Download blood components

Blood Components
and Plasma derivatives
1
M. Zaharna Blood Bank Lab. 2009
• The anticoagulants and preservatives that are
added to blood nowadays enable storage for
long periods of time
– Before acid-citrate-dextrose (ACD) was used- 21 days
• Aseptic separation of blood into cellular &
plasma components by the introduction of plastic
collection systems
– Before glass bottles were used
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M. Zaharna Blood Bank Lab. 2009
Blood collection
• Blood is collected in plastic bag systems
with anticoagulant & preservative
• Whole blood can be stored at 4oC for up to
5 weeks
• Whole blood contains many components
• Wasteful to give whole blood if only red
cells are needed
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M. Zaharna Blood Bank Lab. 2009
Blood Components
• Human blood consists of
plasma, in which cells are
suspended
• The plasma also contains
other specialised substances,
which are important for blood
clot formation (e.g. clotting
factors)
• Whole blood can be separated
at the blood bank into various
components
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M. Zaharna Blood Bank Lab. 2009
BLOOD COMPONENTS
• Blood separated into different parts:
1.
2.
3.
4.
5.
6.
7.
•
Packed red cells
Platelets
Fresh frozen plasma
Cryoprecipitate
Granulocytes
Factor IX conc.
Factor VIII conc.
There are more than 20 different products
available
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M. Zaharna Blood Bank Lab. 2009
Whole blood
Red cells
Granulocytes
Platelets
Plasma
Fractionated
products
(Fresh) frozen
plasma (FFP)
F Vlla
Cryoprecipitate
Stored
Plasma
Immunoglobulins
F Vlll
Albumin
F lX
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M. Zaharna Blood Bank Lab. 2009
Whole Blood
• One unit contains
• 450 ml of blood
• & 63 ml of anticoagulant-preservative
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M. Zaharna Blood Bank Lab. 2009
RBC Anticoagulant/Preservative Solutions
•
Purpose of RBC Preservation
–
–
•
Designed to prevent clotting and maintain red cell
viability and function during storage.
Usual anticoagulant-preservative is CPD-A (Citrate
Phosphate Dextrose Adenine )
Anticoagulant-Preservative Contents
•
•
•
•
Citrate: anticoagulant (binds plasma calcium and prevent
activation of coagulation cascade)
Phosphate: provide substrate to help maintain red cell 2,3
DPG levels
Dextrose: a sugar, provides substrate for ATP production.
Adenine: Acts as a substrate for RBC synthesis of ATP
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M. Zaharna Blood Bank Lab. 2009
• During storage at 4oC
• Platelets and WBCs
• become nonfunctional during hours of collection
• Red cells
• 5 weeks in CPD-A have a mean recovery 70%
• Plasma
•  K+,  H+ →  pH
• Levels of coagulation factors V & VIII decrease
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M. Zaharna Blood Bank Lab. 2009
Blood Components
• Refers to a product separated from a
single unit of whole blood
• The term plasma derivative indicates a
blood product separated from a large
volume of pooled plasma by a process
called fractionation
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M. Zaharna Blood Bank Lab. 2009
• Blood components
• Plasma Derivatives
– Oxygen carrying components
– Red cell concentrates
(RCC)
– Leukocyte poor blood
– Frozen-thawed red cells
– Platelet products
– Platelet rich plasma (PRP)
– Platelet concentrates (PC)
– Plasma products
–
–
–
–
– Coagulation Factor concentrates
• Factor VIII concentrates
• Factor IX complex concentrates &
others
– Oncotic agents
• Albumin
• Plasma protein fraction (PPF)
– Immune serum Globulin
Fresh frozen plasma (FFP)
Frozen plasma (FP)
Cryoprecipitate
Stored plasma
•
•
•
•
Hepatitis B Ig (HBIG)
Varicella-zoster Ig (VZIG)
Rh Ig (RhIG)
Tetanus Ig (TIG)
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M. Zaharna Blood Bank Lab. 2009
A- Blood components that carry oxygen
• Increase the oxygen carrying capacity of
the blood by increasing the circulating red
blood cell mass.
• Carry oxygen and nourishment to the
tissues and take away carbon dioxide.
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M. Zaharna Blood Bank Lab. 2009
1- Red blood cell concentrates
• Prepared by removing
approx. 200 ml of plasma
from whole blood after
centrifugation
• RBCs plus 100 ml of residual
palsma
• In CPD-A can be stored for
35 days at 4oC
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M. Zaharna Blood Bank Lab. 2009
1- Red blood cell concentrates
Whole Blood
Total Volume
500 ml
Red cell
concentrate
300 ml
Volume of red
cells
Volume of
plasma
Hematocrit
200 ml
200 ml
300 ml
100 ml
40 %
70 %
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M. Zaharna Blood Bank Lab. 2009
1- Red blood cell concentrates
• High hematocrit → viscous → infuse slowly
• Rate of infusion increased by adding saline
• Other fluids should not used
– Calcium containg fluids (eg. Ringer’s lactate)
should not be added
– May cause clotting
– Glucose solutions
– can cause clumping
• Only saline can be added to blood
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M. Zaharna Blood Bank Lab. 2009
2- Leukocyte poor blood
• No viable leukocytes
• WBCs are of no
consequence
• In some patients cause
febrile transfusion reaction
• Should receive leukocytes
poor-blood
• WBCs can be removed by
discarding the buffy coat
(inverted centrifugation)
• Or by washing RBCs or by
using filters
Buffy coat
Red cells
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M. Zaharna Blood Bank Lab. 2009
3- Frozen-thawed red cells
• Red cells can be frozen with use of
cryopreservation techniques
• Permit storage for up to 10 years
• Expensive procedure & recommended
only in special circumstances
– e.g. Individuals with rare blood types
– For auto-transfusion
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M. Zaharna Blood Bank Lab. 2009
3- Frozen-thawed red cells
• The RBC's are first incubated in a 40%
glycerol solution which acts as an
"antifreeze" within the cells.
• The units are then placed in special sterile
containers in a deep freezer at less than
-60 degrees C.
• Cryopreserved units are thawed and
washed free of glycerol prior to use as
saline suspended RBC's.
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M. Zaharna Blood Bank Lab. 2009
4- Synthetic oxygen carrying agents
• Synthetic oxygen carrying agents
– Perfluorochemical (e.g. Fluosol-DA )
•
•
•
•
Fluorinated hydrocarbons
Readily dissolve oxygen
Poor soluble in plasma
Side effects:
– Hypotension
– DIC
– Chemically modified hemoglobin
• Free Hb has a very short half life
• Chemically modified to:
– increase intravascular survival
– and to make it more effective in carrying oxygen
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M. Zaharna Blood Bank Lab. 2009
B- Platelet Products
• Platelet Rich Plasma (PRP)
– Gentle centrifugation of whole blood
– Supernatant transferred to the 2nd
bag
• Platelet Concentrates
– Prepared from PRP by a 2nd
centrifugation
– Removal of all but 50 ml of plasma
– Contain approx. 6X1010 platelets
– 60 – 80% Plts present in whole
blood unit
– Remain 5 days
– Longer at 22oC with continuous
agitation
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M. Zaharna Blood Bank Lab. 2009
B- Platelet Products
• Contamination by WBCs &
RBCs is usually small
• But there is enough to induce
alloimmunization
• Plt concentrates from Rh +ve
should not be administered to
Rh –ve women
• Storage at 22oC, therefore care
to prevent contamination
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M. Zaharna Blood Bank Lab. 2009
C- Plasma Products
• Plt poor plasma can be separated into a
number of products
– Fresh frozen plasma
– Frozen plasma
– Cryoprecipitate
– Stored plasma
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M. Zaharna Blood Bank Lab. 2009
1- Fresh frozen plasma (FFP)
• Prepared from whole blood
within 6 hours of collection
• Rapid freezing of plasma
preserves the labile
coagulation factors at
maximum levels
• Donot contain cellular
elements
• 200 ml volume
• Stored at -30oC for 12 months
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M. Zaharna Blood Bank Lab. 2009
2- Frozen Plasma (FP)
• Separated from whole blood within 24
hours of collection
• Contains at least 50 % of original factor
VIII & factor V frozen plasma
• Adequate source for treatment of mild to
moderate coagulation factor deficiencies
• 200 ml volume
• Storage at -30oC for up to 12 months
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M. Zaharna Blood Bank Lab. 2009
3- Cryoprecipitate
• Produced from freshly separated plasma by
freezing at -70oC followed by thawing at 4oC
• Flocculent precipitate is rich in factor VIII,
fibrinogen and fibronectin
• Once thawed, mixture is centrifuged to sediment
the cryoprecipitate & all but 5 to 10 ml of
supernatant plasma is removed
• Contains 250 mg fibrinogen
• 80 clotting units of factor VIII
• Stored at -30oC for 12 months
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M. Zaharna Blood Bank Lab. 2009
3- Cryoprecipitate
• Increase of 2% of factor VIII level for each
bag of cryoprecipitate infused
• Supernatant plasma removed is called
stored plasma
– Must be used within 5 weeks if stored at 4oC
– Lasts for 2 years at -30oC
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M. Zaharna Blood Bank Lab. 2009
4- Stored plasma
• Plasma separated from whole blood after 24 hours of
storage at 4oC
• Can also be derived from cryoprecipitate production
• Contain reduced levels of labile coagulation factors V
VIII & fibrinogen
• It is indicated for patients requiring volume expansion or
protein replacement when labile clotting factors are not
required
• Plasma products do not require crossmatch prior to use
but should be ABO compatible
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M. Zaharna Blood Bank Lab. 2009
Plasma Derivatives
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M. Zaharna Blood Bank Lab. 2009
• Certain plasma derivatives can be
obtained by fractionating the fresh frozen
plasma or stored plasma
• Fractionation:
 Allows the processing of large volumes of
pooled plasma
 Pooling of many units increases the risk of
viral transmission to the recipient
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M. Zaharna Blood Bank Lab. 2009
Plasma protein fractionation
• Plasma proteins are separated according
to differences of each protein.
• Fractionation involves changing the
conditions of the pooled plasma (e.g. the
temperature or the acidity)
• Proteins that are normally dissolved in the
plasma fluid become insoluble, forming
large clumps, called precipitate.
• The insoluble protein can be collected by
centrifugation.
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M. Zaharna Blood Bank Lab. 2009
• One of the very effective ways for carrying out
this process is the addition of alcohol to the
plasma pool while simultaneously cooling the
pool.
• This process is sometimes called cold alcohol
fractionation or ethanol fractionation.
• This procedure is carried out in a series of steps
so that a single pool of plasma yields several
different protein products, such as albumin and
immune globulin.
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M. Zaharna Blood Bank Lab. 2009
Plasma Derivatives
Plasma Derivatives
Preparation avaliable
Factor VIII concentrates
Coagulation Factors
Factor IX concentrates
Anti-thrombin III
Albumin
Albumin
Plasma protein fraction
Non-specific immune serum globulin (ISG)
Rh immune globulin (RhIG)
Immune globulins
Hepatitis B immune globulin (HBIG)
Varicella-Zoster immune globulin (VZIG)
Tetanus immune globulin (TIG)
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M. Zaharna Blood Bank Lab. 2009
1- Coagulation Factor Concentrates
• Prepared in a freeze-dried form
• Indicated for patients with congenital
coagulation deficiencies
– Risk of hepatitis is high
• Should not used for mild acquired
coagulation deficiencies
– Should be treated with FP or FFP
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M. Zaharna Blood Bank Lab. 2009
Factor VIII Concentrate
• Commercially prepared, lyophilized
powder purified from human FFP
• Contain also small amounts of
fibrinogen & other proteins
• Can contain blood group Abs
• Treat patients with hemophilia A
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M. Zaharna Blood Bank Lab. 2009
Differences of Cryoprecipitate & Factor VIII concentrates
Factor VIII
Cryoprecipitate
concentrates
oC
4
Storage Temp.
-30oC
Short period RT
Risk of
Low
High
Hepatitis
Treatment of
Yes
Yes
hemophilia A
Treatment of
Yes
no
vW disease
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M. Zaharna Blood Bank Lab. 2009
Factor IX Concentrate
• For the treatment Factor IX deficiency or
Hemophilia B (Christmas Disease).
• Have been used to treat patients with
acquired inhibitors of factor VIII
– Have factor VIII bypassing activity
• Contains also factors II, VII & X in
concentrated form
• Vials containing 500 units of factor IX
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M. Zaharna Blood Bank Lab. 2009
Factor IX Concentrate & liver
disease
• It is contraindicated in patients with liver
disease
– Have low levels of circulating antithrombin III
– Activation of clotting factors present in some
factor IX concentrates,
– cause DIC
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M. Zaharna Blood Bank Lab. 2009
Blood products & treatment of specific clotting factor deficiencies
Deficiency
Blood product Indicated
Cryoprecipitate
Fibrinogen
Stored plasma
Fresh frozen plasma
Factor V
Frozen plasma
Factor IX concentrate
Factor VII
Stored plasma
Factor VIII concentrate
Factor VIII
Cryoprecipitate
Cryoprecipitate
Von Willebrand’s Disease
Fresh frozen plasma
Frozen plasma
Factor IX
Factor IX concentrate
Factor X
Stored plasma
Factor XI
Stored plasma
Factor XIII
Stored plasma
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M. Zaharna Blood Bank Lab. 2009
2- Oncotic Agents
• Albumin: volume expansion
• Other colloids are available for blood
volume expansion
– Dextran
– Gelatin
– Hydroxyethyl starch
– Polyvinylpyrrolidone
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M. Zaharna Blood Bank Lab. 2009
Albumin
• Albumin is prepared by ethanol
fractionation of pooled plasma
• Available in 5% and 25% concentrations.
• Have physiological sodium content
• No risk of hepatitis, sterilized during
preparation
• No coagulation factors or blood group Abs
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M. Zaharna Blood Bank Lab. 2009
Albumin
• Used for treatment of hypovolaemia and
hypoalbuminaemia (result from abnormal
synthesis, increased metabolism or loss)
• It maintains capillary osmotic pressure
• Carrier protein for drugs, hormones,
enzymes & metabolites
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M. Zaharna Blood Bank Lab. 2009
Plasma protein Fraction
• Partially purified albumin
• Contains ≈ 85% albumin & 15% other
plasma proteins
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M. Zaharna Blood Bank Lab. 2009
3- Immune Globulins
• Contains immune IgG antibodies,
prepared from pools of plasma.
• For disease prophylaxis, hepatitis A,
measles, varicella and rubella.
• For the treatment of hypogammaglobulinemia and agammaglobulinemia.
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M. Zaharna Blood Bank Lab. 2009
Immune Serum Globulin (ISG)
•
•
•
•
•
Primarily IgG Ab
Prevention of some viral diseases
Hypogammaglobulinemia
Congenital immune deficiency
Given by IM injection (aggregates of IgG)
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M. Zaharna Blood Bank Lab. 2009
Hepatitis B Immune Globulin
(HBIG)
• Contains Hepatitis B immune antibodies.
• From plasma of donors with high titer of
Ab to HBsAg
• Provides passive immunization for HBV.
• For treatment after exposure to HBsAg.
• For the prevention of maternally
transferred HBV (perinatal exposure).
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M. Zaharna Blood Bank Lab. 2009
Varicella-Zoster immune globulin (VZIG)
• Derived from patients had recent Herpes
Zoster infections
• Herpes Zoster infections result in severe
fatal infection in immunocompromised
individuals
• Passive administration of VZIG during 72
hours of exposure can prevent or
attenuate infection
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M. Zaharna Blood Bank Lab. 2009
Rh Immune Globulin (RhIG)
• Derived from Rh -ve individuals
• Contains IgG antibodies to the D antigen on red
blood cells.
• Given during pregnancy and post-natally to Rh
negative mothers to prevent the development of
anti-D and hemolytic disease of the newborn
(HDN) due to anti-D.
• Given prophylacticaly following abortion, or
invasive maternal procedures (e.g.,
amniocentesis).
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M. Zaharna Blood Bank Lab. 2009
Tetanus Immune Globulin (TIG)
• Prepared from individuals specifically
immunized for tetanus toxoid
• Available for individuals at risk following
injury
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M. Zaharna Blood Bank Lab. 2009