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Compendium Blood banking/transfusion > Blood components > Flashcards

Flashcards in Blood components Deck (24)
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1

Whole blood 

  • Composition
  • Volume
  • Indications and contraindications
  • Storage conditions
  • Storage time

  • Composition
    • RBCs (hct 40%)
    • plasma 
    • WBC
    • platelets
  • Volume
    • 500 ml
  • Indications and contraindications
    • I: need for increase in RBC mass and plasma volume
    • Relative CI: volume overload
  • Storage conditions
    • 1-6 degrees
  • Storage time
    • varies with preservative
      • citrate phosphate dextrose (CPD), ACD, CP2D
        • 21 days
        • 70% hct
        • whole blood or RBC
      • Citrate dextrose adenine-1
        • 35 days
        • 70% hct
        • whole blood or RBC

2

RBCs

  • Composition

  • Volume

  • Indications and contraindications

  • Storage conditions

  • Storage time

  • Composition

    • RBCs (hct 55-80%)

      • random donor pRBC: hct must be <80%

      • apheresis RBCs: hgb must be >50 g (150 ml of red cell volume) in at least 95% of units tested

    • minimal plasma

    • each ml of red cells contains ~1 mg of iron (a unit of pRBC contains ~200 mg iron)

    • WBC

    • platelets

    • preservative solution

  • Volume

    • 300 ml

  • Indications and contraindications

    • I: symptomatic anemia

    • Relative CI: AIHA or hyperhemolysis in SCD patients

  • Storage conditions

    • 1-6 degrees within 8 hours of collection and for duration of storage

    • 1-10 degrees during transport

  • Storage time

    • Varies with preservative

    • 21 days for CPD, ACD, CP2D

    • 35 days for CPDA-1

    • 42 days for Additive solutions (AS-1, AS-3, AS-5), added to CPD

      • 60% hct

      • must be added within 72 hours of collection 

      • only used for RBCs

    • if system is opened ("spiked") then the product expires in 24 hours when refrigerated or 4 hours at room temperature

3

Frozen RBCs

Composition

Volume

Indications and contraindications

Storage conditions

Storage time

  • Composition

    • RBCS and 40% glycerol

  • Volume

    • 250 ml

  • Indications and contraindications

    • same as RBCs

    • usually rare blood groups are frozen

  • Storage conditions

    • less then or equal to -65 degrees

  • Storage time

    • 10 years frozen

    • 24 hours following thawing

4

Irradiated RBCs

Composition

Volume

Indications and contraindications

Storage conditions

Storage time

  • Composition

    • RBCs

  • Volume

    • 250 ml

  • Indications and contraindications

    • Same as RBCs

    • irradiate to prevent TA-GVHD

  • Storage conditions

    • 1-6 degrees

  • Storage time

    • 28 days or original expiration, whichever is first

5

Platelets (random donor)

Composition

Volume

Indications and contraindications

Storage conditions

Storage time

  • Composition

    • Platelets (>5.5 x 1010)

    • minimal plasma

    • WBC

    • RBC (<0.5 ml)

    • 80 mg fibrinogen

    • pH>=6.2

  • Volume

    • 50 ml

  • Indications and contraindications

    • I: bleeding in thrombocytopenia or prophylactic transfusion for severely thrombocytopenic patietns

      • threshold of 10,000 /uL in absence of fever, sepsis, coagulopathy, hypersplenism, and lesions that pose risk of bleeding

      • in bleeding patient with thrombocytopenia give platelets when count is <50,000 for extracranial bleeds and 100,000 for intracranial bleeding

      • surgical patients should have at least 50,000 for non CNS and 100,000 for neurosurgery

      • some role for platelets in Glanzmann, Bernard-Soulier, aspirin, and renal failure

      • in renal failure a trial of DDAVP or cryoprecipitate is first indicated

    • Relative CI: ITP

    • Absolute CI: HIT, TTP

  • Storage conditions

    • 20-24 degrees

    • constant gentle agitation

    • may go without gentle agitation for 24 hours

  • Storage time

    • 5 days 

    • 4 hours after pooling

6

Apheresis platelets

Composition

Volume

Indications and contraindications

Storage conditions

Storage time

  • Composition

    • platelets >3 x 1011

    • reduced plasma

    • 150 mg fibringoen

    • WBC

    • RBC < 2 ml

  • Volume

    • 100 ml

    • volume is 6x that of single donor derived unit

  • Indications and contraindications

    • same as random donor platelets

    • use of single donor minimizes alloimmunization

  • Storage conditions

    • 20-24 degrees

    • constant gentle agitation

    • may go 24 hours without agitation

  • Storage time

    • 5 days

7

FFP

Composition

Volume

Indications and contraindications

Storage conditions

Storage time

Dosing

  • Composition

    • plasma separated within 8 hours of collection from platelets (all coagulation factors)

    • 2 mg fibrinogen

  • Volume

    • 200 ml

  • Indications and contraindications

    • I: multiple coagulation factors deficiency, PT/PTT >1.5 x midrange of normal

      • PT or PTT that is 1.5x normal (or INR that is 2x normal)

      • in cases of single factor deficiency

        • recombinant factor or factor concentrate is preferred

        • if above not available, cryo is 2nd choice

        • plasma is the 3rd choice

      • warfarin skin necrosis

      • plasma is option of last resort to reverse warfarin

    • treatment of C1 esterase inhibitor deficiency

    • replacement solution in plasma exchange for TTP

    • Relative CI: IgA deficiency

  • Storage conditions

    • less than -18 degrees

    • plasma not frozen within 8 hours may be frozen within 24 hours (FP24)

      • decreased factors V and VIII

      • useful for all indications for FFP except DIC

  • Storage time

    • 1 year 

    • if stored at less than -65 degrees, then can be stored for 7 years

    • must be thawed at 30-37 degrees

    • expires after 24 hours once thawed

  • Dosing

    • 2 units at a time (10-15 ml/kg)

    • given no more than 3 hours before an invasive procedure

    • should increase factor activity by 20%

    • given through 170 um filter

    • shouldbe compatible with recipient red cells

    • donor Rh type should not affect product choice and there is no need to give RhIg

8

Cryoprecipitate AHF (antihemophilic factor)

Composition

Volume

Indications and contraindications

Storage conditions

Storage time

Dosing

t1/2 of factor VIII

  • Composition

    • cold insoluble portions of plasma

      • when FFP is thawed to 1-6 degrees then centrifuged, a precipitate (cold insoluble portion) forms and must be placed in -18 degrees within 1 hour

    • must conatin at least 150 mg of fibrinogen and 80 IU of factor VIII

    • factor XIII

    • vWF

  • Volume

    • 15 ml

  • Indications and contraindications

    • I: deficient fibrinogen or factors VIII, XIII, vWF when safer coagulation factors are not available

      • e.g., hemophilia A (factor VIII deficiency) or factor XIII deficiency

      • e.g., fibrinogen deficiency (DIC)

        • should not be used alone in DIC because it lacks factor V (should also give FFP)

    • bleeding in uremic patients

    • vW disease (first line treatment is DDAVP)

    • fibrin "glue"

  • Storage conditions

    • less than -18 degrees

  • Storage time

    • 1 year in the freezer

    • after thawing, cryo expires in 6 hours unless pooled, in which case it expires in 4 hours

  • Dosing

    • 1 unit of cryo can raise fibrinogen by 7 mg/dl (so 10 pooled cryo units raises it by 70)

    • 10 bags, pooled is dose for adults

    • half life of factor VIII is 12 hours

9

Apheresis granulocytes

Composition

Volume

Indications and contraindications

Storage conditions

Storage time

Dosing

  • Composition

    • granulocytes > 1 x 1010

    • contaminating red cells

    • large number of platelets

    • 1010 WBCs

  • Volume

    • 200 ml

  • Indications and contraindications

    • I: neutropenic patients with infection unresponsive to standard medical therapy

  • Storage conditions

    • 20-24 degrees

  • Storage time

    • 24 hours

  • Dosing

    • no agreed upon dose

    • units should be ABO crossmatch compatible with recipient 

    • units should be irradiated

    • units should never be leukoreduced

10

Anticoagulant preservation solutions

  • blood is collected into bags containing ~60 ml of anticoagulant preservative solution
  • all contain dextrose as a carbohydrate source for ATP production
  • CPDA contains adenine (for ATP), citrate, and sodium phosphate (a pH buffer)
  • additive solutions (AS-1, AS-3, AS-5, etc.) contain different concentrations of additional dextrose, adenine, buffer, and sodium chloride
  • AS-1 and AS-5 contain mannitol, which has diuretic effect

11

Storage lesion

  • Progressive changes that occur within stored red cells, including
    1. reduced 2,3 DPG
    2. increased free K
    3. reduced ATP
    4. decreased pH
    5. increased free hemoglobin
  • after transfusion normal 2,3 DPG, ATP, and pH are restored within 24 hours

12

Units that have left the blood bank and have been returned may be reissued if?

  • unit has not been spiked
  • unit has been maintained continuously between 1-10 degrees (it takes about 30 minutes for the unit to rise about 10 degrees when not refrigerated)
  • at least 1 segment of sealed tubing remains

13

Preparation of frozen red cells

- temperature, timing of storage

- how to thaw

- expiration

  • Must be frozen within 6 days if no additive solution is present; with additive solution, must be frozen before expiration date appropriate for that solution
  • cryoprotective agents are needed (40% glycerol)
  • stored in -80 degrees and  kept for up to 10 years
  • when thawed
    • washed in hypotonic solutions to remove glycerol
    • stored at 1-6 degrees and must be transfused within 24 hours
    • frozen/deglycerolized red cells are considered both leukoreduced and washed

14

pRBC increases hemoglobin and hct by?

1 unit pRBC increases Hgb by 1 g/dl and hct by 3%

pediatric dose of ~4 ml/kg achieves the same effect

15

preparation of platelets

  • when whole blood is slow centrifuged it separates into RBCs and plasma rich platelets
  • when platelet rich plasma is fast centrifuged the cells separate from plasma
  • apheresis separates plasma from platelets

16

leukoreduced platelets

  • must contain <= 8.3 x 105 leukocytes
  • leukoreduced pheresis platelets must contain <=5x 106 leukocytes

17

Platelet dosing

  • adults are given 4 to 6 pooled random donor platelets (RDP) or 1 single donor apheresis platelet at a time
  • neonates are given 10-15 ml/kg or 1 unit/10 kg
  • expected result in adults of transfusing 1 random donor unit of platelets is an increase in count of 5000/uL; hence the average platelet dose will increase the count by 30,000
  • average platelet lifespan is 9.5 days
  • must be transfused through a 170 um filter
  • platelets need not be crossmatched unless they contain > 2ml of RBCs (visibly bloody)
  • should ABO match in
    • recipients with small blood volumes
    • multiply transfused patients 
    • apheresis units with high titer isohemagglutinins (not routinely measured)
  • Rh matching is recommended for patelets
    • platelets themselves do not bear Rh antigens, but contaminating red cells do
    • if an Rh negative person received Rh+ platelets administration of RhIg shold be considered

18

Hard to remember shelf-lives

  1. RBCs, saline washed or thawed and deglycerized
  2. Thawed FFP
  3. Thawed plasma
  4. Pooled platelets in open system
  5. Pooled platelets in closed system
  6. Thawed cryoprecipitate AHF, unpooled
  7. Thawed and pooled cryoprecipitated AHF in open system

  1. RBCs, saline washed or thawed and deglycerized: 24 hours, refrigerated
  2. Thawed FFP: 24 hours, refrigerated (after 24 hours labeled as thawed plasma)
  3. Thawed plasma: 5 days, refrigerated
  4. Pooled platelets in open system: 4 hours, room temperature
  5. Pooled platelets in closed system: 5 days or shortest outdate of RDP in pool, room temp
  6. Thawed cryoprecipitate AHF, unpooled: 6 hours, room temp
  7. Thawed and pooled cryoprecipitated AHF in open system: 4 hours, room temp

19

Factor VII concentrate uses

  • treatment of inherited factor VII deficiency
  • treatment of patients with anti fVIII or anti fIX inhibitors

20

Factor VIII concentrate

- use

- formulation

- dosing

- intravascular recovery

- t1/2

  • used in treatment and prophylaxis of hemophilia A
  • humate-P formulation contains sufficient vWF to be used in the treatment of von Willebrand disease
  • Dose of fVIII depends upon starting fVIII activity and target fVIII activity
    • 1 IU of fVIII is defined as the activity of fVIII in 1 ml of normal plasma and is the expected activity of 1 ml of pooled plasma
    • intravascular recovery of fVIII is 100%
    • t1/2 is 12 hours

21

Factor IX concentrate

  • fIX is used in hemophilia B
  • Dose calculation similar to fVIII, but:
    • t1/2 = 24 hours
    • intravascular recovery is 50%
    • 30% activity desired: need 15 IU/kg
    • 50% activity desired: need 25 IU/kg
    • 100% activity desired: need 50 IU/kg

22

Irradiated products

  • AABB stipulates that 25 Gy are delivered to the midplane of the product 
  • minimum dose is 15 Gy to any portion of the product
  • For red cells, the storage time becomes 28 days or original outdate
  • Indication: prevention of TA-GVHD in at-risk patients:
    1. BMT recipients/candidates
    2. neonates and fetuses
    3. recipients of blood from relatives
    4. immunosuppressed patients with Hodgkin and non-Hodgkin lymphoma
    5. patients with congenital T cell defects, but not B cell or macrophage defects
    6. patients with aplastic anemia
    7. patients taking chemo with purine analogs (fludarabine, mercaptopurine, thioguanine, cladribine)
    8. recipients of granulocyte transfusion

23

Leukoreduced products

  • filtration is usual method
  • labeled as leukoreduced, 95% of tested units must contain
    • <5 x 106 white cells (RBC and apheresis derived platelets)
    • <8.3 x 105 white cells (whole blood derived platelets)
  • the leukoreduced red cell unit must retain >= 85% of original red cells (whole blood derived) or >=51 grams of hemoglobin (pheresis units)
  • both washed and frozen/deglyced red cells are considered leukoreduced
  • prestorage leukoreduction is more desirable than pretransfusion (bedside) leukoreduction
  • indications
    1. prevention of HLA alloimmunization (platelet refractoriness)
    2. prevention of febrile, nonhemolytic transfusion reactions
    3. prevention of CMV transmission
    4. prevention of transfusion related immune modulation (TRIM)
    • not effective in preventing GVHD

24

Washed products

  • cellular products may be washed to remove plasma and resuspended in normal saline 
  • indication: prevention of recurrent or severe allergic reactions, particularly in IgA deficient recipients
  • may be indicated when transfusing neonates with cellular products bearing incompatible plasma
  • frozen, deglycerized products are considered washed
  • shelf life of washed red cells is 24 hours; platelets last 4 hours