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

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

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 hyperglycemia—stimulation 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-GVHDLymphocytes 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