Component Tx

Familiarization with Blood and Blood Components Abelardo J. Alera, MD, FPSP, FPSMID, MHSA Chief Region VII Blood Center Cebu City

Blood and Blood Components considered drugs because of their use in treating diseases Treat two conditions; •inadequate oxygen carrying capacity (anemia/ blood loss) •inadequate hemostasis (insufficient coagulation proteins/ platelets)

Each patients require individualized plan reflecting the patient’s •changing clinical condition •anticipated blood loss •capacity for compensatory mechanisms •laboratory results

Component therapy •transfusion of the specific blood component needed by the patient •several patients can be treated with the blood from one donor, giving optimal use of every donation of blood

Learning Objectives •Describe the blood components available for therapeutic use •Differentiate the blood components •Discuss the composition of each blood component •Discuss Blood Safety

Rationale for component therapy •Whole blood transfusion rarely necessary •Patient will be better served if given only the specific blood component needed •Need to conserve limited blood resources

Reasons for shortage blood supply •Difficulty in getting a blood donor •Cost incurred •Inappropriate use of blood its components

Some patients do not require transfusion even in anemia or thrombocytopenia because their clinical conditions are stable, they have little/ no risk of adverse outcomes (iron-deficiency anemia with minor symptoms)

Common blood products available for transfusion •Components that contain RBCs •Components that do not contain RBCs •Commercially prepared blood derivatives

I. Components that contain RBCs • Whole blood • Packed red blood cells • Washed red blood cells • Leukocyte-reduced red blood cells • Deglycerolized red blood cells

II. Components that do not contain RBCs •Fresh frozen plasma •Cryoprecipitate •Platelet concentrate •Platelet, pheresis •Granulocyte, pheresis

III. Commercially prepared blood derivatives •Factor VIII concentrate •Factor IX concentrate •Albumin solutions •Plasma protein factors •Immune serum globulin •Rh immune globulin

Fresh whole blood Current practice has no scientific justification for its use EXCEPT: – Exchange transfusion in NB – Massive blood loss

Whole blood •Indication – actively bleeding with loss of 30% of the blood volume •Characteristics – provides both oxygen-carrying capacity and blood volume – RBC and plasma (coagulation factors decrease after 2 days of storage)

Whole blood •Approximate volume – 520 ml (450 ml blood + 63 ml CPDA-1) •Shelf life – 35 days at 1 to 6 degrees centigrade •Effect of transfusion of one unit – increase hematocrit by 1 to 3 %

Packed red blood cells •Indication – to increase oxygencarrying capacity in symptomatic anemia patients •Not to be used – in place of hematinics – to improve general “well-being”

Packed red blood cells •Characteristics – RBC and reduced plasma (20 ml) •Approximate volume – 260 ml (225-350 ml blood + 20 ml residual plasma) •Shelf life – 35 days at 1 to 6 degrees C •Effect of transfusion of one unit – increase in hematocrit by 3%

Washed RBC •Indications – increase red cell mass – used to prevent febrile allergic reactions to leukocyte or plasma proteins •Characteristics – RBCs, no plasma, WBC<5 x 108 – Expiry date: 24 hours

Washed RBC •Preparation – automated or manual method – add NSS to RBCs followed by mixing, centrifugation, removal of supernant saline and plasma solution (repeated until most WBCs, platelets and plasma removed)

Leukocyte-reduced RBC •prepared by filtration of RBCs before or after storage using leukocyte-depleting filters •Indication – prevent febrile non-hemolytic transfusion reaction due to sensitization to leukocyte antigens

Components containing RBC Blood Component (Volume in ml) WB (500-520) PRBC (250-260) Washed RBC (180-250) Leukocyte-reduced RBC (200)

Composition RBC, few WBC and platelets RBC, reduced plasma, few WBC and platelets RBC, no plasma, WBC <5 x 108 > 80% of original RBC, few platelets, WBC <5 x 108

II. Components that do not contain RBC •FFP •Cryoprecipitate •Platelet concentration •Platelets, pheresis •Granulocytes, pheresis

FFP •Indications – bleeding patients with multiple coagulation deficiency problems (DIC, liver diseases) – useful for Factors V and XI deficiency •not to be used as plasma expander or source of protein nutrition (risk of TTIs)

FFP •Characteristics – plasma proteins, coagulation factor – prepared by centrifuging a unit of WB at 4 degrees C. Plasma is separated from the RBC, placed at -18 degrees C or lower, within 8 hours from blood collection •Approximate volume – 200 to 260 ml •Shelf-life -one year at -18 degrees C

Cryoprecipitate •Indications – von Willebrand disease, Factor XIII deficiency, hemophilia A, hypofibrinogenemia •Characteristics – 80 units of F VIII, other plasma proteins, vWF, fibrinogen (150 mg)

Cryoprecipitate •Prepared by thawing (overnight) a unit of FFP between 1 to 6 degrees C, small amount of white precipitate, removal of supernatant plasma •Approximate volume – 10 to 15 ml •Shelf-life – 1 year at -18 degrees C

Platelet concentrate •Random-donor platelets •Indications – platelet disorder, bleeding due to thrombocytopenia •Component preparation – separated within 6 hours of collection of WB that has been kept at room temperature before the separation process

Platelet concentrate •Characteristics – 5.5 x 1010 , few WBC, RBC, 50 ml of plasma – six to ten units raises PC to 50,000/ml •Approximate volume – 50 ml •Shelf-life – 5 days room temperature (20-24 degrees C), constant gentle agitation

Single donor Platelet concentrate •Indication – similar to random-donor platelet •Component preparation – uses a machine that removes WB from a donor, mechanically separates this into desired blood components, remaining fraction is returned to the donor

Components that do not contain RBC Blood Component (volume in ml) FFP (220) Cryoprecipitate (10-15) •Platelet concentrate (50) •Platelets conc, SD (300)

Expiration date 24 hours of thawing 6 hours of thawing Up to 5 days 24 hours of preparation

Approximate time required for preparing for a blood transfusion Procedure Collecting the blood ABO and Rh typing ABO and Rh typing, antibody screening Typing, antibody screening, cross-matching FFP thawing Cryoprecipitate thawing Washing RBCs

Time (minutes)

10-15 10 45 60 40 20 45

Blood transfusion 2. Is it safe? 3. Guarantee it will not cause TTIs?

Safe Blood Transfusion

What to look for..

Look for hemolysis at the line between The red cells and plasma

Look at the red cells. Are they purple or black?

Are there any leaks? Have you squeezed the pack? Look for blood here. Look for large clots in the plasma. Look for hemolysis in the plasma. Is the plasma pink?

Clinical Blood Use Handbook WHO 2004

Who gets the blood? 1 am, only a unit of blood is available 1. 5-year old female child with dengue hemorrhagic fever 2. 79-year old man with prostatic cancer 3. 35-year old woman who underwent C-section 4. 25-year old delivery man from Jollibee who had serious VA 5. 45-year old policeman who was shot by a snatcher 6. 60-year old woman with anemia needing a dialysis

Dili dali mangita ug dugo

Give life… it’s in your blood!