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Understand the goals of blood collection, anticoagulants, and solutions used to maintain blood viability, prevent changes, and minimize contamination. Learn about storage lesions, component preparation, and general information regarding blood components.
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Goals Of Blood Collection • Maintain viability and function • Prevent physical changes • Minimize bacterial contamination
Anticoagulants Preservative Solutions • Anticoagulants prevent blood clotting • Preservatives provide nutrients for cells • Heparin • Rarely if ever used anymore • Anticoagulant ONLY • Transfuse within 48 hours, preferably 8
Additive Solution • Primary bag with satellite bags attached. • One bag has additive solution (AS) • Unit drawn into CPD anticoagulant
Additive Solution • Add additive solution to RBCs, ADSOL, which consists of: • Saline • Adenine • Glucose • Mannitol • Extends storage to 42 days • Final hematocrit approximately 66%
Changes Occur During Storage • Shelf life = expiration date • At end of expiration must have 75% recovery • At least 75% of transfused cells remain in circulation 24 hours AFTER transfusion
Storage Lesion • Biochemical changes which occur at 1-6C • Affects oxygen dissociation curve, increased affinity of hemoglobin for oxygen. • Low 2,3-DPG, increased O2 affinity, less O2 released. • pH drops causes 2,3-DPG levels to fall • Once transfused RBCs regenerate ATP and 2,3-DPG • Few functional platelets present • Viable (living) RBCs decrease
Plasma hemoglobin Plasma K+ Na+ K+ Viable cells pH ATP 2,3-DPG Plasma Na+ Helps release oxygen from hemoglobin (once transfused, ATP & 2,3-DPG return to normal)
Storage Lesion • Significant for infants and massive transfusion. • Other biochemical changes • ATP decreases • Potassium increases • Sodium decreases • Plasma hemoglobin increases
Preparation of Components • Collect unit within 15 minutes to prevent activation of coagulation system • Draw into closed system – primary bag with satellite bags with hermetic seal between. • If hermetic seal broken transfuse within 24 hours if stored at 1-4C, 4 hours if stored at 20-24C
Preparation of Components • Centrifuge – light spin, platelets suspended • Remove platelet rich plasma (PRP) • Centrifuge PRP heavy spin • Remove platelet poor plasma • Freeze plasma solid within 8 hours • Thaw plasma at 1-4C – precipitate forms • Centrifuge, express plasma leaving cryoprecipitate. Store both at -18C • RBCs – CPD – 21 days, ADSOL – 42 days – 1-6C
Preparation of Components • Summary – One unit of whole blood can produce: • Packed RBCs • Fresh frozen plasma (FFP) • Cryoprecipitate (CRYO) • Single donor plasma (SDP) – cyro removed • Platelets – terms PC (platelet concentrate) OR RD PC (random donor platelet concentrate)
Blood Component General Information • Transfusion practice • Transfusion requires doctor’s prescription • All components MUST be administered through a filter • Infuse quickly, within 4 hours • D (Rh) neg require D neg cellular products • ABO identical preferred, ABO compatible OK • “Universal donor” – RBCs group O, plasma AB
Blood Component General Information • Fresh Whole Blood • Candidates • Newborns needing exchange transfusion • Patients requiring leukoreduced products
Blood Component General Information • Summary of storage temperatures: • Liquid RBCs 1-6C • Platelets, Cryo (thawed) and granulocytes 20-24C (room temperature) • ANY frozen plasma product ≤ -18C • ANY liquid plasma product EXCEPT Cryo 1-6C
Blood Components • Cellular • Red blood cell products • Platelets • Granulocytes • Plasma • FFP • Cryoprecipitate
Red Blood Cells, Packed (PRBC) • Used to treat symptomatic anemia and routine blood loss during surgery • Hematocrit is approximately 80% for non-additive (CPD), 60% for additive (ADSOL). • Allow WB to sediment or centrifuge WB, remove supernatant plasma.
Leukocyte Reduced Red Cells (LR-RBC) • Leukocytes can induce adverse affects during transfusion, primarily febrile, non-hemolytic reactions. • Reactions to cytokines produced by leukocytes in transfused units. • Other explanations to reactions include: immunization of recipient to transfused HLA or granulocyte antigens, micro aggregates and fragmentation of granulocytes. • Historically, indicated only for patients who had 2 or more febrile transfusion reactions, now a commonly ordered, popular component. • “CMV” safe blood, since CMV lives in WBCs. • Most blood centers now leukoreduce blood immediately after collection. • Bed side filters are available to leukoreduce products during transfusion.
Washed Red Blood Cells (W-RBCs) • Washing removes plasma proteins, platelets, WBCs and micro aggregates which may cause febrile or urticarial reactions. • Patient requiring this product is the IgA deficient patient with anti-IgA antibodies. • Prepared by using a machine which washes the cells 3 times with saline to remove and WBCs. • Two types of labels: • Washed RBCs - do not need to QC for WBCs. • Leukocyte Poor WRBCs, QC must be done to guarantee removal of 85% of WBCs. No longer considered effective method for leukoreduction. • e. Expires 24 hours after unit is entered.
Red Blood Cells Frozen; Red Blood Cells Deglycerolized (D-RBC) • Blood is frozen to preserve: rare types, for autologous transfusion, stock piling blood for military mobilization and/or civilian natural disasters. • Blood is drawn into an anticoagulant preservative. • Plasma is removed and glycerol is added. • After equilibration unit is centrifuged to remove excess glycerol and frozen. • Expiration • If frozen, 10 years. • After deglycerolization, 24 hours. • Storage temperature • high glycerol -65 C. • low glycerol -120 C, liquid nitrogen.
Rejuvenated Red Blood Cells • A special solution is added to expired RBCs up to 3 days after expiration to restore 2,3-DPG and ATP levels to prestorage values. • Rejuvenated RBCs regain normal characteristics of oxygen transport and delivery and improved post transfusion survival. • Expiration is 24 hours or, if frozen, 10 years
Platelets (PLTS), Platelet Concentrate (PC) or Random Donor Platelet Concentrate (RD-PC) • Used to prevent spontaneous bleeding or stop established bleeding in thrombocytopenic patients. • Prepared from a single unit of whole blood. • Due to storage at RT it is the most likely component to be contaminated with bacteria. • Therapeutic dose for adults is 6 to 10 units. • Some patients become "refractory" to platelet therapy. • Expiration is 5 days as a single unit,. • Store at 20-24 C (RT) with constant agitation. • D negative patients should be transfused with D negative platelets due to the presence of a small number of RBCs.
Preparation of platelet concentrate Plasma RBCs PRP Platelet concentrate
Platelets (PLTS), Platelet Concentrate (PC) or Random Donor Platelet Concentrate (RD-PC) • One bag from ONE donor • Need 6-10 for therapeutic dose
Pooling Platelets • 6-10 units transferred into one bag • Expiration = 4 hours
Platelets Pheresis, Apheresis Platelet Concentrate, Single Donor Platelet Concentrate (SD-PC) • Used to decrease donor exposure, obtain HLA matched platelets for patients who are refractory to RD-PC or prevent platelet refractoriness from occurring. • Prepared by hemapheresis, stored in two connected bags to maintain viability. • One pheresed unit is equivalent to 6-8 RD-PC. • Store at 20-24 C (RT) with agitation for 5 days, after combining, 24 hours • D negative patients should be transfused with D negative platelets due to the presence of a small number of RBCs
Platelets Pheresis • One bag (unit) from one donor • One unit is a therapeutic dose • Volume approximately 250 ccs
Granulocytes Lymphocyte Monocyte Neutrophils Eosinophils Basophils
Granulocytes • Primary use is for patients with neutropenia who have gram negative infections documented by culture, but are unresponsive to antibiotics. • Therapeutic efficacy and indications for granulocyte transfusions are not well defined. • Better antimicrobial agents and use of granulocyte and macrophage colony stimulating factors best for adults, best success with this component has been with babies • Daily transfusions are necessary. • Prepared by hemapheresis. • Expiration time is 24 hours but best to infuse ASAP. • Store at 20-24 C.
Fresh Frozen Plasma (FFP) • Used to replace labile and non-labile coagulation factors in massively bleeding patients OR treat bleeding associated with clotting factor deficiencies when factor concentrate is not available. • Must be frozen within 8 hours of collection. • Expiration • frozen - 1 year stored at <-18 C. • frozen - 7 years stored at <-65 C.thawed - 24 hours
Fresh Frozen Plasma (FFP) • Storage temperature • frozen -18 C, preferably -30 C or lower • thawed - 1-6 C • Thawed in 30-37C water bath or FDA approved microwave • Must have mechanism to detect units which have thawed and refrozen due to improper storage. • Must be ABO compatible
Pooled Plasma/Solvent Detergent Treated • Most recently licensed product. • Prepared from pools of no more than 2500 units of ABO specific plasma frozen to preserve labile coagulation factors. • Treated with chemicals to inactivate lipid-enveloped viruses. • Contains labile and non-labile coagulation factors but lacks largest Von Willebrand’s factor multimers. • Used same as FFP.Safety concerns • Decreases disease transmission for diseases tested for. • Doesn’t inactivate viruses with non-lipid envelopes: parvo virus B19, hepatitis A, and unrecognized pathogens
Cryoprecipitate (CRYO), Factor VIII or Anti-Hemophilic Factor (AHF) • Cold insoluble portion of plasma that precipitates when FFP is thawed at 1-6C. • Cryoprecipitate contains high levels of Factor VIII and Fibrinogen, used for treatment of hemophiliacs and Von Willebrands when concentrates are not available. • Used most commonly for patients with DIC or low fibrinogen levels. • A therapeutic dose for an adult is 6 to 10 units. • Can be prepared from WB which is then designated as "Whole Blood Cryoprecipitate Removed" or from FFP • Plasma is frozen. • Plasma is then thawed at 1-6 C, a precipitate forms. • Plasma is centrifuged, cryoprecipitate will go to bottom. • Remove plasma, freeze within 1 hour of preparation
Cryoprecipitate (VIII, vW) Thaw at 30-37°C Store at RT 4 hrs FFP Plasma cryoprecipitate, reduced (TTP, FII, V, Vii, IX, X, XI) Frozen within 8 hours Thawed FFP Refrozen with 24 hrs of separation Store at ≤18°C 1 yr 5 day expiration at 1-6°C
Cryoprecipitate (CRYO), Factor VIII or Anti-Hemophilic Factor (AHF) • Storage Temperature • Frozen -18 C or lower • Thawed - room temperature • Expiration: • Frozen 1 year • Thawed 6 hours • Pooled 4 hours • Best to be ABO compatible but not important due to small volume
Irradiation of Blood Components • Cellular blood components are irradiated to destroy viable T- lymphocytes which may cause Graft Versus Host Disease (GVHD). • GVHD is a disease that results when immunocompetent, viable lymphocytes in donor blood engraft in an immunocompromised host, recognize the patient tissues as foreign and produce antibodies against patient tissues, primarily skin, liver and GI tract. The resulting disease has serious consequences including death. • GVHD may be chronic or acute
Irradiation of Blood Components • Patients at greatest risk are: • severely immunosuppressed, • immunocompromised, • receive blood donated by relatives, or • fetuses receiving intrauterine transfusions • Irradiation inactivates lymphocytes, leaving platelets, RBCs and granulocytes relatively undamaged. • Must be labeled "irradiated". • Expiration date of Red Blood Cell donor unit changes to 28 days. • May be transfused to "normal" patients if not used by intended recipient.