LANDMARKS

• 1492 – FIRST TRANSFUSION TO POPE INNOCENT

VII
• 1628 – WILLIAM HARVEY – CIRCULATION OF
BLOOD
• 1665 – RICHARD LOWER – FIRST
DEMONSTRATION OF TRANSFUSION TO
DOG
• 1666 – JEAN DENYS – SYMPTOMS LIKE HTR
• 1818 – JAMES BLUNDELL (OBSTETRICIAN)- PPH
• 1873 – AVELLING – RECIPIENT’S
NEEDLE - HEART
• 1900 –
LANDSTEINER – ABO
• 1937 –
FIRST BLOOD BANK – CHICAGO
• 1961 –
FIRST TPE – SOLOMON AND FAHEY
• 1962 –
PLASTIC BLOOD BAGS SURGEON
CARL WALTER
• 1972 – FIRST PLATELET COLLECTION BY
APHERESIS
• 1983 – FIRST PBSC AT NEBRASKA-ANNE
KESSINGER
BLOOD PRODUCT ANY THERAPEUTIC SUBSTANCE
PREPARED FROM HUMAN BLOOD

BLOOD COMPONENT 1. A CONSTITUENT OF BLOOD

SEPARATED FROM WHOLE BLOOD
SUCH AS:
* RED CELL CONCENTRATE
* PLASMA
* PLATELET CONCENTRATES
2. PLASMA OR PLATELETS
COLLECTED BY APHERESIS
3. CRYOPRECIPITATE PREPARED
FROM FRESH FROZEN
PLASMA
 PLASMA DERIVATIVE

HUMAN PLASMA PROTEINS PREPARED UNDER PHARMACEUTICAL

MANUFACTURING CONDITIONS SUCH AS:

ALBUMIN
COAGULATION FACTOR
CONCENTRATES
IMMUNOGLOBULINS
 BLOOD COMPONENTS

SR N0 NAME ABBREVIATI0N

1 WHOLE BLOOD WB
2 PACKED RBC/ CONCENTRATED PRBC
RED BLOOD CORPUSCLES
3 WASHED RED BLOOD CELL SW-RBC
4 FRESH FROZEN PLASMA FFP
5 CRYODEFICIENT PLASMA CDP
6 CRYOPRECIPITATE CRYO
7 PLATELET CONCENTRATE PLT
8 SINGLE DONOR PLATELET/ SD-PC
APHERESIS PLATELET CONC
 BLOOD COMPONENTS
PRBC
WHOLE BLOOD FFP
(TRIPLE BAG) PLATELET

PRBC
WHOLE BLOOD CDP
(TRIPLE BAG) CRYO

PRBC
WHOLE BLOOD
(DOUBLE BAG)
FFP

PLATELET
WHOLE BLOOD
(DOUBLE BAG)
PPWB
 QUALITY

 MEETING THE PREDETERMINED REQUIREMENTS OF THE

USERS FOR THE PARTICULAR SUBSTANCES OR SERVICES
 EXPECTATIONS VS FULFILLMENT
 QUALITY ASSUARANCE = INTERNAL QUALITY CONTROL (IQC)
+ EXTERNAL QUALITY ASSESSMENT (EQA)
MURPHY’S LAW: IF ANYTHING CAN GO WRONG
IT WILL

TOTAL QUALITY MANAGEMENT (TQM): EVERY VARIABLE THAT

COULD POSSIBLY AFFECT THE QUALITY OF THE TEST RESULTS HAS
BEEN CONTROLLED

IDEAL SITUATION

QC STAFF

DOCUMENTATION
 QUALITY CONTROL IN TRANSFUSION
MEDICINE: TWO FOLD

SAFE BLOOD

FREE FROM INFECTIOUS DISEASES

LABELLING ERRORS

THERAPEUITIC VALUE OF THE BLOOD COMPONENTS

 WHOLE BLOOD
USED FOR SIMULTANEOUS REPLACEMENT OF RED CELL
MASS AND INTRAVASCULAR VOLUME DISADVANTAGE -
GRANULOCYTES AND PLATELETS DETERIORATE RAPIDLY
UNDER RED CELL STORAGE CONDITIONS. ACTIVITY OF
FACTOR V, VIII AND COMPLEMENT IS MARKEDLY
REDUCED THUS IN MASSIVE HAEMORRHAGE RED CELLS,
SUITABLE CRYSTALLOIDS AND COMPONENTS
PREFERRED.
 QUALITY CONTROL OF WHOLE BLOOD (IP)

PARAMETER TO BE QUALITY FREQUENCY OF

CHECKED REQUIREMENT CONTROL

HBsAg NEGATIVE BY APPROVED ALL UNITS

SCREENING TEST

HIV ANTIBODY NEGATIVE BY APPROVED ALL UNITS

SCREENING TEST

VDRL NEGATIVE SCREENING TEST ALL UNITS

HCV ANTOBODY NEGATIVE BY APPROVED ALL UNITS

SCREENING TEST

VOLUME 450ML/350ML ± 10% ALL UNITS

HEMOGLOBIN NOT LESS THAN 9.7% ALL UNITS

W/V OF HEMOGLOBIN
 PACKED RED BLOOD CELL (PRBC)

• METHOD OF PREPARATION
• 1. SEDIMENTATION
• 2. CENTRIFUGATION - 1500 RPM, 6 MIN, 220C
- 4200 RPM, 5 MIN, 220C
1 UNIT: 220ML, 70-80% Hct
• SAME RED CELL MASS AS 1 UNIT OF WHOLE BLOOD
• 1 UNIT INCREASES Hb BY 1 GM%
• SHELF LIFE: 35 DAYS
• STORAGE: 2 - 80C
PACKED RED BLOOD CELLS (PRBC) (CONTD..)

INDICATIONS:
• TO REPLACE RED CELL MASS
• TISSUE OXYGENATION IMPAIRED eg. ACUTE CHRONIC BLOOD
LOSS
• SYMPTOMATIC ANEMIAS UNRESPONSIVE TO
HEMATINICS ,ANEMIA OF CHRONIC DISORDERS, CRF, BONE
MARROW FAILURE
• HEMOGLOBINOPATHIES - THALASSEMIA, SICKLE CELL ANEMIA

THESE COVER ALL THE INDICATIONS FOR GIVING WHOLE

BLOOD
QUALITY CONTROL OF RED CELL CONCENTRATES (IP)

PARAMETER TO BE QUALITY FREQUENCY OF

CHECKED REQUIREMENT CONTROL

HBsAg NEGATIVE BY APPROVED ALL UNITS

SCREENING TEST

HIV ANTIBODY NEGATIVE BY APPROVED ALL UNITS

SCREENING TEST

VDRL NEGATIVE SCREENING TEST ALL UNITS

HCV ANTOBODY NEGATIVE BY APPROVED ALL UNITS

SCREENING TEST

VOLUME 280 ± 60 ML (WB - 450 ML) ALL UNITS

PCV 0.70 ± 0.05 6 UNITS/MNTH

TRANSFUSION TRIGGER
PRESERVATIVE SOLUTIONS FOR RED BLOOD
CELLS

REPLINISH VOLUME
PRESERVE RED BLOOD CELLS FOR UP TO 42
DAYS
PROVIDE GOOD FLOW CHARACTERISTICS
ARE READILY EXCRETED THROUGH KIDNEYS
DO NOT SUPPLY EXCESS PROTEIN
 SALINE WASHED RED CELLS

METHOD OF PREPARATION

• 2 - 3 WASHINGS IN NORMAL SALINE

• 98% PLASMA, 92% PLATELETS AND WBCs AND 20% RBCs
REMOVED
• SHOULD BE USED WITHIN 24 HRS
 SALINE WASHED RED CELLS (CONTD..)

INDICATIONS:
• PATIENTS WITH KNOWN ALLERGIC OR FEBRILE TRANSFUSION
REACTIONS
• PATEINTS WITH H/O SEVERE URTICARIAL REACTIONS
• PATIENTS WITH IgA DEFFICIENCY OR ANTI IgA-Ab
• INTRAUTERINE TRANSFUSION AND NON - ABO IDENTICAL
TRANSFUSION TO INFANTS
• PATIENTS REQUIRING MULTIPLE TRANSFUSIONS
QUALITY CONTROL OF WASHED RED CELL SUSPENSION

PARAMETER TO QUALITY FREQUENCY OF

BE CHECKED REQUIREMENT CONTROL

RESIDUAL < 0.5 G/UNIT 4 UNITS PER

PLASMA MONTH
PROTEIN IN
PROTEIN –POOR
RED CELLS
 FFP
• OFTEN MISUSED
• PREPARED FROM ANTICOAGULATED BLOOD WITHIN 6 HRS
• VOLUME 200 ML (350 ML BAG)
• STORAGE -300C 1 YEAR
• THAWING 370C ADMINISTER 2 HRS
• 1 UNIT- 5 -6% CLOTTING FACTORS FOR 70 KG ADULT
• DOSE -10 -15 ML/KG
• MONITORING WITH PT/PTT
• ABO - COMPATIBILITY
• Rh - CHILD BEARING AGE (anti D - immunoglobulin - 50iu (10
µgm)/UNIT OF FFP)
 ADVERSE EFFECTS

• ALLERGIC REACTIONS
• INFECTIOUS COMPLICATIONS
• HEMOLYSIS
• FLUID OVERLOAD
 INDICATIONS FFP (BCSH)

DEFINITE

• REPLACEMENT OF COAGULATION FACTOR DEFICIENCY (PCC-

II + IX + X, FACTOR VIII)
• TTP
• REVERSAL OF WARFARIN
• ACUTE DIC
 REVERSAL OF WARFARIN

• LIFE THREATENING HAEMORRHAGE

- VITAMIN K 5 MG SLOW IV WITH
PCC AND FACTOR VIII OR FFP
• LESS SEVERE - (EPISTAXIS)
WITHHOLD - 1 OR MORE DAYS
CONSIDER VIT K (0.5 - 2 MG IV)
• INR > 4.5 WITHOUT HAEMORRHAGE
WITHDRAW - 1 - 2 DAYS - REVIEW
• UNEXPECTED BLEEDING AT THERAPEUTIC LEVEL
UNDERLYING CAUSE
 OTHER INDICATIONS…FFP

• MASSIVE TRANSFUSION

• LIVER DISORDER
• HYPOVOLAEMIA 
• NUTRITIONAL SUPPORT 
QUALITY CONTROL OF FRESH FROZEN PLASMA (BP)

PARAMETER TO QUALITY FREQUENCY OF

BE CHECKED REQUIREMENT CONTROL

ABO + Rh TYPING ALL UNITS

HBsAg NEGATIVE BY APPROVED ALL UNITS

SCREENING TEST

HIV ANTIBODY NEGATIVE BY APPROVED ALL UNITS

SCREENING TEST

HCV ANTIBODY NEGATIVE BY APPROVED TEST ALL UNITS

VDRL NEGATIVE SCREENING TEST ALL UNITS

VOLUME STATED VOLUME ± 10% ALL UNITS

FACTOR VIIIc > 0.7 IU/ML EVERY 2 MONTHS:

a) Pool of 6 units of
plasma during first
month of storage
b) Pool of 6 units of
plasma during last
month of storage
 CRYOPRECIPITATE
IT IS THE COLD INSOLUBLE PORTION REMAINING AFTER SLOWLY
THAWING FFP AT 1- 60C. IT IS REFROZEN AT -200C.
* 1 UNIT CONTAINS ˜ 10 -15 ML OF VOLUME
* 50% FACTOR VIII (100 IU), 20 - 30% vWF AND
FACTOR XIII, 30-50% (150-250MG) OF
FIBRINOGEN
* STORAGE: -180C FOR 1 YR FROM DATE OF COLLECTION
* THAWED AT 30-370C AND USED WITHIN 6 HRS
INDICATIONS…CRYOPRECIPITATE

1. TO REPLACE - FACTOR VIII

vWF
FACTOR XIII
FIBRINOGEN

2. TO CORRECT ABNORMAL BLEEDING

3. TO MAKE FIBRIN GLUE

 CRYOPRECIPITATE DOSE

• FINAL VALUE - 50 IU/100 ML

• PLASMA VOLUME - 3000 ML
• AHF UNITS REQUIRED - 1500 UNITS
• EACHCRYO BAG - 100 UNITS
THEREFORE 15 CRYO BAGS
QUALITY CONTROL OF CRYOPRECIPITATE (USP)

PARAMETER TO BE QUALITY FREQUENCY OF

CHECKED REQUIREMENT CONTROL

ESTIMATED VOLUME 10 - 20 ML ALL UNITS

FACTOR VIIIc > 80 IU/CONTAINER EVERY 2 MONTHS

a) POOL OF 6 UNITS
DURING FIRST
MONTH OF
STORAGE
b) POOL OF 6 UNITS
DURING LAST
MONTH OF
STORAGE
 PLATELETS

PLATELETS ARE SMALL FRAGMENTS OF CYTOPLASM DERIVED

FROM A MEGAKARYOCYTE

MONUMENTAL DISCOVERY BY WRIGHT.

DUKE (1910) WAS THE FIRST TO REALISE THAT
PLATELET TRANSFUSION WOULD RELIEVE HEMORRHAGE
IN THE PRESENCE OF THRMBOCYTOPENIA

PROBLEMS:
A) BLOOD GROUPS AND TRANSFUSION REACTION
B) EFFECTIVE METHODS OF PREPARATION OF
PLATELETS
C) OPTIMAL PRESERVATION / STORAGE
D) METHODS TO PREVENT ALLOIMMUNIZATION
ADVANTAGES OF BUFFY COAT METHOD

PLATELET YEILD – COMPARABLE WITH

PRP METHOD
LESS LEUCOCYTE CONTAMINATION
LESS CYTOKINE ACCUMULATION AT THE
END OF STORAGE PERIOD
 STORAGE OF PLATELETS

• CLOSED SYSTEM - 5 DAYS. OPEN SYSTEM - 1 DAY

• 20-240C. WITH CONTINUOUS GENTLE AGITATION.
• pH > 6.
• NO CROSS MATCHING IF < 5 ML RBCS.
• IRRADIATED PLATELET CONCENTRATES FOR BMT OR SEVERAL
IMMUNOSUPPRESSED PATIENTS
• LEUCOCYTE CONTENT 5 x 105 TO 5 x 106/ UNIT.
• LEUCOCYTE RESPONSIBLE FOR REFRACTORINESS, CHILLS AND RIGORS.
• ONE UNIT OF SHELF PLATELET INCREASES PLATELET COUNT BY 5 - 10 x
109 / L. APHERESIS UNIT IS EQUIVALENT TO 6 - 7 SUCH UNITS.
 INDICATIONS FOR PLATELET TRANSFUSION

I. DECREASED PLATELET PRODUCTION

A. MALIGNANCY WITH CYTOREDUCTIVE DRUGS
ROLE OF PROPHYLACTIC TRANSFUSION IS
DEBATABLE
B. APLASIA

II. PLATELET LOSS

A. HAEMORRHAGE
B. CARDIAC SURGERIES
INDICATIONS FOR PLATELET TRANSFUSION (CONTD..)

III PLATELET SEQUESTRATION

SPLENOMEGALY
IV PLATELET DESTRUCTION
ITP
V PLATELET QUALITATIVE DEFFECTS
MOSTLY WHEN ASSOCIATED WITH
THROMBOCYTOPENIA
VI NATP
PIA1
MOTHER’S PLATELETS USEFUL
 CONTRAINDICATIONS

• TTP: ABNORMAL PLATELET ENDOTHELIAL

INTERACTION AND PRECIPITATES FURTHER
MICROANGIOPATHIC THROMBI
• PRE - ECLAMPSIA AND PLATELET MEDIATED
MICROANGIOPATHIES
 DOSE OF PLATELETS

 1 UNIT /10 Kg BODY WEIGHT

 PL x BV F-1
 PL = DESIRED PLATELET INCREMENT x 109 / L BV =
BLOOD VOLUME (L) F =
CORRECTION FACTOR (0.67)
 40 x 5
= 300 x 109 / L
0.67
 EACH UNIT 55 x 109 / L
 PLATELET DOSE – APPROXIMATELY 6 UNITS
QUALITY CONTROL OF PLATELET CONCENTRATES (USP)

PARAMETER TO QUALITY FREQUENCY OF

BE CHECKED REQUIREMENT CONTROL

VOLUME > 50 ML ALL UNITS

THROMBOCYTE COUNT > 55 x 109/UNIT 1% OF ALL UNITS WITH

A MINIMUM OF
4 UNITS/MONTH

RESIDUAL LECOCYTE < 0.2 x 109/UNIT 1% OF ALL UNITS WITH

A MINIMUM OF
4 UNITS/MONTH

pH MEASURED AT THE >6 1% OF ALL UNITS WITH

END OF THE RECOMMENDED A MINIMUM OF
SHELF LIFE 4 UNITS/MONTH

VISUAL INSPECTION NO AGGREGATION ALL UNITS

TRANSFUSION TRIGGER
 LEUCOCYTE DEPLETED BLOOD COMPONENTS

• < 5 x 106 LEUCOCYTES / UNIT

• PRE - STORAGE LEUCODEPLETION
• INDICATIONS
• TO PREVENT FNHTRs
• TO REDUCE GRAFT REJECTION
FETAL/NEONATAL TRANSFUSION
• TO PREVENT VIRAL INFECTION (CMV/nvCJD)
• PLATELET REFRACTORINESS
PREVENTION OF TA-GVHD 
PREVENTION OF TRALI 
 IRRADIATED BLOOD PRODUCTES

• DOSE- 2500 rads

• RED CELLS AND GRANULOCYTES
• FFP, CRYO AND FRACTIONATED PLASMA PRODUCTES 
• BMT RECIPIENTS
• HODGKIN’S DISEASE
• INTRAUTERINE TRANSFUSIONS
• DIRECTED DONATIONS
 MECH OF TA-GvHD [HLA-MISMATCH]

FATHER MOTHER

A9 A19 A9 A3
B12 B35 B12 B7
DR2 DR7 DR2 DR4

A9 A9 A9 A3 A19 A3
B12 B12 B12 B7 B35 B7
DR2 DR2 DR2 DR4 DR7 DR4

CHILD 1 CHILD 2 CHILD 3