1. BLOOD COMPONENTS
Prepared by Emmanuel H. Ndaki Lab Scientist (components prep) Head of Lab, Lake Zone Blood Transfusion center Mwanza. 23 November 2017

2. Contents Blood components, Description -Contents of each -Types
-Production technique
-Available products in LZBTC
-Indication for each component
-Administration principles.

3. What is blood components?
Therapeutic components of blood
Red cell
White cells
Platelets and
Plasma
.That can be prepared from a unit of whole blood by centrifugation, filtration, and freezing using conventional blood bank methodology,

5. Blood for component preparation should be collected in double or triple blood bag

6. Blood components – why should be used?
Transfusion therapy in the past was largely dependent on the use of whole blood. While whole blood may still be used in certain limited circumstances, the thrust of modern transfusion therapy is to use the specific component that is clinically indicated.

7. Blood components – why should be used?
Refers to the transfusion of the specific part of blood that the patient needs,as opposed to the routine transfusion of whole blood. Because one donated unit can benefit several patiets so this procedure,
Conserves blood resourses
One unit of blood can serve more than one partient
A concentrated form of the required fraction can be administered

8. Advantage of using blood components
The risk of circulatory overload is reduced: – eg hemolytic anaemia in malaria, partient undergone cardiac surgical procedures.
Many partients can be treated effectively from a single unit of blood according to their needs.
Production technique
A unit of whole blood can be processed through a series of centrifugation into the required blood components.

9. Packing of whole blood units prior centrifugation

10. After centrifugation of whole blood into required components.

11. Production technique

12. Production technique
Blood components may be prepared during collection using APHERESIS technology which is the method of obtaining one or more blood components by machine processing of whole blood in which the residual components of the blood are returned to the donor during or at the end of the process.

13. Apheresis blood donation

14. Separation of whole blood to required components after centrifugation

15. The basic componet prepared from a unit of whole blood.
Red blood cells concentrates (packed red cells)
Plateletes concentrate
Fresh frozen plasma(ffp)
The plasma can also be used to manufacture blood derivatives eg. – concentrates of coagulation factors,and immune globulin.
Cryoprecipitate

16. Whole blood.

17. Whole blood.
A unit of whole blood is app. 500mls of blood and 63 mls of anticoagulants/preservatives
With hematocrit of 36% to 44%
Storage is 2 to 6 c
Life shelf depends to the type of anticoagulants used,eg cpda stored for 35days
Whole blood stored longer than 24 hrs contain few viable platelets or

18. Whole blood continued……
Granulocytes,
Factor v(proaccelerin) and factor viii(antihaemophilic globulin) labile factors decrease with storage.

19. Whole blood
Rapid deterioration of factor viii, leucocytes and platelets makes whole blood unsuitable product for treatment of haemostatic disturbances when stored beyond 24 hrs. Upon further liquid storage a number of changes occur, such as increase of oxygen affinity, loss of viability of the red cells, loss of coagulation factors activity(factor viii and v), loss of platelets viability and function.

20. Whole blood
Formation of microaggregates, release of intracellular components such as potassium and leukocytes protease and activation of plasma factors such as kallikrein.

21. Indications of whole blood
Exchange transfusion in neonates
Can be used in absence of PRBCs for patient with acute blood loss and hypovolaemia
In open heart surgery with patients on heart lung machine.
Used also in massive transfusion.

22. Administration Principles for whole blood.
Delivered blood must be compatible, whole blood,PRC must be ABO and Rh-D compatible with the recipient.
The dose of whole blood is given by volume needed (mls)= (Hb desired-Hb current)x weight of the patient (kg)x4 constant OR 20mls/kg
It must be stored in the refrigerator at 2- 60c and transfusion should be started

23. Administration principles for whole blood.
Within 30 minutes after removal from the refrigerator and completed within 4 hrs of commencement.
If additional transfusion are required and the time period since the last transfusion is more than 72 hrs, a new sample shall be submitted to perform compatibility testing.

24. Packed red blood cells

25. Packed red blood cells
Rbcs are prepared from whole blood by centrifugation by the removal of 200 to 250ml of plasma or may be obtained by apheresis collection
Stored at 2 to 60 c
Have hematocrit of 60% to 80% the high hematocrit results in increase visicosity.
A shelf life of 35 days when stored in cpda .

26. Packed red blood cells
The great part of its leucocytes x109/L and a varying content of platelets.
A unit contain an average of 50 mls of plasma and up to 42-80gm of hemoglobin depending on the hemoglobin level of the donor.
If nutrient solution is added, with maximal plasma removal, the shelf life can be prolonged to 42 days at 2-60c.

27. Packed red blood cells.
Dose of one unit compatible red blood cells will increase the hemoglobin level in an average sized adult who is not bleeding or hemolyzing by approximately 1gm/dl or Hct by3%.
In neonates, a dose of 10-15mls/kg is generally given, and will increase the hemoglobin by about 3gm/dl.

28. General indications for (PRBCs)
Prbc are indicated for patients with symptomatic deficiency of oxygen- carrying capacity or tissue hypoxia due to an inadequate circulating red cell mass.
They are also indicated for exchange transfusion (eg, hemolytic disease of a new born) and
Red cells exchange(eg, for acute chest syndrome in sickle cell disease)

29. Specific indications of Prbcs include
Chronic anaemia patients
Haemoglobin of <5gm/dl in patients with symptoms of cardiac or respiratory distress.
Pre radiotherapy patients with haemoglobin value of less than 10gm/dl
Pre and post chemotherapy patients with hemoglobin < 9gm/dl
Patients admitted to ICU With hemoglobin value of less than 7gm/dl.

30. Specific indications of Prbcs include
Acute blood loss patients
General surgery patients and
In cardiac patients

31. Administration principles of PRBCs
Compatibility; PRBCs blood must be ABO & Rh compatible with the recipient and both blood group O negative and O positive are considered to be universal blood type, can be given to patient with any other type.
The dose of PRBCs is given by volume needed (mls) = (Hb desired – Hb current) x weight of patient (kg) x 4 (constant) OR
10 mls/kg for PRBC.

32. Fresh frozen plasma (ffp)

33. Label printing of blood product.

34. Fresh frozen plasma (ffp)
FFP is prepared from whole blood by separating and freezing the plasma within hrs of phlebotomy may also be obtained by using apheresis procedures.
Under these condition loss of factor v and viii the labile clotting factors is minimal
Can be stored for 1 year at – 18c or colder

35. Fresh frozen plasma (ffp)
Approximately ffp contains mls of plasma separated from one unit of whole blood.
FFP contain all the clotting factors in normal physiological levels (from fibrinogen to fibrin)
Thawed ffp contains normal coagulation factor levels up to 5 days except for factors viii(75-86% of normal)

36. Indications of fresh frozen plasma(ffp)
And factor v (84-91% of normal).
Indication;
Congenital single factor deficiency eg, Haemophilia(if no factor concentrate available)
Vitamin K deficiency associated with active bleeding.
Used in treatment of Haemorrhagic Disease of the Newborn;use ffp & intravenous vitamin K.

37. Indications of fresh frozen plasma(ffp
Reversal of warfarin if the patient is bleeding.
Thrombotic Thrombocytopenic Purpura (TTP) or haemolytic uremic syndrome (HUS).
Replacement of multiple clotting factor deficiencies in bleeding patients who have significant coagulopathy(defined as PT>18 sec, or PTT>55 sec) due to multiple factor deficiencies, eg massive transfusion, DIC, vitamin K deficiency.

38. Administration principles for FFP
NB. Don’t use ffp as volume expanders, plasma exchange, replacement in protein losing states and nutritional support. -Compatibility; No compatibilty testing required. -The first choice of ffp is that of the same ABO group as that of the patient, if not avalable, ffp of different ABO group is acceptable, provided anti-A and anti-B titre is low.

39. Administration principles for FFP
AB plasma is the universal plasma and should be used in neonates if ABO compatible ffp is not available. Group O ffp should especially be avoided in non- group O neonates.
The dose; ffp dose is 10-20ml/kg (4-6 units for an adult) to achieve minimum of 30% of plasma clotting factor. For the treatment of warfarin reversal 5-8ml/kg will be sufficient.

40. Administration principles for FFP
Thaw ffp in water bath at c for min and commence transfusion immediately after thawing or within 30 min after thawing. Infuse ffp as rapid as can be tolerated by the patient and complete infusion within min. Ffp expires 24 hrs post-thawing.

41. Plateletes concentrate
Prepared from individual units of whole blood by centrfugation
Units should contain atleast 5.5 x109/L
Volume of platelates concentrate is 50 to 70ml
Life shelf is 5 days
Storage is room temperature 20 to 220c with constant gently agitation

42. Indications for platelet transfusions
Transfusion of platelet concentrates is standard Rx for bleeding associated with thrombocytopenia and/or defective platelet function in conditions such as
Bone marrow failure e.g. aplastic anaemia, acute Leukaemia.
Massive transfusion with dilutional thrombocytopenia.
Acute disseminated intravascular coagulation.
Congenital disorders of platelet function.

43. Cryoprecipitate
A component containing the cryoglobulin fraction of plasma obtained by further processing of fresh frozen plasma prepared from hard spin cell free plasma and concentrated to a final volume of up to 40 ml.
Contain a major portion of the factor viii, von willebrand factor, fibrinogen, factor xiii and fibronectin present in freshly drawn and separated plasma.

44. Available products in LZBTC
Whole blood
Packed red cells
Platelets concentrates &
Fresh frozen plasma ( FFP)
Pediatrics packs of whole blood & packed red cells

45. References
Principles and practice in immunohematology second edition by Eva D. QUINLEY
Guide to the preparation, use and quality assurance of blood components (European countries)
Clinical guideline for appropriate use of blood and blood products (MoHsW- Tanzania.

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