SDLS 2008

Medicine for the intoxicated

font in bold letters are the parts she particularly emphasized - Kacy PLASMA, PLASMA COMPONENTS & DERIVATIVES * Components italicized are commercially manufactured blood derivatives .
CHARACTERISTI CS

Detoxicol

Subject: Pathology Topic: Supplement for Blood Transfusion Prepared by: Kathryn Cecille Umali

No. of pages: 4

STORED PLASMA
~ Prepared from 1 unit of WB ~ uses a plasma extractor

FRESH FROZEN PLASMA (FFP)

~ plasma from Fresh Whole Blood (FWB) ~ immediately separated & frozen ~ 200-260 ml ~ plasma proteins (6-8%) ~ all coagulation factors ~ complement ~ 90% water ~ carbohydrates & lipids

CRYOPRECIPITATE
~ material does not become totally liquid when FFP is thawed ~ 10-15 ml ~ 80 units of factor VIII ~ Von Willebrands Factor ~ Factor XIII, ~ Fibrinogen, Fibronectin ~ other plasma proteins ~ Separate plasma from RBC 4 hours after collection ~ Freeze plasma (within 8 hours after collection of WB) at 30C or less ~ centrifuge & decant, leaving 15 ml of plasma w/ the cryoprecipitate ~ refreeze cryoprecipitate within 1 hour ~ 1 year at 18C or colder ~ Use within 6 hours after thawing ~ Should not be refrozen once thawed

COAGULATION FACTOR CONCENTRATE

~ Prepared from a pool of donor blood & lypholized

PLASMA PROTEIN FRACTION (PPF)

~ plasma colloid derivative made from pools of plasma ~ 200-250 ml

ALBUMIN
~ Prepared from pools of plasma

IMMUNE SERUM GLOBULINS

~ Solutions or lypholized preparations containing many of the Ab present in human blood ~ antibodies present in human blood ~ IgG (90%) ~ small quantities of IgA, IgM ~ other plasma proteins

CONTENTS

~ Factor VIII Concentrate hemophilia A ~ Factor IX concentrate contains Factors IX, II, VII & X

~ Albumin (*3%) ~ globulins & globulins (17%)

PREPARATION

~ prepared using a plasma extractor

~ centrifuge 1 unit of FWB & separate fluid portion ~ freeze at 18C or colder within 8 hours after collection ~ for use: thaw at 37C with constant agitation

STORAGE

~ 1-6C ~ for 40 days from the date of WB collection

~ 1 year at 18C or colder ~ after thawing, store at 1-6 C ~ use within 24 hours

INDICATION

~ Blood volume expansion ~ Coagulation defects

~ Bleeding due to liver disease, DIC, or massive transfusion ~ in single or multiple coagulation deficiencies, either prophylactically or for treatment of bleeding ~ replacement of factor deficiency when specific component therapy is not available or appropriate (Factor II, V, VII, IX, X, XI)

~ Factor VIII deficiency ~ Von Willebrands disease ~ Factor XIII deficiency ~ Hypofibrogenemia ~ Replacement of fibronectin lost in burns & traumatic shock

~ Factor VIII Concentrate Hemolphilia A ~ Factor IX Concentrate Factor IX deficiency (Hemophilia B / Christmas Disease) ~ Hemophilia A patients who have factor VII inhibitors ~ May be used for factor II, VII or X deficiency if FFP cannot be used ~ Factor VIII Concentrate ~ Factor VIII activity is already assayed by manufacturer ~ Heating during its manufacture inactivates the HIV virus (but not HBV or HCB) ~ Factor IX concentrate ~ rapid method of achieving & monitoring hemostasis in appropriate patient

~ Plasma expander for hypovolemia & shock

~ Plasma expander for hypovolemia & shock

~ Treatment or prophylaxis for hypogammaglobulinemia

ADVANTAGE

~ since it doesnt contain cells, it risk of sensitization to cellular antigens

~ reduces risk of alloimmunization to RBC, WBC, & platelet antigen (compared to whole blood) ~ cross-matching not required

~ Preferable to FFP in correction of bleeding disorders because of smaller volume

~ pasteurization during manufacture kills viruses

~ Does not contain bradykinin

DISADVANTAGE

~ high risk for transmission of disease

~ risk is same as Whole Blood ~ Should not be used as plasma expander or source of protein nutrition or immunoglobulins ~ Should be ABO compatible with recipients RBC

~ Cannot be used for bleeding disorders other than those specified

~ Factor IX Concentrate ~ risk of blood-borne disease which may not be eliminated during heating ~ may cause DIC, thrombosis, or embolization

~ Very expensive ~ May cause hypotention in patient with cardiopulmonary bypass

~ Should not be used for hypoalbunimea, due to a nutritional deficiency, chronic liver disease, protein-losing enteropathy or nephropathy. Will not alter disease & has only a short-time effect

BLOOD PRODUCTS CONTAINING RBCs WHOLE BLOOD (WB, Stored)

Characteristics ~ Red cells + most of plasma ~ Used in instances of active bleeding ~ Also used in massive transfusion wherein almost all of the patients circulatory volume is replaced within 24 hours ~ 520 ml ~ RBC ~ Plasma ~ WBC ~ platelets ~ 1 unit raises hemoglobin by 10 g/L (1g/dl) & the hematocrit by 0.3 (3%)

PACKED RED BLOOD CELLS (pRBC)

~ fresh blood with of plasma removed ~ contains pRBC with reduced

WASHED pRBC
~ pRBC that has undergone several saline washing to remove up to 99% of WBC (if WBCs are removed, almost all of the Abs from the blood that can elicit non-hemolytic reactions in the patient will be removed)

LEUKOCYTE-POOR pRBC
~ pRBC with 80-90% of white cells removed by several methods like sedimentation, centrifugation, microaggregates blood filtration

FROZEN (deglycerolized) RBC

~ pRBC frozen to prolong storage life up to 10 years ~ contain only RBC and about 5% of WBC, no plasma or platelets ~ 250 ml

IRRADIATED RBC
~ red cells exposed to gamma rays to destroy donor lymphocytes and prevent graft vs. host reactions (GVHD) in immunocompromised patients

Contents

~ pRBC with reduced plasma volume

~ contains RBC & minimal platelets, no plasma ~ 250 ml ~ Washed by saline ~ centrifuged & supernatant saline is decanted ~ Addition of glycerol prevents crystallization of intracellular water at low temperatures ~ Thawed & washed before use (up to 20% of RBCs are lost during thawing)

Preparation

~ 1 unit of blood is centrifuged ~ RBC sinks to the bottom ~ WBC & plasma remains on top ~ RBC expressed into satellite to form leukocyte pool or packed RBC ~ Overnight sedimentation in refrigerator or by refrigerated centrifuge As WB

Storage

1-35 days at 1-6C (depending on anticoagulant) ~ Active bleeding with blood loss >25%

~ 10 years at 65C or colder ~ 24 hours at 1-6C after washing ~ PNH (complement is removed) ~ Repeated febrile nonhemolytic transfusion reactions due to leukocyte antibodies ~ emergency transfusion of group O red cells to patients of other ABO group ~ prevention of anaphylactic reaction reactions in IgA-deficient patients ~ repeated febrile nonhemolytic reactions due leukoagglutinins ~ same as washed RBC ~ Autologous transfusion ~ recipients of autologous or allogenic bone marrow grafts ~ severe congenital immunodeficiency syndromes involving T-lymphocytes ~ donation of immunocompetent 1st degree relatives of immunocompromised patients

Indications

~ chronic anemia, anemia due to destruction or poor production of RBC ~ Anemia in patients with CHF ~ neonates and infants ~ debilitated patients

Advantage

~ Provides both red cells and volume replacement ~ Rapid flow characteristics

~ less risk for volume overload ~ contains lesser anticoagulant, ammonia, & electrolytes ~ contains less antibodies & plasma protein

~ reduces risk of febrile reactions due to WBC & platelets ~ washing reduces formation of microaggregates ~ almost devoid of plasma ~ eliminates anticoagulants and unwanted metabolites

~ allows storage of rare blood types ~ enables blood bank to maintain a large inventory of blood types ~ eliminates 95% of WBC platelets & plasma proteins (prevents febrile reactions & immunizations) ~ most of potassium, ammonium & citrate ~ Costly ~ Significant time lost during thawing ~ Once thawed, cells must be used within 24 hours

~ efficient & economical method to prevent posttransfusion GVHD in at-risk patients ~ irradiation prior to storage may be useful in mass casualty situations involving immunosuppression due to toxic chemicals & nuclear radiation ~ Costly

Disadvantage

~ indiscriminate use can reduce availability of components to multiple patients ~ may cause hypervolemia & CHF in patients who are not actively bleeding ~ absence of any functioning platelets (platelets are not viable in 48 hours) ~ factors V & VIII ~ ammonia (dangerous to patients with liver disease) ~citrate accumulation can lead to hypocalcemia development of M.I.

~ slower infusion rate

~ preparation is timeconsuming & labor-intensive

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