blood component therapy: what a clinician needs to know !
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Blood Component Therapy
•Gravity•Apheresis
Blood Components:
•Red Cell Concentrate ( pRBC)•Leukoreduced RBC•Platelet Concentrate•Leukoreduced Platelets•Fresh Frozen Plasma•Cryoprecipitate•Cryo poor Plasma•Granulocyte concentrate
•Low and high speed Centrifugation
Whole Blood
Soft spin @ 2000 rpm for 3min
pRBC Platelet Rich Plasma (PRP)
Hard Spin @5000 rpm for 5 mins
Platelet ConcentrateFresh Frozen Plasma
CryoprecipitatePlasma Derivatives
Need of blood component therapy:It aims at transfusing only the required component.It helps to prevent the wastage of a resource , ie, blood.Blood from a single donor can be used to provide blood
components to multiple patients.Prevents circulatory overload.
Blood CollectionIs done using a 16 G needle450 ml of blood is collected in a
continuous flow into a primary bag which has 63 ml of anticoagulant and preservative solution.
The primary blood collecting bag is attached to 1, 2 or 3 satellite bags forming the basis of component separation through a closed system.
Blood preservatives:
Solution
Purpose Storage Period
Components
CPD Anticoagulation and storage of blood
21 days
Sodium Citrate : Binds with Calcium and acts as an anticoagulantPhosphate (Sodium di phospahte): Prevents fall in pHDextrose: Supports ATP generation by glycolytic pathway.*Adenine: Substrate for ATP synthesis.
CPDA 1 Anticoagulation and storage of blood
35 days
SAG- M Red cell preservation
42 days
Sodium chloride: Adjusts osmotic pressure Adenine: Substrate for ATP synthesisGlucose: Supports ATP productionMannitol: Supports integrity of red cell membrane
Whole BloodThe only indication for whole blood transfusion today is
Exchange transfusion.Stored at a temperature of 1-6. CRaises Hb by 1 gm% and Hematocrit by 3%.Should be transfused within 4 hours of issuing from blood
bank.
pRBCHas the same Oxygen carrying capacity as Whole blood but
has half the volume ( prevents circulatory overload).Has significantly lower levels of electrolytes, metabolites and
agglutinins.Volume: 200 mlStored at a temperature of 1-6. CRaises Hb by 1 gm% and Hematocrit by 3%Should be transfused within 4 hours of issuing from blood
bank.
Leukoreduced RBCThese are packed red cells from which 99.9% white cells have
been removed either by filtration or by freezing/thawing/washing.
The white blood cells are the reason for non hemolytic febrile reactions.
The immunomodulatory effect of blood transfusion is due to WBC’s which is said to increase the risk of Post operative infections.
Leukoreduction is an expensive procedure.Leukoreduction reduces the risk if transmission of EBV, CMV
and HTLV.
AAAB Clinical practice guidelines for Red Cell transfusion (2016)It recommends a restrictive RBC transfusion threshold of
7gm% in hospitalised hemodynamically stable patients, including critical care patients, rather than 10 gm%.
For patients undergoing orthopedic and cardiac surgery and those with existing Cardiovascular disease, it recommends restrictive RBC transfusion threshold of 8 gm%.
AAAB: American Association of Blood Banks
Platelet concentrate:It is harvested from PRP ( platelet rich plasma) by separating
the plasma.Volume: 50-80 mlDose: 1 unit/ 10 kg body weight1 unit increases the platelet count by 10-15, 000/ul.Stored at 20-24. C on an agitatorShelf life: 5 daysSDP ( Single donor platelet) is equivalent to 6 RDP units.1 unit SDP has 3*10 11 platelets.
Indications for Platelet Transfusion:In stable patients with normal platelet function, when platelet
count is <10,000.For elective procedure: Minor (eg, LP) when count <50000 Major suregry when count <100000
Fresh Frozen PlasmaIt has: all coagulation factors Plasma proteins ( eg, albumin) Factor VIII FibrinogenVolume: 180-220 mlStored at -20.CShelf life: 1 yearDose: 15-20 ml/kg body weightTransfusion should be completed within 30 mins of issue.
Indications for FFP use:Deficiency of coagulation factors ( Vit K dependent)Hemophilia ADICMassive transfusionReversal of warfarin therapy
It should not be used for:Volume expansionImmunoglobulin replacementNutritional SupportWound Healing
CryoprecipitateThey are cold precipitated proteins of plasmaVolume: 10-20 mlVery rich in Factor VIII , Fibrinogen and vWF ( von
Willebrand’s factor).Stored at -20.CShelf life: 1 yearDose : 1 unit /10 kg body weightMainly used for treating coagulopathy due to
Hypofibrinogemia.