Blood components

• Whole blood
•
• One unit of donor blood collected in a suitable anticoagulant-preservative
solution and which contains blood cells and plasma.
•
• Blood components
•
• A constituent separated from whole blood, by differential centrifugation of
one donor unit or by apheresis.
•
• Blood derivatives
•
• A product obtained from multiple donor units of plasma by fractionation.
• Whole blood still remains a commonly employed blood
product at some places because of the lack of facility
for component separation.
• Whole blood is one unit of donor blood collected in a
suitable anticoagulant-preservative solution. Its total
volume is about 400 ml (350 ml of blood + 49 ml of
anticoagulant). It consists of cellular elements and
plasma. Whole blood is stored in a properly maintained
blood bank refrigerator at 2° to 6°C and shelf-life of
such blood (collected in CPDA anticoagulant) is 35 days
• Before ordering whole blood transfusion, following should be
noted:
• Transfusion of one unit raises haemoglobin by 1 g/dl or
haematocrit by 3%.
• Whole blood stored at 2° to 6°C does not contain functionally
effective platelets after 48 hours of collection and also labile
coagulation factors (i.e. F V and F VIII). Therefore stored whole
blood should not be used to replace platelets, granulocytes, or
coagulation factors.
• Whole blood transfusion is associated with the risk of volume
overload in patients with chronic severe anaemia and
compromised cardiovascular function.
•
• Contains no functionally effective platelets and
• no labile coagulation factors
• Storage temperature: 2–6°C in appropriate
• blood bank refrigerator
• Shelf-life: 35 days (in CPDA-1)
• Indication: Acute massive blood loss, exchange
• transfusion, non-availability of packed red cells
• Risk of volume overload in patients with chronic
anaemia and compromised cardiovascular
function
 Blood components
••Red cells
• Packed red cells
• Red cells in additive solution
• Leucocyte-poor red cells
• Washed red cells
• Frozen red cells
• Irradiated red cells
••Platelets
••Platelet concentrate
••Granulocytes
••Granulocyte concentrate
••Plasma
• Fresh frozen plasma
• Cryoprecipitate
 Red Cell Components

• Packed Red Cells

• Packed red cells are prepared by removing most of
the plasma from one unit of whole blood. Whole
blood is either allowed to sediment overnight in a
refrigerator at 2° to 6°C or is spun in a refrigerated
centrifuge. Supernatant plasma is then separated
from red cells in a closed system by transferring it
to the attached empty satellite bag. Red cells and a
small amount of plasma are left behind in the
primary blood bag.
• Main indication for packed red cells is replacement of red cells in anaemia
(chronic anaemia, severe anaemia with congestive cardiac failure,
anaemia in elderly).
•
• Transfusion of packed red cells lowers the risk of volume overload. In
contrast to whole blood, for a given volume, double the amount of red
cells can be infused, i.e. total volume of whole blood is 400 ml (150 ml red
cells + 250 ml plasma) while that of packed red cells is 250 ml (150 ml red
cells + 100 ml plasma). Haematocrit of whole blood is about 40% while
that of packed red cells is 55 to 75%. Normal saline can be added using Y-
pattern infusion set to increase the speed of transfusion by reducing the
viscosity. Packed red cells have a high viscosity and therefore the rate of
infusion is slow.
• Transfusion of one unit of red cells increases haemoglobin by 1 g% (or
increases PCV by 3%). This rise becomes detectable 24 hours after
transfusion
 Red Cells in Additive Solution (Red cell
suspension)
• Commonly used additive solution is SAGM (which contains saline, adenine, glucose,
and mannitol). After collection of whole blood in the primary collection bag
(containing CPDA-1), maximum amount of plasma is removed (after centrifugation)
and transferred to one satellite bag. The additive solution from the second satellite
bag is transferred into the primary collection bag (containing packed red cells) in a
closed circuit.
• Advantages of this method are :
• Maximum amount of plasma can be removed for preparation of plasma
components
• Red cells with improved viability are obtained (shelf-life increases from 35 days to
• 42 days)
• Flow of infusion is improved due to reduction in viscosity.
• Indications for red cells in SAGM are similar to those for packed red cells. Red cells
• in SAGM are contraindicated for exchange transfusion in neonates.
 Leucocyte-poor red Cells
• These are the red cells from which most of the white cells have been
removed. By definition, leucocyte-depleted red cells should contain less than
5×106 white cells per bag. They are obtained by passing blood through a
special leucocyte-depletion filter at the time of transfusion; they can also be
prepared in the blood bank
• Leucocyte-poor red cells are indicated:
• To avoid sensitisation to HLA antigens (e.g. in patients with severe aplastic
anaemia who are likely to receive allogeneic bone marrow transplant)
•
• To avoid febrile transfusion reactions in persons who require repeated
transfusions or who have earlier been sensitised to white cell antigens
• To reduce the risk of transmission of cytomegalovirus (CMV) in certain
patients
• (if CMV-seronegative blood is not available)
 Washed Red Cells,Frozen Red Cells

• Washed Red Cells

• Packed red cells can be washed with normal saline to remove plasma
proteins, white cells, and platelets. Use of such red cells is restricted for IgA-
deficient individuals who have developed anti-IgA antibodies
• Frozen Red Cells
• Red cells can be stored frozen for up to 10 years. To prevent haemolysis of
red cells during freezing and thawing, a cryoprotective agent such as
glycerol is added. Donor red cells with rare blood groups can be stored
frozen for recipients who have developed antibodies against frequently-
occurring red cell antigens. Similarly, red cells can be stored frozen for future
autologous transfusion, if blood group is rare. Before transfusion, red cells
are thawed and glycerol removed gradually by using progressively less
hypertonic solutions. Such red cells are virtually free from leucocytes,
platelets, and plasma and thus their use is associated with low-risk of
nonhaemolytic transfusion reactions.
 Irradiated Red Cells

• Transfusion of gamma-irradiated red cells is

indicated for prevention of graft-versus-host
disease in susceptible individuals like:
• Immunodeficient individuals, and
• Patients receiving blood from first-degree
relatives.
• Lymphocytes from donor blood react against the
tissues of the recipient. Gamma irradiation (25
Gy) inhibits replication of donor lymphocytes.
 Platelets

• There are two methods for obtaining platelets

for transfusion:
• Differential centrifugation of a unit of whole
blood (platelet concentrate).
• Plateletpheresis
 Indication
• Platelets are administered for prevention and
treatment of bleeding due to thrombocytopaenia or
platelet dysfunction.
• The usual indications are:
• Thrombocytopaenia due to decreased platelet
production, e.g. aplastic anaemia, haematologic
malignancies, following chemotherapy or
radiotherapy, etc.
• Hereditary disorders of platelet function
• Massive blood transfusion.
 Granulocyte Concentrate

• Granulocyte concentrates are rarely used because:

• Most infections can be effectively controlled by appropriate antibiotic therapy
• A granulocyte concentrate prepared from a single donor unit has insufficient
granulocytes and is also heavily contaminated with red cells.
• Transfusion of granulocyte concentrate is associated with significant risks (like
non-haemolytic transfusion reactions, lung infiltrates, transmission of cell-
associated viruses like cytomegalovirus, etc.).
• Granulocytes for transfusion can be obtained either from a single donor unit
by
• differential centrifugation or by leucapheresis. Leucapheresis is preferred
because of better granulocyte yield, which can further be enhanced by
administration of corticosteroids to the donor.
• Administration of granulocyte concentrates can be considered in a patient with
severe neutropaenia with documented bacterial or fungal infection, which is
not responding to appropriate antibiotic therapy.
 Plasma Components
• Plasma can be obtained either by
centrifugation of a unit of whole blood or by
plasmapheresis. Various components can be
prepared from plasma, the important ones
being fresh frozen plasma and cryoprecipitate
 Fresh Frozen Plasma (FFP)

• For preparation of FFP, plasma is separated from whole blood by

centrifugation, transferred into the attached satellite bag, and
rapidly frozen at –25°C or at lower temperature. This process is
carried out within 6 hours of collection because after this time,
labile coagulation factors (F V and F VIII) are lost. Volume of FFP is
200 to 250 ml. FFP contains all the coagulation factors .
•
• FFP can be stored for 1 year if temperature is maintained below –
25°C. When required for transfusion, FFP is thawed between 30°C
and 37°C and then stored in the refrigerator at 2 to 6°C. Since
labile coagulation factors rapidly deteriorate, FFP should be
transfused within 2 hours of thawing.
•
• Indications for FFP are:
• Deficiency of multiple coagulation factors as in
liver disease, massive transfusion,
disseminated intravascular coagulation, and
thrombotic thrombocytopaenic purpura
• Reversal of warfarin overdose
• Inherited deficiency of a coagulation factor for
which no specific concentrate is available.
 Cryoprecipitate
• Cryoprecipitate is prepared by slowly thawing 1 unit of FFP at 4° to
6°C. Plasma and a white precipitate are obtained. After
centrifugation, most of the supernatant plasma is removed leaving
behind sediment of cryoprecipitate suspended in 10 to 20 ml of
plasma. The unit is then refrozen (–25°C or colder) for storage and
can be kept for 1 year at this temperature. When required for
transfusion, cryoprecipitate is thawed at 30° to 37°C and then kept in
the refrigerator at 2° to 6°C till transfusion (for maximum of 6 hours).
• Cryoprecipitate contains F VIII (about 80 units), von Willebrand factor,
fibrinogen, F XIII, and fibronectin. If specific factor concentrates are
not available, cryoprecipitate can be used for treatment of F VIII
deficiency, von Willebrand disease, F XIII deficiency, and
hypofibrinogenaemia