BLOOD AND BLOOD COMPONENTS

 Blood products are any therapeutic

substances prepared from human blood and
are classified into:
 Whole blood
 Blood components: red cell
concentrates,paltelet concentrates,fresh
plasma and cryoprecipitate.
 Plasma derivatives: Albumin, coagulation
factors and immunoglobulins.
 1628:British physician William Harvey
discovered the circulation of blood.
 1658:Microscopist Jan Swammerdam
observes and describes Red Blood Cells.
 1665:First successful Blood transfusion in
Dog.
 1667:successful blood transfusion from sheep
to humans.
The American national Red Cross 2019
 1818:British Obstetrician James Blundell
performs the first successful transfusion of
human blood to a patient for the treatment
of PPH.
 1901:Karl Landsteiner an Austrian physician
discovers the first 3 blood group(A,B,O).
 1989:first approved oxygen carrying blood
substitute called Fluosol-DA-20 was
manufactured by Green cross in Japan.
 There are 2 pathways: Intrinsic pathway and
extrinsic pathway. The extrinsic pathway,
involving tissue factor and factor VII, and the
intrinsic pathway, in which factors XII, XI, IX,
VIII, and V participate. Both pathways
converge to activate factor X and lead to
transformation of prothrombin into thrombin
and, through the action of thrombin, from
fibrinogen into fibrin.
 Factor l- Fibrinogen
 Factor ll- Prothrombin
 Factor lll- Thromboplastin
 Factor lV- Calcium
 Factor Vl- Same as factor V
 Factor Vll- Proconvertin
 Factor Vlll- Antihemophilic factor
 Factor lX- Christmas factor
 Factor X- Stuart-power factor
 Factor Xl- Plasma thromboplastin antecedent
 Factor Xll- Hagemen factor
 Factor Xlll- Fibrin stabilizing factor.
 Blood products can transmit infectious
agents including:
- HIV
- hepatitis B
- hepatitis C
- Syphilis
- malaria and Chagas disease ( Trypanosoma
cruzi) to the recipient.
In red cell transfusion, there must be ABO and RhD
compatibility between the donor’s red cells and
the recipient’s plasma.
 Group O individuals can receive blood from
group O donors only .
 Group A individuals can receive blood from
group A and O donors .
 Group B individuals can receive blood from
group B and O donors .
 Group AB individuals can receive blood from AB
donors, and also from group A, B and O donors
 Whole blood is rarely used in developed
countries although it is widely used in many
countries.
 Whole blood has a shelf life of 35 days.
 Citrate phosphate dextrose adenine(CPDA-1)
is an anticoagulant preservative in which
blood is stored at 1-6 degree C.
 Storage at 2-6 degree C slows the rate of
glycolysis approximately 40 times compared
to body temperature.
 Contains 450ml of donor blood with 63ml of
anticoagulant.
 Approximately Hb-12gm/ml
 Haematocrit 35-45%
 No functional platelet
 No labile coagulation factors(V and Vlll)
 Non-sterile
 Transfusion should start within 30mins of
removal from the refrigerator and completed
within 4 hours.
 Citrate :anticoagulant, prevents clotting by
binding calcium.
 Phosphate: serves as buffer
 Dextrose: red cell energy source (allows RBCs
to continue glycolysis)
 Adenine : allows RBCs to resynthesize ATP,
which extends the storage time from 21 to 35
days.
 The shelf life is extended to 42 days with AS-
1(ADSOL),AS-3(NUTRICEL),or AS-
5(OPTISOL)
 ADSOL: contains adenine, mannitol, glucose
and sodium chloride.
 NUTRICEL: contains adenine, glucose,
citrate, phosphate and sodium chloride.
 OPTISOL: contains only dextrose, adenine,
sodium chloride and mannitol.
 Patients developing hypovolemia due to
massive blood loss.
 Massive trauma.
 Obstetrical emergencies.
 Also during exchange transfusion.
 An urgent transfusion is recommended if the
loss is more than 40% of the blood volume.
blood transfusion is rarely needed if the blood
loss is around 15-30%.

Journal of the Scientifi c Society, Vol 41 / Issue 3 / September-December 2014

 Risk of volume overload: chronic anaemia
,cardiac failure.
 Blood components may be prepared from
either whole blood donations or by apheresis.
 APHERESIS: a process by which the
component which is to be used is separated
out and collected and the rest is returned to
the donor.
 Produced by removing about 150-200ml of
citrated plasma from a unit of whole blood.
 Haematocrit of 55-75%.
 Haemoglobin (Hb) of ~20 g/dl.
 Stored at 2-6°C.
 Average shelf-life is 21-42 days.
 Should be transfused within 4 h of rewarming
to body temperature.
 1 unit of PRBS increases Haematocrit by 3%
and Hb by 1gm/dl.
 Hb level is <7 g/dl .
 In patients with CAD, CRF, CCF and Bone
marrow failure, even if the Hb is more than 7
g/dl PRBC transfusion can be considered.
 If Hb concentration is between 7 and 10 g/dl,
RBC transfusion may be required depending
on clinical condition.

Journal of the Scientifi c Society, Vol 41 / Issue 3 / September-December

2014
 Stored at 20-24°C with constant agitation for
up to 5 days.
 Should be infused within 4 h of collection to
avoid contamination.
 Total transfusion time should not exceed 30
min.
 Dosage:1 unit of platelet concentrate/10kg BW.
 Should be ABO compatible whenever possible.
 Must not be refrigerated before infusion.
WHO blood transfusion safety handbook 2001
 SDP(single donor platelet):Platelets prepared
from one donation. contains 55x109 platelets
 Pooled units: Platelets prepared from 4-6 donor
units pooled into one pack, contains at least
240x 109 platelets.
 The transfusion of 1 single donor platelets units
raises count by 20,000/μl.
 NOT indicated in: ITP, TTP, untreated DIC,
Thrombocytopenia associated with sepsis

WHO blood transfusion safety handbook 2001

 Active bleeding and platelet count
<50,000/μl.
 Active bleeding and platelet function defect.
 Haematology patients with active bleeding:
autoimmune platelet disorders, dengue,
malaria, kalaazar.

Journal of the Scientifi c Society, Vol 41 / Issue 3 / September-December 2014

 Surgical or invasive procedures with:
-Platelet count <50,000/μl for procedures
with minimal bleeding risk.
-Platelet count <100,000/μl for central
nervous system, ophthalmological surgery
where Microvascular Bleeding is hazardous.

Journal of the Scientifi c Society, Vol 41 / Issue 3 / September-December 2014

 Oncology patients with:
-Platelet count <10,000/μl in stable patients.
-Platelet count <20,000/μl in the presence of
risk factors.
 Massive blood transfusion, that is, replacement
of whole blood volume within 24 h.
 Post-cardiopulmonary bypass with uncontrolled
bleeding.
Journal of the Scientifi c Society, Vol 41 / Issue 3 / September-December 2014
 It is obtained by separating the liquid portion
of blood from the cells and rapidly freezing it.
 Contains stable clotting factors,
immunoglobulins (Igs) and albumin.
 Volume is about 200-300 ml/unit.
 Frozen within 6 h of collection to –25°C to
maintain the coagulation factors.

WHO blood transfusion safety handbook 2001

 Can be stored at −25°C for up to 1 year.
 Thawed at 30-37°C before transfusing.
 Transfusion should be started within 6 h of
thawing.
 Once thawed, should be stored in the
refrigerator at +2 to +6 degree Celsius.
 dose:10-15ml/kg(1 pack/15kg BW)

WHO blood transfusion safety handbook 2001

 Active bleeding with documented
coagulopathy (international normalized ratio
INR >2 or prothrombin time (PT) >1.5 or
activated partial thromboplastin time (APTT)
twice the normal.
 Liver disease with coagulopathy.
 Emergent reversal of warfarin effect.
 Disseminated intravascular coagulopathy
(DIC).
Journal of the Scientifi c Society, Vol 41 / Issue 3 / September-December 2014
 Dilutional coagulopathy due to infusion of
large volumes of transfusion.
 Replacement of single factor deficiencies
(factor XI, V deficiency).
 Prophylaxis in patients undergoing surgery or
invasive procedure with coagulopathy.
 The target INR should be <1.7 or PT should be
<15 or APTT should be less than twice the
normal.
Journal of the Scientifi c Society, Vol 41 / Issue 3 / September-December 2014
 Must be ABO compatible to avoid haemolysis
in recipient.
 Labile coagulation factors degrade rapidly;
use within 6hours of thawing.
 Severe life threatening anaphylactic reaction
occurs occasionally.
 Acute allergic reactions are not uncommon.

WHO blood transfusion safety handbook 2001

 It is the fraction of plasma that remains
undissolved after controlled thawing of FFP
at 4°C.
 Rich in fibrinogen (150-300 mg/pack), factor
VIII (80-100 IU/pack), vonwillibrand factor and
fibronectin.
 Resuspended in 10-20 ml plasma.
 Can be stored at −25°C for up to 1 year,
Should be infused within 6 hrs of thawing
WHO blood transfusion safety handbook 2001
 Fibrinogen levels <80-100 mg/dL with bleeding.
 Disseminated intravascular coagulopathy.
 Liver disease.
 Massive transfusion.[20-22] 5. Factor XIII
deficiency.
 The amount of cryoprecipitate recommended
for transfusion is 1 unit per 7-10 kg of body
weight (5-10 units in an adult).

Journal of the Scientifi c Society, Vol 41 / Issue 3 / September-December 2014

 Leucocyte depleted red cells have 99.9% of
the white cells removed either by freezing or
microfiltration.
 Haemoglobin concentration and Haematocrit
depend on whether the product is whole
blood, red cell concentrate or red cell
suspension.
 Leucocyte depletion significantly reduces the
risk of transmission of cytomegalovirus
(CMV) ,Epstein bar virus and febrile reactions.
 Replacement fluid in therapeutic plasma exchange:
use albumin 5%.
 Treatment of diuretic-resistant oedema in
hypoproteinemic patients: e.g. nephrotic syndrome or
ascitis. Use albumin 20% with a diuretic .
 Although 5% human albumin is currently licensed for
a wide range of indications (e.g. volume replacement,
burns and hypoalbuminemia), there is no evidence
that it is superior to saline solution or other crystalloid
replacement fluids for acute plasma volume
replacement
 Partially purified Factor VIII prepared from
large pools of donor plasma .
 Storage +2°C to +6°C up to stated expiry
date.
 Indications :
- Treatment of haemophilia A .
- Treatment of von Willebrand’s disease.
 Supplied as Vials of freeze-dried protein
labelled with content, usually about 250 IU of
Factor VIII .
 prepared from large pools of donations and
contains antibodies against infectious agents
to which the donor population has been
exposed .
 Transmission of virus infections has not been
reported with intramuscular immunoglobulin.
 Indications :
-treatment of hepatitis B, rabies, tetanus etc.
-Prevention of specific infections.
- Treatment of immune deficiency states
 For each unit of blood transfused, monitor
the patient:
-Before starting the transfusion.
-As soon as the transfusion is started.
-15 minutes after starting the transfusion.
-At least every hour during transfusion.
- On completion of the transfusion.
- 4 hours after completing the transfusion.
 Immediate management:
 Slow the transfusion.
 Administer antihistamine IM (e.g.
chlorpheniramine 0.1 mg/kg or equivalent). 3
If no clinical improvement within 30 minutes
or if signs and symptoms worsen, treat as
Category 2.
WHO blood transfusion safety handbook 2001
Immediate management :
 Stop the transfusion.
 Notify the blood bank immediately.
 Send blood unit with infusion set, freshly
collected urine and new blood samples (1
clotted and 1 anticoagulated) from vein
opposite infusion site with appropriate
request form to blood bank for laboratory
investigations.
 Administer antihistamine IM (e.g.
chlorpheniramine 0.1 mg/kg or equivalent)
and oral or rectal antipyretic (e.g.
Paracetamol). Avoid aspirin in
thrombocytopenic patients.
 Give IV corticosteroids and bronchodilators if
there are anaphylactoid features (e.g.
broncospasm, stridor).
WHO blood transfusion safety handbook 2001
 Collect urine for next 24 hours for evidence of
haemolysis and send to laboratory.
 If clinical improvement, restart transfusion
slowly with new blood unit and observe
carefully.
 If no clinical improvement within 15 minutes
or if signs and symptoms worsen, treat as
Category 3.
WHO blood transfusion safety handbook 2001
 Signs :Rigors,Fever,Restlessness,Hypotension,
Tachycardia,Haemoglobinuria ,Unexplained
bleeding (DIC)
 Symptoms :Anxiety ,Chest pain, Pain near
infusion site, Respiratory distress, Headache.
 Possible causes :Acute intravascular haemolysis,
Bacterial contamination and septic shock ,Fluid
overload ,Anaphylaxis ,Transfusion associated
acute lung injury (TRALI).
 Immediate management :
 Stop the transfusion.
 Infuse normal saline (initially 20–30 ml/kg) to
maintain systolic BP.
 Maintain airway and give high flow oxygen .
 Give adrenaline 0.01 mg/kg body weight by slow
intramuscular injection.
 Give IV corticosteroids and bronchodilators if
there are anaphylactoid features (e.g.
broncospasm, stridor).
 Give diuretic: e.g. frusemide 1 mg/kg IV or
equivalent.
 Notify blood bank immediately.
 Send blood unit with infusion set, fresh urine
sample and new blood samples (1 clotted and
1 anticoagulated) from vein opposite infusion
site for investigations.
 Check a fresh urine specimen visually for
signs of Haemoglobinuria
 Assess for bleeding from puncture sites or
wounds. If there is clinical or laboratory
evidence of DIC, give platelets and either
cryoprecipitate or fresh frozen plasma.
 Inotropic support for hypotension.
 Oxyglobin
 Polyheme
 Hemospan
 Dextran-haemoglobin
 Hyperbranched polymer-protected
porphyrin.