component & effective use of blood

8/3/2019 Component & Effective Use of Blood

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Component preparation,Component preparation,

storage and effective use of storage and effective use of blood productsblood products

©©noleata@iium/bms/07noleata@iium/bms/07--0808



BLOODCOLLECTION

APHERESIS

WHOLE BLOOD

TRANSPORT & STORAGE OFSCREENED

BLOOD COMPONENTS

STORAGE ofBLOOD COMPONENTS

(SCREENED AND UNSCREENED)

SEPARATION OFBLOOD COMPONENTS

SCREENING

& TESTING

INDICATIONS FOR TRANSFUSION



Definition:Definition:

• Blood products: any theraeutic

substance prepared from humanblood.

• Whole blood: Unseparated bloodcollected into an approved container

containing an anticoagulant-preservative solution.



Blood componentsBlood components

1. A constituent of blood separated fromwhole blood, Red cell concentrate Red cell suspension Plasma

Platelet concentrates

2. Plasma or platelets collected by apheresis

3. Cryoprecipitate, prepared from freshfrozen plasma rich in FVIII and

fibrinogen.



Plasma derivatives

• Human plasma proteins preparedunder pharmaceutical manufacturingconditions:

– Albumin – Coagulation factor concentrates;

FVIII,FIX, FVII concentrates.

– Immunoglobulin.



HTAA

Blood Bank



Dr, please savemy girlfriend,

you can take my

blood, anything..

You are tooyoung to donate

and to have agirlfriend..

Historical note:1665

The first recorded successful lood transfusion occurs in England

(dogs to dogs)

Richard Lower, performed the firstsuccessful animal transfusion in 1665,

when he transferred blood from the carotid

artery of one dog to the jugular vein ofanother.



Historical Note:1667Historical Note:1667

• In November 1667, Lower

transfused Mr. Arthur Coga, "amildly melancholy insane man,"with the blood of a lamb. Mr.Coga, described his experience to

the Royal Society of Medicine andstated that he was much better."cracked a little in his head.“

• Denis’ fourth attempt endedfatally, he was charged withmurder

I ’ v e

t o l d

y o u,

i t ’ s n o

t s a f

e

t o t

a k e m

y

b l o o d

.. s e e



Historical Note

• For the next 150 years, there was littleinterest in transfusion.



Historical Note:1818

•• JAMES BLUNDELL 1818JAMES BLUNDELL 1818

– interest in transfusionwas revived by James

Blundell in 1818, it wason the basis of replacement of lostblood in puerperal

hemorrhage and afterseries of experiments.



Historical Note:1818

• Blundell failed in hisfirst four desperate

attempts to savewomen on the pointof death frompostpartal

hemorrhage, but

• he succeeded in fiveof the next six

attempts…….

• Patient’sselection……early

stage of PPH.



Blood Components

Separation

GOALS:

1. To maintain viability & function of relevant constituent.2. To prevent physical changes detrimental to constituent.3. Minimize bacterial proliferation.



d BLOOD PRODUCTS



• Adenosine Energy.

• Glucose Dextrose.

• Citrate

Anticoagulant.

• Concentration ofanticoagulant and

other derivativeshave been modifiedthrough times

optimum value.• Closedsystem…tubingmethods.

• Sterile low risk ofcontamination.

modern BLOOD PRODUCTS :in plastic bag



BEGIN:

END:

Wholeblood

PackedRBC

Plateletrichplasma

Plateletrichplasma

PackedRBC

PackedRBC

plasma

platelets

platelets

plasmaPackedRBC



Preparation Of Packed

Rbc



Blood is collected as whole blood.

Blood destined for component preparation is drawn into bags with integrallyattached transfer container (closed system)



Light centrifugation:

for separation of packedRBC & Platelet Rich Plasma(PRP )



PRP

Sediment:Packed RBC-70-80%plasmaremoved

SEPARATOR STAND: allows PRP to flow into one of thetransfer bag

Platelet Rich



PackedRBC

stored as

unscreenedblood

Platelet RichPlasma

use forpreparation

of FFP



Preparation Of FFP & Platelet



SEPARATOR STAND: express platelet-poor-plasma into the 3rd

attached transfer bag

Plasma placeat



at< -180C within 6

hours after

donation to getFFP (stored asunscreened

blood)

Platelet stored as

unscreened

blood onagitator



FFP Packed RBCplatelets

a single donation of whole blood has supplied three separate components(packed red blood cells, platelets, fresh frozen plasma) that can potentially

benefit three different patients.

CRYOPRECIPITATE:



Melt FFP between 1-6oC Cold insoluble portion of plasma remaining is called cryoprecipitate



Platelet collection using

apheresis system yield

higher concentration of

platelets.

1 bag = Equivalent to 4- 6 donors (units)



RECORDS & LABELS



http://e/compilation%20of%20blood%20donation%20seminar-30.12.2004/SEPARATION%20OF%20BLOOD%20COMPONENTS.ppt



STORAGE OF BLOODSTORAGE OF BLOODCOMPONENTS andCOMPONENTS and

SPECIFIC INDICATIONS OFSPECIFIC INDICATIONS OFBLOOD COMPONENTSBLOOD COMPONENTS

HISTORICAL NOTES: EARLY 1900HISTORICAL NOTES: EARLY 1900



TILL 1950sTILL 1950s – – blood storage in bottleblood storage in bottle

Back then



Back then …

1950Still usingbottle



Inventors:

Carl Walter and W.P. Murphy, Jr.

I’m using thenew plasticbag..COOL!

Whole Blood (CPD-Adenine-1)



( )

A 450 ml wholeA 450 ml whole

blood donationblood donation

containscontains:

510 total volumes

450 ml donor blood.

63 ml anti-coagulantpreservative solution

Hb ~ 12 g/ml

Hct -35%-45%

No functionalplatelets

No labile coagulationfactors (V and VIII)

StorageStorage:

+2oC

_ +6o C in

approved bloodbank refrigerator,fitted with atemperature chart

and alarm.TransfusionTransfusion

should be startedshould be started

within 30 minuteswithin 30 minutes

after removal frafter removal frrefrigerator.refrigerator.





Indications:Indications:

Red cell

replacement in acuteblood loss withhypovolaemia

Exchangetransfusion

Patients needingred cell transfusionwhere red cellconcentrates are notavailable

Contraindications:Contraindications:

Risk of volume

overload in ptswith:

Chronic anaemia

Incipient cardiacfailure

ADMINISTRATION:ADMINISTRATION:

Must be ABO and RhD compatible.

Never add medication to a unit of blood.

Complete transfusion within 4 hours ofcommencement.

Red Cell Concentrate(Red Cell Concentrate(‘‘packed Redpacked Red



150-200ml red cells.

Hb ~ 20g/100 ml

Hct ~ 55% - 75%

Storage:

+2oC- 6o C

Indications:

Replacement of red

cells in anaemicpatients.

Use with crystalloid

replacement orcolloid solution inacute blood loss

150-200ml red cells.

Hb ~ 20g/100 ml

Hct ~ 55% - 75%

Storage:Storage:

+2oC-

6o C


Replacement of red


Use with crystalloidreplacement orcolloid solution inacute blood loss

Administration:Same as whole blood.

Administration:Same as whole blood.

CellsCells’’,, ‘‘PlasmaPlasma--reduced Bloodreduced Blood’’))

Red Cell SuspensionRed Cell Suspension



150-200ml red cellswith minimal

residual plasma towhich NS,adenine,glucose,mannitolsolution(SAG-M)

has been addded.Hb ~ 15g/100 ml

Hct ~ 50% - 70%

150-200ml red cellswith minimalresidual plasma to

which NS,adenine,glucose,mannitolsolution(SAG-M)has been addded.

Hb ~ 15g/100 ml

Hct ~ 50% - 70%

Indications:

Replacement of red


Use with crystalloid

replacement orcolloid solution inacute blood loss


Replacement of red


Use with crystalloidreplacement orcolloid solution inacute blood loss

Storage:

+2oC- 6o C

Storage:Storage:+2oC- 6o C

Contraindications:Not advised forexchange transfusionin neonates

Contraindications:Contraindications:

Not advised forexchange transfusionin neonates

(CPD(CPD--SAGM)SAGM)



Standard Blood Bank refrigerator should be fittedwith a temperature chart and alarm.

Storage for SCREENEDSCREENED blood

components



components

should be separated from theUNSCREENED.UNSCREENED.

Platelet concentratePlatelet concentrate Infection riskInfection risk



Platelet concentratePlatelet concentrate

CONTENTSCONTENTS::

•Single donor unit

(prepared fromwhole blood in avolume of 50-60 mlof plasma contain at

least•55×109 platelets)•< 1.2 x 10 9 redcells

•< 0.12 x 10

9

leucocytes.

• 150-500 x 109

platelets (from

apheresis.

Infection riskInfection risk

•Same as whole

blood but for adultdose involvesbtween 5 – 6 donorexposures.

•Bacterialcontamination: 1%of pooled units.

STORAGE:STORAGE:Up to 5 DAYS at

20°C – 24°C(with

agitation).

Longer storageincreases the riskof bact proliferationand septicaemia inthe recipient.

INDICATIONS:

Treatment of bleeding due to:

INDICATIONS:INDICATIONS:





•Thrombocytopenia•Platelet function defects.

•Prevention of bleeding d2

thrombocytopenia

CONTRAINDICATIONS:Not for prophylaxis of bleeding,

unless known to have significantpre-operative platelet deficiency.Not indicated in:•ITP

•TTP•Untreated DIC•Thrombocytopenia ass withsepticaemia, until treatment has

commenced or in cases ofhypersplenism.


•Thrombocytopenia

•Platelet function defects.

•Prevention of bleeding d2thrombocytopenia

CONTRAINDICATIONSCONTRAINDICATIONS:Not for prophylaxis of bleeding,

unless known to have significantpre-operative platelet deficiency.Not indicated in:•ITP

•TTP•Untreated DIC•Thrombocytopenia ass withsepticaemia, until treatment has

commenced or in cases ofhypersplenism.





DOSAGE

I unit of plt conc/10 kgBW in a 60-70 kg adult,

4-6 single donor unitscontaining 240 x 10 9 pltsshould raise the plt countby 20-40 x 10 9 /L

Increment will be less ifthere is:

SplenomegalyDIC

Septicaemia

DOSAGEDOSAGE

I unit of plt conc/10 kgBW in a 60-70 kg adult,

4-6 single donor unitscontaining 240 x 10 9 pltsshould raise the plt countby 20-40 x 10 9 /L

Increment will be less ifthere is:

Splenomegaly

DIC

Septicaemia

ADMINISTRATION

ADMINISTRATIONADMINISTRATION



After pooling, plt conc

should be infused ASAP.MUST NOT BEREFRIGERATED beforeinfusion – reduces plt fx.

Should be infusedthough a fresh standardblood administration set.Should be infused over a

period of about 30minutes.Do not give plt concprepared fr RhD positive

donors to an Rh D negativefemale with child bearingpotential.Give plt that are ABO

compatible wheneverpossible.

After pooling, plt conc

should be infused ASAP.MUST NOT BEREFRIGERATED beforeinfusion – reduces plt fx.

Should be infusedthough a fresh standardblood administration set.Should be infused over a

period of about 30minutes.Do not give plt concprepared fr RhD positive

donors to an Rh D negativefemale with child bearingpotential.Give plt that are ABO

compatible wheneverpossible.

Fresh Frozen Plasma



Contains normalplasma levels ofstable clotting factors,

albumin and Ig.

Fc VIII level at least70% of normal fresh

plasma level.

UNIT OF ISSUE:Usual volume of packis 200-300 ml.

Contains normalplasma levels ofstable clotting factors,

albumin and Ig.

Fc VIII level at least70% of normal fresh

plasma level.

UNIT OF ISSUE:UNIT OF ISSUE:Usual volume of pack

is 200-300 ml.

Fresh Frozen P lasmaFresh Frozen Plasma



INDICATIONS:

Replacement ofmultipe coagulation

factor def•Liver dise

•Warfarin overdose

•DIC

•TTP

•Depletion of

coagulation factorsin pts receiving largevolume transfusion.


Replacement ofmultipe coagulationfactor def

•Liver dise

•Warfarin overdose

•DIC•TTP

•Depletion ofcoagulation factors

in pts receiving largevolume transfusion.

DOSAGE:

Initial dose: 15ml/kg

DOSAGE:DOSAGE:

Initial dose: 15Initial dose: 15

ml/kgml/kg







STORAGE:At -25°C or colder up to 1year.

Before use, should bethawed in the blood bank in

water between 30 - 37°C.

Higher temperatures will

destroy clotting factors andproteins.

STORAGE:STORAGE:

At -25°C or colder up to 1year.

Before use, should bethawed in the blood bank inwater between 30 - 37°C.

Higher temperatures will

destroy clotting factors andproteins.






























ADMINITSTRATION:

ABO compatible to avoid

risk of haemolysis in

recipient.No compatibil ity testing

required.

Infuse using standard

blood administration set as

soon as possible after

thawing.

Labile coagulation factors

rapidly degrade, use within 6

hours of thawing.

ADMINITSTRATION:ADMINITSTRATION:

ABO compatible to avoid

risk of haemolysis in

recipient.

No compatibil ity testing

required.

Infuse using standardblood administration set as

soon as possible after

thawing.

Labile coagulation factors

rapidly degrade, use within 6

hours of thawing.

CryoprecipitateCryoprecipitate



Fac VIII:80-100iu/pack

Fibrinogen:150-300 mg/pack

UNIT OF ISSUE:UNIT OF ISSUE:

Usu supplied as asingle donor pack orpack of 6 or moresingle donor units.

-involves at least 6donor exposures.

y p py p p




STORAGE:AT -25oC or colderfor up to 1 year.

y p py p p




INDICATIONS:

Alternative for Fc VIII conc in the tx of inherited

def (Haemop A, fc XIII, VWD)

As a source of fibrinogen in acquired

coagulopathies eg DIVC


Alternative for Fc VIII conc in the tx of inherited

def (Haemop A, fc XIII, VWD) As a source of fibrinogen in acquired

coagulopathies eg DIVC

y p py p p




Administration:

•If possible: use ABOcompatible.

•No compatibility

testing required.

•After thawing infuseas soon as possible .

•Must be infusedwithin 6 hours ofthawing

Administration:Administration:

•If possible: use ABOcompatible.

•No compatibility

testing required.

•After thawing infuseas soon as possible .

•Must be infusedwithin 6 hours ofthawing

y p p

Effective use of blood productsBlood bankBlood bank



Blood bank Blood bank

•Proper collection, separationand storage of blood

components.

•Correct legal identification

procedure:•Donor

•Blood

group

ect

•Quality assurance in everysteps.

•Proper screening procedure

•Pre-donation.

•Post-donation.•Appropriate release of blood

and its products

Clear indication.

Proper handling of units.Documentatations.

PatientsPatients ’ ’ sitesite

•Indications must be clear.

•Check on documentations and

avoid mishandling of units.

•Correct transportation system and

storage prior transfusion.

•Timing of transfusion.

•Corret use of drif set and branulas.

•Patient’s monitoring during and

after transfusion.

•Good Ward-blood bank

communication.

•Blood transfusion reaction.

•Any queries…

•Ect

Think of your intention to



transfuse……• Sensible..

• Clear indication/s.

• No other alternatives.

• is the most appropriate therapy?

• Can the risk be avoided?

• Is the patient fully informed?

• Hazard of components therapy?• What is the time frame for decision-making

process?



.

component & effective use of blood

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