Gallardo, Michelle BLOOD COMPONENT PREPARATION

OBJECTIVES • Blood stored is reinfused during or at the end of the

1.List various forms of autologous and directed donations surgery
2.Describe the apheresis procedure, donor requirements, and
the products that can be collected
3.Explain the benefits of component separation
4.Define storage lesion, and list the elements that change during
blood storage
5.Compare anticoagulant and preservative solutions with regard
to expiration and content
6.Illustrate the steps in blood component preparation
7.State the storage temperature and storage limits for each
blood component
8.Explain proper blood component labeling, transport, and
issuance

PART I: SPECIAL BLOOD DONATIONS

ALLOGENEIC AND AUTOLOGOUS DONATIONS

• A voluntary donation of blood for use by the general patient
population is called an allogeneic donation
• Any donation of blood reserved for the donor's own use at a
later time is considered an autologous donation
• Three general types of autologous procedures (for people with -crystalloid more commonly used; poor retention and easily
future surgeries): excreted; inexpensive
A. Preoperative collection -colloid expensive; good retention better compensation for
B. Normovolemic hemodilution blood loss
C. Blood recovery
ADVANTAGES DISADVANTAGES C. BLOOD RECOVERY
Prevention of TTD Preoperative anemia • Is the collection and of shed or reinfusion salvaged blood
(transfusion transmitted • This process can take place in the intraoperative or
diseases) postoperative period (on the spot autologous donation)
Prevention of Increased incidence of • A medical device collects, washes, filters, and concentrates
alloimmunization adverse reactions any shed blood during operation reinfuse directly
Prevention of febrile and High wastage • Indication: to reduce the need for allogeneic transfusion
allergic reactions • Note: washing and filtering; DOES NOT remove bacteria
Supplementing blood supply Increased cost
Reassurance of patient Inventory control

A. PREOPERATIVE COLLECTION
• Blood is drawn and stored before the anticipated
transfusion
• Indications:
- Stable patients for surgery (>72 hrs)
- Patients with rare antibodies
- Patients with religious beliefs that do not allow
allogeneic transfusions
• Donors are given a consent form and are not restricted by PATIENT- DIRECTED DONATIONS
age • Recipients choose their own donors to provide blood than
• Requirements: allogeneic donations
- Patient-donor hematocrit: >33% • Donor requirements and testing must meet the same criteria
- Hemoglobin concentration: >11 g/dL as allogeneic donations
• Pretransfusion testing follows same protocols as allogeneic
B. NORMOVOLEMIC HEMODILUTION • 56-day between donations may be waived by medical director
• Involves removing one or more units of blood at the (compared to 86 normally)
beginning of surgery
• Blood removed is replaced with crystalloid or colloid
solutions to restore fluid volume
Gallardo, Michelle BLOOD COMPONENT PREPARATION
APHERESIS DONATIONS D. RED CELL APHERESIS
• Whole blood is removed from a donor or patient, a specific • Two units of RBCs are removed
component is separated by mechanical means, and the • Current FDA requires donors to be larger:
remainder of the blood is returned • Males:
• Several categories of procedure: -Minimum 130 lbs (59 kgs)
A. Leukapheresis -Minimum height 5'1
B. Plateletpheresis -Minimum hematocrit > 40 %
C. Plasmapheresis • Females:
D. Red cell apheresis -Minimum 150 lbs (68 kgs)
E. Therapeutic apheresis -Minimum height 5'5
-Minimum hematocrit > 40 %
A. LEUKAPHERESIS • Donors deferred 16 weeks after a double RBC donation
• White blood cells are removed E. THERAPEUTIC APHERESIS
• Collection of sufficient granulocytes for a therapeutic dose • Used to treat various diseases
• Requires drugs or sedimenting materials to be given to the • Cell separator machine uses centrifugal force to separate
donor before collection a s this enhances optimal leukocyte blood into components based on their specific gravity
yield • Depending on procedure and the equipment used, process
can take 30 minutes to 2 hours:
• One venipuncture
-Blood is removed, centrifuged, and returned in
alternating steps back to the same arm
• Continuous flow
-Venipuncture in both arms, blood is removed from one
arm, centrifuged and returned to the other arm (faster
than OV)

THERAPEUTIC PHLEBOTOMY

B. PLATELETPHERESIS
• Platelets are removed
• At least 48 hours must elapse between donations
• Donors should NOT undergo procedure >2x/week or
>24x/year
• Plateletpheresis donors must have a platelet count of at
least 150,000/uL before the collection if the interval
between donations is <4 weeks
C. PLASMAPHERESIS • Performed to withdraw blood from a patient for medical
• Plasma is removed reasons
• Collection of plasma by apheresis is designated as either • Although removal of blood does not cure the disease, it may
• Frequent program: help treat the patient’s symptoms
- More often than >1x/4 weeks • Common indications are:
- Necessitates monitoring of total plasma protein, lgG, • Hemochromatosis- iron overload in the body damages joints
and IgM levels at 4 month intervals • Polycythemia vera- abnormally increased red cell production
• Infrequent program: • Porphyrias- buildup of porphyrin that can be toxic
- Donors who donate <1x/4 weeks
- Donors must weigh 50 kg (110 lbs) Why Do We Need to Prepare Blood Components?
Gallardo, Michelle BLOOD COMPONENT PREPARATION
• One unit of blood can save up to four (4) lives, thus,
maximizing one donor collection
• Only the appropriate blood components will be transfused
therefore efficiently targeting patient needs
• Allows the issuance of the correct blood unit for therapy

BLOOD COMPONENT PRODUCTION

• The separation of whole blood into its parts, or components,
allows for optimal storage of each part and the ability to
provide appropriate therapy for patients
• Regulations regarding current Good Manufacturing Practices
(cGMPs) and blood product manufacture can be found in the
FDA Code of Federal Regulations and are written to optimize
the “safety, purity, potency, quality, and identity” of blood
products
• Component names reflect the ISBT 128 terminology used by
AABB Standards • Due to storage lesion, “fresh” RBC products (<7 days old) are
indicated to maximize 2,3-DPG and avoid high K+ levels for the
BLOOD COLLECTION AND STORAGE following:
• Blood is collected in a primary bag that contains an • Neonates
anticoagulant-preservative mixture • Intrauterine transfusion
• The entire blood collection set, including integrally attached • Exchange transfusion
satellite bags and tubing, is sterile and considered a closed (babies have jaundice due to
system (35 days expiration date) hemolyzed red cells; transfuse
• The sterile system becomes an open system when through umbilical cord and only
administration ports or other areas are exposed to air, and the RBC aliquots are given)
allowable storage time is reduced because of potential • Blood collected in CPD and CP2D:
bacterial contamination (24 hours expiration date) • 21 days at 1-6 C
• Standard whole blood collection volume is: • Blood collected in CPDA-1:
- 450 + 45 mL or + 10% for blood collected in a bag • 35 days at 1-6 C
containing 63 mL anticoagulant • RBCs prepared from blood collected in CPDA-1 must have a
- 500 + 50 mL or + 10% for the larger volume bag hematocrit <80% to ensure sufficient plasma still remains for
containing 70 mL anticoagulant red cell metabolism
• If collection is <300 mL, volume of anticoagulant should be -maximum time for transfusion allowable: 4 hours
adjusted
• If whole blood collection does not meet required volume and RED CELL ADDITIVE SOLUTIONS
the anticoagulant was not adjusted, separate the RBCs and • Additive solutions (AS-1, AS-3, AS-5, AS-7) are provided as an
label “Red Blood Cells Low Volume”, discard the rest of the integral part of the bag collection system
components left • After plasma is separated from RBC, the additive solution is
allowed to flow into the RBCs to enhance red cell survival and
STORAGE LESION function
• Are the biochemical and morphologic (cell membrane shape) • Amount of additive solution:
changes that occur when blood is stored at 1-6 C which affects - 100 mL/ 450 mL WB collection
red cell viability and function - 110 mL/ 500 mL WB collection
• Purpose of the preservative solution/additive solutions: • Additive solution must be added within 72 hours of
minimize the effects of storage lesion and maximize product preparation
shelf life More Advantages:
• Storage limits are set by the FDA to ensure that at least 75% of - Extends storage life to 42 days from date of collection
original RBCs remain viable in the recipient’s circulation 24 - Reduces unit’s viscosity
hours after transfusion with <1% hemolysis - Improves flow rate during administration of blood unit
• Temperature of storage units are checked and recorded every
8 hours in the blood bank for quality control
INCREASED DECREASED
Plasma hemoglobin Red cell glucose (viable cells)
Plasma potassium (K+) Plasma pH
Plasma Na+
RBC ATP + 2,3- DPG/ 2,3-BPG
Gallardo, Michelle BLOOD COMPONENT PREPARATION
CHEMICAL PURPOSE
Dextrose Supports ATP generation by glycolic pathway PATHOGEN REDUCTION TECHNOLOGY
• Pathogen reduction is a post-collection manufacturing process
Adenine Acts as substrate for red cell ATP synthesis • Uses ultraviolet radiation and photosensitizers which creates
Citrate Prevents coagulation by chelating calcium. damage to pathogen nucleuc acids and prevents their
Also protects red cell membrane replication and growth
Sodium Prevents excessive decrease in pH • Goal of the process: reduce the risk of certain transfusion-
biphosphate transmitted infections (TTI)
Mannitol Osmotic diuretic acts as membrane stabilizer
STEPS IN PREPARING BLOOD COMPONENTS
RED CELL ANTICOAGULANT/ PRESERVATIVE STORAGE
LIMIT
CPD/ citrate-phosphate-dextrose 21 days
CP2D/ citrate-phosphate-2-dextrose 21 days
CPDA-1/ citrate-phosphate-dextrose-adenine 35 days
AS-1 (Adsol); AS-5 (Nutricel)/ dextrose, adenine, 42 days
mannitol, saline
AS-3 (Optisol)/dextrose, adenine, saline, citrate 42 days
AS-7 (SLOX)/ dextrose, adenine, mannitol, saline, 42 days
citrate, NaHCO3

PLATELET ADDITIVE SOLUTIONS (PAS)

• PAS is a buffered salt solution that replaces a portion of the
plasma used to store platelets developed to increase platelet
viability during storage and make more plasma available for
other needs
• PAS platelets are leukocyte-reduced apheresis platelets that
are stored in a mix of 65% PAS and 35% plasma
• Research suggests PAS-platelets reduce allergic transfusion
reactions
• Stored up to 5 days at 20-24 C
REJUVENATING SOLUTIONS
• Although the procedure is not routine, it may be necessary to
restore 2,3-DPG and ATP levels in RBC units collected in CPD or
CPDA-1 during storage or up to 3 days after expiration with a
solution containing PIPA (pyruvate, inosine, phosphate,
adenine) [Rejuvesol]
• Extends the expiration date which may be necessary for rare or
autologous units involved
• Rejuvenated RBCs require washing to remove inosine before
transfusion due to patient toxicity
• Added to expired blood not more than 3 days. But since you
are adding solutions, it becomes open system and expires in 24
hours
1. After the whole blood (450 mL) is centrifuged at a light /
soft spin (3,200 rpm for 2-3 minutes), platelet-rich plasma
(PRP) is expressed or pushed through the attached tubing
into an empty satellite bag. (LS- fast; low speed)
2. The PRBCs (150 mL) remain the original bag, and the tube
between the plasma and red cells is heat-sealed and cut.
3. If collected in an additive system, the additive solution is
added to the RBCs. Otherwise, PRBCs are sealed and split
from the remaining bags and refrigerated at 1-6°C.
4. The PRP unit (300 mL) is centrifuged again this time at a
heavy/ hard spin (3,600 rpm for 5 minutes) which causes the
platelets to sediment to the bottom of the bag. (HS- longer;
higher speed)
5. All but about 50-70 mL of plasma is removed from the
platelets. The remaining plasma is required to maintains
pH of 6.2 or higher during the storage period.
6. The platelets are sealed and allowed to "rest" for 1-2 hours
before they are stored on a rotator that maintains
continuous agitation (gentle).
7. Platelet concentrates are stored at 20°C-24°C for a maximum
period of 5 days.
8. The plasma (230-250 mL) can be produced further as:
• Fresh Frozen Plasma (FFP) = within 8 hours of collection
• Plasma Frozen within 24 hours (PF24)
• Recovered plasma = NSA, other volume expanders
9. If FFP will be processed further into Cryoprecipitate
antihemophilic factor (AHF)/CRYO, an empty satellite bag is
left attached to the FFP and frozen with it.
10. When ready to prepare the CRYO, the FFP is thawed at 1-6°C
in which a white precipitate forms.
11. Thawed FFP and empty satellite bag are then centrifuged at
another heavy spin
12. All but about 10 to 15 mL of the supernatant plasma is
expressed into the empty satellite bag.
Gallardo, Michelle BLOOD COMPONENT PREPARATION
13. CRYO remains in the bag that originally contained FFP. Can
be used as fibrin glue applied to surgical sites. (CRYO is
precipitate from thawed frozen plasma rich in factors 8 and
9)
14. It is relabeled "cryoprecipitated AHF" refrozen within 1 hour
of thawing and stored at or below -18C for upto 1 year
15. Ref-thawed plasma can be refrozen at -18°C for 12 months

-irradiation removes very active WBC; done in immunocompromised px ISG- immune serum globulin
who may suffer GvHD NSA- normal serum albumin
-glycerol is a cryoprotective agent protecting components in low PPF- plasma protein fraction
temperatures, preserving it. If need to be used, diglycerol Red cells but
HES- hydroxyethyl starch (synthetic volume expanders)
allows air and becomes open system expiring in 24h
High glycerol (40% weight per volume)- increased
-RD (random donor) SD (single donor)
-plasma volume expanders are given to severely burnt patients or during cryoprotection
shock Low glycerol (20% weight per volume)- stored -120 C liquid
nitrogen temperature
Gallardo, Michelle BLOOD COMPONENT PREPARATION
BLOOD COMPONENT LABELING
• Labeled in accordance with the AABB Standards, FDA
regulations, and ISBT Code 128 (previously Codabar)
• Donor Identification Number (DIN) containing information
regarding the country, center of origin, and year of collection
among other information
• Any modifications must be identified and handwritten
changes must be legible
• Unique identifier of the unit, the ABO and Rh type,
expiration date, and component labels must be checked
with a second person
• Serologic results must be reviewed with appropriate labels
• Maximum of two unique identifier units (e.g. Blood Center
where unit is prepared + Blood Bank where recipient is)
• Method in place to trace unit from origin to final disposition

BLOOD COMPONENT TRANSPORT AND ISSUANCE

• For transportation:
- Whole blood = maintain at 1-10 ° C
• For platelet production:
- Must be HLA-matched in patients with anti-platelet
antibodies due to platelet refractoriness (platelets have
HLA antigens)
• For FFP production:
- Prepared within 8 hours of blood collection
- Otherwise, labile factors will be lost
• For FFP issuance:
- Thaw in water bath 30-37°C for 30-45 minutes
- Store at 1-6°C and transfuse within 24 hours
- Cannot re-freeze FFP once it is waterbath-thawed

Whole Blood Collection

Component Donor Processing

- Packed red blood cells - ABO and Rh

- Fresh frozen plasma and - Antibody screen
FP24 - Serological test for syphilis
- Platelets - Viral testing
- Cryoprecipitate

Product Labeling