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II. Blood and Blood Components

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II. Blood and Blood Components Terry Kotrla, MS, MT(ASCP)BB Spring 2010 Goals Of Blood Collection Maintain viability and function Prevent physical changes Minimize ... – PowerPoint PPT presentation

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Title: II. Blood and Blood Components


1
II. Blood and Blood Components
  • Terry Kotrla, MS, MT(ASCP)BB
  • Spring 2010

2
Goals Of Blood Collection
  • Maintain viability and function
  • Prevent physical changes
  • Minimize bacterial contamination

3
Anticoagulants Preservative Solutions
  • Anticoagulants prevent blood clotting
  • Preservatives provide nutrients for cells
  • Heparin
  • Rarely if ever used anymore
  • Anticoagulant ONLY
  • Transfuse within 48 hours, preferably 8

4
Anticoagulants
5
Additive Solution
  • Primary bag with satellite bags attached.
  • One bag has additive solution (AS)
  • Unit drawn into CPD anticoagulant

6
Additive Solution
  • Remove platelet rich plasma within 72 hours
  • Add additive solution to RBCs, ADSOL, which
    consists of
  • Saline
  • Adenine
  • Glucose
  • Mannitol
  • Extends storage to 42 days
  • Final hematocrit approximately 66

7
Changes Occur During Storage
  • Shelf life expiration date
  • At end of expiration must have 75 recovery
  • At least 75 of transfused cells remain in
    circulation 24 hours AFTER transfusion

8
Storage Lesion
  • Biochemical changes which occur at 1-6C
  • Affects oxygen dissociation curve, increased
    affinity of hemoglobin for oxygen.
  • Low 2,3-DPG, increased O2 affinity, less O2
    released.
  • pH drops causes 2,3-DPG levels to fall
  • Once transfused RBCs regenerate ATP and 2,3-DPG
  • Few functional platelets present
  • Viable (living) RBCs decrease

9
Plasma hemoglobin Plasma K
Na
K
Viable cells pH ATP 2,3-DPG Plasma Na
Helps release oxygen from hemoglobin (once
transfused, ATP 2,3-DPG return to normal)
10
Storage Lesion
  • Significant for infants and massive transfusion.
  • Other biochemical changes
  • ATP decreases
  • Potassium increases
  • Sodium decreases
  • Plasma hemoglobin increases

11
Preparation of Components
  • Collect unit within 15 minutes to prevent
    activation of coagulation system
  • Draw into closed system primary bag with
    satellite bags with hermetic seal between.
  • If hermetic seal broken transfuse within 24 hours
    if stored at 1-4C, 4 hours if stored at 20-24C

12
Preparation of Components
  • Centrifuge light spin, platelets suspended
  • Remove platelet rich plasma (PRP)
  • Centrifuge PRP heavy spin
  • Remove platelet poor plasma
  • Freeze plasma solid within 8 hours
  • Thaw plasma at 1-4C precipitate forms
  • Centrifuge, express plasma leaving
    cryoprecipitate. Store both at -18C
  • RBCs CPD 21 days, ADSOL 42 days 1-6C

13
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14
Preparation of Components
  • Summary One unit of whole blood can produce
  • Packed RBCs
  • Fresh frozen plasma (FFP)
  • Cryoprecipitate (CRYO)
  • Single donor plasma (SDP) cyro removed
  • Platelets terms PC (platelet concentrate) OR RD
    PC (random donor platelet concentrate)

15
Preparation of Components
  • Sterile docking device joins tubing
  • Used to add satellite bags to maintain original
    expiration of component
  • May be used to pool components

16
Blood Component General Information
  • Blood separated into components to specifically
    treat patients with product needed
  • Advantages of component separation
  • Allow optimum survival of each component
  • Transfuse only component needed

17
Blood Component General Information
  • Transfusion practice
  • Transfusion requires doctors prescription
  • All components MUST be administered through a
    filter
  • Infuse quickly, within 4 hours
  • D (Rh) neg require D neg cellular products
  • ABO identical preferred, ABO compatible OK
  • Universal donor RBCs group O, plasma AB

18
Blood Component General Information
  • Fresh Whole Blood
  • Blood not usually available until 12-24 hours
  • Candidates
  • Newborns needing exchange transfusion
  • Patients requiring leukoreduced products

19
Blood Component General Information
  • Summary of storage temperatures
  • Liquid RBCs 1-6C
  • Platelets, Cryo (thawed) and granulocytes 20-24C
    (room temperature)
  • ANY frozen plasma product -18C
  • ANY liquid plasma product EXCEPT Cryo 1-6C

20
Blood Components
  • Cellular
  • Red blood cell products
  • Platelets
  • Granulocytes
  • Plasma
  • FFP
  • Cryoprecipitate

21
Products With Red Cells
22
Whole Blood
  • Clinical indications for use of WB are extremely
    limited.
  • Used for massive transfusion to correct acute
    hypovolemia such as in trauma and shock, exchange
    transfusion.
  • RARELY used today, platelets non-functional,
    labile coagulation factors gone.
  • Must be ABO identical.

23
Changes in Stored Blood
24
Red Blood Cells, Packed (PRBC)
  • Used to treat symptomatic anemia and routine
    blood loss during surgery
  • Hematocrit is approximately 80 for non-additive
    (CPD), 60 for additive (ADSOL).
  • Allow WB to sediment or centrifuge WB, remove
    supernatant plasma.

25
Leukocyte Reduced Red Cells (LR-RBC)
  • Leukocytes can induce adverse affects during
    transfusion, primarily febrile, non-hemolytic
    reactions.
  • Reactions to cytokines produced by leukocytes in
    transfused units.
  • Other explanations to reactions include
    immunization of recipient to transfused HLA or
    granulocyte antigens, micro aggregates and
    fragmentation of granulocytes.
  • Historically, indicated only for patients who had
    2 or more febrile transfusion reactions, now a
    commonly ordered, popular component.
  • CMV safe blood, since CMV lives in WBCs.
  • Most blood centers now leukoreduce blood
    immediately after collection.
  • Bed side filters are available to leukoreduce
    products during transfusion.

26
Leukocyte Reduction
27
Washed Red Blood Cells (W-RBCs)
  • Washing removes plasma proteins, platelets, WBCs
    and micro aggregates which may cause febrile or
    urticarial reactions.
  • Patient requiring this product is the IgA
    deficient patient with anti-IgA antibodies.
  • Prepared by using a machine which washes the
    cells 3 times with saline to remove and WBCs.
  • Two types of labels
  • Washed RBCs - do not need to QC for WBCs.
  • Leukocyte Poor WRBCs, QC must be done to
    guarantee removal of 85 of WBCs. No longer
    considered effective method for leukoreduction.
  • e. Expires 24 hours after unit is entered.

28
Cell Washer to Prepare Washed Cells
29
Frozen Blood
30
Red Blood Cells Frozen Red Blood Cells
Deglycerolized (D-RBC)
  • Blood is frozen to preserve rare types, for
    autologous transfusion, stock piling blood for
    military mobilization and/or civilian natural
    disasters.
  • Blood is drawn into an anticoagulant
    preservative.
  • Plasma is removed and glycerol is added.
  • After equilibration unit is centrifuged to remove
    excess glycerol and frozen.
  • Expiration
  • If frozen, 10 years.
  • After deglycerolization, 24 hours.
  • Storage temperature
  • high glycerol -65 C.
  • low glycerol -120 C, liquid nitrogen.

31
Red Blood Cells Frozen Red Blood Cells
Deglycerolized (D-RBC)
  • Thaw unit at 37C, thawed RBCs will have high
    concentration of glycerol.
  • A solution of glycerol of lesser concentration of
    the original glycerol is added.
  • This causes glycerol to come out of the red blood
    cells slowly to prevent hemolysis of the RBCs.
  • After a period of equilibration the unit is spun,
    the solution is removed and a solution with a
    lower glycerol concentration is added.
  • This procedure is repeated until all glycerol is
    removed, more steps are required for the high
    glycerol stored units.
  • The unit is then washed.

32
Rejuvenated Red Blood Cells
  • A special solution is added to expired RBCs up to
    3 days after expiration to restore 2,3-DPG and
    ATP levels to prestorage values.
  • Rejuvenated RBCs regain normal characteristics of
    oxygen transport and delivery and improved post
    transfusion survival.
  • Expiration is 24 hours or, if frozen, 10 years

33
Platelet Products
34
Platelets (PLTS), Platelet Concentrate (PC) or
Random Donor Platelet Concentrate (RD-PC)
  • Used to prevent spontaneous bleeding or stop
    established bleeding in thrombocytopenic
    patients.
  • Prepared from a single unit of whole blood.
  • Due to storage at RT it is the most likely
    component to be contaminated with bacteria.
  • Therapeutic dose for adults is 6 to 10 units.
  • Some patients become "refractory" to platelet
    therapy.
  • Expiration is 5 days as a single unit, 4 hours if
    pooled.
  • Store at 20-24 C (RT) with constant agitation.
  • D negative patients should be transfused with D
    negative platelets due to the presence of a small
    number of RBCs.

35
Preparation of platelet concentrate
Plasma
RBCs
PRP
Platelet concentrate
36
Platelets (PLTS), Platelet Concentrate (PC) or
Random Donor Platelet Concentrate (RD-PC)
  • One bag from ONE donor
  • Need 6-10 for therapeutic dose

37
Pooling Platelets
  • 6-10 units transferred into one bag
  • Expiration 4 hours

38
Platelets Pheresis, Apheresis Platelet
Concentrate, Single Donor Platelet Concentrate
(SD-PC)
  • Used to decrease donor exposure, obtain HLA
    matched platelets for patients who are refractory
    to RD-PC or prevent platelet refractoriness from
    occurring.
  • Prepared by hemapheresis, stored in two connected
    bags to maintain viability.
  • One pheresed unit is equivalent to 6-8 RD-PC.
  • Store at 20-24 C (RT) with agitation for 5 days,
    after combining, 24 hours
  • D negative patients should be transfused with D
    negative platelets due to the presence of a small
    number of RBCs

39
Apheresis
40
Apheresis
41
Platelets Pheresis
  • One bag (unit) from one donor
  • One unit is a therapeutic dose
  • Volume approximately 250 ccs

42
Granulocytes
Lymphocyte
Monocyte
Neutrophils
Eosinophils
Basophils
43
Granulocytes
  • Primary use is for patients with neutropenia who
    have gram negative infections documented by
    culture, but are unresponsive to antibiotics.
  • Therapeutic efficacy and indications for
    granulocyte transfusions are not well defined.
  • Better antimicrobial agents and use of
    granulocyte and macrophage colony stimulating
    factors best for adults, best success with this
    component has been with babies
  • Daily transfusions are necessary.
  • Prepared by hemapheresis.
  • Expiration time is 24 hours but best to infuse
    ASAP.
  • Store at 20-24 C.

44
Plasma Components
45
Fresh Frozen Plasma Volume 200-250cc
46
Fresh Frozen Plasma (FFP)
  • Used to replace labile and non-labile coagulation
    factors in massively bleeding patients OR treat
    bleeding associated with clotting factor
    deficiencies when factor concentrate is not
    available.
  • Must be frozen within 8 hours of collection.
  • Expiration
  • frozen - 1 year stored at lt-18 C.
  • frozen - 7 years stored at lt-65 C.thawed - 24
    hours

47
Fresh Frozen Plasma (FFP)
  • Storage temperature
  • frozen -18 C, preferably -30 C or lower
  • thawed - 1-6 C
  • Thawed in 30-37C water bath or FDA approved
    microwave
  • Must have mechanism to detect units which have
    thawed and refrozen due to improper storage.
  • Must be ABO compatible

48
Plasma, Liquid Plasma, Recovered Plasma and
Source Plasma
  • Used to treat patients with stable clotting
    factor deficiencies for which no concentrate is
    available or for patients undergoing therapeutic
    plasmapheresis.
  • Prepared by separating the plasma from the RBCs
    on or before the 5th day after expiration of the
    whole blood.
  • Once separated can
  • Freeze, store at -18 C for 5 years
  • If not frozen, called liquid plasma, store at 1-6
    C for up to 5 days after expiration of WB.
  • Once FFP is one year old can redesignate as
    Plasma, expiration is 5 years.

49
Pooled Plasma/Solvent Detergent Treated
  • Most recently licensed product.
  • Prepared from pools of no more than 2500 units of
    ABO specific plasma frozen to preserve labile
    coagulation factors.
  • Treated with chemicals to inactivate
    lipid-enveloped viruses.
  • Contains labile and non-labile coagulation
    factors but lacks largest Von Willebrands factor
    multimers.
  • Used same as FFP.Safety concerns
  • Decreases disease transmission for diseases
    tested for.
  • Doesnt inactivate viruses with non-lipid
    envelopes parvo virus B19, hepatitis A, and
    unrecognized pathogens

50
Cryoprecipitate (CRYO), Factor VIII or
Anti-Hemophilic Factor (AHF)
  • Cold insoluble portion of plasma that
    precipitates when FFP is thawed at 1-6C.
  • Cryoprecipitate contains high levels of Factor
    VIII and Fibrinogen, used for treatment of
    hemophiliacs and Von Willebrands when
    concentrates are not available.
  • Used most commonly for patients with DIC or low
    fibrinogen levels.
  • A therapeutic dose for an adult is 6 to 10 units.
  • Can be prepared from WB which is then designated
    as "Whole Blood Cryoprecipitate Removed" or from
    FFP
  • Plasma is frozen.
  • Plasma is then thawed at 1-6 C, a precipitate
    forms.
  • Plasma is centrifuged, cryoprecipitate will go to
    bottom.
  • Remove plasma, freeze within 1 hour of preparation

51
Cryoprecipitate (VIII, vW)
Thaw at 30-37C Store at RT 4 hrs
FFP
Plasma cryoprecipitate, reduced (TTP, FII, V,
Vii, IX, X, XI)
Frozen within 8 hours
Thawed FFP
Refrozen with 24 hrs of separation
Store at 18C 1 yr 5 day expiration at 1-6C
52
Cryoprecipitate (CRYO), Factor VIII or
Anti-Hemophilic Factor (AHF)
  • Storage Temperature
  • Frozen -18 C or lower
  • Thawed - room temperature
  • Expiration
  • Frozen 1 year
  • Thawed 6 hours
  • Pooled 4 hours
  • Best to be ABO compatible but not important due
    to small volume

53
Cryoprecipitate volume 15ccs
54
Irradiation of Blood Components
55
Irradiation of Blood Components
  • Cellular blood components are irradiated to
    destroy viable T- lymphocytes which may cause
    Graft Versus Host Disease (GVHD).
  • GVHD is a disease that results when
    immunocompetent, viable lymphocytes in donor
    blood engraft in an immunocompromised host,
    recognize the patient tissues as foreign and
    produce antibodies against patient tissues,
    primarily skin, liver and GI tract. The
    resulting disease has serious consequences
    including death.
  • GVHD may be chronic or acute

56
Irradiation of Blood Components
  • Patients at greatest risk are
  • severely immunosuppressed,
  • immunocompromised,
  • receive blood donated by relatives, or
  • fetuses receiving intrauterine transfusions
  • Irradiation inactivates lymphocytes, leaving
    platelets, RBCs and granulocytes relatively
    undamaged.
  • Must be labeled "irradiated".
  • Expiration date of Red Blood Cell donor unit
    changes to 28 days.
  • May be transfused to "normal" patients if not
    used by intended recipient.

57
Irradiation of Blood Components
58
Donor Blood Inspection and Disposition
  • It is required that donor units be inspected
    periodically during storage and prior to issuing
    to patient.
  • The following may indicate an unacceptable unit
  • Red cell mass looks purple or clots are visible.
  • Zone of hemolysis observed just above RBC mass,
    look for hemolysis in sprigs, especially those
    closest to the unit.
  • Plasma or supernatant plasma appears murky,
    purple, brown or red.
  • A greenish hue need not cause a unit to be
    rejected.
  • Inspect platelets for aggregates.
  • Inspect FFP and CRYO for signs of thawing,
    evidence of cracks in bag, or unusual turbidity
    in CRYO or FFP (i.e., extreme lipemia).

59
Inspection of Donor Blood
  • Segment closest to unit is hemolyzed.
  • May indicate bacterial contamination

60
Donor Blood Inspection and Disposition
  • If a unit's appearance looks questionable do the
    following
  • Quarantine unit until disposition is decided.
  • Gently mix, allow to settle and observe
    appearance.
  • If bacterial contamination is suspected the unit
    should be cultured and a gram stain performed.
  • Positive blood cultures usually indicative of
  • Inadequate donor arm preparation
  • Improper pooling technique
  • Health of donor - bacteremia in donor
  • If one component is contaminated, other
    components prepared from the same donor unit may
    be contaminated.

61
Inspection of Donor Blood
  • Reissuing blood cannot be done unless the
    following criteria is met
  • Container closure must not have been penetrated
    or entered in any manner.
  • Most facilities set 30" time limit for accepting
    units back, warming above 6-10C even with
    subsequent cooling increases RBC metabolism
    producing hemolysis and permitting bacterial
    growth.
  • Blood must have been kept at the appropriate
    temperature.
  • One sealed segment must remain attached to
    container.
  • Records must indicate that blood has been
    reissued and inspected prior to reissue.

62
Transportation of Blood and Blood Components
  • WB and RBC
  • Sturdy well insulated cardboard and/or styrofoam
    container, wet ice in ziplock bag to cool,
    temperature must be monitored.
  • Mobile collection units should transport blood
    ASAP and leave at RT if platelets are to be made.
  • In-house transport place in cooler with wet ice
    and thermometer, monitor temperature every 30
    minutes.

63
Safe-T-Vue Temperature Monitor
64
Transportation of Blood and Blood Components
  • Frozen components
  • Temperature must be maintained at or below
    required storage temperature.
  • Use dry ice in well insulated container.
  • Platelets and granulocytes
  • Maintain at 20-24 C.
  • Transport in well insulated containers without
    ice.
  • Commercial coolers available to maintain at
    20-24C.

65
Transportation of Blood and Blood Components
  • Handling donor units
  • Should not remain at RT unnecessarily, when blood
    is issued it should be transfused as soon as
    possible.
  • When numerous units are removed from fridge,
    remove fluid filled container with a thermometer
    at same time as blood, when temperature reaches 6
    C return to fridge.

66
Records
  • Must be made concurrently with each step of
    component preparation, being as detailed as
    possible for clear understanding.
  • Must be legible and indelible.
  • Must include dates of various steps and person
    responsible.

67
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68
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