Faculty of Allied Medical Science

Blood Banking (MLBB 201)

Changes that occur in Stored Blood Bags

Prof.Dr Nadia Aly SadekProf. in Haematology and

Director of Blood Bank Centre,Medical Research Inst, University of Alexandria

Presented by: Tamer mohamed allam

Ayman mohamed elsaeed

Changes that occur in Stored Blood Bags

Outcomes By the end of this lecture, the

students will be able to: Know the changes that occur in blood

bags with storage Know what is blood filtration and its

types.

AnticoagulantsCPD or CP2-D

CPD-A1

Storage time

21 days 35 days

Temperature 1-6 C 1-6 CSlows glycolytic activity

Adenine None Substrate for ATP synthesis

Volume 450 +/- 10%Dextrose Supports ATP generation by glycolytic

pathwayCitrate Prevents coagulation by binding

calcium

Additive Solution (AS) Primary bag with satellite bags attached. One bag has additive solution (AS) Unit drawn into CPD anticoagulant

Whole Blood Clinical indications for use of WB are extremely

limited. Used for massive transfusion to correct acute

hypovolemia such as in trauma and shock, exchange transfusion.

RARELY used today, platelets non-functional, labile coagulation factors gone.

Must be ABO identical.

Storage LesionLong storage times of blood bags may

influence the quality of blood that is transfused. During storage, the red cells undergo a number of physical and chemical changes including:

Storage LesionIncreased membrane rigidityLoss of organic phosphatesRelease of pro-inflammatory cytokinesSome changes take place slowly and some take place rapidly.

Consequences of transfusing older blood

1- Increased in-hospital mortality2- Increased rates of sepsis2- Delayed healing of wounds3- Tumor recurrence.

Consequences of transfusing older blood

Immediately after blood donation, the red cells are subjected to an acidic, hypotonic, anticoagulant solution which damages a small proportion of them irreversibly.

Cells that survive the first 24 hours will remain viable for the end of their life spans.

Consequences of transfusing older blood

At least 70% of them remain viable in the recipient’s circulation 24 hours after transfusion.

Granulocytes become non-functional after 24 hours, but still they can cause febrile transfusion reactions.

Consequences of transfusing older blood

Some lymphocytes may remain viable for several weeks.Platelet function declines to zero after 24 hours of storage.

Biochemical changes1- Oxygen affinity increasing the oxygen affinity of

hemoglobin = less release of oxygen to the tissues.

2- ATP There is a time-dependent reduction

in intracellular RBC ATP

Biochemical changes The biochemical changes that occur

in the stored bags leads to alteration in corpuscle shape, decreased deformability, increased aggregability and intracellular viscosity as well as changes in osmotic fragility.

Electrolytes1- Potassium: During storage, there is constant

leak of potassium out of the cells and levels may sometimes exceed 30mmol/L. After transfusion, potassium rapidly enters the red cells as they begin active metabolism.

Plasma hemoglobin

Plasma K+

Viable cellspH

ATP2,3-DPG

Plasma Na+

Helps release oxygen from hemoglobin (once transfused, ATP & 2,3-DPG return to normal)

K+Na+

2 -Calcium Each unit of blood contains 3g.

Citrate which binds ionized calcium. The liver is able to metabolize 3g of citrate every 5 minutes.

In patients with impaired liver function, there is a risk of citrate toxicity and hypocalcemia. It does not affect coagulation but patients may have transient tetany and hypotension.

Acid-Base balance During storage, there is gradual

accumulation of lactic acid with a resultant fall in pH, but it is rapidly metabolized and the citrate by the recipient to bicarbonate which may then produce metabolic alkalosis.

Coagulation Labile coagulation factors i.e. FV and

FVIII have a 50% decrease in activity within the first 72 hours of storage, but the other coagulation factors remain normal.

Study questions1- Complete:- a- Storage produces………..in DPG

and ATP b- Oxygen affinity is……..by storage c- The pH of stored blood………due to

gradual accumulation of …………

Assignments Stem cell transplantation

صالح حصافى سامى

Thank you