BLOOD COMPONENTS
Platelet Rich Plasma – alloantibodies against class I HLA antigens.
• Non – immune - infection,
• Platelet rich plasma (PRP) is separated from whole – splenomegaly,
blood within 6 hours of donation and before – drugs (e.g. amphotericin B),
refrigeration of the unit of blood. – accelerated consumption
• Extra centrifugation with removal of more plasma
yields Platelet Concentrate (PC). Prevention of platelet refractoriness
• Each unit contains greater than 5.5 x 1010 platelets • Transfusion of HLA matched apheresis platelets.
in approximately 50 – 70 ml of plasma. • Leucoreduction may assist.
• Platelets can also be processed as a single donor,
pooled or through apheresis. One unit of apheresis Fresh Frozen Plasma (FFP)
platelets is equivalent to 5-6 units of random donor FFP is the acellular portion of blood that is frozen
platelets within 8 hours of donation.
FFP must be ABO-compatible with the recipient’s red
Indications of Platelet Transfusion blood cells.
• Patients undergoing major invasive procedures
with platelet counts < 50,000/mm3 Indications for FFP transfusion
• Patients undergoing neurologic and ophthalmic • Correction of coagulation abnormalities with
surgeries with platelet count <100,000/mm3. bleeding e.g Hemophilias and coagulation factor
• Prophylactic platelet transfusion is given for deficiencies.
patients undergoing chemotherapy when the • Massive transfusion.
platelet count is <20,000 m3 • Bleeding due to warfarin therapy refractory to
• Thrombocytopenic patient with bleeding vitamin K.
tendencies. The dose is 10-20ml/kg of group specific plasma
• Qualitative platelet disorders with bleeding transfused over 2-4hrs.
tendencies. The amount of FFP to be given should be pegged on
Platelet transfusion is generally not indicated for normalization of PT and aPTT.
patients with immune platelet disorders like ITP.
Four to eight units of concentrated platelets are the Apheretic Blood Components
usual adult dose for profound thrombocytopenia. Apheresis is a process that involves selective
Each unit of platelet concentrate increases the removal of blood components from blood donors or
platelet count of an average adult by 5-6,000/mm3 patients. The desired component is collected and the
. Response to platelet transfusion may be adversely remainder of the blood is returned to the donor or
affected by fever, sepsis, severe bleeding, patient. This avoids taking components that are not
splenomegaly, consumptive coagulopathy and needed.
antiplatelet drugs. The following are apheretic components;
• The cell count of the component is already • Red Blood Cells.
determined before the procedure. • Platelets.
• The donor can donate more frequently compared • Plasma.
to whole blood donation. • Granulocyte.
• For a patient who requires frequent transfusion Benefits of apheresis
e.g. Sickle Cell Disease, it minimizes the risk of allo- • The required component is collected directly
immunization. avoiding further processing.
• The component is ready to use immediately after
Refractoriness to platelet transfusion; collection.
• 3 platelet transfusion over two weeks that yield • It is an effective closed system.
inadequate post transfusion count. Or • The components collected are of higher yield
• 2 consecutive 1hour post-transfusion platelet compared with those prepared from whole blood.
Cellular Count Increment(CCI) of <5000 platelet x
body SA(m2) /uL. Disadvantages of Apheresis
• The cost of production is higher.
Causes of platelet refractoriness: • Need for specially trained staff.
• Immune - auto-antibodies e.g. in ITP.
BLOOD COMPONENTS
• Lowers capacity to collect large volumes of blood x 106 (UK)
for manufacturing of plasma products. Several blood components contain WBCs;
• Possible risk of bleeding to the donor due to citrate • Whole blood - 1 x 109.
toxicity. • PRBCs- 1 x 108.
• Platelet - 1x 107 in pooled unit,
Cryoprecipitate – <8.3x 105 WBCs for single donor units.
Is a concentration of high molecular weight plasma
proteins including Fibrinogen, Fibronectin, Factor Leucoreduction reduces the risks of;
VIII, von Willebrand’s factor (vWF) and Factor XIII. • Febrile Non-haemolytic Transfusion
Reactions(FNHTR).
Indications for Cryoprecipitate transfusion • CMV transmission.
• Hemophilia A. • HLA alloimmunization that would lead to platelet
• Von Willebrands disease. refractoriness.
• Fibrinogen deficiency.
• Massive transfusion. CMV -reduced- risk componentsIndications include;
• As a topical hemostat in surgeries. • Low Birth Weight premature infants.
• Recipients of hematopoietic progenitor cells or
Plasma derivatives & indications organ transplants.
Many blood products can be manufactured through • Pregnant women.
several methods when there is available excess • Intrauterine transfusion.
plasma.
The commonest include the following:
• Individual coagulation factor concentrates e.g.
factor VIII, IX
• Human albumin at different concentrations
(5%,25%) eg severe burns of >50%., removal of
ascitic fluids of > 2 L, severe necrotizing pancreatitis,
severe liver disease.
• Immunoglobulins in Myasthenia Gravis (MG),
Guillian Barre Syndrome (GBS), Multiple Sclerosis
(MS) etc.
• Colloid solutions eg hemorrhage.
Many other products can be made that are outside
the scope of this guideline e.g Blood grouping sera.
Special Blood Components
Irradiation
Radiation is done on components that have viable
lymphocytes in order to prevent Graft Versus Host
Disease (GVHD).
Indications for irradiated components include: -
• intrauterine transfusion.
• patients who receive multiple transfusions e.g
sickle cell disease.
• transfusion of patients who are
immunosuppressed including transplant and cancer
patients.
• platelets selected for HLA compatibility.
Leucoreduction
Leukoreduced components contain residual donor
WBCs in the final products that is <5 x 106 (US) or <1
