Blood Components

Compiled by Dr Chizoba Nwankwo

 BLOOD COMPONENTS
• Blood components are those products derived
from whole blood collected from normal
donors by
1.Phlebotomy or

2.Apheresis using the techniques of

different centrifugation.
• It enhances the utilization of individual
donations for several patients and decreases
the need for whole blood.
 BLOOD COMPONENTS
• Whole blood comprises of cellular elements
and plasma
• Some plasma derivatives are prepared from
large pools of human plasma under
pharmaceutical manufacturing conditions
eg albumin, coagulation factors ,
immunoglobulins.
Blood components

Picture from internet

 Separation of blood components
• Is carried out in double or triple bags with
closed integral tubing
• Separation is done in cold centrifuge.
• Due to different specific gravity of cellular
components, they can be separated by
centrifuging.
Separation of blood components

Pictures from internet

 Apheresis
• Apheresis = separation, derived from greek
word “take away”
• Process in which whole blood is withdrawn
, separated into component parts; the
desired component is retained ,while the
remainder is returned to the donor/patient
 Apheresis applications

1. Plasmapheresis
2. Cytapheresis
a) Plateletpheresis Single donor platelet collection

b) Leukapheresis
Peripheral blood stem cell collection
Donor lymphocyte collection
Granulocyte collection

c) Erythrocytapheresis
Apheresis machine- Optia
 Additional processing
• Irradiation of cellular components
• Washing of cellular components
• Platelets in platelet additive solution
• Pathogen inactivation/reduction for FFP
and cryoprecipitate
• Small volume components for neonatal use
• Concentration of red cells or platelets for
intrauterine transfusion
 leucodepletion
• Blood products should be routinely filtered to
remove majority of wbc,
• A blood component is defined as leucocyte
depleted if there are <5 x106 wbc present..
• Leucodepletion reduces the incidence of
febrile transfusion reaction and HLA
alloimmunization, prevents transmission of
Variant Creutzfeldt Jakob Disease
 Irradiation of blood components
• Transfusion containing viable lymphocytes can result in
GVHD.
• 25gy of external radiation to blood components can
render lymphocytes incapable of post transfusion graft
versus host disease.
• Indication for blood irradiation,
– Cytopenia from whole body irradiation exposure.
– Haemopoietic transplant
– Immunocompromised recipient of organ transplant.
– Intrauterine transfusion
 Goals Of Blood Collection
• Maintain viability and function
• Prevent physical changes
• Minimize bacterial contamination
 Storage Lesion
• Biochemical changes
– pH decreases
– 2,3 DPG decreases
– ATP decreases, glucose decreases
– Potassium increases, Sodium decreases,loss of
Ca
• Clotting factors V,VIII decrease
• Few functional platelets present
• Viable (living) RBCs decrease
 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
 Action of ingredients of anticoagulant
solution
• Glucose - supports ATP generation by
glycolytic pathways
• Adenine -synthesizes ATP, increases level
of ATP, extends the shelf-life of red cells.
• Citrate - prevents coagulation by chelating
calcium.
• Sodium di-phosphate –prevents fall in pH
 Anticoagulants
• Acidified ditrate dextrose (ACD)
• Citrate-phosphate-dextrose (CPD)
• Citrate-phosphate-dextrose with adenine
(CPDA-1)
• Heparin
 Anticoagulants
CPD or CP2-D CPD-A1
Storage time 21 days 35 days
Temperature 2-6 C 2-6 C
Slows glycolytic activity
Adenine None Substrate for ATP synthesis
Volume 450 +/- 10%
Dextrose Supports ATP generation by glycolytic
pathway
Citrate Prevents coagulation by binding calcium
 Various blood components
• Red cells
• Granulocyte concentrate
• Platelet concentrate
• Plasma derivatives
– Conc of specific plasma proteins that are prepared from
pools of plasma.
– Obtained through a process known as fractionation, are
heat treated and /or solvent detergent treated to kill
certain viruses e.g. HIV, Hep B, C
– eg FFP,Albumin, cryoprecipitate, freeze dried factor VIII,
IX- Prothrombin complex conc., Protein C,
immunoglobulins.Anti D Ig (Rhogam)
 RBC Transfusions
Preparations
• Type
– Blood group of RBC’s for ABO and Rh are determined
for both donor and recipient
• Screen
– Screen for atypical antibodies
– Approx 1-2% of patients have antibodies
• Crossmatch
– Donor cells and recipient serum are mixed and
evaluated for agglutination
 Whole Blood
• Storage
– Stored 4° for up to 35 days
• Indications
– Massive Blood Loss/Trauma/Exchange Transfusion
• Considerations
– Donor and recipient must be ABO identical
 Fresh Whole Blood
• Clinicians may request for fresh whole blood
( blood less than 24 hours)
• It is requested when there is anemia and
bleeding disorder by platelet, coagulation factor
deficiency since platelets and labile coagulation
factors become functionally ineffective after 48
hours of storage
• Can be used for neonatal blood exchange
• if available, packed red cells, plasma
components,or platelet concentrates are more
effective and preferred forms of therapy for such
patients
 Fresh Whole Blood
• Useful in managing conditions associated
with loss of whole blood like road traffic
accident , in obstetrics ( uterine rupture, post
partum hemorrhage etc) and bone marrow
failure where all the cell lineage are
depressed.
 Red cells
They are available in 4 different types
• Packed red cells
• Red cell concentrate
• Leucocyte depleted red cells (LDRC)
• Washed red cells
 Red cells
• Packed red cells-
– 2/3 of the donor plasma is removed.
– PCV is about 70%
• Red cell concentrate
– Nearly all visible donor plasma has been
removed,useful in patient with allergic reaction
– PCV- 90%
– It is very viscous and need wide bore cannula
 Red Cells
• Leucocyte depleted red cells (LDRC)
– More than 99% of WBC has been removed by
filtration or centrifugation
– Useful in patient with history of febrile
transfusion reaction
• Washed red cells
– Has no trace of donor plasma, the cells are
washed with saline and additive solution added
– Useful in IgA negative individuals
 RBC Concentrate
• Storage is 4° for up to 42 days depending
on anticoagulant used, can be frozen
• Indications are anemia, hypoxia, etc.
• Washed red cells have plasma protein,
electrolytes, antibodies removed and has 24
hrs expiration.
• Frozen, thawed, deglycerolized red cells are
not routinely done, useful in autologous
units before surgery and rare blood, last
10yrs when frozen
 Platelets
• Storage is at room temp 20-220c and prone to
bacteria contamination, has shelf life of 5 days in
packs of plastic with agitation to prevent
aggregation

• Indications
– Thrombocytopenia, Plt <15,000
– Bleeding and Plt <50,000
– Invasive procedure and Plt <50,000
• Considerations
– Contain Leukocytes and cytokines
 Platelets concentrates
• Patients requiring frequent platelet transfusions
are advised to be vaccinated against Hepatitis
B.
• Patients who receive repeated platelet
transfusions are well advised to use a single-
donor product, thereby decreasing the risk of
alloimmunization to HLA and glycoprotein
antigens.
• Alloimmunization can lead to refractoriness to
transfusions.
 Fresh plasma
• This plasma that is prepared and used
within 6 hours of collection from a normal
blood donor
• It is used to treat bleeding conditions
associated with deficiency of clotting
factors
• See other indication of use like in Fresh
frozen plasma
 Fresh Frozen Plasma FFP
• Contents—Coagulation Factors (1 unit/ml)
• frozen to -300 c and viable for one year. When
needed thawed at 37oc and transfused immediately
• Indications
– Coagulation Factor deficiency, fibrinogen
replacement, DIC, liver disease, exchange
transfusion, massive transfusion
– Usual dose is 20 ml/kg to raise coagulation
factors approx 20%
 Cryoprecipitate
• Description
– Precipitate formed/collected when FFP is thawed at 4°.
Contains von willebrand factor, Factor VIII,
plasminogen activator and fibrinogen
• Storage
– After collection, refrozen and stored up to 1 year at -
18°
• Indication
– Fibrinogen deficiency or dysfibrinogenemia
– vonWillebrands Disease
– Factor VIII or XIII deficiency
– DIC (not used alone)
• Considerations
– ABO compatible preferred (but not limiting)
 Cryosupernatant.

• Indication is plasma exchange in TTP, because

it supplies more of the metalloproteinase and
lacks HMW multipliers.
• Stored at -30 o c or below for 24 months.
• Do not use for condition that require vWF or
factor VIII replacement
 Granulocyte Concentrate
• Prepared at the time for immediate transfusion (no
storage available)
• Indications – severe neutropenia assoc with
infection that has failed antibiotic therapy, and
recovery of BM is expected
• Donor is given G-CSF and steroids or Hetastarch
• Complications
– Severe allergic reactions, may transmit CMV
– Can irradiate granulocytes for GVHD prevention
 Human albumin solution (4.5%)
• Useful plasma volume expander when a sustained
osmotic effect is required prior to administration of
blood.
• For fluid replacement in patient undergoing
plasmapheresis and sometimes in selected patient
with hypoalbuminaemia.
Human albumin solution (20%) salt poor
• For severe hypoalbuminaemia especially in liver
disease and nephrotic syndrome. Excessive burn
 Factor VIII freeze-dried concentrate.
• For treating haemophilia A or VWD.Its use is declining
with recombinant factor available.

Freeze –dried factor IX- prothrombin

complex.
• A number of preparations are available that contain
factor II, VIII, IX and X.
• Used for treating Factor IX def, liver disease or
overdose with oral anticoagulant or patient with factor
VIII inhibitiors.
• There is a risk of thrombosis.
Prothrombin Complex Concentrate (PCC)
• contains factors II, IX, and X, and
sometimes also F VII.
• PCC contains trace amounts of activated
coagulation factor and can result in
thrombosis
• Used in
– Haemophilia A with inhibitor antibodies against
F VIII and who are nonresponsive to F VIII
concentrate
– Inherited factor Ix, X and II deficiency
 PCC
• PCCs have replaced frozen plasma as the
product of choice for emergency reversal of
warfarin effect or vitamin K deficiency
• Off label use include the reversal of anti-Xa
inhibitors (Rivaroxaban and Apixiban
• Products available are Octaplex® and
Beriplex®
 Specific Immunoglobulin
• Obtained from donors with high titre of
antibodies, anti-RhD, anti hepatitis B, anti
herpes Zoster or anti-rubella.
Selection of ABO Donor Units
• Questions
• What are the blood group selection for
transfusion of plasma and platelet eg what
blood group can donate plasma to recipient
O
• AB is the only universal plasma to all
recipient