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Diagrammatic Description of

Blood Preparation

Gov. Faustino N. Dy Memorial Hospital


February 26-27, 2009
Whole Blood

 Red Blood Cells  Fresh Frozen Plasma

 Liquid Plasma

 Washed Filtered RBC Frozen Red White Blood  Platelets  Cryosupernate Albumin Normal Anti- Prothrombin Hyper-
RBC Cells Cells  Cryoprecipitate Serum Hemophilic Complex immune
Normal
Albumin Factor Globulin
Immunoglobalin
Solution

 Prepared in the BSF


Processed by
Fractionation
Table 3.1 Blood Product Specifications

Cellular Blood Collection of Volume Contents per


Description Processing Storage
Products WB (+/-10%) Bag
Whole Blood Unprocessed Single blood bag 450 ml (In 65 ml Erythrocyte None 1-6°C
(WB) blood containing anticoagulant volume fraction CPD – 21 days
all cellular & solution) or 250 (EVF) = 0.35 to CPDA1 – 35 days
components of ml (in 31.5 ml 0.45
donor blood anticoagulant CPDA2 – 42 days
solution) SAG-M – 42
7 Parts blood to days
1 part
anticoagulant
If platelets are to
be harvested:
20-24°C (Rm1)
(6 hours)

Red Blood Cells Cellular products Double blood bag 350 ml Hematocrit = 55 - Centrituge WB or 1-6”
(RBC) remaining after 70% allow to settle Same as WB
removal of most undisturbed; from which it has
of plasma by extract plasma been prepared
sedimentation or into satellite bag under closed
centrifugation of using extractor or system.
WB; contains separator
RBC, platelets &
leucocytes w/c If underopen
are potential system – 24 hrs.
immunizing
agents
Cellular Blood Collection of Volume Contents per
Description Processing Storage
Products WB (+/-10%) Bag
Fresh Frozen The non-cellular Double blood 240 ml (adult) Contains all Centrifugation & -18°C to -30°C
Plasma (FFP) fluid portion of bag coagulation sedimentation (12 months)
anticoagulated 60 ml (pedia) factors plus of WB followed
blood w/c has complement by extraction of
been extracted plasma into
from a single satellite bag
donor unit within within 8 hours
8 hours post- post-donation;
donation & freeze
rapidly frozen to immediately
-30°C

Platelets Platelets Triple blood bag 60 ml At least 5.5 × Within 6 hours 22-24°C (Rm T)
suspended in a 1010 platelets in post-donation in continuous
small quantity of 60 ml plasma centrituge WB agitation (72
plasma at low speed; hours)
separated from pH > 6 separate
post-donation platelet-rich
before plasma (PRP),
refrigeration; recentrituge
may be from a PRP at high
single donor speed; set aside
at Rm T (1
hour); agitate
continuously
until use
Cellular Blood Collection of Volume Contents per
Description Processing Storage
Products WB (+/-10%) Bag

Leucocyte-reduced RBC
1. Washed RBC RBC w/c has Triple blood bag 350 ml RBC w/ variable Multiple batch 1-6°C
been washed w/ quantities of processing (24 hours)
compatible leucocytes & through
solution to platelets centrifugation &
reduce decanting of
leucocytes compatible
saline solution
2. Filtered RBC RBC from w/c Triple blood bag 350 ml RBC w/ variable After removing 20-24°C
leucocytes have quantities of plasma to (Room Temp.)
been reduced platelets & harvest RBC, (6 hours)
through filtration some transfuse unit
leucocytes using micro-
aggregate blood
filter
Cryoprecipitat`e The cold Triple blood bag 30 ml Factor VIII Thaw FFP bet. -30°C or lower
insoluble portion Fibrinogen 1-6°C Separate (12 months)
of plasma after vWF.AG & refreeze
FFP has been Fibronectin precipitate
thawed bet.
Ristocetin
1-6 C
Cryosupernate Residual Triple blood bag 200 ml Same as FFP Extract -30°C or lower
plasma refrozen except for cryoprecipitate (12 months)
after removal of Factor VIII Refreeze
cryoprecipitate supernatant
Fluid
Table 7.1A Indications for Transfusion of Cellular Blood Products
Cellular Blood
Composition Indications Dosage Administration Contraindications Hazards
Products
1. Whole Blood  All cellular & (Largely replaced  Depends on IV. Set: Standard Do not use:  Hemolytic
(WB) plasma by RBC specific blood loss but if sterile blood  For anemia tranfusion
components component WB is truly tranfusion set w/ w/out reactions
 Deficient in theraphy) needed, at least filter (pare size hypovolemia or  Transmission of
active platelets, Use for: 2 standard adult about 200 active bleeding Infectious
granulocytes &  Actively units (450 ml) are microns) (see RBC) diseases
labile clotting bleeding patient given to the Rate: Depends  When blood 
factors (VIII, (more than 25- average adult on urgency of volume can be Alloimmunization
vWF, & Factor V) 30% blood loss need; safely & of recipient
 Albumin/other or about 2 liters) administration adequately  Febrile reaction
clotting factors w/ symptomatic under pressure replaced by
to speed infusion  Allergic
essentially deficit in oxygen- volume reactions
normal carrying & shock may contribute to expanders
hemolysis  Circulatory
 WB (5 days old  For deficiencies overload/
in CPD) used Caution: Do not (see specific
add anything to pulmonary
mainly in components) edema
neonatal the blood unit
exchange  Bacterial
transfusion contamination
 Iron overload
(chronic
transfusion)
 Metabolic
disease (usually
in neonates or
massive
transfusion)
 Graft vs host
disease (GVHD)
Cellular Blood
Composition Indications Dosage Administration Contraindications Hazards
Products
2. Red Blood  RBC w/c has Use for:  Standard unit IV Set: Standard Do not use: Same as for
Cells (RBC) been depleted of  Patients w/ (55-70% HcT) sterile blood  For nutritional whole blood
much plasma symptomatic will raise Hct transfusion set w/ anemia, instead except, removal
 Leucocytes san deficit of oxygen- level by 3% filter give iron, Vitamin of plasma:
be further carrying capacity Rate: Usually 1 B12 or folic acid  Reduces the
depleted using e.g. severe or  Volume unit infused in 1-2  For correcting quantity of
leucocytes filters chronic anemia depends on hours; should not coagulation, metabolites &
or washing w/ not corrected by clinical condition take longer than deficiencies, antibodies;
isotonic saline iron, Vitamin B12 & body size 6 hours; Assess instead use  Reduces the
or folic acid (regular adult circulatory state specific risk of circulatory
 Exchange blood volume after every 2 components overload
tranfusion in about 80 ml/kg) units
neonates Caution:
(RBC≤5 days old)  Do not add any
 If volume solution except
expansion also normal saline
needed, may use (50-100 ml 0.9%
w/ isotonic saline NaCl injection
 If coagulation may be added to
factors also RBC prior to
needed, may use infusion to
w/ FFP or decrease
specific viscosity)
component  May still be
used in exchange
transfusion even
if not ABO
identical
Cellular Blood
Composition Indications Dosage Administration Contraindications Hazards
Products
3. Washed RBC RBC w/c has  Use only for Same as RBC IV. Set” Same as RBC Same as RBC
been depleted by those requiring Use leucocyte
more than 95% repeated filter
of leucocytes & transfusions who Rate & Cautions:
plasma proteins develop febrile
transfusion Same as RBC
reactions
4. Platelet At least 5.5 × Use for:  One unit IV Set: Standard Not usually  Chills, fever &
1010 platelets in  Treatment or usually increases blood transfusion effective in: allergic reactions
60’ ml plasma; prevention of platelet count or set w/ integral in Immune  Disease
depending on bleeding due to a 70 kg adult by line filter, thrombocytopeni transmission
centrifugation deficient platelet 5-10 × 109/l preferably c purpura (ITP)  Refractory or
rate, may contain number (<20 ×  Volume leucocyte Do not use: “resistant” state
many 109/l); abnormal depends on removal filter (do
lymphocytes or not use  If bleeding not
platlet function or clinical condition related to
some red cells both but usually 6-8 microaggregate
filters); May also reduced platelet
Example: sepsis, units or (1) unit number or
DIC, renal failure, for every 10 kg give by syringe
function
coagulopathy, body weight Rate: One unit in
10 minutes or as  For thos w/
splenomegaly  Repeat when hemolytic
 Patients about platelet falls fast as can be
tolerated by the urenimic
to undergo major below 20 × 109/l syndrome
surgery w/ (about 2 days) patient; count
platelets <50 × every 1-2 hours
109/l) Cautions: Must
 Long term be ABO
supportive compatible but
treatment of RBC crossmatch
conditions w/ & Rh typing not
bone marrow necessary; Do
depression not add anything
to unit
Cellular Blood
Composition Indications Dosage Administration Contraindications Hazards
Products
5. Granulocytes Usually obtained Effectiveness still  Average adult: IV Sets: Standard Do not use:  Febrile
using cell under > 100 × 109 blood transfusion  Without first reactions
separator investigation granulocytes set (do not use trying broad  Allergic
machine for 3-3 Used as daily or twice leucocyte or spectrum reactions
hours yielding supportive daily for 4-7 days microaggregate antibiotics  Disease
variable theraphy for  Give when filter)  Use as
quantities transmission
those w/ absolute Rate: Same as prophylaxis for
ranging from 55- neutropenia (<0.5 neutrophil count RBC  Immunization to
infection still HLA & red cell
300 × 109 × 109/l) & < 0.5 × 109/l after Caution: under
granulocytes infections not trial of blood antigens
 Use within 24 investigation
responsive to spectrum  GVHD
hours after
antibiotic therapy antibiotics for 1-2 collection  Allergic
days reactions to
 Do not add sedimenting
anything to unit agent
 Mix thoroughly
before use
 Irradiate if for
infants or
transplant
recipients
Table 7.1B Indications for Transfusion of Non-Cellular Blood Products
Non-Cellular
Composition Indications Dosage Administration Contraindications Hazards
Blood Products
1. Fresh Frozen  Plasma Use for: Control One (1) unit will IV. Set: Standard Do not use:  Disease
Plasma (FFP) proteins & all or prevention of increase level of blood transfusion  When transmission
coagulation bleeding in any clotting factor set coagulopathy can  Anaphylaxis
factors (including multiple by 2.3% in an Rate: 10 be corrected by  Chills, fever &
V & VIII) plus coagulation average adult ml/minute specific therapy allergic reaction
complement defects e.g. liver Caution:  As volume
disease  Circulatory
 Standard adult  Thaw slowly in expander when overload
volume: 180 ml  Those requiring a waterbath (30° other fluids are
or 240 ml factors V & VIII  Allolmmunization
37°C) adequate or (infrequent)
 Pediatric: 60 ml but concentrates available e.g.
not available  Use within 6  In massive
hours after crystalloids &
 As adjunct in albumin transfusion,
thawing citrate toxicity of
massive  For lgG
transfusion to  Monitor hypotherma
prothrombin time replacement for especially in
prevent dilutional which a specific
hypoccagulability (PT) & partial children
thromboplastin product is
 Thrombatic time (PTT) available
Thrombacy-
topenic purpura  Do not add any
(TTP); medication or
antithrombin III solution to unit
deficiency;  Compatability
pseudo-cholin- testing & Rh
esterase typing not
deficiency necessary but
better to give on
ABO compatible
basis
Non-Cellular
Composition Indications Dosage Administration Contraindications Hazards
Blood Products
2. Cryoprecipitate  Contains Use during:  Hemophilia A & IV. Set: Standard Do not use:  Disease
coagulation  Acute vWF disease: set  Unless transmission
factors VIII hemorrhage or One unit for Rate: Loading laboratory  Febrile &
(activity > 0.7 anticipated every 10 kg daily dose in studies indicate allergic reaction
IU/ml), XIII, surgery in dose (as one unit Hemophilia A: specific  Hypertibrino-
fibrinogen & hemophilia A loading dose; Rapid infusion: coagulation genemia
fibronecin & vWF patients if freeze then smaller 10 ml of diluted detect for which
(200 – 250 mg) dose  Hemolysis
dried Factor VIII component per product is (rare)
not available maintenance minute indicated
 vWF disease every 12 hours);
larger doses if w/ Caution:
 Prophylaxis for antibodies to  Thaw 15
Factor XIII or Factor VIII. Start minutes in
fibrinogen one day before waterbath (30-
deficiencies surgery up to 37°C)
about 10 days  Dilute w/ 10-15
post-operation ml NaCl, mix well
 Factor XIII  Use within 6
Deficiency: One hours after
unit for every 10 thawing
kg every 2-3  Compatibility
weeks testing & Rh
 Fibrinogen typing not
Deficiency: 5.6 necessary: ABO
or 8 unit compatibility
increments preferred but not
essential
 Do not refreeze
 Monitor periodic
assays
Non-Cellular
Composition Indications Dosage Administration Contraindications Hazards
Blood Products
3. Crysupernate  Contains half the  Thrombotic Same as Same as Same as Same as
contents of Thrombocytopenic cryoprecipitate cryoprecipitate cryoprecipitate cryoprecipitate
cryoprecipitate Pupura
 Depleted of vWF
4. Plasma-derived Freeze dried 250  Use in acute Varies w/ clinical Same as  Recombinant  Development of
Factor VIII IU neat treated at hemorrhage in conditions & cryoprecipitate Factor VIII is all antibodies
concentrate 80°C for 72 hours hemophilia A or patient response sometimes against Factor VIII
prophylactic General preferred when it in 6-15% of cases
treatment Guidelines: is available &
 8-12 hourly affordable
repeated doses to
maintain
circulating Factor
VIII > 30% of
normal; or about
10-20 IU/kg
 Prophylaxis
needs massive
dosed to be
effective
5. Albumin  Chemically Use for:  5% Albumin: IV Set: Administer Not included:  Circulatory
processed  Shock due to 250-500 ml through filter  For long term overload
derivative from massive burns (w/ loss theraphy of
of plasma fluids but  20% Albumin: 20 Rate: According to hypoprotelnemic  Urticaria, chills &
pooled plasma not RBC) ml will pull 60 ml of clinical response states such as chronic fever
 Available as 5%  Kernicterus plasma fluids in 15 (take vital signs) cirrhosis,  Headache &
or 20% albumin in  Prevention & minutes malabsorption protein-
Cautions: No flushing especially
balanced losing enteropathies,
treatment of cerebral  Maintain compatibility tests pancreatic due to rapid
electrolyte solution edema, in conjunction
circulatory plasma needed insufficiencies & infusion > 10
w/ limitation of fluid
intake & dehydration albumin level at malnutrition ml/minute
w/ hypertonic solutions 2.5/0.5g/dl  For parenteral
nutrition
Non-Cellular
Composition Indications Dosage Administration Contraindications Hazards
Blood Products
6. Prothrombin Lyophilized pooled Use:  Loading dose:  Reconstitute w/  Chills & fever
Complex plasma derivative  To arrest acute 15-20 u/kg; distilled water  Headache,
containing Factors hemorrhage or Maintenance  Infuse slowly IV flushing & tingling
II, IX, X & low avert dose: 10 u/kg within 3 hours  Overdose may
levels of VII (20 ml operative/post-  For coumarin lead to
bottle of 500 u) operative bleeding overdosage: intravascular
in hemophilia B depends on coagulation &
(Christmas clinical status & thrombotic events
Disease) & rare coagulation test
congenital results
deficiencies of
Factor II or X
 In multiple factor
deficiency induced
by overdose of
coumarin-type
drugs
 For those w/
Factor VIII inhibits
7. Factor IX See Factor IX  Minor See See Same as above
manufacturer’s deficiency hemorrhage: manufacturer’s manufacturer’s
instructions Loading dose: 30 instructions instructions
u/kg
Maintenance dose:
25-30 u/kg every 24
hours
Major hemorrhage:
Loading dose 60
u/kg
Maintenace dose:
10-15 u/kg every 24
hours
Non-Cellular
Composition Indications Dosage Administration Contraindications Hazards
Blood Products
8. Immunoglobalins

8.1 Normal human  Sterile 16g/dl Use for: See See See  Local initiation of
Immunoglobalin solution of  Neonatal sepsis manufacturer’s manufacturer’s manufacturer’s injection site (for
(IM or IV) gammaglobulin especially instructions instructions instructions IM products)
protein prematures  Anaphylaxis
fractionated using  Specific (rare)
ethanol from infections
pooled plasma
 Congenital or
 Conatains aquired
antibodies against hypogamma-
infections to which
the general globulinemia
population has (lgG < 2g/l)
been exposed to  Immune
thrombocytopenia
 Kawasaki’s
disease

8.2 Hyper-immune  Contains high  Ans-D lgG:


Globulins filters of specific RhD Immunization
antibodies from  Specific
plasma of diseases e.g.
immunized donors tetanus, hepatitis,
measles, polio,
chickenpox, etc.
Table 7.4 Management of Common Complications of Blood Transfusion

COMPLICATIONS PREVENTION MANAGEMENT


1. Volume overload Care and observation Stop transfusion,
Diuretics, oxygen, posture

2. Cellular incompatibility Careful crossmatch and clerical checks Review for clerical error
Individualized management

3. Plasma incompatibility Careful croosmatch and clerical checks Review for clerical error
Individualized management

4. Infected blood:
4.1 Bacterial Correct storage and handling Stop transfusion. Support
toxic shock. Notify blood bank

4.2 Viral Check/Improve donor selection and Proper diagnosis. Notify blood
HBV, HIV, CMV screening bank

4.3 Malaria Check/Improve donor selection and Antimalarials. Notify blood


screening bank
COMPLICATIONS PREVENTION MANAGEMENT
5. Embolism, especially air Avoid air in system. Do not vent a Medical emergency
embolism plastic container to speed up transfusion.
Use microaggegate filters for massive
transfusion.

6. Drugs Use only 0.9% NaCl or NSS in contact


w/ blood

7. Sidarosis Anticipate in multi-transfused patients Desferrioxamine

bye!
Thank you…

Prepared by:

MILA AMOR V. REYES, MD.


Fellow Philippine Society of Pathologist
Anatomic & Clinical Pathologist
Head Clinical Laboratory
GFDMH