1. Blood components

2. Collection of blood

About 450ml-500ml blood collected- antecubital
vein

Collected in bags pre-filled with anticoagulant

ACD & CPD shelf life 21 days(citrate chelates
calcium, phosphate and dextrose provide
energy)

CPD-A 35 days(adenine is an added
component, increased production of ATPs for
longer shelf life)

Donors tested for Hep B, Hep C, HIV I & II
Syphilis

Some for CMV additional typing such as HLA

3. Apheresis

Blood components are collected selectively
from the whole blood donations and remaining
blood is returned to the circulation of donor

Advantage is that more than one doses of
plateletes or red cells can be collected from one
donor per donation

4. Preservation and Storage

Whole Blood is processed into its basic
components by centrifugation

Whole Blood (Primary collection pack)--
centrifugation – Manual OR Automated
extraction of components (Satellite Pack)

Platelet - Whole blood Processed on the same
day of collection or stored overnight at 22'c

Plasma - processed on the came day or stored
at 22'c upto 24 hrs

PRBC – stored at 4'c for 48 to 72 hrs

5. Preservation of RBCs:
1)Additive solutions
2)Frozen RBCs

6. Additive solutions:

Whole Blood in primary bag containing CPD--
Plasma is removed into another empty satellite
bag-- additive solution added to red cells for
improved viability

Three types of additive solutions are available
AS-1 AS-3 AS-5

Red cells can be stored for 6 weeks at 2-6 'c

8. Frozen RBCs

Red cells less than 6 days old frozen rapidly
after adding cryo preservative agent containing
glycerols

Glycerol maintains liquid phase, prevents
hypertonicity & damage due to freezing

Frozen red cells can be stored for 10 yrs

For use thawed and deglycerolised

Once thawed should be used within 24hrs

RBCs are frozen in autologous transfusion and
storage of rare blood group

9. Special RBC preparations:
1)Leucocytes depleted RBCs
2)Gamma irradiated RBCs
3)Washed RBCs
4)CMV negative RBCs

10. Leucocyte depletion:
Concentration of leucocytes less than 5x10*6 per
RBC unit by using special filters
Helps in preventing-
1)non hemolytic febrile transfusion reactions,
2)transmission of CMV EBV ,
3)transfusion related GVHD and
4)transfusion related acute lung injury (TRALI)

11. Gamma radiation:
To inactivate donor T-cells
Used to prevent GVHD in immunossupressed
patients, very small babies, in large volume
transfusion and during intrauterine transfusion
or when donor is related
Small babies – weight bellow 1.2kg, preferable
for any transfusion till 4 months of age
Irradiation reduces shelf life of RBCs to 28days,
causes hyperkalemia
Used with in 4hrs in neonates

12. Washed RBCs
Used to remove plasma and reduce potassium
Used in intrauterine transfusion, exchange
transfusion, large volume transfusion, patients
with immunoglobuline A deficiency

13. CMV reduced RBCs:
CMV reduced RBCs
Formed By leucocyte reduction or using CMV
negative donors
Indicated in neonates and immunocompromised

14. Guidelines for transfusion of
PRBC

16. Term Neonate
Condition Hb in gm/dl
Severe pulmonary disease <13
Moderate pulmonary disease <10
Severe cardiac disease <13
Major surgery <10
Symptomatic anemia <8

17. Children and Adolescents

Acute loss of >25% of circulating blood volume

Hemoglobin <8gm/dl in perioperative period

Hb <8 and symptomatic chronic anemia

Hb <8 and marrow failure

Hb <13 and severe cardiopulmonary disease

18. How much to give

Volume of PRBC
=blood volume(ml/kg) x (desired- actual
hematocrit) / hematocrit of transfused RBC

5-15ml/kg of PRBC

@5ml/kg/hr

Should not ideally exceed 4 hrs due increased
risk of bacterial contamination

Large volume transfusions->20ml/kg

Exchange transfusion-160ml/kg replaces 87%
of blood

19. Side Effects of RBC Transfusion
1) Infectious
2) Non-infectious
a) Acute
– Immunological
– Non immunological
b) delayed

20. Infections

Viral infections- HIV, HBV, HCV, CMV
risk of post transfusion hep B/C is 10% in adults
causes are low viremia, undetected mutant
strains

Bacterial infections- traponema etc in case of
asympomatic bacteremia in donor
specially platelets as are stored room temp.

Parasites- Plasmodium, Trypanosomes others

Prions- Cruetzfold desease-incubation period of
approx 6.5years

21. Non- infectious cause-Acute
Immune mediated hemolysis:
Antibodies present in patient's plasma react with
RBC antigen present in donor blood.
Eg. ABO, Rh, other minor group incompatibility
Infants less than 4 months do not produce
isoagglutinins eg anti A, anti B
But hemolysis can occur due to materal
antibodies
Should be screened for maternal antibodies if non
O RBCs are to be given

22. Immune mediated hemolysis:
Signs and symptoms:
Fever,
Pain at infusion site,
Palpitations, giddiness,
Tachycardia,
Red urine
hypotension

23. Treatment:
Stop infusion
Hydrate the child- 10-20ml/kg
Frusemide
Treat hypotension with pressors if needed
Infusion of compatible RBCs

24. Transfusion related acute lung injury
(TRALI)
Due to interaction of antibodies present in donor
plasma with patients histocompatibility(HLA)
antigens.
Cause non-cadiogenic pulmonary edema
Associated with transfusion of whole blood,
packed cells, platelets, FFP, IVIG, cryo.

25. Signs and symptoms:
Mostly within the initial 6 hrs of transfusion

Dyspnea

Cough

Fever

Tachycardia

Hypo/hypertension

26. Diagnosis: high degree of suspicion
Presence of donor serum antibodies cross
reacting against the recipient
self limiting condition
Treatment is mainly supportive
Care of ABC

27. Febrile non-hemolytic transfusion
reactions:
Due to cytokines released from leucocytes in
donor unit
Increase in body temperature less than 2 degree
Less frequent if product is leucoreduced

28. Allergic reactions:
Due to preformed IgE antibodies in patients
plasma against an allergen(protein) in donors
plasma.
Mild form- hives and wheezing
Severe-anaphylaxis-rare
Treatment- antihistamines, bronchodilators,
corticosteroids
RBCs and platelets can be washed

29. Acute non-immune reactions:
1)Fluid overload- in case of larger volume
transfusion. >10-20ml/kg
Transfusion in chronically anemic pts
2)Hyperkalemia- potassium levels increase in
stored blood.
Seen in large vol tx.
PRBC is to be washed and reconstituted in FFP
before exchange transfusion

30. 3)Hypoglycemia-

blood stored in CPD has high glucose content.

Initial hyperglycemia—stimulation of insulin
production ---hypoglycemia after 2-6 hrs.
4)Acid-base problems
5)Hypocalcemia, hypomagnesemia due to binding
to citrate
6)Hypothermia- when cool blood is used

31. Delayed complications:
1)Alloimmunisation:
Uncommon before 4 months of age
Caused by transfusion of blood products with
mismatched highly immunogenic antigens eg
Rh
2)Transfusion associated graft versus host
disease(TA-GVHD)

32. TA-GVHD
Lymphocytes from donor mount response against
the recipient's cells
Host is not able to mount response against donor
lymphocytes cause they are
immunocompromised

premature babies,

congenital immunodeficiencies,

donation in relation,

immunosuppressive drugs

33. Signs and symptoms:
Acute GVHD:
Develops from 2-5weeks of transfusion
Erythematous maculopapular rash, persistent
anorexia, vomiting, diarrhoea
Increased liver enzymes, bilirubin
Chronic GVHD: persists or develops >3 months
post transfusion
Prevented by leucocyte reduction and irradiation

34. Platelets

RDP: whole blood is subjected to centrifugation

SDP: collected by method of plateletpheresis
PLT collected fm single donor, repeated 4-6 times.
3x10*11 platelets v/s 0.5x10*10

Stored for 5 days at 22+/-2 C with agitation

Washed platelets decreased anaphylaxis but
shelf life only 24hrs

35. Indications of Plt transfusion in
non-immune thrombocytopenia in
newborn
1) Plt count less than 30,000/cu mm: transfuse all
2) Plt count 30,000-50,000/cu mm: transfuse if
a)sick or bleeding newborn
b)newborn less than 1000gm or less than 1 week
c)previous major bleeding tendency(IVH grade3-4)
d)newborns wit concurrent coagulopathy
e)requiring surgery or exchange transfusion
3)Plt count 50,000-99,000/cu mm: transfuse if
actively bleeding

36. Transfusion of Plt:
Immune- mediated: ITP
Platelets indicated only in severe form (<10000)
of thrombocytopenia or bleeding along wit IVIG
infusion.
NAIT: high risk of ICH
<50000 plt: IVIG to all
<50000 plt and bleeding: antigen negative plt in
addition to IVIG

37. Dose: 5ml/kg should raise count by 30,000/cu mm
Recommended: 1 unit of platelet per 10 kg body
weight

38. Granulocytes:

Indications:

severe sepsis, funfal inf not responding to
antibiotics,

Severe neutropenia or dysfunctional neutrophils

Dosing: 10-15ml/kg may need to be repeated
every 12-24 hours

Granulocytes should be used within 24hours of
collection

39. FFP:

CONTAINS:

1unit/ml of each coagulation factor

Plasma proteins and antibodies

Indications: coagulopathies

DIC

Vit K def bleeding

Inherited deficiencies of coagulation factors

Should not be used for increasing proteins or
antibodies as safer, more effective options avbl

40. S/E as compared with PRBC
transfusion
Dose: 10-20ml/kg repeated every 8-12 hrs
S/E:
Hyperkalemia will not occur
TRALI more likely
Acute hemolytic reactions less likely
Citrate induced hypocalcemia can occur

41. Cryoprecipitate:
Contains:
80-100 U of factor viii in 10-25 ml of plasma
300mg fibrinogen
Varying amount of factor xiii
Von Willebrand factor

42. Indications:
Congenital factor viii deficiency
Congenital factor ix deficiency
Afibrinogenemia and dysfibrogenemia
Von Willebrand disease
Dose: 5ml/kg