Blood Components 101
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Transcript of Blood Components 101
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Blood Components 101
Kim-Anh Nguyen, MD, PhDTransfusion Medicine Symposium
August 6, 2016
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Disclosures
• I have no financial relationships related to this presentation.
• I will not be speaking about any specific commercial product, device, or medication.
• I will not be speaking of any off-label use of medications or devices
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Objectives
• Describe the acceptable parameters for a therapeutic dose of red cells.
• Describe the acceptable parameters for a therapeutic dose of platelets.
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Component Overview
• Red cells• Platelets• Plasma• Cryoprecipitate AHF• Modified components
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Definitions
Differential centrifugation separate components along density gradient• Light (Soft) Spin
– 2000 RPM for 3 min– RBCs & Platelet-rich plasma (PRP)
• Heavy (Hard) Spin – 5000 RPM for 5-7 min – RBCs-WBC-Plts & Platelet-poor plasma– Platelets & Platelet-poor plasma
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Whole Blood → RBC
www.nature.com
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Anticoagulant-Preservative Solutions
• Citrate
• Dextrose
• Adenine
• Na phosphate
• Prevents coagulation
• Glycolytic pathway
• ATP synthesis
• Buffer
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Anticoagulant - Preservatives
CPD CP2D ACD-AApheresis CPDA-1
Trisodium Citrate 26.3g/L 26.3g/L 22.3g/L 26.3g/L
Citric Acid 3.27 g/L 3.27 g/L 8.0 g/L 3.27 g/L
NaH2PO4 2.22g/L 2.22g/L 0 2.22g/L
Dextrose 25.5 g/L 51.1 g/L 24.5 g/L 31.9g/L
Adenine 0 0 0 0.275g/L
Shelf Life 21 days 21 days 21 days 35 days
* Apheresis Only
(63-70 mL/bag or 14mL/100mL of WB collected)
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Additive Solution (AS)
• Extends shelf life of RBCs → 42 days• Replaces plasma in RBCs
– More volume in Frozen Plasma unit• Hct 55-65%
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RBC Additive Solutions
AS-1 (Adsol)
AS-3(Nutricel
)
AS-5(Optisol)
AS-7(SOLX)
Dextrose 2200 1100 900 1585Adenine 27 30 30 27NaH2PO4 0 276 0 0Na2HPO4 0 0 0 170Mannitol 750 0 525 1000Na Bicarbonate
0 0 0 218
Na Chloride 900 410 877 0Na Citrate 0 588 0 0Citric Acid 0 42 0 0
(100/450mL bag or 110/500mL bag)
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CPDA-1 vs. AS Red Cells
CPDA-1 Red Cells• 225-350mL total volume• 160-275mL RBCs• 50-80g Hgb
• 65-80% Hct• 35 day shelf-life
AS Red Cells• 300-400mL total volume• 160-275mL RBCs• 50-80g Hgb
– ~60g Hgb apheresis RBC• 55-65% Hct• 42 day shelf-life
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Frozen Plasma
• Processed from WB • Collected by apheresis
– Concurrent: Part of RBC or platelet procedure
– “Plasmapheresis”: plasma only procedure• Volume 200-800mL
– WB derived ~200-250mL– Pheresis variable, divided or “Jumbo” units
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Plasma Components
• Fresh Frozen Plasma (FFP): 6-8 hrs of phlebotomy
• Frozen Plasma (FP24):24 hrs of phlebotomy
• Freezing methods– Dry ice-ethanol bath– Blast freezer (-18C)– Mechanical freezer (-65C)
• Equivalent therapeutic indications
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Frozen Plasma
• Store at -20C• Shelf-life 1 year• Thawing Methods (30-37C)
– Waterbath– Microwave– Ultrasound
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Thawed Plasma
• “FFP & FP24, thawed”– 1-6C– 24 hours (no FDA variance needed)
• “Thawed plasma”– 1-6C– 5 days– closed system only
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Thawed PlasmaClotting Factor Changes Over Time
AABB Technical Manual, 17th ed. 2011Downes et al. Transfusion (2001) 41:570.
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Cryoprecipitate AHF
• 5-20mL Volume
• Fibrinogen ≥ 150 mg / unit• FVIII ≥ 80 IU / unit• vWF, FXIII, fibronectin
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Cryo Pooling & Storage
• May be pooled during production– 5U per pool
• Store at ≤ -18 ºC • Shelf-life 1 year
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Thawed Cryoppt
• Thaw at 30-37 C• May be pooled post-thaw
– 10U per adult dose pool • Store at Room Temperature• Thawed cryoppt shelf-life:
– 4 hrs Open system – 6 hrs Closed system
• ABO Compatibility not required for transfusion
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WB Derived Platelets
www.researchgate.net
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Apheresis Platelets
• Automated Collection Device– Trima (Terumo)– Amicus (Fenwal)
• Single or double needle• Leukoreduction occurs during
procedure • 50-120 minutes• 1-4 Units (doses) / procedure
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Platelet Storage
• Blood must be received at– ≥ 20 ºC (≥ 68 ºF)
• Storage:– 20-24 ºC (68-75 ºF)
– Continuous gentle agitation
– Shelf-life 5 days
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Pheresis vs. WB platelets
Apheresis WB Volume 250-400 mL 40-70 mLPlatelet Count >3.0 x 1011 >5.5 x 1010
Platelet Concentration
~1 x 109/mL ~1 x 109/mL
Adult Dose 5-10mL/kg;1U
5-10mL/kg;4-6U
Shelf-life 5 days 5 daysStorage 20-24C + agitation 20-24C + agitation
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Platelet Tx for infants
• Pheresis platelets or WB platelets• 1U pheresis = 4-6 U WB platelets• Dose same way• 1U pheresis may be “split” into several aliquots
for multiple dosing– Done in blood bank by request– Reduces donor exposure– Aliquots may be given to other patients
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Pediatric transfer bags
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ISBT128 Label
Global standard for identification, labeling and information processing of human blood, tissue and organ products across international borders and disparate health care systems• Unique donation identification # (DIN)• Blood collection center listed• Product Code is expandable • Adopted in USA in 2008
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DIN
• Longer : W 1234 06 123456
• Country: W• Facility: 1234• Year: 06• Unique ID: 123456 ( 100 years)
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Blood Component Label
4 quadrants, black & white onlyBarcode readable elements• Donor Identification Number (DIN) • Product code • ABO/Rh Type includes donation type • Expiration Date and time• Special testing performed
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Blood Component Label
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Component Modifications
• Leukoreduction• Washing• Irradiation• Freezing
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Leukocytes in Blood
Whole blood 109
Red blood cells (RBC) 108 - 109
Whole-blood platelets 107 - 108
Apheresis platelets 106 - 108
FFP < 104
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Filter Leukoreduction
• Prestorage (donor center)– 3-5 days post collection
• Bedside (hospital)• Pre-storage LR preferred
– > reliable– < variable
• 100% of RBCs and platelets at BBH are pre-storage LR
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Leukoreduction QC
• Red cells– ≤ 5 x 106 WBC/unit (≥ 95%)– ≥ 85% of original red cells
• Apheresis platelets– ≤ 5 x 106 WBC/unit (≥ 95%)
• WBD platelets– ≤ 8.3 x 105 WBC/unit (≥ 95%)
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Washing Components
• Saline (1-2 L) removes– ≈ 99% of plasma– Potassium– Anticoagulant– Additive solution– Cellular debris
• Product loss– 10-20% red cells– 20-30% platelets
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Washed Components
• Red cells– 1-6C– 24 hours
• Platelets– 20-24C + agitation– 4 hours
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Frozen Red Cells
• Freeze in 20-40% glycerol• Storage
– Store at -65C– Shelf-life10 years
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Thawing & Deglycerolyzing
• Thaw 20-25 min in waterbath or dry warmer• Wash with solutions of ↓osmolality
– Cobe 2991 – open system– Haemonetics ACP215 – closed system
• QC: >80% recovery• Shelf-life of deglyc’d RBCs at 1-6C
– 24hrs open system– 14 days closed system
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Irradiation
• Objective: inactivate T-lymphocytes
• Prevent Graft vs. host disease (TA-GVHD)
• Red cell damage– Decreased % recovery after transfusion– Increased potassium levels in unit (2x)
• No damage to platelets
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Irradiation
• Methods:– Cobalt-60– Cesium-137– X-ray
• Dosage:– Minimum 25 Gy (2500cGy) to center, 15 Gy
to any portion– Maximum 50 Gy to center
• Method to ensure irradiation has occurred
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Irradiated components
Shelf-life• Red cells (shorter of the following)
– 28 days – Original date
• Platelets: Original date
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Summary
• Blood component production (collection, processing) has evolved
• Variety of volumes, storage media, specifications
• ISBT128 label → extensive information• Production uses validated methods• Components undergo routine QC
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Acceptable parameters - RBC
• CPD, CPDA-1, AS-1, AS-3, AS-5
• 225-400 mL Volume
• 55-65% / 65-80% Hct
• Shelf-life 21-42 days
• LR: < 5 x 106 WBC/Unit
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Acceptable parameters - Platelets
Pheresis• 250-400 mL volume• >3.0 x 1011 platelets/Unit• <5 x 106 WBC/Unit• ~1 x 109 platelets/mL
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