faculty of allied medical science
DESCRIPTION
Faculty of Allied Medical Science. Blood Banking (MLBB 201). Changes that occur in Stored Blood. Prof. Dr. Nadia Aly Sadek Prof. in Haematology and Director of Blood Bank Centre, Medical Research Inst, University of Alexandria. Outcomes. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/1.jpg)
Faculty of Allied Medical ScienceBlood Banking (MLBB 201)
![Page 2: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/2.jpg)
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
![Page 3: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/3.jpg)
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.
![Page 4: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/4.jpg)
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:
![Page 5: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/5.jpg)
Increased membrane rigidityLoss of organic phosphatesRelease of pro-inflammatory cytokinesSome changes take place slowly and some take
place rapidly.
![Page 6: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/6.jpg)
Consequences of transfusing older blood1- Increased in-hospital mortality2- Increased rates of sepsis2- Delayed healing of wounds3- Tumour recurrence.
![Page 7: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/7.jpg)
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.
![Page 8: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/8.jpg)
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.
![Page 9: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/9.jpg)
Some lymphocytes may remain viable for several weeks.
Platelet function declines to zero after 24 hours of storage.
![Page 10: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/10.jpg)
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.
![Page 11: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/11.jpg)
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
![Page 12: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/12.jpg)
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.
![Page 13: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/13.jpg)
Immunologic changesRBcs transfusion produces a state of
immunosuppression in the recipients which predisposes them to acquire infections or develop transfusion-related acute lung injury.
![Page 14: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/14.jpg)
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.
![Page 15: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/15.jpg)
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.
![Page 16: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/16.jpg)
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.
![Page 17: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/17.jpg)
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.
![Page 18: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/18.jpg)
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.
![Page 19: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/19.jpg)
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.
![Page 20: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/20.jpg)
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.
![Page 21: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/21.jpg)
3- It decreases recurrent transfusion febrile reactions.
4- Improves RBCs potency5- Reduces HLA alloimmunizationDisadvantage:-It may activate the complement system.
![Page 22: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/22.jpg)
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.
![Page 23: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/23.jpg)
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.
![Page 24: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/24.jpg)
AssignmentsStem cell transplantation
الشرقاوى على احمد
![Page 25: Faculty of Allied Medical Science](https://reader035.vdocuments.us/reader035/viewer/2022062315/56816597550346895dd86e42/html5/thumbnails/25.jpg)
Thank you