Blood and Blood Component Maziar Mojtabavi Naini M

Blood and Blood Component Maziar Mojtabavi Naini M. D. Hematologist and Oncologist

Blood Products

Whole Blood

Whole Blood Description: • • Up to 510 ml total volume 450 ml donor blood 63 ml anticoagulant-preservative solution Haemoglobin approximately 12 g/ml Haematocrit 35%– 45% No functional platelets No labile coagulation factors (V and VIII)

Indications • Red cell replacement in acute blood loss with hypovolaemia • Exchange transfusion • Patients needing red cell transfusions where red cell concentrates or suspensions are not available

Contraindications Risk of volume overload in patients with: • Chronic anaemia • Incipient cardiac failure

RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-reduced blood’) Description • 150– 200 ml red cells from which most of the plasma has been removed • Haemoglobin approximately 20 g/100 ml • Haematocrit 55%– 75%

General guidelines • Hb and Hematocrit: There is no an absolute acceptable level for all patients exists. But the concept of, transfusion is only indicated when Hb <7 g/dl, has been general accepted in most of the countries in the world. • Clinical data: Clinical data like age, function of the end organs, sepsis, causes of anemia etc, should be evaluated first at all. • Acute blood loss: Blood transfusion is indicated when adequate fluid resuscitation has failed to: a) correct intravascular volume depletion b) relieve symptoms c) stabilize vital signs • Chronic blood loss: Blood transfusion is only indicated to relieve symptoms when appropriate medical measures to improve red cell mass have been inadequate. • Patient under anesthesia: Blood transfusion should be based upon stability of vital signs.

Indications: • Acute blood loss (> 1000 ml within few hours) ± symptoms of hypovolemic shock • Perioperative with intra-operative blood loss > 750 ml • Perioperative with Hb < 8 g / dl

Frozen RBCs • Add cryoprotectant glycerol to RBCs followed by appropriate freezing (-65°C or lower) allows storage of RBCs for 10 years. • When Cells needed, unit thawed and washed with saline to remove glycerol. Washing “enters” storage bag-unit can be stored for only 24 hours at 1° to 6°C after thawing. • Used primarily to maintain supplies of uncommon RBC phenotypes needed by patients with alloantibodies against frequently occurring RBC antigens • Military uses to maintain emergent blood supplies.

Leukocyte Poor RBCs Leukocyte-Reduced Red Blood Cells Ø All blood donations have the white cells removed (>99. 99%) Description • A red cell suspension or concentrate containing <5 x 106 white cells per pack, prepared by filtration through a leucocytedepleting filter • Haemoglobin concentration and haematocrit depend on whether the product is whole blood, red cell concentrate or red cell suspension • Leucocyte depletion significantly reduces the risk of transmission of cytomegalovirus (CMV)

Indications • Minimizes white cell immunization in patients receiving repeated transfusions but, to achieve this, all blood components given to the patient must be leucocyte-depleted • Reduces risk of CMV transmission in special situations • Patients who have experienced two or more previous febrile reactions to red cell transfusion

Contraindications • Will not prevent graft-vs-host disease: for this purpose, blood components should be irradiated where facilities are available (radiation dose: 25– 30 Gy)

Washed RBCs • Washed RBCS are RBCs washed with saline to remove most of the plasma. • Washed RBCs are not leukoreduced. • Indications-patients who have had severe allergic reactions associated with transfusion or immunoglobulin A (Ig. A) deficiency. • Washed RBCs must be given through a standard blood filter, can transmit hepatitis and other infectious diseases • Because bag must be entered to introduce saline, washed RBCs must be given within 24 hrs of preparation.

IRRADIATED BLOOD COMPONENTS Irradiated blood products are exposed to approximately 2500 rads of Gamma radiation to destroy the lymphocyte ’s ability to divide. Transfusion-associated graft-versus-host disease (TA-GVHD) has not been reported from transfusion of cryoprecipitate or fresh frozen plasma (FFP), thus these components do not require irradiation. Fresh plasma (never frozen) for transfusion should be irradiated if the patient is at risk for TA-GVHD.

Indications Ø Absolute Indication: 1. bone marrow transplant (BMT) recipients (allogeneic, autologous) 2. Cellular (T-cell) Immune Deficiency (congenital or acquired) 3. Intrauterine transfusion 4. Transfusions from family members (any degree) 5. Directed donors (when not identified as family members versus friends) 6. HLA-matched platelet transfusions

Ø 1. 2. 3. 4. 5. 6. Appropriate Indication: hematologic malignancies (leukemias) Hodgkin’s Disease Non-Hodgkin’s Lymphoma Neonatal exchange transfusion Premature infants Certain solid tumors (neuroblastoma, glioblastoma) Therapeutic Effect Irradiation destroys the ability of transfused lymphocytes to respond to host foreign antigens thereby preventing graft vs. host disease in susceptible recipients.

FFP

Description • Pack containing the plasma separated from one whole blood donation within 6 hours of collection and then rapidly frozen to – 25°C or colder • Contains normal plasma levels of stable clotting factors, albumin and immunoglobulin • Factor VIII level at least 70% of normal fresh plasma level

FFP • Need ABO Compatibility, but Rh Neg patients can receive Rh Pos FFP

Indications • Replacement of multiple coagulation factor deficiencies: e. g. —Liver disease —Warfarin (anticoagulant) overdose —Depletion of coagulation factors in patients receiving large volume transfusions • Disseminated intravascular coagulation (DIC) • Thrombotic thrombocytopenic purpura (TTP)

Precautions • Acute allergic reactions are not uncommon, especially with rapid infusions • Severe life-threatening anaphylactic reactions occasionally occur • Hypovolaemia alone is not an indication for use

Cryoprecipitate

Description • Prepared from fresh frozen plasma by collecting the precipitate formed during controlled thawing at +4°C and resuspending it in 10– 20 ml plasma • Contains about half of the Factor VIII and fibrinogen in the donated whole blood: e. g. Factor VIII: 80– 100 iu/pack; fibrinogen: 150– 300 mg/pack; factor XIII: 40 to 60 U/pack

Cryoprecipitate • Shelf life-Frozen: 1 yr (<– 30°C) Thawed: Give within 6 hours • Preferable to be ABO compatible (AABB) May have RBC fragments that can sensitize Rh-D neg patients

Indications • As an alternative to Factor VIII concentrate in the treatment of inherited deficiencies of: — von Willebrand Factor (von Willebrand’s disease) — Factor VIII (haemophilia A) — Factor XIII • As a source of fibrinogen in acquired coagulopathies: e. g. disseminated intravascular coagulation

Platelets

Description Random donor unit in a volume of 50– 60 ml of plasma should contain: • At least 55 x 109 platelets • <1. 2 x 109 red cells • <0. 12 x 109 leucocytes

Unit of issue May be supplied as either: • Random donor unit: platelets prepared from one donation • Pooled unit: platelets prepared from 4 to 6 donor units ‘pooled’ into one pack to contain an adult dose of at least 240 x 109 platelets • Apheresis platelets: Collected from an individual donor during 2 -3 hours apheresis procedure. Volume: 200 -300 ml/unit Platelet count: 300 x 109

Indications • Treatment of bleeding due to: — Thrombocytopenia — Platelet function defects • Prevention of bleeding due to thrombocytopenia, such as in bone marrow failure

Contraindications • Not generally indicated for prophylaxis of bleeding in surgical patients, unless known to have significant preoperative platelet deficiency • Not indicated in: — Idiopathic autoimmune thrombocytopenic purpura (ITP) —Thrombotic thrombocytopenic purpura (TTP) — Untreated disseminated intravascular coagulation (DIC) — Thrombocytopenia associated with septicaemia, until treatment has commenced or in cases of hypersplenism

Platelet Transfusion: Response evaluation to plt transfusion: Corrected Count Increment: ( CCI) CCI= Plt increment multiply BSA/ Number of plt transfused

Platelet Transfusion: Response Evaluation: CCI must be at least 7500 one hour and 4500 , 20 hours after transfusion. So if it doesn’t occur we can say that patient has platelet resistance.

Dosage • 1 unit of platelet concentrate/10 kg body weight: in a 60 or 70 kg adult, 4– 6 single donor units containing at least 240 x 109 platelets should raise the platelet count by 20– 40 x 109/L • Increment will be less if there is: — Splenomegaly — Disseminated intravascular coagulation — Septicaemia