Blood Components

Apharesis
Cytaphresis (platelets) Plasmapharesis.
Lymphocytes Monocytes Granulocytes

Plasma

Platelets neocytes

WBC

RBC

Apharesis Machines
The machine is provided with sensors (optical) to detect plasma-cell interfaces and divert components according to pre-selected mode. Two main types of machines: Continuous and intermittent flow centrifugation.

APHARESIS
Continuous flow Usually requires 2 venipuncture sites Smaller extracorporeal blood volume. Requires less time (continuous procedure) Larger equipment More useful in elderly and children. Intermittent flow Single venipuncture site Larger extracorporeal blood volume Longer time (runs in cycles) Smaller equipement Less useful

Some facts on Red cell Transfusion Adequate Oxygen carrying capacity can be met by a Hb of 7 g /dl (Hct of 21%), or even less if IV volume is adequate for perfusion. Each unit of blood raises the Hb by 1 g/dl and Hct by 2-3% in an average 70 kg adult man. Individual factors determine the physician choice whether to transfuse or not.

Some tips on Red cell Transfusion

Infuse the first 25 mls slowly over 15 minutes. If tolerant then proceed, and classically the unit can be given over ~ 2 hrs, in hemodynamically stable persons. 3-4 ml/kg/hrs could be tolerated easily in healthy adults. Hypovolemics tolerate larger amounts easily. Those with cardiovascular compromise, 1 ml/kg/hour could may be tolerated.

Plasma reduced Blood:

whole blood-180 ml plasma

TRANSFUSE RED BLOOD CELLS: to increase oxygen-carrying capacity in anemic patients

DO NOT TRANSFUSE RED BLOOD CELLS: for volume expansion in place of a hematinic to enhance wound healing to improve general "well-being"

Platelets Concentrates
Single units (Random): * content usually > 5.5 x1010/50 ml plasma. Cell separators: * content usually 3-7 x1011/bag, could be collected over 2-3 hrs.

Platelets Concentrates
Donor for cell separator :
Platelets > 150 000/cmm. Platelets returns to pre-donation in one week. Could donate once per week, but may do so in 48 hrs in emergency. Should be transfused in 24 hours, slowly at first 15 minutes, then 4-8 ml/kg/hr in adults.

Platelets Concentrates
Storage : - Special plastic containers. - CPD, or CPDA anticoagulants. - Storage time depends on : - Plastic bag used. - Volume of suspending fluid. - Platelets count in unit. - Availability of O2.

Platelets Concentrates
Storage : - Storage temperature : - At 4 C poorly viable but immediate hemostatic effect. - At 22 C, on flat-bed agitator (horizontal) at 70 cycles /minutes.

Platelets Concentrates
Each unit of manually prepared standard platelets concentrates raise count by 5-10 x 109/L. Standard dose is 1 unit / 10 kg.

Platelets Concentrates
to control or prevent bleeding associated with deficiencies in platelet number or function

TRANSFUSE PLATELETS:

to patients with immune thrombocytopenic purpura (unless there is life-threatening bleeding) prophylactically with massive blood transfusion prophylactically following cardiopulmonary bypass

DO NOT TRANSFUSE PLATELETS:

Fresh frozen Plasma (FFP)

200-250 ml in each bag. Stored at -20 C, up to 12 months. Should be used with 2 hours of thawing. No need for Cross match. ABO identical and preferably Rh (D) identical. Average dose is 5-15 ml/kg; give slowly at first 15 minutes, then at a rate of 4-8 ml/kg/hr.

FFP
To increase the level of clotting factors in patients with demonstrated deficiency (each unit increases factors by 2-3% in adults)

TRANSFUSE FRESH FROZEN PLASMA:

DO NOT TRANSFUSE FRESH FROZEN PLASMA:

for volume expansion as a nutritional supplement prophylactically with massive blood transfusion prophylactically following cardiopulmonary bypass

Cryoprecipitate
Plasma is frozen solid, allowed to thaw at 4 for 24 hours, a precipitate forms, this is left with ~ 10 ml plasma to reconstitute, store at -30 C for up to 1-2 years. When required thaw at 37 C and use in < 3 hours.

Factor VIII VW factor. Factor XIII. Fibrinogen. Fibronectin.

What are the contents of Cryoprecipitate ?

Accordingly a patient suffering from a deficiency of above could benefit from Cryoppt. Given regardless of ABO-Rh phenotype.

Leucocyte-Reduced blood
Preparation :
Centrifugation of inverted bag (90% removed). Sedimentation by HMW dextran (95% removed). Filters :
Microaggregate filters (Nylon filters) Online-bedside. Cotton-wool filters (Immungard 100%).

Frozen blood.

Leucocyte-Reduced blood
Uses mainly in : 1. Febrile transfusion reaction history. 2. To reduce Toxoplasma and CMV viral transmission.

Granulocyte concentrates
Collection method (through cell separators with various methods to improve yield). Minimum daily dose : 2-3 x1010 PMN (not less than 1010
.

Indicated in infection, failing to respond to Antibiotics for > 48 hrs, and should continue until :
Infection has resolved. Neutrophils > 500/cmm

Should not be used prophylactically