blood banking (mlbb 201). changes that occur in stored blood prof. dr. nadia aly sadek prof. in...
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Faculty of Allied Medical ScienceBlood Banking (MLBB 201)
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Changes that occur in Stored Blood
Prof. Dr. Nadia Aly SadekProf. in Haematology and
Director of Blood Bank Centre,Medical Research Inst, University of Alexandria
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OutcomesBy the end of this lecture, the students will
be able to:Know the changes that occur in blood bags
with storageKnow what is blood filtration and its types.
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Storage Lesion Long 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:
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Increased membrane rigidityLoss of organic phosphatesRelease of pro-inflammatory cytokinesSome changes take place slowly and some take
place rapidly.
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Consequences of transfusing older blood1- Increased in-hospital mortality2- Increased rates of sepsis2- Delayed healing of wounds3- Tumour recurrence.
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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 span.
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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.
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Some lymphocytes may remain viable for several weeks.
Platelet function declines to zero after 24 hours of storage.
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Biochemical changes1- Oxygen affinity Stored blood has depleted levels of 2,3
Diphosphoglycerate (DPG) which causes the oxygen dissociation curve to shift to the left, so increasing the oxygen affinity of hemoglobin = less release of oxygen to the tissues.
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2- ATPThere is a time-dependent reduction in
intracellular RBC ATP which is essential for:- membrane stability - glucose transport- oxidative stress defense mechanisms- membrane phospholipid distribution
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The biochemical changes that occur in the stored bags lead to alteration in corpuscle shape, decreased deformability, increased aggregability and intracellular viscosity as well as changes in osmotic fragility.
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Immunologic changesRBcs transfusion produces a state of
immunosuppression in the recipients which predisposes them to acquire infections or develop transfusion-related acute lung injury.
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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.
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But it may become a problem with rapid transfusion of large amounts of stored blood especially in severe renal failure or in neonatal exchange transfusion.
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2- CalciumEach 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.
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Acid-Base balanceDuring 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.
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CoagulationLabile 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.
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Blood filtration= Leucoreduction of blood components which
is a process by which leucocytes are removed from blood by specific WBC reduction filters. There are two types:
1- Pre-storage filtration2- Bedside filtration.
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Pre-storage filtrationEach unit of whole blood is filtered before
storage. Pre-storage filtration has many advantages:-
1- Diminished accumulation of leucocyte-derived cytokines during storage.
2- Removal of cells infected with cytomegalovirus (CMV) and Epstein-Bar virus (EBV) and HTLV-1 virus.
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3- It decreases recurrent transfusion febrile reactions.
4- Improves RBCs potency5- Reduces HLA alloimmunizationDisadvantage:-It may activate the complement system.
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Bedside filtrationIt is carried at the beside of the patient with a
different type of filter.Although it removes the remaining leucocytes
yet it does not remove the cytokines already secreted from the leucocytes and which are responsible for the transfusion reactions.
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Study questionsState true or false:a- Bedside filtration is better than prestorage
filtrationb- Tetany is a sign of hypocalcemiac- Potassium decreases in blood bags by
prolonged storaged- RC membrane rigidity decreases by storage.
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AssignmentsStem cell transplantation
الشرقاوى على احمد
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Thank you