Blood Products - BloodBook, Blood Information For Life

Blood Products - BloodBook, Blood Information for Life
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COMMON BLOOD PRODUCTS

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BLOOD PRODUCTS; WHOLE BLOOD

PRODUCTS AND BLOOD PLASMA PRODUCTS
AND HOW BLOOD PRODUCTS ARE PRODUCED
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In the United States, much of the nation's Blood supply of whole Blood is drawn from volunteer
Blood donors and is given at such places as hospitals and community Blood banks. Most of the
whole Blood collected is separated, before it is sold, into Blood products (Blood components)
including red Blood cells, Blood platelets, Blood plasma and other human Blood clotting agents.
All of these Blood products are transfused into patients needing just that particular part (fraction) of
the whole Blood that is donated. A number of Blood donors also donate platelets by apheresis (a
procedure in which Blood is drawn from a Blood donor and separated into its components, some of
which are retained, such as plasma or platelets, and the remainder of the Blood is returned, by
transfusion, to the Blood donor; also called hemapheresis). Blood plasma, the fluid in which red
Blood cells, Blood platelets and other Blood clotting factors are suspended, also can be collected
by apheresis. For this process, whole Blood is drawn, Blood plasma is removed, and the red Blood
cells are transfused back into the Blood donor. This Blood plasma collection process normally takes
one to two hours to complete. Blood plasma is often collected from donors by a variety of entities,
particularly commercial for-profit organizations that sell it to companies for manufacture into a
variety of Blood products. These Blood products often undergo a purification process to make them
safer. Some of these Blood products provide, among other things, clotting factors for people who
suffer from abnormal bleeding disorders (hemophilia, etc.) Blood Products
Rather than using whole Blood transfusions, doctors are increasingly using individual Blood
components such as red cells, white cells, platelets, and plasma. Plasma is fractionated into an
increasing number of Blood products, including albumin, gamma globulins, blood-typing sera,
clotting factors for people with hemophilia, and more. Umbilical Cord Blood and Free Cord Blood
Registry products.
Blood and Blood component products, like any other use of intrusive medicine, should be used only
in critical conditions. All around the world, most countries have stopped giving whole Blood to the
patients for the following reasons:
Whole Blood is a more likely carrier of transfusion transmitted diseases;
Keeping in mind the frequency of serious shortages of quality Blood, it is considered
imprudent to use whole Blood;
Most patients require only one particular component of whole Blood. Better patient
management is achieved by giving only the desired and/or essential component;
Utilizing normal Blood storage techniques, Blood products have a greater shelf life than
whole Blood;
Blood filtration and other techniques help to make Blood safer; and,
Blood products can often be infused regardless of ABO Blood group.
Following here is a brief, though at times technical, commentary and definition set of common
products made from donated Blood. There are others, however, these are the ones that are most
often are needed in the United States.
Whole Blood Products
Whole Blood
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Red Blood Cell Components

Red Blood Cells (RBCs)
Washed Red Blood Cells
Leukoreduced Red Blood Cells
Pediatric/Divided RBC Units
Platelets
Platelets
Granulocytes
Granulocytes (Neutrophils)
Fresh Frozen Plasma
Fresh Frozen Plasma (FFP)
Cryoprecipitate
Cryoprecipitate (CRYO)
Factor Concentrates
Factor VIII Concentrates
Factor IX Concentrates
Antithrombin III
CMV Negative, Irradiated, and Leukoreduced Preparations
CMV Negative Blood and Components
Irradiated Blood and Components
Leukoreduced Blood and Components
Useful Links to Quality Information
Blood Components - Details from the University of Michigan
Summary
Short Summary Chart w/Shelf Life
Whole Blood Blood Products

Description - The product of one unit of donated and unadulterated Blood plus ACD
(anticoagulant/preservative). By definition, whole Blood contains one unit of plasma and cells.
Whole Blood can be stored, normally and conventionally, for 5 weeks. Factors V and VIII are labile
and are significantly decreased after 7 days.
Indication - If "fresh" (less than 24 hours since drawn,) whole Blood is still utilized in resuscitation
of a patient who has been loosing a lot of Blood. Whole Blood is not used for "routine" Blood
transfusion when red cells (RBC) will suffice. Since one unit of donated Blood can be broken down
into one unit RBC, one unit platelets, and one unit fresh frozen plasma (FFP), and more, the use of
whole Blood is considered to be a waste of resources.
Red Blood Cells (RBCs)
Description - One unit of red Blood cells (RBC) contains approximately 180ml (range 150 to 210
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ml) of red cells, 100ml of Optisol, and approximately 30ml (range 10 to 50 ml) of plasma. As an
average, in the United States, the total volume of a RBC unit is 310 ml (range 270 to 350 ml). Blood
Products
A unit of RBC is prepared from a whole Blood collection using a closed sterile system. Blood is
drawn into a bag containing the anticoagulant CPD. Most of the platelet rich plasma is separated
with a centrifuge and separated into an attached container. 100 ml of an additive nutritive solution
(Optisol) is added to RBC. Optisol is a crystalloid solution containing sodium, dextrose, adenine
and mannitol. The Optisol supports red cell survival and extends the shelf life of the unit to 42
days. The added fluid volume of the Optisol also reduces the unit's hematocrit to ~57% (range 50
to 65%), thereby improving the flow characteristics of the component. Optisol is also known as
AS-5.
All RBC transfusions must be ABO/Rh compatible with the recipient. Packed red Blood cells do not
provide viable platelets or neutrophils, nor do they provide clinically significant amounts of
coagulation factors. RBC must be stored between 1 to 6C.
Indication - Red Blood cells are indicated for patients with symptomatic anemia that is not treatable
with specific therapy such as iron, vitamin B12 or with folic acid.
Therapeutic Effect - In a 155-pound adult, one unit of RBCs can be expected to increase the
hematocrit by approximately 3% or the hemoglobin by 1 gm/dl.
Washed Red Blood Cells Blood Products
Description - Washed red Blood cells are red Blood cells washed with normal saline to remove
most of the plasma. Washed red Blood cells should not be considered leukoreduced. Because the
bag must be entered to introduce the saline, washed red cells must be given within 24 hours of their
preparation.
Indication - Washed red cells can be considered for patients who have had repeated
hypersensitivity reactions to Blood or components despite prophylactic administration of
antihistamines. It should be kept in mind, however, that the red cell washing procedure may not
reduce the proteins enough to prevent hypersensitivity reactions (e.g. hypersensitivity to IgA).
Controversial indicators for washed red Blood cells include complement mediated immune
hemolysis and paroxysmal nocturnal hemoglobinuria. Blood Products
Therapeutic Effect - A unit of washed red Blood cells will raise the hematocrit less than will a unit
of red Blood cells because of an approximate 20% loss of red cells from the unit during the washing
process.
Leukoreduced Red Blood Cells
Description - Leukoreduced red Blood cell units contain leukocytes in a specifically reduced
amount. In the United States, Blood processing centers use filtration to make leukoreduced red
Blood cell units. Blood Products
Indication - The most common indication for leukoreduced red Blood cells is for patients who have
experienced two or more non-hemolytic febrile transfusion reactions. Leukoreduced red cells are
usually effective in preventing non-hemolytic febrile transfusion reactions for most patients.
Leukoreduced red Blood cells are also effective in prevention of CMV transmission or HLA
alloimmunization. Blood Products
Therapeutic Effect - Leukoreduced red Blood cells will have a slightly lower therapeutic effect than
red cells that have not been leukoreduced. Depending on the filter used, there is a 10 to 15% loss
of red cells with leukoreduction by filtration.
Pediatric/Divided RBC Units
Description - Pediatric/Divided red Blood cell units are prepared by separating a CPD
anticoagulated (containing no Optisol) packed red Blood cell unit into four bags. Each pedi-pack
contains approximately 45 to 50 ml of red Blood cells and approximately 15 ml of plasma. This
processing minimizes wasting Blood when only small volume transfusion is required. In addition, it
may reduce the recipient's donor exposure because four units for transfusion are available from one
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unit of donated Blood. Divided red cell units are issued when they are less than six days old. This
helps ensure adequate amounts of 2,3 DPG for optimal delivery of oxygen to the tissues and
relatively low plasma potassium levels when stored a shorter period of time. All divided units are
routinely prepared from units which have been screened and found negative for HgbS. All divided
units are irradiated. They may or may not be serologically negative for CMV, but all divided units are
leukoreduced. Studies indicate leukoreduction by filtration is equivalent to CMV screened negative
for prevention of CMV transmission by transfusion.
Because of the small number of these Blood products (components) requested and for inventory
management purposes, divided RBC units are only available as type O. These units may be
transfused to any ABO type recipient in any clinical circumstance, including intrauterine transfusion
when the fetus ABO type may be unknown, as well as for exchange transfusion in neonates when
fetal-maternal ABO incompatibility may be involved. Blood Products
Divided red Blood cells units have a higher hematocrit, approximately 72%, higher than standard
Optisol preserved RBC units. Unprotected and unprepared divided Blood units expire 21 days after
collection. Blood Products
Indication - Divided red Blood cell units are indicated for infants who require small amounts of red
cells. Blood Products
Therapeutic Effect - A divided red Blood cell unit will increase the hematocrit/hemoglobin the same
as a standard red Blood cell unit when corrected for the weight of the child and the volume infused.
Platelets
Description - Platelets are cells essential for the coagulation of Blood. Platelet products also
contain plasma (coagulation factors), some red cells and some white cells (leukocytes). Platelet
products are usually cloudy and yellowish in color but may occasionally have a pink tone because
of the presence of residual red cells. Platelets are stored at 68 to 75 Fahrenheit (room
temperature) and require continuous gentle agitation. They can be stored at the Blood center for up
to five days. When received for transfusion, both pooled and apheresis platelets will expire in less
than four hours. Since preparation for transfusion involves processes such as pooling, volume
reduction and leukoreduction which require entry into the component, a four hour expiration is
placed on the platelets once preparation is started at the Blood center to avoid bacterial growth.
A Whole Blood Platelet Concentrate is prepared from whole Blood by an initial soft centrifugation to
separate the red cells from the platelet rich plasma. A second harder centrifugation is used to
concentrate the platelets that are then resuspended in 60 ml of residual plasma. Each unit contains
a specific ratio/quantity of platelets. To provide an adequate dose of platelets for an adult, four to six
platelet concentrates of the same Blood type are pooled at the Blood center prior to issue. Pooled
platelets are generally issued ABO type compatible, but other types may be substituted. One
should avoid, if possible, giving type A platelets to an O recipient. If the O recipient happens to have
a high titer of anti-A, the post transfusion platelet increment will be reduced. Platelets products
contain an insufficient number of red cells to cause an incompatibility reaction. There are sufficient
numbers of red cells, however, for an Rh negative person to be sensitized (develop Rh antibodies) if
they receive Rh positive Blood. There is very little risk of the patient having an incompatibility
reaction because the plasma in a pooled unit is combined from different donors thereby reducing
the possibility that isoagglutinins (anti-A and/or anti-B) would be present in high titer. Due to the
smaller Blood volumes of infants and small children, ABO compatible or reduced volume ABO
incompatible platelets must be given.
Apheresis Platelets are obtained from one donor with the use of an apheresis machine. Blood is
drawn from a donors arm into a self contained, single use Blood tubing/collection set which has
been inserted into the apheresis machine. Blood does not come into contact with the apheresis
machine itself. Anticoagulant is added to the Blood as it is drawn from the donor. The platelets are
separated from the red cells, leukocytes and most of the plasma by centrifugation. The red cells,
leukocytes and plasma are returned to the donor through his or her other arm, and the platelets are
retained in a collection bag for later transfusion to a patient. The procedure takes approximately 60
to 90 minutes.
The majority of apheresis platelets collected contain less than a specific amount of leukocytes and
are labeled as leukocyte reduced.
One apheresis collection of platelets generally contains 200 to 400 ml of plasma. Because of the
possibility of a high titer of ABO antibodies in the donor plasma, the unit is volume reduced in cases
of minor ABO incompatibility. Apheresis platelet concentrates can be collected from unselected
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community donors. This yields a product known as a Random Apheresis Platelet (RAP). Alternately
the platelets may be drawn from a family or community donor who has been specifically matched to
the patient on the basis of HLA (Human Lymphocyte Antigen) typing. This yields a product known
as a Matched Apheresis Platelet (MAP).
Random Apheresis Platelets are available in two doses: Standard and Large. The standard dose
contains a smaller average count of platelets (approximately equivalent to four units of pooled
platelets). The standard dose is generally ordered for smaller patients, for those in whom a high
platelet count is not required, and for patients who respond well to transfusion. The large dose
contains, as the name would indicate, a greater average number of platelets, approximately
equivalent to six units of pooled platelets. The large dose is generally ordered for larger and heavier
patients, for those in whom a high platelet count is desired, and for those who do not respond well
to transfusion.
As many platelets as possible are collected from HLA matched apheresis donors, therefore it is not
necessary to specify dose when ordering these platelets.
Indications - Platelet transfusions are indicated for patients with bleeding due to either
thrombocytopenia, platelet dysfunction or some combination of the two conditions. The point at
which bleeding may occur varies depending on the patients condition. The majority of patients with
normal platelet function will not experience bleeding until the platelet count drops below a certain
point. In patients with abnormal platelet function, usually caused by drugs (e.g. aspirin or
semi-synthetic penicillin), uremia or elevated split products of fibrinogen/fibrin, bleeding may occur
with higher platelet counts. In patients undergoing surgery, bleeding may occur with relatively low
platelet counts. Blood Products
In addition to evaluating platelet count and patient condition, bleeding time may also be used in
determining the need for platelet transfusions. A bleeding time twice the upper normal limit may be
an indication for a platelet transfusion in a bleeding patient. HLA Matched platelets are indicated for
patients who are refractory (demonstrate a poor post-transfusion platelets increment) to random
donor platelets due to alloimmunization.
Patients with auto-immune thrombocytopenic purpura (ITP) should not receive platelet transfusions
unless bleeding is significant or life threatening. Platelet transfusions given to patients with ITP will
be rapidly removed from circulation by the patients anti-platelet antibodies and thus will be, at most,
only of transient benefit.
Therapeutic Effect - Each unit of platelets prepared from donated whole Blood contains a certain
number of platelets and can be expected to increase the platelet count of a 155-pound patient by a
known approximate amount by one hour after transfusion. Since the usual dose for adults with
platelet related bleeding is a pool of four to six units of platelet concentrates from whole Blood or
one standard sized unit of apheresis platelets, an increase in the platelet count by one hour after
transfusion is expected. Blood Products
Effect of Platelet Product and Patient Weight on Platelet Increment*
Patient weight (in
pounds)
Single whole
Blood platelet
concentrate
Standard apheresis of four

pooled whole
Blood platelets
Large apheresis or
six pooled whole Blood
platelets
50
17,600
70,400
105,600
100
8,800
35,200
52,800
150
5,900
23,500
35,200
200
4,400
17,600
26,400
*Data is given as one hour post transfusion platelet increment
Patients demonstrating two consecutive platelet count increases of less than a known standard
range at one hour after transfusion of four to six units of pooled platelets (or one unit of apheresis
platelets) are considered refractory. Failure to achieve hemostasis or the expected increment in the
platelet count may signify a refractory state. A refractory state to platelets may be caused by fever,
sepsis, DIC, or splenomegaly or an immune response to the platelets also referred to as platelet
alloimmunization. In patients with alloimmunization, HLA matched platelets may be necessary to
control bleeding due to thrombocytopenia.
Granulocytes (Neutrophils)
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Description - Granulocytes (neutrophils) are obtained by an apheresis procedure from an ABO-Rh

compatible donor. Since there are large numbers of red cells in granulocyte concentrates,
compatibility testing must be performed between the donor unit and the recipient. Granulocyte
concentrates from donors who have been stimulated by G-CSF, a practice currently under study,
contain much larger numbers of leukocytes. Granulocyte concentrates are always irradiated to
prevent graft versus host disease. Granulocytes should be administered as soon as possible after
collection. If this is not possible, storage should be at room temperature for no longer than 24 hours
after collection. A four hour expiration time is placed on the granulocytes once issued from the
Blood center. Blood Products
Indications - Granulocytes should be considered for patients with severe neutropenia (<200/l) and
a documented life-threatening bacterial or fungal infection not responsive to appropriate antibiotic
therapy. Additional indications include neonates with clinical sepsis and patients with infections who
have neutrophil function defects. After granulocyte therapy is initiated, it is generally continued once
daily until the infection clears or the neutrophil count begins to recover.
Therapeutic Effect - Even though there may be a clinical effect, there may not be an increase in
the recipients neutrophil count.
Fresh Frozen Plasma (FFP)
Description - Fresh frozen plasma (FFP) is the plasma removed from a unit of whole Blood and
frozen at or below 55 Fahrenheit within eight hours of collection. FFP contains all coagulation
factors in normal amounts and is free of red cells, leukocytes and platelets. It is not a concentrate of
clotting factors. One unit is approximately 225 ml and must be ABO compatible with the recipients
red cells, Rh need not be considered.
Indications - FFP is indicated for patients with documented coagulation factor deficiencies who are
actively bleeding or who are about to undergo an invasive procedure. Causes of such deficiencies
include congenital deficiency, liver disease, anticoagulation with warfarin or massive transfusion with
red cells and crystalloid/colloid solutions. Factor deficiencies severe enough to be clinically
significant are usually associated with prolongation of the coagulation screening tests (prothrombin
time, partial thromboplastin time) at least 1.5 times the control value or an INR of 1.6. FFP is also
indicated in treatment of thrombotic thrombocytopenic purpura (TTP), usually in conjunction with
plasma exchange. FFP should not be used for volume expansion or nutritional support. Immune
globulin preparations are available for the provision of immune proteins instead of FFP. Reversal of
warfarin anticoagulation should be accomplished with Vitamin K rather than FFP if two to three days
can be allowed for clotting factors to return to hemostatic levels. Massively bleeding patients may be
given FFP along with red Blood cells to prevent dilution of clotting proteins. Blood Products
Therapeutic Effect - One ml of FFP per 2.2 pounds of patient weight will raise most clotting factors
by approximately 1%. FFP should be used as soon as possible after it is thawed and always within
24 hours after thawing. The amount of FFP needed depends on the patients clotting factor levels,
levels needed to achieve a therapeutic effect, whether or not the patient is bleeding and the
patients Blood volume. Clotting factor activity should be estimated by specific coagulation factor
assays, or in emergencies, at least by coagulation screening tests.
Cryoprecipitate (CRYO)
Description - Cryoprecipitate (Cryo) is a low purity concentrate of three hemostatic proteins
prepared from donated whole Blood. A single bag of Cryo contains an average of 100 units of factor
VIII and von Willebrand factor and 150 to 250 mg of fibrinogen with some factor XIII and fibronectin.
No compatibility testing is required and ABO-Rh type is not relevant. However, due to their small
Blood volumes, children less than one year of age should be given ABO compatible Cryo in case
trace amounts of anti-A or anti-B are present. When Cryo is ordered, units are thawed, suspended
in sterile normal saline (20ml/bag) and pooled. Once pooled, Cryo should not be chilled or
refrigerated as the protein will re-precipitate. The volume of a dose of Cryo depends upon the
number of units pooled. For young children who cannot tolerate a large volume or to increase the
fibrinogen concentration for fibrin glue preparation, Cryo can be suspended in 10 ml of saline per
bag (reduced-volume Cryo). Cryoprecipitate is the only fibrinogen concentrate available for
intravenous use.
Indication - Cryoprecipitate is indicated for bleeding or imminent invasive procedures for patients
with significant hypofibrinogenemia (<100 mg/dl). Commercial Clotting Factor Concentrates made
with viral inactivation methods are preferred over Cryo for hemophilia A and von Willebrand
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treatment.
The use of cryoprecipitate for the preparation of fibrin glue is increasing as applications in
neurosurgery, orthopedic and ENT surgeries are expanding. Autologous units can be collected
ahead of time and processed into Cryo to be used for fibrin glue. Blood Products
Therapeutic Effect - When used for fibrinogen replacement, ten bags should provide enough
fibrinogen to raise the fibrinogen 60 to 70 mg/dl in a 155 pound adult. Therapeutic effect can be
monitored by fibrinogen levels and the patients clinical response.
Note: Cryoprecipitate transfusions may be prepared from a designated donor for some young or
mildly affected patients with hemophilia A or von Willebrand disease to limit potential viral exposure
through transfusions. These single donor Cryo products may have higher concentrations of factor
VIII and von Willebrand factor than regular donor Cryo because of DDAVP used to stimulate the
apheresis donor prior to collection. Multiple bags of high potency Cryo are then prepared from one
collection. Blood Products
A single unit (bag) of Cryo is usually adequate for the preparation of fibrin glue unless more than 10
ml is needed.
Factor VIII Concentrates
Description - Factor VIII concentrates are a commercially prepared, lyophilized powder purified from
human plasma to treat patients with hemophilia A or von Willebrands disease. Alternatively,
recombinant (synthetic) protein is purified from genetically engineered non-human cells grown in
tissue culture. The quantity of factor VIII coagulant activity is stated on the bottle. One factor VIII
concentrate unit equals the clotting activity in 1 ml of fresh plasma. Factor VIII concentrate is cell
free and is administered without regard to patient or donor ABO or Rh type. It is heat treated and/or
solvent detergent treated to reduce the risk of virus transmission. Current processes appear to have
eliminated the risk of HIV, HBV and HCV transmission. concentrates differ in the purification
procedures. Highly purified factor VIII, e.g., preparations purified over a monoclonal antibody column
or current recombinant factor VIII concentrates, are stabilized by adding 98% of pasteurized human
albumin. Porcine factor VIII concentrate is available for patients with high titer anti-human factor VIII
'allo' or autoantibody inhibitors. Factor VIII concentrates are stored refrigerated at 35 to 45
Fahrenheit for up to two years from the date of manufacture (expiration date will be indicated on
each vial). Some preparations may be kept at room temperature for extended periods. Once
reconstituted, it should not be refrigerated. Factor VIII concentrate should be infused within four
hours of preparation to reduce the risk of bacterial growth. Vials are usually shipped to a hospital
pharmacy, Blood service or nursing unit and mixed there prior to use. Many patients or families
receive them directly for home care. Blood Products
Indication - Factor VIII concentrate is indicated for the treatment of bleeding or imminent invasive
procedures in patients with hemophilia A, (congenital factor VIII deficiency) and for patients with low
titer factor VIII inhibitors. Regular prophylactic doses are often used, as well as daily doses in some
hemophilic inhibitor patients to try to induce immune tolerance. Patients with von Willebrands
disease respond to one specific, pasteurized intermediate purity concentrate in which that factor
activity is relatively preserved.
Therapeutic Effect - Dosage is dependent on the nature of the injury, the degree of factor
deficiency, the weight of the patient and the presence and level or absence of factor VIII inhibitors.
The half life of circulating factor VIII is eight to twelve hours, therefore transfusions may need to be
repeated every 12 to 24 hours to maintain hemostatic levels. Following surgery, it is necessary to
maintain hemostatic levels for up to two weeks to prevent delayed bleeding and promote wound
healing in the hemophilic patient.
Factor IX Concentrates
Description - Factor IX concentrates are a commercially prepared, lyophilized powder purified from
human plasma to treat patients with hemophilia B. Crude preparations, previously referred to as
prothrombin complex concentrates, contain coagulation factors II (prothrombin), IX, X and variable
amounts of factor VII and carry a risk of thrombosis associated with administration. Purified factor IX
concentrates, available since early 1991, essentially contain only factor IX and thus have eliminated
the risk of thrombosis. Since both products are used primarily to treat factor IX deficiencies, the
amount of Factor IX contained in each product is stated on the label. Factor IX concentrates are
heat treated to reduce the risk of disease transmission, particularly HIV and hepatitis, and the
purified forms currently manufactured are treated sufficiently to inactivate hepatitis viruses B and C.
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Prior to reconstituting, factor IX concentrates may be refrigerated at 35 to 45 Fahrenheit until the

expiration date indicated on each vial, but should not be frozen.
Indication - Factor IX concentrates are indicated for patients with hemophilia B (factor IX
deficiency), also called Christmas Disease, who are requiring treatment of bleeding or about to
undergo invasive procedures. Low purity factor IX concentrate may be used in treatment of
hemophilia A patients with high titer inhibitors. It may be of value to patients with congenital factors
X or II (prothrombin) deficiency. "Activated" concentrates are also used for some factor VIII inhibitor
patients.
Factor IX concentrates should not be used for patients with acquired combined deficiency of
factor(s) II, VII, IX and/or X as plasma or whole Blood provides safer, more effective treatment in
these patients. Purified factor IX concentrate is considerably more expensive than crude factor IX
concentrates and is generally indicated only for hemophilia B patients who require repeated infusion
and/or are at greater risk for thrombosis. A recombinant (synthetic) product was FDA approved in
early 1997 and is recommended for hemophilia B patients with minimal or no prior exposure to
plasma derived products or FFP. Low purity factor IX concentrates are contraindicated for patients
with liver disease, as there has been an increased risk of thrombosis seen with the use of these
products in this group of patients.
Therapeutic Effect - Dosage will depend on the patient factor level and the circumstances making
the transfusion necessary. Treatment for bleeding generally requires every 12-hour or daily infusions
until symptoms resolve. For major surgery in hemophilia patients, purified concentrate is indicated
for ten to fourteen days (until sufficient wound healing has taken place to prevent re-occurrence of
the bleeding condition). In hemophilia A patients with inhibitors, undergoing surgery or experiencing
major bleeding episodes, the treatment may consist of infusions of the crude concentrates every
eight to twelve hours. Blood Products
Antithrombin III
Description - Antithrombin III concentrates are commercially purified from human plasma pools and
lyophilized. They are provided as a powder in one vial and a diluent (e.g. sterile water) in a
companion vial. Viracidal treatment appears to eliminate the risks of HIV or hepatitis B or C
transmission. Prior to reconstituting, antithrombin III concentrates should be refrigerated (35 to 45
Fahrenheit) until they expire, but should not be frozen.
Indication - Antithrombin III concentrates are approved for and indicated in reducing an acute
increased risk of venous thrombo-embolic disorders in patients with symptomatic, congenital
antithrombin III deficiency. This will usually be prophylactic therapy to correct levels from half-normal
to around 100% during surgical procedures or periods of increased risk from immobility, etc. A
potential role in acquired thrombic disorders or DIC is being investigated but has not been
established.
Therapeutic Effect - Due to a short life, long term prophylaxis with antithrombin III infusions is not
feasible (versus use of oral anticoagulants). The dosage is as indicated in the paper included in the
package. This Blood product is an 'order item' norrnally available, in most areas, within two working
days. Blood Products
CMV Negative Blood Components
Description - CMV is a herpes virus that resides in the white Blood cells of persons who have been
infected with the virus. There is a high prevalence of CMV positive persons worldwide. Most persons
that are CMV positive have no history of illness.
CMV transmission to susceptible patients is effectively prevented by use of either CMV seronegative,
a donor determined to be negative for antibody to CMV, or Leukoreduced, containing less than a
certain range of leukocytes.
Cryoprecipitate and Fresh Frozen Plasma are cell free and have not been implicated in CMV
transmission. Blood Products
Indications - CMV negative Blood products are indicated for patients in the following categories,
regardless of CMV status of the mother:
Premature infants;
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Infants under four weeks of age; and,

Patients requiring intrauterine transfusion.
CMV negative Blood products are indicated for CMV negative patients in the following categories:
Bone marrow or organ transplant recipients (if the marrow or the organ donor is also
CMV negative);
Potential candidates for transplant;
AIDS or HIV infected patients;
Patients who have congenital immune deficiency;
Patients undergoing splenectomy; and,
Pregnant women.
If CMV status is pending in these patients, CMV negative components are indicated. CMV negative
components are not considered necessary for patients receiving chemotherapy. Blood Products
Therapeutic Effect - In patients with compromised immune systems, a CMV infection could result in
a serious complication. CMV negative or leukoreduced Blood products reduce this hazard.
Irradiated Blood Products
Description - Irradiated Blood products are exposed to approximately 2500 rads of Gamma
radiation to destroy the lymphocytes ability to divide. Transfusion-associated graft-versus-host
disease (TA-GVHD) has not been reported from transfusion of cryoprecipitate or fresh frozen plasma
(FFP), thus these components do not require irradiation. Fresh plasma (not frozen) for transfusion
should be irradiated if the patient is at risk for TA-GVHD.
Indications - The following indications for irradiation apply to patients with the listed diagnoses.
Absolute Indication:
Bone marrow transplant (BMT) recipients (allogeneic, autologous);
BMT or stem cell donors if allogeneic transfusion must be given prior to completing the
harvest;
Cellular (T-cell) Immune Deficiency (congenital or acquired);
Intrauterine transfusion;
Transfusions from family members (any degree);
Directed donors (when not identified as family members versus friends);
HLA-matched platelet transfusions.
Appropriate Indication:
Hematologic malignancies (leukemias);
Hodgkins Disease;
Non-Hodgkins Lymphoma;
Neonatal exchange transfusion;
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Premature infants; and,

Certain solid tumors (neuroblastoma, glioblastoma).
Irradiation not considered as indicated: Blood Products
AIDS;
Most solid tumors;
Non-myeloablative chemotherapy recipients;
Routine immunosuppressive drugs (such as prednisone);
Solid organ transplant recipients;
Aplastic anemia (except if BMT); and,
Humoral immunodeficiency.
Therapeutic Effect - Irradiation destroys the ability of transfused lymphocytes to respond to host
foreign antigens thereby preventing graft vs. host disease in susceptible recipients. Patients with
functional immune systems will destroy foreign lymphocytes, making irradiation of Blood and Blood
components unnecessary.
Leukoreduced Blood Components
Description - Cellular Blood components that contain less than a known and accepted range of
leukocytes (white Blood cells) are considered leukocyte reduced. The leukocyte content of Blood
components can be reduced by filtration. With platelet preparations, filtration results in the loss of
10 to 30% of the platelets. Single donor platelets prepared with the most modern apheresis
machines will already contain a miniscule amount of leukocytes (LRS platelets), can be labeled as
leukocyte reduced, and do not require filtration. Cryoprecipitate and fresh frozen plasma do not
contain intact or viable leukocytes making leukoreduction unnecessary.
Indications - Leukoreduced Blood and components are indicated:
For patients who have experienced two or more non-hemolytic febrile transfusion
reactions;
As a method of preventing transfusion transmitted CMV; and,
As a method of preventing platelet alloimmunization in some cases
SUMMARY
BLOOD COMPONENT
CONTENTS
VOLUME SHELF
LIFE**
Whole Blood (autologous Red Blood cells (RBC); plasma. White Blood Cells (WBCs); platelets
not viable after 24 hr. Factors V; VIII significantly decreased after 2
or directed donations)
days. Hct 35%. 450mL Blood; 63 Ml CPDA-1 anticoagulant
520 ml
Red cells (AS-1)
RBC w/ appx. 25 mL of plasma; 100 mL of saline; additive solution

(adenine, mannitol). Hct 60%
340 mL 42 days
4o C
Platelet concentrate
Platelets; includes some WBC; 50 mL of plasma, a few RBC (Hct

less than .005)
50 mL
Platelet pheresis
Platelets; includes some WBC; 300 mL of plasma; a few RBC
300 mL 5 days
200 C
Fresh frozen plasma
Plasma proteins, all coagulation factors, complement
225 mL 1 year
18o C
35 days
4o C
5 days
20o C
12/8/2016 6:18 PM
11 of 11
Cryoprecipitate
150 mg of fibrinogen, at least 80 units of factor VIII, von Willebrand

factor, factor XIII, fibronectin
15 mL
1 year
18o C
* Note 1 - these are not "packed" red cells. Packed red cells have a Hct of 70-80%.
** Note 2 - these times do not consider cryo-freezing technologies.
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COMMON BLOOD PRODUCTS

BLOOD PRODUCTS; WHOLE BLOOD