Fresh Frozen Plasma – FFP (LRF)Indications: • The majority of clinical situations for which FFP is currently used do not require FFP. • FFP is indicated for massive transfusion (replacement of the patient’s blood volume in < 24 hours) with a demonstrated deficiency of Factor VIII and V, otherwise frozen plasma is adequate. • Fresh frozen plasma is also indicated in exchange transfusion in neonates.

14. Fresh Frozen Plasma – FFP (LRF)Contraindications: • Fresh frozen plasma should not be used when a coagulopathy can be corrected more effectively with specific therapy, such as vitamin K, cryoprecipitate, or Factor VIII concentrates. • Fresh frozen plasma has the same infectious disease risk as whole blood. • Fresh frozen plasma should not be used when the blood volume can be replaced with other volume expanders such as 0.9% sodium chloride, lactated ringer’s, albumin or pentaspan.

15. Frozen Plasma – FP (LRF) • Frozen plasma is prepared from whole blood, collected in CP2D anticoagulation solution. • The plasma is separated after cold centrifugation and processed to the frozen state within 24 hours of collection.

16. Frozen Plasma – FP (LRF) • Frozen plasma contains stable coagulation factors such as Factor IX and fibrinogen in concentrations similar to FFP, but reduced amounts of Factor V and VIII. • On average, each unit of frozen plasma contains an average of 250 mL (>100 mL) of anticoagulated plasma. • The indications and side effects are the same as for FFP, except that FP should not be used to treat coagulation factor deficiencies of Factor V and Factor VIII.

17. Fresh Frozen Plasma (FFP) Unit of FFP (Approx. 250 mL) Apheresis FFP (Approx. 500 mL)

18. Cryosupernatant Plasma (CSP)Description: • CSP is prepared by thawing fresh frozen plasma at a temperature between 1°C and 6°C. After centrifugation, the plasma is separated from the insoluble cryoprecipitate which is then harvested and frozen. The CSP is frozen. • On average, each unit of CSP has a volume of approximately 200 mL. • CSP is deficient in the high molecular weight multimers of von Willebrand Factor (vWF) which are found in plasma, and cryoprecipitated AHF. It contains only 20-30% of the plasma Factor VIII.

19. Cryosupernatant Plasma (CSP) Indications: • This component is used as an exchange fluid in the treatment of Thrombotic Thrombocytopenic Purpura (TTP) and Adult Hemolytic Uremic Syndrome (HUS). Contraindications: • Do not use for conditions that require von Willebrand or Factor VIII replacement.

20. Cryoprecipitate (Cryo)Description: • Cryoprecipitate is prepared by thawing fresh frozen plasma at a temperature between 1°C and 6°C. After centrifugation, the supernatant plasma is removed and the insoluble cryoprecipitate is refrozen. • On average, each unit of cryoprecipitate contains 80 IU or more Factor VIII (FVIII:C) and at least 150 mg of fibrinogen in 5-15 mL of plasma.

21. Cryoprecipitate (Cryo)Function: • Cryoprecipitate provides a source of coagulation factors. Factor VIII, Factor XIII and von Willebrand Factor. • Fibrinogen and fibronectin are present.

22. Cryoprecipitate (Cryo)Indications: • Currently the main indication for this component is as a source of fibrinogen or Factor XIII. • It may be used as a source of Factor VIII only when inactivated fractionation products or recombinant Factor VIII are not available.

23. Cryoprecipitate (Cryo)Contraindications: • Cryoprecipitate should not be used unless results of laboratory studies indicate a specific hemostatic defect for which this product is indicated. • Specific factor concentrates are preferred, when available, because of their reduced risk of transmissible diseases (because of viral inactivation during manufacturing). • Cryoprecipitate can be used to make fibrin glue. Alternatively, virally inactivated commercial products can be purchased for this purpose.

24. Cryoprecipitate (Cryo) Cryoprecipitate Pooling Cryoprecipitate