Blood Bank Components

Trans by: nahaeminrmt

 Whole Blood donor RBCs for the initial or subsequent transfusions. If positive for clinically
 It contains RBCs and plasma significant antibodies, transfuse blood to neonate that does not contain the said
 Hematocrit level: 38% antibodies.
 Oxygen-carrying capacity and volume expansion  Anticoagulant - CPDA-1 or addistive solution (minimal)
 Storage: 1 - 6°C  Additive solution however contains adenine and mannitol and AS is toxic to renal
 Irradiated Whole Blood syst
 Shelf-life: 28 days from date of irradiation  10 mL/kg with hematocrit level 0f 80% = ↑ 3 g/dL
 Dose of radiation: 25 Gy (center of container) or 15 Gy (any other point in
container) II. RBCs Irradiated
 Storage: 1 - 6°C  Probable patients to be transfused: immunocompromised, patients receiving bone
marrow transplant or stem cell transplant, fetuses undergoing an intrauterine
Preservatives transfusion, and recipients of blood from relatives
ACD 21 days  Function/Use: The process of irradiation inhibits the proliferation of T cells and
CPD subsequent transfusion-associated-graft-versus-host-disease (GVHD)
CPDA-1 35 days  RBCs, platelets, and granulocyte concentrates contain viable T lymphocytes that may
identified by the host’s immune system as foreign therefore initiating immune
response
Red Blood Cell Components  FDA and AABB recommended a minimum dose of gamma irradiation using Cesium-
 Prepared from whole blood by centrifugation, sedimentation, apheresis 137 or Cobalt-160
 Function/Use: indicated for patient who require an increase RBC mass and oxygen-  25 Gy - central portion of the blood unit
carrying capacity and patients at risk at circulatory overload  15 Gy - delivered to any part of the blood unit
 Plasma to be removed depends on the amount of anticoagulant-preservative solution  Confirmatory procedure for irradiation - a radiochromic label is affixed to the
 CPDA-1 = 200 - 250 mL (hematocrit 65% - 80%) component placing it into the metal cannister
 Additive solutions = 250 - 300 mL (hematocrit < 80% or 55%-65%)  Positive for irradiation - darkening of the film
I. RBC Aliquots  Shelf life: 28 days from the time of irradiation
 Probable transfused patients: neonates or infants (<4 months)
 Function/Use III. RBC’s Leukoreduced
 Anemia caused by spontaneous fetomaternal or fetoplacental hemorrhage  Leukoreduced red cells is a product in which absolute WBC count in the unit is reduced
 Twin-twin transfusion to less than 5 × 106 and contains at least 85% of the original RBC mass
 Obstetric accidents  Function/Use: febrile nonhemolytic transfusion reactions, transfusion-related acute
 Internal hemorrhage lung injury, and transmission of EBV, CMV, and human T-cell lymphotrophic virus
 Neonates with iatrogenic anemia (> 10mL of blood removed)  Two Major Categories of Leukoreduced RBCs: prestorage and poststorage
 Neonatal transfusion volume = 10 - 25 mL  Prestorage Leukoreduction
 Multiple-pack system or Quad Pack - closed system bag with four attached sterile  Special filters procure at least a 99.9% (a 2- to 4-log) removal of leukocytes
containers; single unit of whole blood  Employing multiple layers of polyester or cellulose acetate non-woven fibers
 ADVANTAGE: 1 donor can transfuse to multiple infants which trap leukocytes and platelets but that allow RBCs to flow through
 Shelf life: 24 hours  End product: leukoreduced blood with normal shelf life (85% retention of
 Storage: 1°C - 6°C original RBCs)
 Initial Screening for Neonates: ABO, Rh, and anti-body screen for unexpected  Biological Response Modifiers (BRMs) -
antibodies (serum from infant or mother)  Released from leukocytes during storage
 AABB Standards - repetition of ABO and Rh typing can be omitted and if initial  Promote febrile transfusion reactions
screening for RBCs antibodies is negative, it is not necessary to crossmatch the
  Examples: proinflammatory cytokines (IL-1, IL-6, and TNF) and
complement fragments (C5a and C3a)
 Methods for prestorage leukoreduction
1. In-Line Filter - attached to the whole blood unit and filtered via gravity;
RBCs and plasma can be prepared (
2. Plasma is initially removed then pRBC are passed through an in-line
reduction filter
* random donor is not suitable for these methods
3. Sterile docking device - attach a leukoreduction filter to a unit of RBCs,
which is allowed to flow via gravity
 Poststorage Leukoreduction
 Leukocytes are removed in the blood bank prior to issuing blood or at the
bedside before transfusion
 Procurement of leukocytes by centrifugation (< 5 × 108) - prevents most
febrile hemolytic reactions to RBC concentrates
 Third generation filters reduce leukocytes to levels 5 × 106 or lower
 Procurement of leukocytes by centrifugation or filtration will prevent the
reaction of antibodies from patient’s plasma and leukocyte present in
transfused blood but not the reaction caused by BRM’s
 Age of RBC unit is predictor of febrile reaction and cytokine involvment may
still occur
 Frozen, thawed, deglycerolized, and washed RBCs could also produce a
leukoreduced product
 Removal of buffy coat at the time of collection can lower leukocyte level to
acceptable limits (1.9 × 106) after freezing
 Deglycerolization could provide economic alternative to leukocyte filtration
after freezing
 Shelf life: 24 hrs
 Open System
Frozen, Deglycerolized RBCs
 Frozen RBCs
 For patients with rare phenotypes, for autologous use, and for the military to
maintain blood inventories around the world for US military use
 Shelf life: 10 years
 Degylcerolized RBCs
 Products free of leukocytes, platelets, and plasma due to the washing process
 Washed red cells - used for patients with PNH and IgA deficiency with circulating
Anti-IgA
 Cryoprotective Agents
 Penetrating Agent - It involves small molecules that cross the cell membrane into
the cytoplasm
 Osmotic force of the agent prevents water from migrating outward as
extracellular ice is formed, preventing intracellular dehydration
 Example: glycerol
 Non-penetrating Agent
 Do not enter the cell but instead from a shell around it, preventing loss of
water and subsequent dehydration
 Example: Hydroxyethyl starch (HES) and dimethylsulfoxide
 HES and dimethylsulfoxide - used to freeze hematopoietic progenitor
cells
 Two procedures used for deglycerolizing and freezing RBCs: high-glycerol and low
glyercol methods
 Differ in the equipment used, the temperature of storage, and the rate of
freezing
 Cells should be frozen within 6 hours unless rejuvenated
 Rejuvenation - after 3 days of expiry to be glycerolized and frozen
 Purpose or rejuvenated blood - it increase the levels of 2,3-DPG and ATP in RBCs
stored in citrate/phosphate/dextrose (CPD) or CPDA-1
 QC procedures:
 RBC recovery - estimation of the recovered RBC mass
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% Recovery = ��. �� ������ ��� (�) × ��� �� ������ ���
DRBC = deglycerolized RBCs
 Post-transfusion survival study
 Glycerol must be removed to a level of less that 1% residual
 Measure osmolality by osmometer = 420 mOsm (max 500 mOsm)
 Check for hemolysis by centrifugation = 7mL of 0.7% NaCl + 3 inches of
deglycerolized cells → mix → centrifuge → check for hemolysis
 Standard hemoglobin comparator = >500 mOsm level (hemolysis too great =
not suitable for trsnfusion)
 Postdegycerolized tests:ABO, Rh, and DAT
I. High Glycerol (40% weight per volume)
 Increases the cryoprotective power of the glycerol, thus allowing a slow uncontrolled
freezing process
 Freezer type: mechanical freezer
 Storage temp: -80°C
 Widely used because equipment is simple and products require less delicate handling
 Require a larger volume of wash solution for deglycerolization
 Freezing according to preservative
 CPD or CPDA-1: within 6 days after collection
  AS-1, AS-3, and AS-5: 42 days platelets due to HLA
 RBCs must be placed in the freezer within 4 hours after opening the system alloimmunization
 Freeze the donor’s serum for additional testing required for donor screening - To limit platelet exposure from
 Thawing Process/Deglycerolization multiple donors
 Time allotted: 30 mins Whether random donor or single donor, irradiated if the patient’s diagnosis indicates
 Immerse the units in 37°C waterbath → wash RBCs with solutions of decreasing that is appropriate or the platelets have been HLA matched
osmolarity (12% NaCl, 1.6% NaCl, 0.9% NaCl, + 0.2% dextrose)
 Donors with sickle cell trait (hemolysis upon suspension to hypertonic Platelets Aliquots
solutions) - omit 1.6% solution  For neonates
 Open system  Single unit (sterile docked/connected quad bag or “Pedi-Pak”), closed system -
 Viable for only 24 hrs and stored at 1°C-6°C increase number of transfusions an infant can receive from one donor limiting donor
II. Low Glycerol (20% weight per volume) exposures
 Minimal and very rapid cryoprotection of glycerol  Neonates <50,00/μL and neonates with bleeding is considered a case
 More controlled freezing procedure (use of liquid nitrogen) thrombocytopenia - increase platelet count by transfusing 50,000 - 100,000 given a
 Storage temp: 120°C (vapor temp of liquid nitrogen vapor) - temp fluctuations may dose of 5-10ml/kg
lead to RBC destruction due to minimal amount of glycerol  Immaturity of the coagulation system
 QC: monitoring refrigerators, freezers, water baths, dry thaw baths, and centrifuges  Platelet dysfunction
 Increased platelet destruction
Platelet Concentrates  Dilution effect secondary to massive transfusion
 Produced from conversion of whole blood into concentrated RBCs or by apheresis  Exchange transfusion and intraventricular hemorrhage
 Transfused patients:
 Thrombocytopenic (<less than 50,000/μL) - patients undergoing to radiation and Platelets Leukoreduced
chemotherapy (cancer patients) causing decreased production of functional  Use: for prevention of febrile non-hemolytic reactions
platelets (< 20,000/μL)  Random donor platelets
 Thrombocytopenic preoperative patients (> 50,000/μL)  leukoreduced by the use of leukoreduction filter for platelets
 DIC and ITP - prophylactic platelet transfusion is not usually indicated in these  WBC count: < 8.3 × 105 WBCs;final pooled = < 5×106 WBCs
disorders  Single donor platelets
 Platelet concentrates - random donor platelets and single donor platelets (or  WBC count: < 5×106 WBCs
appheresis)
 Whole blood must be drawn by a single nontraumatic venipuncture Single-Donor Plasma
 4 hrs preparation  Products (from frozen plasma) = fresh frozen plasma (FFP), plasma frozen within 24 hrs
Platelet Random-Donor Platelets Apheresis or Single-Donor (PF24), or plasma cryoprecipitate-reduced
Concentration Platelets  Fresh Frozen Plasma
Composition 5.5 × 1010 platelets 3 × 1011 platelets  Anticoagulants: CPD, CD2D, or CPDA-1 (frozen within 8 hrs); AS (frozen within 6
Storage Temp 20°C-24°C 22°C-24°C hrs)
With continuous agitation, With continuous agitation,  Storage Temperature: -18°C or colder for 1 year or at -65°C for 7 years
contain sufficient plasma (40 - contain 300 mL of plasma  Contains both stable and labile clotting factors (ano yun haha) about 1 IU/mL
70 mL)  Plasma Frozen within 24 hours (PF24)
pH 6.2  Frozen within 8 - 24 hrs
Shelf-life 5 days  Storage Temperature: -18°C or colder
Purpose - For patient who are  Contains all stable proteins found in FFP, normal levels of factor V and slightly
unresponsive to random donor reduced levels of factor VIII
 FFP and PF24
Thawing Process Temperature: 30°C and 37°C (waterbath) or in FDA approved
microwave
Storage: 1-6°C for 24 hrs
*if not transfused within 24 hrs, store up to 5 days as thawed
plasma
Content 150-250 mL of plasma, approx. 400 mg of fibrinogen, 1 unit of
activity per mL of each of the stable clotting factors.
 FFP - also contains the same level (1 unit/mL) of factors V
and VIII
 FFP or PF24 (apheresis) - 400-600 mL of stable clotting
factors
Patients to be  Patients who are actively bleeding and have multiple
transfused clotting factor deficiencies - massive trauma, routine
surgical bleeding, liver disease, DIC, and/or idiopathic
 Patient on warfarin who will undergo surgery and there is
not sufficient time for vitamin K to reverse the effect.
 Patients with Thrombotic Thrombocytopenic Purpura (TTP)
 It cannot be transfused in patients with specific and known
coagulation disorders - transfused with specific factor
concentrates or vitamin K
 Not used as volume expander
 Cryoprecipitate-Reduced Plasma
 Prepared from FFP after thawing and centrifugation
 Cryoprecipitation - Process removes factor VIII, fibrinogen, factor XIII, vWF,
cryoglobulin, and fibronectin
 Cryo-poor plasma - It should be refrozen within 24 hrs and stored at -18°C
or colder for 1 year from the time of collection
 Content: Factors II, V, VII, IX, X, XI and ADAMTS13
 Use: for transfusion or plasma exchange in patients with TTP but could also
be used as a source of those factors that remains
 Not used a substitute for FFP, PF24, or thawed plasma
Thawed Plasma and Liquid Plasma
 Thawed Plasma
 Contains stable coagulation factors such as fibrinogen and prothrombin
 Reduced amounts of factor V, VII, VIII, and X
 Prepared from FFP and PF24 thawed at 30°C-37°C and maintained at 1°C-6°C for
up to 4 days after the initial 24-hr post-thaw period elapsed
 Transfused in patients with disorders parallel to FFP or PF24
 It should not be used to treat specific factor deficiencies
 Advantage: prevent spoilage of FFP and PF24 and facilitate emergency and
trauma situations
 Liquid Plasma
 Separated no later than 5 days after the expiration date of whole blood
 Storage: 1°C-6°C
 Coagulation factors are poorly characterized
 Indications include patients undergoing massive transfusion with concurrent
coagulation deficiencies
Cryoprecipitated Antihemophilic Factor
 Cold-precipitated concentration of factor VIII (Antihemophilic Factor).
 Prepared from FFP thawed slowly between 1°C-6°C (single whole blood unit collected
in CPDA-1 or CPD)
 Content: most of the factor VIII (80 units) and part of fibrinogen (150 mg) from the
original plasma and others (Factor XIII, vWf, and fibronectin)
 Shelf-life: 12 months in frozen state
 Transfused within 6 hrs of thawing (once thawed, store at 22°C-24°C until transfused)
or within 4 hrs of pooling
 Indication: treatment of factor XIII deficiency as a source of fibrinogen for
hypofibrinogenemia, secondary line of treatment for classic hemophilia (hemophilia A)
and von Willebrand disease
 Should not be used to treat hemophilia A or von Willebrand disease if virus-
inactivated or recombinant factor preparations are available
 Used as fibrin glue (cryoprecipitate (fibrinogen) + topical thrombin) - for controlling
the bleeding in cardiovascular surgeries
Plasma Derivatives
 Pooled, human source, and recovered plasma
 Produced by recombinant DNA technology or monoclonal antibody purification
 Source Plasma - It is defined as plasma collected by plasmapheresis and intended for
further manufacture into plasma derivatives
 Recovered Plasma - It is a plasma recovered from whole blood donations
 Frozen → separation of cryoprecipitate from the plasma→ factor VIII concentrate
 Residual Plasma - It is separated into various proteins by manipulating the pH, alcohol
content, and temperature and then is viral inactivated
 Viral inactivation - heat, solvent-detergent treatment, and nanofiltration
 Derivates for hepatitis A and parvovirus
1. Activated Factor VII (Factor VIIa)
 It is produced by recombinant DNA technology
 Indication - for patients with hemophilia A who have circulating antibodies or
inhibitors to Factor VIII and in patients with congenital factor VII deficiency; trauma,
 massive transfusion, and liver transplantation, where bleeding is uncontrollable
(intercranial bleeding in patients with major head trauma and cerebral hematomas;
implantation of VADs
 Disadvantage: associated with increased risk of spontaneous thrombosis and
thromboemboli; very expensive
 A theory suggests that rFVIIa bind to tissue factor that is released from injured tissue
and then activates factor IX and X
2. Factor VIII Concentrates (FVIII)
 Indication: for patients with hemophilia A or classical hemophilia
 Almost completely replaced cryoprecipitate as product of choice
 Preparation: utilized from large volumes of pooled plasma but commonly prepared by
recombinant DNA technology
 Pooled plasma prep: plasma should undergo pasteurization, solvent/detergent
treatment. Or monoclonal purification to inactivate or eliminate viral
contamination.
Inactivation/Denaturation Process
Process Chemical Content
Pasteurization Stabilizers: albumin, sucrose, or glycine
- Added to prevent the denaturation of the
product
- Heated to 60°C for 10 hours
- Product is safe from HIV-1 and hepatitis
transmission
Solvent/Detergent Solvent: Ethyl ether and tri(n-butyl)
phosphate; detergent: sodium cholate and
Tween 80
- Disrupt the viral coat membrane to
prevent transmission of HIV and hepatitis B
- Optivate (manufactured) - tri-n-butl
phosphate and polysorbate 20 combination
Monoclonal Purification Immonoaffinity Chromatography
- to select out the vWF:FVIII complex from
the plasma pool
- A murine monoclonal antibody directed at
the vWF:FVIII complex is bound to a solid-
phase matrix.
- Safe from viral transmission
All products are lyophilized
Other Products of FVIII Concentrates
Porcine Factor VIII  Indication: for patients with hemophilia A who have
developed inhibitors or antibodies to human factor VIII
 It is a xenographic form of FVIII
 Made up from porcine plasma
 It has been shown to provide effective hemostatic control
for patients with intermediate FVIII inhibitor levels
Recombinant Factor  First generation rFVIII products are synthesized by
VIII introducing human FVIII gene into BHK (baby hamster
kidney) cells.
 It is released into culture medium and harvested, isolated,
and purified using a combination of ion-exchange
chromatography,gel filtration, and immunoaffinity
chromatigraphy
First Generation rVIII
Purification and final formulations
- Stabilizer: human albumin
Second Generation (rVIII:FS)
Purification and final formulations
- Stabilizer: sucrose as final stabilizer
 More efficient than the first generation
 It now includes a solvent/detergent step and purification
step
3. Factor IX Concentrates
 Three forms: pro-thrombin complex concentrates, factor IX concentrates, and
recombinant FIX
Type Definition
Pro-thrombin complex - Indication: for patients with liver disease, it must be
concentrates used with caution due to possible occurence of DIC and
Thrombosis (failur eof the liver to produce adequate
amounts of antithrombin III and decreased hepatic
clearance of activated factors
- It contains significant levels of vitamin K-dependent
factors: II, VII, IX, and X
- Preparation: utilized from large volumes of pooled
plasma by absorbing the factors using barium sulfate or
aluminum hydroxide
Factor IX Concentrate - Developed by monoclonal antibody purification
- Less thrombogenic than the prothrombin complex
- Components: 20%-30% of FIX
- Stored in ref as lyophilized form
 Recombinant Factor IX - it is produced from Chinese Hamster ovary cell line and 7. Plasma Protein Fraction
not thought to transmit human infectious disease  Indication: not to be infused during cardiopulmonary bypass procedures
- It can be used for treatment of hemophilia B however  Similar to NSA however with fewer purification steps.
 Components: 83% albumin and17% globulins
4. Factor XIII Concentrates  Available in 5% preparation
 Indication: for Factor XIII deficiency  Storage: 5 years at 2°C to 10°C
 Factor XIII deficiency - It is a severe autosomal-recessive bleeding disorder
associated with a characteristic pattern of neonatal hemorrhage and a life-long 8. Rh0 (D) Immune Globulin
bleeding diathesis  Indication: treatment of ITP and prevention of Rh HDN
 Available in two parts; FDA investigational new drug (South America, South Africa, Indications
Japan, and US); “Named Patient” basis only for UK ITP and immunization - IV Prep (heat-treated): 120 μg dose or 300 μg dose
against D antigen - IM Prep: 50 μg dose or 300 μg dose (300 μg is full dose
5. Immune Serum Globulin protective against 15mL of D positive RBCs)
 Indications: Preventing immunization During 12 weeks of pregnancy (miscarriage or abortion) →
 Patients with immunodeficiency diseases (I.e., severe combined to the D antigen during 50μg
immunodeficiency and Wiskott-Aldrich Syndrome) gestation After 12 weeks of gestation (miscarriage or abortion) →
 hepatitis and herpes (for passive antibody prophylaxis) 300μg
 Idiopathic thrombocytopenic purpura After 34 weeks of gestation (amniocentesis obstetric
 Post-transfusion purpura complication following termination of pregnancy) - 120 μg
 HIV-related thrombocytopenia Antepartum dose (non- 300 μg IM or IV
 Neonatal alloimmune thrombocytopenia immunized females at 28 - DAT (positive): RhIg dose should refer FMH quantity using
 IT SHOULD NOT BE TRANSFUSED to patients with history of IgA deficiency or weeks of gestation) Kleihauer-Betke Test
anaphylactic reactions due to the presence of trace amounts of IgA - DAT (negative) - 72 hrs after delivery
 It contains concentrated plasma gamma globulins in an aqueous solution Rh-positive platelet - 300 μg dose IM (120-ug dose IV)
 Prepared from pooled plasma by cold ethanol fractionation concentrates transfused
 IV or IM solutions to Rh-negative patient
 IV Prep contains more IgG protein than IM
 Half life: 18 - 32 days  It is a solution of concentrated anti-Rh0 (D)
 No transmission cases of HIV or Hepa B but a report was accounted for transmission of  It is prepared from pooled human plasma of patients who have been hyperimmunized
Hepa C and contains predominantly IgG anti-D
 Treatment of IVIg prep with solvent/detergent method for viral inactivation
9. Synthetic Volume Expanders
6. Normal Serum Albumin  Useful in burn patients because of their ability to rapidly cross the capillary membrane
 Indication: for patients who are hypovolemic and hypoproteinemic; for clinical settings, and increase the plasma volume
shock and burn patients  Colloids - volume expanders in hemorrhagic shock and burn patients
 Prepared from salvaged plasma, pooled and fractionated by a cold alcohol process  It has two forms: crystalloids and colloids
then treated with heat inactivation (60°C for 10 hours)  Crystalloids - Ringers lactate (sodium, chloride, potassium, calcium, and lactate
 Component: 96% albumin and 4% globulin ions), Normal isotonic saline (sodium and chloride ions)
 Available in 25% or 5% solution  Colloids - Dextran (6% and 10% solution with a half-life of 6 hours); HES (6%
 25% Preparation - for patients who are dehydrated, unless it is followed by solution with an IV half life of >24 hrs)
crystalloid infusions for volume expansion
 Comparison of Crystalloid and Colloid Solutions
Characteristic Crystalloid Colloid
Intravascular retention Poor Good
Peripheral Edema Common Possible
Pulmonary Edema Possible Possible
Easily Excreted Yes No
Allergic Reactions Absent Rare
Cost Inexpensive Expensive
Examples Ringer’s lactate solution Albumin
75% Normal Saline Dextran
Hydroxyethyl starch
Table 13-3, page 322 (Modern Blood Banking and Transfusion Practices by Harmening)

10. Antithrombin III Concentrates

 Indication: treatment for patients with hereditary antithrombin deficiency
 AT-III is an inhibitor of Factors IX, X, XI, XII, and thrombin
 Patients with plasma levels of AT-III <50% than normal are at risk of thrombosis
 Prepared from pooled human plasma and heat-treated to prevent viral transmission

Table in harmening 323-325