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Blood Components
Blood Components
Overview
Blood component preparation Characteristics Shelf life Storage conditions Indications Dosage Considerations
Introduction
Blood components are used like other pharmacy products to treat and manage patients. A single blood donation can provide transfusion therapy to multiple patients in the form of RBCs, platelets, fresh frozen plasma, and cryoprecipitate.
Component Preparation
Describes the manufacturing process of all components used in transfusion therapy. The appropriate use of blood and its component is of prime importance for a safety of blood transfusion.
Centrifugation
Slow/Light spin - 2000 g (RCF) x 3 minutes @ 4 C
Hard/Heavy spin - 5000 g (RCF) x 5-7 minutes @ 4 C
Preparation
F VIIa
F VIII F IX
Albumin
Indications: - massive transfusion - active brisk bleeding Dosage effect: 1 unit = 3% Hct increase = 1 g/dL Hb increase Must be ABO & Rh compatible Compatible crossmatch
Whole Blood Irradiated - irradiated to inhibit T-cell proliferation in the recipient - expiration date of 28 days from date of irradiation - prevent graft vs. host disease (GVHD)
Indication: - chronic symptomatic anemia - to increase the oxygen carrying capacity Dosage effect: 1 unit = 3% Hct increment = 1 g/dL Hb increase
RBC Aliquots
Red blood cell aliquots for neonatal transfusion 1-6 C CPDA-1: 35 days 10 ml/kg (Hct 80%) will increase Hb by 2 g/dL ABO & Rh, & crossmatch compatible Vol.:Varies
Irradiated RBCs
expiration date of 28 days from date of irradiation 1-6C Vol.: 250-300 mL Dosage effect: 1 unit = 3% Hct increment = 1 g/dL Hb increase
Indications -Used to inhibit the proliferation of T cells and subsequent transfusionassociated graft-versus-host disease in patients who are:
a. immunocompromised or who are receiving a bone marrow or stem cell transplant, b. fetuses undergoing a intrauterine transfusion; and c. recipients of units from blood relatives or of HLA selected platelets .
Leukocyte-Reduced RBCs
Contains RBC, few platelets & residual WBC Absolute WBC count: <5 x 106 >85% of original RBC mass Two categories: 1) Prestorage leukoreduction 2) Poststorage leukoreduction
Prestorage leukoreduction
99.9% removal of leukocytes Multiple layers of synthetic nonwoven fibers To prevent reactions caused by Biologic response modifiers (BRMs) - proinflammatory cytokines - complement fragments
Poststorage leukoreduction
Leukocytes removed in the blood bank prior to issuing blood or at the bedside before transfusion
Centrifugation: <5 x 108 WBC Filtration: <5 x 106 WBC or lower Prevent reactions caused by leukocyte antibodies but will not prevent reactions caused by BRMs
Indications: - Febrile reactions, increase Oxygen capacity - prevent HLA sensitization -prevent transmission of Epstein-Barr virus, CMV, and human T-cell lymphotrophic virus. Dosage effect: 1 unit = 3% Hct increment = 1 g/dL Hb increase
Indications: - for preventing febrile and allergic reactions due to WBC & plasma proteins - prevent anaphylactic reaction in IgAdeficient recipients Dosage effect: 1 unit = 3% Hct increment = 1 g/dL Hb increase
Cryoprotective Agents
Penetrating (Glycerol) - small molecules that cross cell membrane - prevents water from migrating outward as extracellular ice is formed prevents intracellular dehydration Non-penetrating (Hydroxyethyl starch) - large molecules form a shell around the cell - prevents loss of water and subsequent dehydration
Deglycerolizing methods
High Glycerol (40% weight per volume) - increased cryoprotection - slow, uncontrolled freezing process - require larger volume of wash solution (stored at -80C) - most widely used Low Glycerol (20% weight per volume) - minimal cryoprotection - very rapid, more controlled freezing - liquid nitrogen routinely used (stored at -120C) - temperature fluctuations cause RBC destruction
Preparation
Glycerolization
Deglycerolization
Thaw frozen cells at 37C in water bath Deglycerolized cells using a continuous flow washer Apply a deglycerolize label to transfer pack; ABO, Rh, WB unit #s & expiration date Dilute unit with hypertonic 12% NaCl and let equilibrate for 5 minutes
Weigh RBCs Place cells on a shaker & add 100 ml glycerol Adjust to 260-400g 0.9% NaCl Prewarm rbcs & glycerol to 25C Stop agitation & allow cells to equilibrate 530 min Set glycerol bottles in a water bath for 15 min at 25-37C Let partially glycerolized cells flow into freezing bag; slowly add glycerol Maintain glycerolized cells at 24-32C until ready to freeze (not to exceed 4 hours) Freeze at < 65C
Label the freezing bag with name of facility, WB unit #x, ABO, Rh, date collected, date frozen, cryoprotective agent, expiration & red blood cells frozen
Wash with 1.6% NaCl until residual glycerol is <1%; wash with 0.9% NaCl+ 0.2% dextrose Store at 1-6C
Platelet concentrate
Platelet concentrates can be produced during the routine conversion of whole blood into concentrated RBCs or by apheresis Single Donor Platelet (SDP) - apheresis Random Donor Platelet (RDP) - within 8 hours of whole blood collection
Whole blood
Light spin
PRBC
Indications:
- prophylactically correct severe thrombocytopenia to prevent hemorrhage in CNS/other organs in patients undergoing chemotherapy - bleeding patients in surgery & trauma cases with platelets < 75,000/uL - bleeding patients with thrombocytopathy - active bleeding with thrombocytopenia (DIC)
Platelet Leukoreduced
Stored at 20-24 C for 5 days must contain less than 8.3 x 105 leukocytes for Random Donor 5 x 106 leukocytes for Single Donor Indication: -prevention of febrile nonhemolytic reactions
Granulocyte concentrate
Prepared by apheresis from a single donor Steroids given prior to procedure & exposed to Hydroxyethyl starch At least 1.0 x 1010 granulocytes Contain WBC, platelets, RBC (10%), plasma Volume: 200-600 mL 20-24C without agitation within 24 hours ABO & Rh, crossmatch compatible
Indications: - severe neutropenia (<500/uL) - patients unresponsive to antibiotic therapy for 48 hours
Seldom used - newer antibiotics - use of G-CSF/GM-CSF - severe complications & difficult monitoring
Prepared within 8 hours of WB collection by centrifugation & separating 200-250 ml plasma ABO compatible Increases factor by 20-30% Indications: - Coagulation deficiencies - Liver disease - DIC - Massive transfusion
Cryoprecipitate
Cold-precipitated concentration of factor VIII Prepared from FFP thawed slowly between 16 C Contains > 80 U AHF activity & > 150 mg fibrinogen Other significant factors include Factor XIII, vWF, and fibronectin.
Frozen: 1 year at <-18C Pooled: maximum of 4 hours Thawed: at 37C 20-24C until transfused (w/in 6 hours) Indications: Classic hemophilia von Willebrands disease Factor XIII deficiency Hypofibrogenemia It should not be used to treat : Classic hemophilia or von Willebrands disease if virusinactivated or recombinant factor preparations are available.
Plasma derivatives
Factor IX Concentrate
3 forms: 1) Prothrombin complex concentrate - vitamin K dependent factors (II, VII, IX, X) - prepared from large volumes of pooled plasma by absorbing the factors using barium sulfate and aluminum hydroxide. 2) Factor IX concentrate - manufactured by monoclonal Ab purification and is less thrombogenic than prothrombin complex concentrates. - approximately 20-30% Factor IX
Factor IX Concentrate
3) Recombinant factor IX (rFIX) -produced in Chinese hamster ovary cell line and thought to transmit human infectious disease - still controversial with regards to reliability of the product
Indications: - immunodeficiency diseases - passive antibody prophylaxis against hepatitis & herpes - ITP - post transfusion purpura - HIV- related thrombocytopenia - neonatal alloimmune thrombocytopenia
Summary
Whole blood Packed rbc leukocyte poor - washed prbc - Frozen, thawed, deglycerolized Platelet concentrate single donor - random donor Granulocyte concentrate
Fresh frozen plasma Cryoprecipitate Other plasma derivatives - Factor VIII - Factor IX - Factor XIII - Immune Serum Globulins - Plasma Protein Fraction - Albumin
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