Blood component

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BLOODBank

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Blood components Dr. Abdullah Aljedai

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Introduction • Whole blood unit obtained from donors is separated in the donor processing area of blood bank into various components. • This allow for effective use of donated blood and lowers the exposure risk of the transfused patient. • Blood is composed of plasma and blood cells. • Plasma contains vital proteins such as coagulation factors, fibrinogens, albumin, and globulin (including immunoglobulins). • The clinical requirement of a patient determines which blood product should be transfused.

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Blood components • Blood components and products are obtained by donors. • A donated blood unit consists of around 450- 500 ml of blood mixed with anticoagulant. • An alternative process for the collection of blood is that of apheresis , which uses cell separation equipment and centrifugation.

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Blood components • Blood components available from whole blood include: • Red cell concentrates (packed RBCs). • Platelets concentrates. • Fresh frozen plasma • Cryoprecipitate • Products derived fro pooled plasma: • (human albumin, immunoglobulins, coagulation factor concentrates)

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Blood is collected as whole blood, as shown below Processing of blood components

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packed red blood cells (PRBC's) is prepared by light centrifugation PRBC's Plasma + platelets light centrifugation

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PRBC's Plasma + platelets heavy centrifugation PRBC's platelet rich plasma fresh frozen  plasma platelets

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Red cell concentrates • Red cell concentrates are obtained by centrifugation and removal of plasma. • Red cells contain the oxygen carrying molecule haemoglobin. • A solution of citrate, phosphate, dextrose-adenine (CPD-A) is used as anticoagulant in the blood unit. • Citrate prevents blood from clotting by removing calcium ions. • Adenine is required to maintain the metabolic activity of red cells in the blood pack. • Red cell concentrates in CPD-A are kept @ 2-6 C and their shelf life is 35 days.

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• As the blood ages, the 2,3-DPG levels and the oxygen carrying capacity are reduced. • The shelf life of red cell concentrates can be increased by using preservative substances to prolong the activity of 2,3-DPG and maintain the ATP level required by RBCs. • An example of theses is SAGM (Saline, Adenine, glucose and mannitol). Red cell concentrates

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Leukocytes-depleted blood components • Leucocytes in the blood units may cause infections and non-haemolytic transfusion reactions to the recipients. • Therefore, leucocytes are removed from blood components by filtering through leucocytes specific filters prior to transfusions. • This process called leucocytes depletion. • Examples of infections transmitted by leucocytes in blood products: Creutzfeldt-Jakob disease (CJD) and CMV.

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Plasma derived components • Plasma is separated from whole blood by high centrifugation. • Aspiration of plasma components is performed in a ‘cosed system’ to prevent infection of the blood. 1)Human albumin is important as a binding protein. It is also critical for providing osmotic activity and maintaining blood in blood vessels. • Human albumin is produced from plasma and treated to inactivate viruses and bacteria before it is given to burns patients. 2) Immunoglobulins: produced from standard donation or apheresis. • Can be stored for 12 months at 4-6 C. • Indicated for patients with immunodeficiecy conditions (SCID). 3) Coagulation factors: - Factor VIII can be derived from plasma to treat haemophilia A patients. - Recombinant factor VIII is now available. - Factor VII and factor IX concentrates are also of clinical use.

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Fresh frozen plasma (FFP) • FFP is produced from single donors. • Plasma is harvested within 6 hours of donation from the red cells and rapidly frozen @ -70 C, and stored @ -30 to maintain coagulation factors at optimum conditions. • FFP is leucodepleted and may be virally inactivated before being given to patients. • Clinical indications: - 1) coagulation deficiencies and haemorrhage conditions (massive blood loss, infection or surgery of the liver). - 2) acquired coagulation factor deficiencies such as DIC. - Compatibility: - Only compatible FFP should be given (ABO specific or AB units) to prevent transfusion reactions.

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Cryoprecipitate • Cryoprecipitate is a source of factor VIII and fibrinogen extracted from single donor plasma. • It is prepared by slowly thawing FFP @ 4C. This process precipitate and enrich a fraction of FFP with factor VIII. • Cryoprecipitate is then stored @ -30. • Cryoprecipitate is used mainly for patients with DIC and patients with factor VIII deficiency.

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Platelets concentrates • Platelets are essential for preventing blood loss by forming the platelet plug at the site of damaged vessel wall. • Patients lacking platelets are prone to bruising and bleeding. • Platelets concentrates are prepared from platelets rich plasma by aspiration into another satellite pack. • 4 packs pooled to provide one adult unit. • Platelets units can also be collected by plasmapheresis. • Platelets are stored @ RT for 5 days. • Platelets units should be leucodepleted before transfusion. • Blood group-specific platelets should be given.

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Transfusion requirements for massive blood loss • Surgical haemorrhage or traffic accidents cause severe blood loss. • Patients who had massive blood loss has 3 major requirements: replacements of the lost volume of blood and to provide oxygen carrying capacity, and replacement of lost coagulation factors. • Blood volume is replaced by whole blood or soloutions such as (human albumin, saline). • Oxygen carrying capacity is provided by giving whole blood or packed RBCs (red cell concentrates). • Coagulation factors are replaced by giving fresh frozen plasma.

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• To compensate for blood loss during surgery a ‘top up’ of packed RBCs is needed. • Fresh frozen plasma may be required post surgery as well to compensate for coagulation factors. Transfusion requirements pre and post surgery

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Transfusion requirements for certain blood diseases • Certain blood disorders such as leukaemia and aplastic anaemia require supportive therapy to correct for anaemia and low platelets count. • Supportive therapy can be achieved by giving various blood products such as packed RBCs, platelets concentrates, and coagulation factors.

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Component Majorindications Volume(ml) Wholeblood Symptomaticanemiawithlargevolumedeficit 750 Redbloodcells(RBCs) Symptomaticanemia 330 RBCs(washed) Symptomaticanemia Severallergicreactions 180 RBCs(Leukocyte- reduced) Symptomaticanemia FebrilereactionsduetoWBCantibodies ReduceCMVtransmission ReduceHLAalloimmunization 330 Platelets Thrombocytopeniaorplateletfunctionabnormality Bonemarrowhypoplasia 60 Plateletsphersis CrossmatchedandorHLAmatched 300 Platelets(WBC reduced) Preventionoffebrilereactions PreventionofHLA-alloimmunization 300 Granulocytespheresis Neutropenia(resistanttoantibiotics) 220 Freshfrozenplasma Coagulationfactorsdeficiency TTP 220 Thawedplasma Deficiencyofstablecoagulationfactors 220 Cryoprecipitate Hypofibrinogenemia FactorXIIIdeficiency 15 Clinical indications for blood components therapy

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