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Blood components

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Aditya Sadawarte
Aditya Sadawarte

1. Blood components like red blood cells, platelets, plasma, and granulocytes are collected from whole blood donations or through apheresis and stored under specific conditions. 2. Red blood cells can be stored for 6 weeks with additive solutions or frozen for 10 years, while platelets are stored for 5 days at room temperature with agitation. 3. Transfusion of blood components follows guidelines based on hemoglobin levels, symptoms, and medical conditions to treat anemia, bleeding, or other issues. 4. Potential risks of transfusion include infectious, immunological, and non-infectious acute or delayed complications that can generally be treated with supportive care.

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Blood components
Collection of blood About 450ml-500ml blood collected- antecubital vein Collected in bags pre-filled with anticoagulant ACD & CPD shelf life 21 days(citrate chelates calcium, phosphate and dextrose provide energy) CPD-A 35 days(adenine is an added component, increased production of ATPs for longer shelf life) Donors tested for Hep B, Hep C, HIV I & II Syphilis Some for CMV additional typing such as HLA
Apheresis Blood components are collected selectively from the whole blood donations and remaining blood is returned to the circulation of donor Advantage is that more than one doses of plateletes or red cells can be collected from one donor per donation
Preservation and Storage Whole Blood is processed into its basic components by centrifugation Whole Blood (Primary collection pack)-- centrifugation Manual OR Automated extraction of components (Satellite Pack) Platelet - Whole blood Processed on the same day of collection or stored overnight at 22'c Plasma - processed on the came day or stored at 22'c upto 24 hrs PRBC stored at 4'c for 48 to 72 hrs
Preservation of RBCs: 1)Additive solutions 2)Frozen RBCs
Additive solutions: Whole Blood in primary bag containing CPD-- Plasma is removed into another empty satellite bag-- additive solution added to red cells for improved viability Three types of additive solutions are available AS-1 AS-3 AS-5 Red cells can be stored for 6 weeks at 2-6 'c
Blood components
Frozen RBCs Red cells less than 6 days old frozen rapidly after adding cryo preservative agent containing glycerols Glycerol maintains liquid phase, prevents hypertonicity & damage due to freezing Frozen red cells can be stored for 10 yrs For use thawed and deglycerolised Once thawed should be used within 24hrs RBCs are frozen in autologous transfusion and storage of rare blood group
Special RBC preparations: 1)Leucocytes depleted RBCs 2)Gamma irradiated RBCs 3)Washed RBCs 4)CMV negative RBCs
Leucocyte depletion: Concentration of leucocytes less than 5x10*6 per RBC unit by using special filters Helps in preventing- 1)non hemolytic febrile transfusion reactions, 2)transmission of CMV EBV , 3)transfusion related GVHD and 4)transfusion related acute lung injury (TRALI)
Gamma radiation: To inactivate donor T-cells Used to prevent GVHD in immunossupressed patients, very small babies, in large volume transfusion and during intrauterine transfusion or when donor is related Small babies weight bellow 1.2kg, preferable for any transfusion till 4 months of age Irradiation reduces shelf life of RBCs to 28days, causes hyperkalemia Used with in 4hrs in neonates
Washed RBCs Used to remove plasma and reduce potassium Used in intrauterine transfusion, exchange transfusion, large volume transfusion, patients with immunoglobuline A deficiency
CMV reduced RBCs: CMV reduced RBCs Formed By leucocyte reduction or using CMV negative donors Indicated in neonates and immunocompromised
Guidelines for transfusion of PRBC
Blood components
Term Neonate Condition Hb in gm/dl Severe pulmonary disease <13 Moderate pulmonary disease <10 Severe cardiac disease <13 Major surgery <10 Symptomatic anemia <8
Children and Adolescents Acute loss of >25% of circulating blood volume Hemoglobin <8gm/dl in perioperative period Hb <8 and symptomatic chronic anemia Hb <8 and marrow failure Hb <13 and severe cardiopulmonary disease
How much to give Volume of PRBC =blood volume(ml/kg) x (desired- actual hematocrit) / hematocrit of transfused RBC 5-15ml/kg of PRBC @5ml/kg/hr Should not ideally exceed 4 hrs due increased risk of bacterial contamination Large volume transfusions->20ml/kg Exchange transfusion-160ml/kg replaces 87% of blood
Side Effects of RBC Transfusion 1) Infectious 2) Non-infectious a) Acute Immunological Non immunological b) delayed
Infections Viral infections- HIV, HBV, HCV, CMV risk of post transfusion hep B/C is 10% in adults causes are low viremia, undetected mutant strains Bacterial infections- traponema etc in case of asympomatic bacteremia in donor specially platelets as are stored room temp. Parasites- Plasmodium, Trypanosomes others Prions- Cruetzfold desease-incubation period of approx 6.5years
Non- infectious cause-Acute Immune mediated hemolysis: Antibodies present in patient's plasma react with RBC antigen present in donor blood. Eg. ABO, Rh, other minor group incompatibility Infants less than 4 months do not produce isoagglutinins eg anti A, anti B But hemolysis can occur due to materal antibodies Should be screened for maternal antibodies if non O RBCs are to be given
Immune mediated hemolysis: Signs and symptoms: Fever, Pain at infusion site, Palpitations, giddiness, Tachycardia, Red urine hypotension
Treatment: Stop infusion Hydrate the child- 10-20ml/kg Frusemide Treat hypotension with pressors if needed Infusion of compatible RBCs
Transfusion related acute lung injury (TRALI) Due to interaction of antibodies present in donor plasma with patients histocompatibility(HLA) antigens. Cause non-cadiogenic pulmonary edema Associated with transfusion of whole blood, packed cells, platelets, FFP, IVIG, cryo.
Signs and symptoms: Mostly within the initial 6 hrs of transfusion Dyspnea Cough Fever Tachycardia Hypo/hypertension
Diagnosis: high degree of suspicion Presence of donor serum antibodies cross reacting against the recipient self limiting condition Treatment is mainly supportive Care of ABC
Febrile non-hemolytic transfusion reactions: Due to cytokines released from leucocytes in donor unit Increase in body temperature less than 2 degree Less frequent if product is leucoreduced
Allergic reactions: Due to preformed IgE antibodies in patients plasma against an allergen(protein) in donors plasma. Mild form- hives and wheezing Severe-anaphylaxis-rare Treatment- antihistamines, bronchodilators, corticosteroids RBCs and platelets can be washed
Acute non-immune reactions: 1)Fluid overload- in case of larger volume transfusion. >10-20ml/kg Transfusion in chronically anemic pts 2)Hyperkalemia- potassium levels increase in stored blood. Seen in large vol tx. PRBC is to be washed and reconstituted in FFP before exchange transfusion
3)Hypoglycemia- blood stored in CPD has high glucose content. Initial hyperglycemiastimulation of insulin production ---hypoglycemia after 2-6 hrs. 4)Acid-base problems 5)Hypocalcemia, hypomagnesemia due to binding to citrate 6)Hypothermia- when cool blood is used
Delayed complications: 1)Alloimmunisation: Uncommon before 4 months of age Caused by transfusion of blood products with mismatched highly immunogenic antigens eg Rh 2)Transfusion associated graft versus host disease(TA-GVHD)
TA-GVHD Lymphocytes from donor mount response against the recipient's cells Host is not able to mount response against donor lymphocytes cause they are immunocompromised premature babies, congenital immunodeficiencies, donation in relation, immunosuppressive drugs
Signs and symptoms: Acute GVHD: Develops from 2-5weeks of transfusion Erythematous maculopapular rash, persistent anorexia, vomiting, diarrhoea Increased liver enzymes, bilirubin Chronic GVHD: persists or develops >3 months post transfusion Prevented by leucocyte reduction and irradiation
Platelets RDP: whole blood is subjected to centrifugation SDP: collected by method of plateletpheresis PLT collected fm single donor, repeated 4-6 times. 3x10*11 platelets v/s 0.5x10*10 Stored for 5 days at 22+/-2 C with agitation Washed platelets decreased anaphylaxis but shelf life only 24hrs
Indications of Plt transfusion in non-immune thrombocytopenia in newborn 1) Plt count less than 30,000/cu mm: transfuse all 2) Plt count 30,000-50,000/cu mm: transfuse if a)sick or bleeding newborn b)newborn less than 1000gm or less than 1 week c)previous major bleeding tendency(IVH grade3-4) d)newborns wit concurrent coagulopathy e)requiring surgery or exchange transfusion 3)Plt count 50,000-99,000/cu mm: transfuse if actively bleeding
Transfusion of Plt: Immune- mediated: ITP Platelets indicated only in severe form (<10000) of thrombocytopenia or bleeding along wit IVIG infusion. NAIT: high risk of ICH <50000 plt: IVIG to all <50000 plt and bleeding: antigen negative plt in addition to IVIG
Dose: 5ml/kg should raise count by 30,000/cu mm Recommended: 1 unit of platelet per 10 kg body weight
Granulocytes: Indications: severe sepsis, funfal inf not responding to antibiotics, Severe neutropenia or dysfunctional neutrophils Dosing: 10-15ml/kg may need to be repeated every 12-24 hours Granulocytes should be used within 24hours of collection
FFP: CONTAINS: 1unit/ml of each coagulation factor Plasma proteins and antibodies Indications: coagulopathies DIC Vit K def bleeding Inherited deficiencies of coagulation factors Should not be used for increasing proteins or antibodies as safer, more effective options avbl
S/E as compared with PRBC transfusion Dose: 10-20ml/kg repeated every 8-12 hrs S/E: Hyperkalemia will not occur TRALI more likely Acute hemolytic reactions less likely Citrate induced hypocalcemia can occur
Cryoprecipitate: Contains: 80-100 U of factor viii in 10-25 ml of plasma 300mg fibrinogen Varying amount of factor xiii Von Willebrand factor
Indications: Congenital factor viii deficiency Congenital factor ix deficiency Afibrinogenemia and dysfibrogenemia Von Willebrand disease Dose: 5ml/kg

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Blood components

  • 2. Collection of blood About 450ml-500ml blood collected- antecubital vein Collected in bags pre-filled with anticoagulant ACD & CPD shelf life 21 days(citrate chelates calcium, phosphate and dextrose provide energy) CPD-A 35 days(adenine is an added component, increased production of ATPs for longer shelf life) Donors tested for Hep B, Hep C, HIV I & II Syphilis Some for CMV additional typing such as HLA
  • 3. Apheresis Blood components are collected selectively from the whole blood donations and remaining blood is returned to the circulation of donor Advantage is that more than one doses of plateletes or red cells can be collected from one donor per donation
  • 4. Preservation and Storage Whole Blood is processed into its basic components by centrifugation Whole Blood (Primary collection pack)-- centrifugation Manual OR Automated extraction of components (Satellite Pack) Platelet - Whole blood Processed on the same day of collection or stored overnight at 22'c Plasma - processed on the came day or stored at 22'c upto 24 hrs PRBC stored at 4'c for 48 to 72 hrs
  • 5. Preservation of RBCs: 1)Additive solutions 2)Frozen RBCs
  • 6. Additive solutions: Whole Blood in primary bag containing CPD-- Plasma is removed into another empty satellite bag-- additive solution added to red cells for improved viability Three types of additive solutions are available AS-1 AS-3 AS-5 Red cells can be stored for 6 weeks at 2-6 'c
  • 8. Frozen RBCs Red cells less than 6 days old frozen rapidly after adding cryo preservative agent containing glycerols Glycerol maintains liquid phase, prevents hypertonicity & damage due to freezing Frozen red cells can be stored for 10 yrs For use thawed and deglycerolised Once thawed should be used within 24hrs RBCs are frozen in autologous transfusion and storage of rare blood group
  • 9. Special RBC preparations: 1)Leucocytes depleted RBCs 2)Gamma irradiated RBCs 3)Washed RBCs 4)CMV negative RBCs
  • 10. Leucocyte depletion: Concentration of leucocytes less than 5x10*6 per RBC unit by using special filters Helps in preventing- 1)non hemolytic febrile transfusion reactions, 2)transmission of CMV EBV , 3)transfusion related GVHD and 4)transfusion related acute lung injury (TRALI)
  • 11. Gamma radiation: To inactivate donor T-cells Used to prevent GVHD in immunossupressed patients, very small babies, in large volume transfusion and during intrauterine transfusion or when donor is related Small babies weight bellow 1.2kg, preferable for any transfusion till 4 months of age Irradiation reduces shelf life of RBCs to 28days, causes hyperkalemia Used with in 4hrs in neonates
  • 12. Washed RBCs Used to remove plasma and reduce potassium Used in intrauterine transfusion, exchange transfusion, large volume transfusion, patients with immunoglobuline A deficiency
  • 13. CMV reduced RBCs: CMV reduced RBCs Formed By leucocyte reduction or using CMV negative donors Indicated in neonates and immunocompromised
  • 16. Term Neonate Condition Hb in gm/dl Severe pulmonary disease <13 Moderate pulmonary disease <10 Severe cardiac disease <13 Major surgery <10 Symptomatic anemia <8
  • 17. Children and Adolescents Acute loss of >25% of circulating blood volume Hemoglobin <8gm/dl in perioperative period Hb <8 and symptomatic chronic anemia Hb <8 and marrow failure Hb <13 and severe cardiopulmonary disease
  • 18. How much to give Volume of PRBC =blood volume(ml/kg) x (desired- actual hematocrit) / hematocrit of transfused RBC 5-15ml/kg of PRBC @5ml/kg/hr Should not ideally exceed 4 hrs due increased risk of bacterial contamination Large volume transfusions->20ml/kg Exchange transfusion-160ml/kg replaces 87% of blood
  • 19. Side Effects of RBC Transfusion 1) Infectious 2) Non-infectious a) Acute Immunological Non immunological b) delayed
  • 20. Infections Viral infections- HIV, HBV, HCV, CMV risk of post transfusion hep B/C is 10% in adults causes are low viremia, undetected mutant strains Bacterial infections- traponema etc in case of asympomatic bacteremia in donor specially platelets as are stored room temp. Parasites- Plasmodium, Trypanosomes others Prions- Cruetzfold desease-incubation period of approx 6.5years
  • 21. Non- infectious cause-Acute Immune mediated hemolysis: Antibodies present in patient's plasma react with RBC antigen present in donor blood. Eg. ABO, Rh, other minor group incompatibility Infants less than 4 months do not produce isoagglutinins eg anti A, anti B But hemolysis can occur due to materal antibodies Should be screened for maternal antibodies if non O RBCs are to be given
  • 22. Immune mediated hemolysis: Signs and symptoms: Fever, Pain at infusion site, Palpitations, giddiness, Tachycardia, Red urine hypotension
  • 23. Treatment: Stop infusion Hydrate the child- 10-20ml/kg Frusemide Treat hypotension with pressors if needed Infusion of compatible RBCs
  • 24. Transfusion related acute lung injury (TRALI) Due to interaction of antibodies present in donor plasma with patients histocompatibility(HLA) antigens. Cause non-cadiogenic pulmonary edema Associated with transfusion of whole blood, packed cells, platelets, FFP, IVIG, cryo.
  • 25. Signs and symptoms: Mostly within the initial 6 hrs of transfusion Dyspnea Cough Fever Tachycardia Hypo/hypertension
  • 26. Diagnosis: high degree of suspicion Presence of donor serum antibodies cross reacting against the recipient self limiting condition Treatment is mainly supportive Care of ABC
  • 27. Febrile non-hemolytic transfusion reactions: Due to cytokines released from leucocytes in donor unit Increase in body temperature less than 2 degree Less frequent if product is leucoreduced
  • 28. Allergic reactions: Due to preformed IgE antibodies in patients plasma against an allergen(protein) in donors plasma. Mild form- hives and wheezing Severe-anaphylaxis-rare Treatment- antihistamines, bronchodilators, corticosteroids RBCs and platelets can be washed
  • 29. Acute non-immune reactions: 1)Fluid overload- in case of larger volume transfusion. >10-20ml/kg Transfusion in chronically anemic pts 2)Hyperkalemia- potassium levels increase in stored blood. Seen in large vol tx. PRBC is to be washed and reconstituted in FFP before exchange transfusion
  • 30. 3)Hypoglycemia- blood stored in CPD has high glucose content. Initial hyperglycemiastimulation of insulin production ---hypoglycemia after 2-6 hrs. 4)Acid-base problems 5)Hypocalcemia, hypomagnesemia due to binding to citrate 6)Hypothermia- when cool blood is used
  • 31. Delayed complications: 1)Alloimmunisation: Uncommon before 4 months of age Caused by transfusion of blood products with mismatched highly immunogenic antigens eg Rh 2)Transfusion associated graft versus host disease(TA-GVHD)
  • 32. TA-GVHD Lymphocytes from donor mount response against the recipient's cells Host is not able to mount response against donor lymphocytes cause they are immunocompromised premature babies, congenital immunodeficiencies, donation in relation, immunosuppressive drugs
  • 33. Signs and symptoms: Acute GVHD: Develops from 2-5weeks of transfusion Erythematous maculopapular rash, persistent anorexia, vomiting, diarrhoea Increased liver enzymes, bilirubin Chronic GVHD: persists or develops >3 months post transfusion Prevented by leucocyte reduction and irradiation
  • 34. Platelets RDP: whole blood is subjected to centrifugation SDP: collected by method of plateletpheresis PLT collected fm single donor, repeated 4-6 times. 3x10*11 platelets v/s 0.5x10*10 Stored for 5 days at 22+/-2 C with agitation Washed platelets decreased anaphylaxis but shelf life only 24hrs
  • 35. Indications of Plt transfusion in non-immune thrombocytopenia in newborn 1) Plt count less than 30,000/cu mm: transfuse all 2) Plt count 30,000-50,000/cu mm: transfuse if a)sick or bleeding newborn b)newborn less than 1000gm or less than 1 week c)previous major bleeding tendency(IVH grade3-4) d)newborns wit concurrent coagulopathy e)requiring surgery or exchange transfusion 3)Plt count 50,000-99,000/cu mm: transfuse if actively bleeding
  • 36. Transfusion of Plt: Immune- mediated: ITP Platelets indicated only in severe form (<10000) of thrombocytopenia or bleeding along wit IVIG infusion. NAIT: high risk of ICH <50000 plt: IVIG to all <50000 plt and bleeding: antigen negative plt in addition to IVIG
  • 37. Dose: 5ml/kg should raise count by 30,000/cu mm Recommended: 1 unit of platelet per 10 kg body weight
  • 38. Granulocytes: Indications: severe sepsis, funfal inf not responding to antibiotics, Severe neutropenia or dysfunctional neutrophils Dosing: 10-15ml/kg may need to be repeated every 12-24 hours Granulocytes should be used within 24hours of collection
  • 39. FFP: CONTAINS: 1unit/ml of each coagulation factor Plasma proteins and antibodies Indications: coagulopathies DIC Vit K def bleeding Inherited deficiencies of coagulation factors Should not be used for increasing proteins or antibodies as safer, more effective options avbl
  • 40. S/E as compared with PRBC transfusion Dose: 10-20ml/kg repeated every 8-12 hrs S/E: Hyperkalemia will not occur TRALI more likely Acute hemolytic reactions less likely Citrate induced hypocalcemia can occur
  • 41. Cryoprecipitate: Contains: 80-100 U of factor viii in 10-25 ml of plasma 300mg fibrinogen Varying amount of factor xiii Von Willebrand factor
  • 42. Indications: Congenital factor viii deficiency Congenital factor ix deficiency Afibrinogenemia and dysfibrogenemia Von Willebrand disease Dose: 5ml/kg