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Blood Components

and Plasma derivatives

The anticoagulants and preservatives that are


added to blood nowadays enable storage for
long periods of time
Before acid-citrate-dextrose (ACD) was used- 21 days

Aseptic separation of blood into cellular &


plasma components by the introduction of
plastic collection systems
Before glass bottles were used

Blood collection
Blood is collected in plastic bag systems
with anticoagulant & preservative
Whole blood can be stored at 4 oC for up to
5 weeks
Whole blood contains many components
Wasteful to give whole blood if only red
cells are needed

Blood Components
Human blood consists of
plasma, in which cells are
suspended
The plasma also contains
other specialised substances,
which are important for blood
clot formation (e.g. clotting
factors)
Whole blood can be separated
at the blood bank into various
components
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BLOOD COMPONENTS
Blood separated into different parts:
1.
2.
3.
4.
5.
6.
7.

Packed red cells


Platelets
Fresh frozen plasma
Cryoprecipitate
Granulocytes
Factor IX conc.
Factor VIII conc.

There are more than 20 different products


available
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Whole blood

Red cells

Granulocytes

Platelets

Plasma

Fractionated
products

(Fresh) frozen
plasma (FFP)
F Vlla

Cryoprecipitate

Stored
Plasma

Immunoglobulins
F Vlll

Albumin
F lX

Whole Blood
One unit contains
450 ml of blood
& 63 ml of anticoagulant-preservative

RBC Anticoagulant/Preservative Solutions

Purpose of RBC Preservation

Designed to prevent clotting and maintain red cell


viability and function during storage.
Usual anticoagulant-preservative is CPD-A (Citrate
Phosphate Dextrose Adenine )

Anticoagulant-Preservative Contents

Citrate: anticoagulant (binds plasma calcium and prevent


activation of coagulation cascade)
Phosphate: provide substrate to help maintain red cell 2,3
DPG levels
Dextrose: a sugar, provides substrate for ATP production.
Adenine: Acts as a substrate for RBC synthesis of ATP
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During storage at 4oC


Platelets and WBCs
become nonfunctional during hours of collection

Red cells
5 weeks in CPD-A have a mean recovery 70%

Plasma
K+, H+ pH
Levels of coagulation factors V & VIII decrease

Blood Components
Refers to a product separated from a
single unit of whole blood
The term plasma derivative indicates a
blood product separated from a large
volume of pooled plasma by a process
called fractionation

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Blood components
Oxygen carrying components
Red cell concentrates
(RCC)
Leukocyte poor blood
Frozen-thawed red cells

Platelet products
Platelet rich plasma (PRP)
Platelet concentrates (PC)

Plasma products

Fresh frozen plasma (FFP)


Frozen plasma (FP)
Cryoprecipitate
Stored plasma

Plasma Derivatives
Coagulation Factor concentrates
Factor VIII concentrates
Factor IX complex concentrates &
others

Oncotic agents
Albumin
Plasma protein fraction (PPF)

Immune serum Globulin

Hepatitis B Ig (HBIG)
Varicella-zoster Ig (VZIG)
Rh Ig (RhIG)
Tetanus Ig (TIG)

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A- Blood components that carry oxygen


Increase the oxygen carrying capacity of
the blood by increasing the circulating red
blood cell mass.
Carry oxygen and nourishment to the
tissues and take away carbon dioxide.

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1- Red blood cell concentrates


Prepared by removing
approx. 200 ml of plasma
from whole blood after
centrifugation
RBCs plus 100 ml of residual
palsma
In CPD-A can be stored for
35 days at 4oC

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1- Red blood cell concentrates


Whole Blood

Red cell
concentrate

Total Volume

500 ml

300 ml

Volume of red
cells

200 ml

200 ml

Volume of
plasma

300 ml

100 ml

Hematocrit

40 %

70 %
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1- Red blood cell concentrates


High hematocrit viscous infuse slowly
Rate of infusion increased by adding saline
Other fluids should not used
Calcium containg fluids (eg. Ringers lactate)
should not be added
May cause clotting

Glucose solutions
can cause clumping

Only saline can be added to blood


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2- Leukocyte poor blood


No viable leukocytes
WBCs are of no
consequence
In some patients cause
febrile transfusion reaction
Should receive leukocytes
poor-blood
WBCs can be removed by
discarding the buffy coat
(inverted centrifugation)
Or by washing RBCs or by
using filters

Buffy coat
Red cells

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3- Frozen-thawed red cells


Red cells can be frozen with use of
cryopreservation techniques
Permit storage for up to 10 years
Expensive procedure & recommended
only in special circumstances
e.g. Individuals with rare blood types
For auto-transfusion

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3- Frozen-thawed red cells


The RBC's are first incubated in a 40%
glycerol solution which acts as an
"antifreeze" within the cells.
The units are then placed in special sterile
containers in a deep freezer at less than
-60 degrees C.
Cryopreserved units are thawed and
washed free of glycerol prior to use as
saline suspended RBC's.
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4- Synthetic oxygen carrying agents


Synthetic oxygen carrying agents
Perfluorochemical (e.g. Fluosol-DA )

Fluorinated hydrocarbons
Readily dissolve oxygen
Poor soluble in plasma
Side effects:
Hypotension
DIC

Chemically modified hemoglobin


Free Hb has a very short half life
Chemically modified to:
increase intravascular survival
and to make it more effective in carrying oxygen

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B- Platelet Products
Platelet Rich Plasma (PRP)
Gentle centrifugation of whole blood
Supernatant transferred to the 2nd
bag

Platelet Concentrates
Prepared from PRP by a 2nd
centrifugation
Removal of all but 50 ml of plasma
Contain approx. 6X1010 platelets
60 80% Plts present in whole blood
unit
Remain 5 days
Longer at 22oC with continuous
agitation

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B- Platelet Products
Contamination by WBCs &
RBCs is usually small
But there is enough to induce
alloimmunization
Plt concentrates from Rh +ve
should not be administered to
Rh ve women
Storage at 22oC, therefore care
to prevent contamination
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C- Plasma Products
Plt poor plasma can be separated into a
number of products
Fresh frozen plasma
Frozen plasma
Cryoprecipitate
Stored plasma

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1- Fresh frozen plasma (FFP)


Prepared from whole blood
within 6 hours of collection
Rapid freezing of plasma
preserves the labile
coagulation factors at
maximum levels
Donot contain cellular
elements
200 ml volume
Stored at -30oC for 12 months
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2- Frozen Plasma (FP)


Separated from whole blood within 24
hours of collection
Contains at least 50 % of original factor
VIII & factor V frozen plasma
Adequate source for treatment of mild to
moderate coagulation factor deficiencies
200 ml volume

Storage at -30oC for up to 12 months


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3- Cryoprecipitate
Produced from freshly separated plasma by
freezing at -70oC followed by thawing at 4oC
Flocculent precipitate is rich in factor VIII,
fibrinogen and fibronectin
Once thawed, mixture is centrifuged to sediment
the cryoprecipitate & all but 5 to 10 ml of
supernatant plasma is removed
Contains 250 mg fibrinogen
80 clotting units of factor VIII
Stored at -30oC for 12 months
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3- Cryoprecipitate
Increase of 2% of factor VIII level for each
bag of cryoprecipitate infused
Supernatant plasma removed is called
stored plasma
Must be used within 5 weeks if stored at 4oC
Lasts for 2 years at -30oC

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4- Stored plasma
Plasma separated from whole blood after 24 hours of
storage at 4oC
Can also be derived from cryoprecipitate production
Contain reduced levels of labile coagulation factors V VIII
& fibrinogen
It is indicated for patients requiring volume expansion or
protein replacement when labile clotting factors are not
required
Plasma products do not require crossmatch prior to use
but should be ABO compatible
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Plasma Derivatives

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Certain plasma derivatives can be


obtained by fractionating the fresh frozen
plasma or stored plasma
Fractionation:
Allows the processing of large volumes of

pooled plasma
Pooling of many units increases the risk of
viral transmission to the recipient

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Plasma protein fractionation


Plasma proteins are separated according
to differences of each protein.
Fractionation involves changing the
conditions of the pooled plasma (e.g. the
temperature or the acidity)
Proteins that are normally dissolved in the
plasma fluid become insoluble, forming
large clumps, called precipitate.
The insoluble protein can be collected by
centrifugation.
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One of the very effective ways for carrying out


this process is the addition of alcohol to the
plasma pool while simultaneously cooling the
pool.
This process is sometimes called cold alcohol
fractionation or ethanol fractionation.
This procedure is carried out in a series of steps
so that a single pool of plasma yields several
different protein products, such as albumin and
immune globulin.
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Plasma Derivatives
Plasma Derivatives

Preparation avaliable
Factor VIII concentrates

Coagulation Factors

Factor IX concentrates
Anti-thrombin III

Albumin

Albumin
Plasma protein fraction
Non-specific immune serum globulin (ISG)
Rh immune globulin (RhIG)

Immune globulins

Hepatitis B immune globulin (HBIG)


Varicella-Zoster immune globulin (VZIG)
Tetanus immune globulin (TIG)
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1- Coagulation Factor Concentrates


Prepared in a freeze-dried form
Indicated for patients with congenital
coagulation deficiencies
Risk of hepatitis is high

Should not used for mild acquired


coagulation deficiencies
Should be treated with FP or FFP

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Factor VIII Concentrate


Commercially prepared, lyophilized
powder purified from human FFP
Contain also small amounts of
fibrinogen & other proteins
Can contain blood group Abs
Treat patients with hemophilia A

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Differences of Cryoprecipitate & Factor VIII concentrates

Cryoprecipitate

Factor VIII
concentrates

Storage Temp. -30oC

4oC
Short period RT

Risk of
Hepatitis

Low

High

Treatment of
hemophilia A

Yes

Yes

Treatment of
vW disease

Yes

no
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Factor IX Concentrate
For the treatment Factor IX deficiency or
Hemophilia B (Christmas Disease).
Have been used to treat patients with
acquired inhibitors of factor VIII
Have factor VIII bypassing activity

Contains also factors II, VII & X in


concentrated form
Vials containing 500 units of factor IX
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Factor IX Concentrate & liver


disease
It is contraindicated in patients with liver
disease
Have low levels of circulating antithrombin III
Activation of clotting factors present in some
factor IX concentrates,
cause DIC

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Blood products & treatment of specific clotting factor deficiencies


Deficiency
Fibrinogen
Factor V
Factor VII
Factor VIII

Blood product Indicated


Cryoprecipitate
Stored plasma
Fresh frozen plasma
Frozen plasma
Factor IX concentrate
Stored plasma
Factor VIII concentrate
Cryoprecipitate
Cryoprecipitate

Von Willebrands Disease

Fresh frozen plasma


Frozen plasma

Factor IX

Factor IX concentrate

Factor X

Stored plasma

Factor XI

Stored plasma

Factor XIII

Stored plasma

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2- Oncotic Agents
Albumin: volume expansion
Other colloids are available for blood
volume expansion
Dextran
Gelatin
Hydroxyethyl starch
Polyvinylpyrrolidone

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Albumin
Albumin is prepared by ethanol
fractionation of pooled plasma
Available in 5% and 25% concentrations.
Have physiological sodium content
No risk of hepatitis, sterilized during
preparation
No coagulation factors or blood group Abs

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Albumin
Used for treatment of hypovolaemia and
hypoalbuminaemia (result from abnormal
synthesis, increased metabolism or loss)
It maintains capillary osmotic pressure
Carrier protein for drugs, hormones,
enzymes & metabolites

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Plasma protein Fraction


Partially purified albumin
Contains 85% albumin & 15% other
plasma proteins

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3- Immune Globulins
Contains immune IgG antibodies,
prepared from pools of plasma.
For disease prophylaxis, hepatitis A,
measles, varicella and rubella.
For the treatment of hypogammaglobulinemia and agammaglobulinemia.

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Immune Serum Globulin (ISG)

Primarily IgG Ab
Prevention of some viral diseases
Hypogammaglobulinemia
Congenital immune deficiency
Given by IM injection (aggregates of IgG)

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Hepatitis B Immune Globulin


(HBIG)
Contains Hepatitis B immune antibodies.
From plasma of donors with high titer of
Ab to HBsAg
Provides passive immunization for HBV.
For treatment after exposure to HBsAg.
For the prevention of maternally
transferred HBV (perinatal exposure).

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Varicella-Zoster immune globulin (VZIG)


Derived from patients had recent Herpes
Zoster infections
Herpes Zoster infections result in severe
fatal infection in immunocompromised
individuals
Passive administration of VZIG during 72
hours of exposure can prevent or
attenuate infection
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Rh Immune Globulin (RhIG)


Derived from Rh -ve individuals
Contains IgG antibodies to the D antigen on red
blood cells.
Given during pregnancy and post-natally to Rh
negative mothers to prevent the development of
anti-D and hemolytic disease of the newborn
(HDN) due to anti-D.
Given prophylacticaly following abortion, or
invasive maternal procedures (e.g.,
amniocentesis).
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Tetanus Immune Globulin (TIG)


Prepared from individuals specifically
immunized for tetanus toxoid
Available for individuals at risk following
injury

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