Blood Component Therapy MCC

Blood Component
Therapy
Dr. M. Mohandoss
Assistant Professor
Transfusion Medicine
Malabar Cancer Centre, Thalaserry
Outline
Whole Blood
Blood Components
Apheresis
Special Blood Components
MALABAR CANCER CENTRE
21/03/15
Blood In History
Richard Lower is credited with

performing, in 1665, the first
authentic blood transfusion
(animal to animal)
Human to Human
Transfusion
In 1818, James Blundell -Attempted human-to human transfusion
Modern Transfusion Therapy

.means component therapy
21/03/15
Whole blood in True sense.
21/03/15
Whole blood is not

Whole!
After 24hrs of storage WB essentially becomes red

cells suspended in a protein solution
Changes in Platelets
WB stored at 4C platelets rapidly lose viability
Granulocytes & Monocytes function reduced

within 8hrs and disintegrates within 24hrs
Microaggregates increase in number
FVIII, FV levels decreases
21/03/15
Component Therapy
1. Optimal preservation of in vitro function of blood

2. Efficient utilization of blood donations
21/03/15
COMPONENTS
STORAGE
TEMPERATURE
Packed red blood cells (PRBC) +2 to 6C

Platelets (PLTS)
+22 to +24C under

constant agitation
Fresh frozen plasma (FFP)

Cryoprecipitate (CRYO)
-30C or below
-30C or below
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Blood Bags
21/03/15
21/03/15
Methods of Component
Preparation
Whole Blood
Platelet Rich
Plasma
Method
Manual
Method
Apheresis
Buffy Coat
Method
Automation
21/03/15
Platelet Rich Plasma (PRP) method

Whole blood
Soft spin
within
(1800 rpm
6 hrs
x 9 min at 22oC)
Red cells
PRP
RBC
Platelet rich plasma (PRP)

Hard spin
(3000 rpm
PRP
x 7 min at 22oC)
Plasma
Platelet Conc.
FFP
PC
(RDP)
21/03/15
PRP Method
Manual plasma expresser
21/03/15
Buffy Coat method

Whole blood
Hard spin
(3000 rpm
x 9 min at 22oC)
Red cells
within
6 hrs
Plasma
RBC
Buffy coat
plasma
Soft spin
(1800 rpm x 7 min at 22oC)
Platelet Conc.
WBC with few RBC
21/03/15
Benefits of Buffy coat

method
Platelet yield improved a lot
Reduced WBCs in product
RBC contamination drastically

decreased
21/03/15
Separation using component extraction

Quadruple Bag
(Top And Top Bags)
Top and Bottom Bag

(TAB)
21/03/15
Blood Component
Extractor
Sealer
Sealers
Sensor
Sensors
Press
21/03/15
Dosage
Packed Red Blood
Cells
Platelets
1 unit of PRBC contains

approx 50g of Hb
1 unit of RDP raises PLT

count by 5000-10,000/l
One unit of PRBC

transfused in adult
(70kg) raises
Hb by 1g/dl
Adult dose requires 6

units of RDP increase
PLT count by 30,00060,000/l
Dosage
Fresh Frozen
Plasma
1 unit of FFP increases
each factor by 2-3% in
adult
Dose:
10-20ml/kg
1unit/10kg body
wt
Cryoprecipitate
Adults
1unit/10kg body wt
Infants
single unit (1015ml)
Apheresis
To take away or Withdraw
Process in which blood is removed from a

subject and continuously separated into
component parts, allowing a desired
component (s) to be retained while the
remainder is returned to the subject
21/03/15
Principle: Centrifugation
Separation efficiency based on gforce and dwell time (inlet flow rate)
21/03/15
Principle of Apheresis
Anticoagulant
added
Plasma
Remaining blood
components
recombined and
returned
Platelets
Whole
blood
(vein)
Lymphocytes
Granulocytes
Erythrocytes
Blood components separated by

centrifugation and selectively
removed
Whole
blood
(vein)
21/03/15
Principle of Apheresis
21/03/15
Apheresis Modalities
Plasmapheresis
Plasma removal or
exchange
(Centrifugal/Filtration
system)
Donor Plasmapheresis
Cytapheresis
Cell removal or exchange
(Centrifugal system)
Red cell
collection
(Double unit)
Plateletpheresis
(Single donor
platelets)
Granulocyte
collection
&
Stem cells
21/03/15
Donor for Apheresis
Similar to normal donation criteria

Weight > 60 Kg
Preferably a repeat donor - might have given
blood 1-2 times earlier
Venous access peripheral line
First degree relative donors are deferred to
prevent risk of GvHD
21/03/15
Multicomponent blood
apheresis
Collection of two or more identical or

different blood components by apheresis
RCC +RCC = 2 RBC

RCC+ FFP
RCC+ platelet
RBC+ FFP+ PC
PC+ PC = 2PC
PC+ FFP
FFP + FFP + FFP
Aggressive
Multicomponent
Apheresis
Atleast 3 components
are collected, including
atleast one SDP, and
one PRBC
21/03/15
Apheresis
Apheresis
Platelets
Single Donor Platelets
Whole blood
derived
platelet
21/03/15
SDP Vs RDP
Decreased chances of TTI and alloimmunization
number of donor support required
Lesser Donor reactions
Ensures adequate dose
ABO matched platelet support
Consistent and standardized yield
= 1 adult dose
(3x 1011/ unit)
SDP
RDP
RDP
+ RDP +
RDP
RDP
RDP
= 1 adult dose
(4 x 1010/unit)
Plateletpheresis or
SDP
Platelet count 150 x 109/l (preferably >250

x 109/l)
Usually not more than 2 procedure in a week
48 hours must elapse between two

procedures
Maximum of 24 procedures / year
Double Product
Platelet Count of 300 x109/l
21/03/15
Advantages of Apheresis Blood

Components
Patients
Reduced donor exposure : full transfusion dose
Matching donor to patients
Safety enhancement for patient
Donors
Frequent repeat donor

Reduced donor reactions
High donor acceptance
Products
Higher quality products

Consistent and standardized products
Double yield or multiple component collections
21/03/15
Special Blood
Components
Leukoreduced Blood Components
Irradiated Blood components
Saline Washed Components (Red
Cells/Platelets)
Minor Phenotype Matched Components
21/03/15
What is Leukoreduction?
A process in which the residual leukocyte count
of the components is reduced to a very low
level, so that the deleterious effects of
leukocytes are minimized or prevented
21/03/15
Adverse effect of Leukocytes in blood

components
Immunological effects
Disease Transmission
CMV
brile non-hemolytic transfusion reactions (FNHTR)
immunization to HLA/Leukocyte antigens
atelets refractoriness)
nsfusion related immunomodulation (TRIM)
HTLV1
EBV
GvHD (Transplant rejection)
nsfusion related acute lung injury (TRALI)

21/03/15
Why Leukoreduction?
Of many adverse transfusion reactions,
five are associated with leukocytes.
These five comprise over 90% of all
reported reactions associated with
transfusion of blood components.
21/03/15
storage time
passenger leukocytes
Transfused Leukocytes
Cytokine generation in stored

PC
Cytokine production in
vivo
Circulating cytokine
Threshold
Exceeded
IL - 1
IL 6
IL 8
TNF-
RANTES
FNHTR
TGF-
GRO-
21/03/15
21/03/15
21/03/15
Methods of Leukoreduction
Centrifugation
Freezing
Washing
Buffy Coat Removal
Screen Filtration
Apheresis
21/03/15
Leukocyte Content of
Various Blood Components
Leukoreduction (LR) labeling
requirements
US < 5 x 106/unit
EU < 1 x 106/unit
Whole Blood
Red Cells
Red Cells, LR
Apheresis Platelets, LR
Buffy Coat Platelets
Buffy Coat Platelets, LR
WBC Content per

Unit
109
2-5 x109
<1-5 x106
<1-5 x106
108
<1-5 x106
21/03/15
Leukocyte depletion various stages

Pre process
filtration
Component processing
In process
filtration
storage
storage
Pre storage
storage
Post process
filtration
transfusion
transfusion
transfusion
storage
transfusion
Post storage
21/03/15
Levels of Leukoreduction
% WBC removal
90%
99%
99.9 %
99.99 %
Log Reduction
Log 1 ( 108 )
Log 2 ( 107 )
Log 3 ( 106 )
Log 4 ( 105 )
21/03/15
Irradiated Blood Products

Irradiation of cellular components with ionizing radiation
results in the inactivation of T-lymphocytes
The damage to T-lymphocytes DNA prevents post infusion
proliferation that abrogates the potential for GVHD
Minimum dose 15- 25Gy
Reduced shelf life (28 days)
Ionizing Radiation
21/03/15
Principle of Irradiation
biophysics
Action of Gamma rays
Direct
Nuclear DNA
strands broken
Indirect
Interact with cell water
Free radical production
Disruption of cell division Oxidative injury

cell death
21/03/15
Blood components which

should be irradiated
All components that
contain viable T
cells
Not recommended
Whole blood
FFP???
PRBC/ LP-PRBC
Cryoprecipitate
SDP/ RDP
fractionated plasma
products (clotting
factor concentrates,
albumin and IVIG)
Granulocyte conc
Fresh plasma
Frozen
deglycerolized red
MALABAR CANCERcells
CENTRE
21/03/15
Irradiated Blood
Components
IndicationsBMT /Stem cell Recipients
Relatives blood usage
HLA Matched Platelets
Intra uterine transfusions
Transfusions newborn/infant
21/03/15
Instrumentation
21/03/15
21/03/15
Washed Components
Removal of:
Plasma (residual protein < 0.5g/unit)
Most of WBC
Few indications
Reactions to plasma proteins
Red cells for IgA deficient patients with Ab.
Limits shelf life (Open Vs Closed System)
Risk of contamination
Delay in issuing
21/03/15
Minor Phenotype Matched
Alloimmunization to red blood cell (RBC)

blood group antigens
21/03/15
After transfusion or pregnancy, a person makes

antibody to red cell antigen, he or she lacks
Re-exposure with corresponding Ag
Indicated in
Repeat blood
transfusion
Thalassemia
Sickle cell disease
Autoimmune hemolytic
anemia
Minor Phenotype Matched

Rh
MNSs
P Lewis
Lutheran
Kell
Duffy
Kidd
Xga
D C E c e f V VS Cw M N S s P1 Lea Leb Lua Lub K k Kpa Jsa Fya Fyb Jka Jkb Xga
Patient
+ + 0 + + + 0 0 0 + + + 0 0 + 0 + + 0 + 0
Donor 1
+ + 0 + + 0 0 0 + + + 0 + + + 0 0 + 0 + 0
Donor 2
+ + 0 0 + 0 0 0 0 + + 0 + + 0 + 0 + + + 0
Donor 3
+ 0 + + O 0 0 /
0 + 0 0 + + 0 0 0 + 0 + 0
21/03/15
Conclusion
Whole blood has limited use in the current

era.....
Component therapy has revolutionized

transfusion medicine
Standardized blood components help to assess

the outcome of the component therapy.
Apheresis collection units (more feasible)
Other procedures as leukofiltration, Irradiation

of blood & phenotype matched blood should
be employed when ever possible
21/03/15
Thank You
21/03/15
Pathogen Inactivation of
blood
21/03/15
Methods: Pathogen
Inactivation
21/03/15
Pathogen Inactivation
21/03/15

Blood Component Therapy MCC

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Blood Component Therapy MCC

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Blood Component

Special Blood Components

MALABAR CANCER CENTRE

Richard Lower is credited with

In 1818, James Blundell -Attempted human-to human transfusion

Modern Transfusion Therapy

MALABAR CANCER CENTRE

Whole blood in True sense.

MALABAR CANCER CENTRE

Whole blood is not

After 24hrs of storage WB essentially becomes red

Granulocytes & Monocytes function reduced

Microaggregates increase in number

FVIII, FV levels decreases

MALABAR CANCER CENTRE

1. Optimal preservation of in vitro function of blood

MALABAR CANCER CENTRE

Packed red blood cells (PRBC) +2 to 6C

+22 to +24C under

Fresh frozen plasma (FFP)

MALABAR CANCER CENTRE

MALABAR CANCER CENTRE

MALABAR CANCER CENTRE

Platelet Rich Plasma (PRP) method

Platelet rich plasma (PRP)

Manual plasma expresser

MALABAR CANCER CENTRE

Buffy Coat method

MALABAR CANCER CENTRE

WBC with few RBC

Benefits of Buffy coat

Platelet yield improved a lot

Reduced WBCs in product

RBC contamination drastically

MALABAR CANCER CENTRE

Separation using component extraction

MALABAR CANCER CENTRE

Top and Bottom Bag

MALABAR CANCER CENTRE

1 unit of PRBC contains

1 unit of RDP raises PLT

One unit of PRBC

Adult dose requires 6

Process in which blood is removed from a

MALABAR CANCER CENTRE

MALABAR CANCER CENTRE

MALABAR CANCER CENTRE

Blood components separated by

MALABAR CANCER CENTRE

MALABAR CANCER CENTRE

Donor for Apheresis

Similar to normal donation criteria

MALABAR CANCER CENTRE

Collection of two or more identical or

RCC +RCC = 2 RBC

MALABAR CANCER CENTRE

Single Donor Platelets

Platelet count 150 x 109/l (preferably >250

Usually not more than 2 procedure in a week

48 hours must elapse between two

Maximum of 24 procedures / year

Platelet Count of 300 x109/l

MALABAR CANCER CENTRE

Advantages of Apheresis Blood