BLOOD COMPONENTS

PRESENTER : DR.G. SANATH KUMAR

Moderator : DR. SARFRAZ AHMED M.D.,
ASSISTANT PROFESSOR
DEPARTMENT OF GENERAL MEDICINE
NARAYANA MEDICAL COLLEGE
 BLOOD GROUP ANTIGENS AND ANTIBODIES
• The cellular blood elements such as the red blood cell(RBC), platelets,
neutrophils, plasma proteins and the widely distributed human leukocyte
antigens(HLA) are antigenic in nature.

• These antigens can result in alloimmunization, production of antibodies

against antigenic determinants of another individual.

• These antibodies are called alloantibodies, and comprise anti-RBC Abs, anti
human platelet antigen(HPA) antibodies, anti human leukocyte antigen(HLA)
antibodies.
• The study of RBC antigens and antibodies forms the foundation of
transfusion medicine.

• Have antibodies directed against RBC antigens a result of natural exposure

and are usually produced buy a T cell independent response and are mainly
IgM Isotype.

• These Ig M antibodies arise spontaneously or as a result of infectious

Sequalae( Mycoplasma pneumonia).

• Have these antibodies are often clinically insignificant due to their low
affinity for antigen at body temperature however these can activate the
complement cascade and result in hemolysis.
• These auto antibodies can also arise in an autoimmune setting or as a
result of allogenic exposure, such as transfusion or pregnancy and these
are usually IgG isotype.

• Examples:-
1.Anti-RBC antibodies result in hemolytic disease of the newborn.
2. Anti HPA antibodies lead to intracranial hemorrhage.

• Alloimmunization to leukocytes and plasma proteins may result in

transfusion complications such as fevers, urticaria as well as platelet
transfusion refractoriness ,but generally does not cause any hemolysis.
 ABO ANTIGENS AND ANTIBODIES
• The first and the most important blood group antigen system in transfusion
medicine was ABO system, recognized in 1900.

• The major blood groups are A,B,AB,O .

• A and B antigens are carbohydrates and attached to a precursor backbone(H

substance), may be found on the cellular membrane either as
glycosphingolipids or glycoproteins and are secreted into the plasma and body
fluids as glycoproteins.
• In most people , A,B and H antigens are secreted by cells and are present in
the circulation and as well as in various secretions such as saliva (Se
phenotype).

• Others do not secrete A B and H antigens and are called “NON

SECRETORS” (se phenotype).

• ABO and Se/se systems influence the susceptibility to a variety of diseases .

• Examples : Malaria is less severe in O group

O group is susceptible to Helicobacter pylori, cholera bacillus
and norovirus and also exhibits a lesser pro coagulation phenotype.
 The Rh system
• It is the second most important blood group system in pre transfusion
testing.
• The Rh antigens found on the RBC membrane protein that has no
defined function.
• The two RH genes are located on chromosome 1.
• The D antigen is a potent alloantigen. About 15% of individuals lack this
antigen , exposure of these people to even small amounts of Rh positive
cells by either transfusion or pregnancy can result in the production of
anti-D alloantibodies.
 PRE TRANSFUSION TESTING
• Pre transfusion testing other potential recipient consists of the “type and
screen”.

• The forward type determines the ABO and Rh phenotype of the recipients
RBC using antisera directed against the A ,B and D antigens.
• The reverse type detects isoagglutinins in the patient’s serum and should
correlate with the ABO phenotype or forward type.
CROSS MATCHING
• Non reactive crossmatching confirms the absence of any major
incompatibility and reserves that unit for the patient.

• It Rh(D) negative patient need to be provided with Rh negative blood

components to prevent alloimmunization to the D antigen.

• In case of emergency Rh positive blood can be safely transfused to Rh

negative patient who lacks anti D, however the recipient is likely to become
alloimmunized and produce anti D.

• RH negative women of childbearing age who are transfused with products

containing RH positive RBC’s should receive passive immunization with antiD
to reduce or prevent sensitization.
WHOLE BLOOD
• . One unit of donor blood collected in a suitable anticoagulant
preservative solution and contains blood cells and plasma.

BLOOD COMPONENTS
• A constituent separated from whole blood, by differential
centrifugation of one product obtained from donor unit or by
apheresis.

BLOOD DERIVATIVES
• A product obtained from multiple donor units of plasma by
fractionation.
 BLOOD COMPONENTS :
• Transfusing only the portion of the blood needed by the patient is called
blood component therapy.

Whole Blood
Packed RBCS
Platelets
Granulocytes
FFP
Cryoprecipitate
Cryoprecipitate Poor Plasma
 WHOLE BLOOD

HIGH SPEED CENTRIFUGATION

PLASMA PACKED RBC BUFFY COAT

POOLING AND LOW SPEED

CENTRIFUGATION

PLATELET RICH PLASMA

HIGH SPEED
CENTRIFUGATION
PLATELET POOR PLATELET
PLASMA (PPP) CONCENTRATE
CRYOPRECIPITATE
 WHOLE BLOOD
• 450ML of blood
• 63ML of anticoagulant solution.
• Hematocrit 36 to 44%.
• no components have been removed.
• Stored at 1-6 C.
• shelf life : Citrate Phosphate Dextrose(CPD)- 21 days
CPDA-1 (Adenine) -35 days.
Adsol or AS-1, Nutricel or AS-3, Optiso or AS-5 – 42 days
• Infuse within 4 hours of issue.
CHANGES IN STORED BLOOD

PLASMA HEMOGLOBIN
PLASMA POTASSIUM

VIABLE CELLS
PH
ATP
2,3BPG
PLASMA SODIUM
• EFFECT:
One unit increases hematocrit by 3% and hemoglobin by 1gm/dL.

• INDICATIONS:
1.Acute haemorrhage with >25% of TBV loss .
2.Exchange transfusion .

• CONTRAINDICATIONS:
Risk of volume overload such as chronic anemia, incipient cardiac failure.
• DRAWBACKS:
1.After storage for greater than 24 hours, platelets and WBC become
nonfunctional.
2.Factor V and factor VIII (liable factor) decrease with storage.
3.Fluid overload.
4. The 2,3 BPG levels fall overtime leading to increase in the oxygen affinity
of the hemoglobin and decreased capacity to deliver the oxygen to the
tissues.
 PACKED CELLS
• Principle: RBCS are obtained by removal of supernatant plasma from
centrifuged cold blood.
• Volume: 250 to 300mL.
• Anticoagulant : mostly CPD-A1
• Packed cell volume:80%
• Components: RBC (65-80%)
plasma (20-35%)
few platelets, white cells and anticoagulant preservative
solutions.
• Storage temperature:4C(2-6 C)
• Shelf life : 35 days with CPD-A1 anticoagulant.
• To be transfused within 4 hours off issue.
• EFFECT:
One unit PRBC raises HCT by 3% and hemoglobin by 1 gm/dL.
DOSAGE : 10-15mL/KG bodyweight.

• Indications:
1. Anemia associated with incipient or established cardiac failure .
2. Replacement fluid blood loss <20% of total blood volume.
3. Anticipated surgical blood loss greater than 1000 mL.
4. Patient with <10 grams hemoglobin requiring emergency surgical
intervention.
 ASA Guidelines for Transfusion of Packed Red Cells in
Adults
• Transfusion for patients on cardiopulmonary bypass with hemoglobin level <6.0g/dL is
indicated.

• Hemoglobin level <7.0g/dL in patients >65years and patient with chronic cardiovascular
or respiratory diseases justifies transfusion.

• For stable patients with hemoglobin level between 7 and 10g/dL , the benefit of
transfusion is unclear.

• Transfusion is recommended for patients with acute blood loss more than 1,500mL or
30% of blood volume.
• Evidence of rapid blood loss without immediate control warrants blood transfusion .
• OTHER RED CELL CONCENTRATES :

1.Leukocyte depleted RBC

2.Washed RBC
3.Frozen RBC
4.Irridiated RBC
5.Granulocyte concentrates.
 LEUKOCYTE REDUCED RBC’s:
Shelf life is 32-42 Days when stored at 2-6 C

1.Leukocytes can be reduced either by centrifugation or filtration method .

2.Filtration method is easy and quick but more expensive, but is highly
efficient , removes WBC more than 99.9%.
INDICATIONS:
• Patients requiring multiple transfusions like thalassemia.
• Immunosuppression
• Immunodeficiency
• Aplastic anemia, Leukemia
• Prevention of recurrent FNHTR’s
• Reduces the risk of CMV, EBV, HTLV-1 transmission
 WASHED RBC’s
• RBCs washed with 1-2 Liters of normal saline.
• Washing removes residual plasma eliminating antibodies, metabolic and
other plasma constituents.
• To be transfused within 24hours.
• INDICATIONS:
1.Multiple transfused patients with recurrent FNHTR’s
2.Urticarial reactions.
3.Anaphylactic reactions.
4.IgA deficiency with IgA antibodies .
 FROZEN RBC’s
• Autologous units of patients with multiple red cells alloantibodies stored for
future use .
• Blood is collected , RBC’s separated and are frozen using glycerol and stored
upto 10years.
• To use , they must be washed and thawed, and unit expires within 24 hours
and cannot be re –frozen .
INDICATIONS :
1.Indicated in patients with complex immuno haematological profiles in the
absence of compatible donors.
2. IgA deficient patients with antibodies to IgA.
3.Safe in massive blood transfusions .
 IRRADIATED RBC’s
• Gamma radiated to kill the lymphocytes .
• The lack of T cells prevents GVHD.
• Shelf life 28 days .
• INDICATIONS:
1. Bone marrow or stem cell transplantation.
2. Intrauterine transfusions
3. Congenital immunodeficiency syndrome
4. Neonatal exchange transfusion given within 24 hours .
5. Lymphomas.
 GRANULOCYTE CONCENTRATES

• Obtained by apheresis from family members for the administration to cancer

patients .
• Usually contains 1.0x1010 granulocytes.
• Pre treatment with recombinant G-CSF and Dexamethasone can yield
4-8x 10 10 granulocytes.
• Stored at 24 C and need to be infused within 24 hours of collection .
CRITERIA FOR GRANULOCYTE TRANSFUSION :

• ANC >500
• Fever
• Documented infection ( bacterial or fungal ) for 24-48hours
• Unresponsive to appropriate antibiotics .
• Reasonable hope of marrow recovery .
 INDICATIONS FOR GRANULOCYTE CONCENTRATE :

1.Septicemia not responding to antibiotics.

2.Neutrophil count >500/mm3 , having gram negative infection failed to
respond to antibiotics .
3.Temporary bone marrow suppression for 1-2 weeks.
4.Infections in patient’s undergoing chemo or radiotherapy for neoplastic
diseases .
 PLATELET RICH PLASMA
• It is prepared from whole blood within 6 hours of collection preferably
stored at a temperature of 20-24 C in a platelet incubator with a
constant agitation for a max period of 48-72 hours .
• If the donor is on antiplatelet drugs ,platelets are accepted after 3 days
after the discontinuation of drugs.
• PRP therapy has generated a buzz over the past few years , particularly
successful in treating injuries on high profile athletes.
 PLATELET CONCENTRATES (RDP)
• This supplies the same amount of PRP but in lesser volumes .
• Volume : 40-50mL
• Anticoagulant : CDP-A1
• Quality control requirements : To be prepared within 8 hours
after collection and pH should be <6.2 or more at the end of
storage time.
• Contents : platelets 5.5x 1010/bag, plasma 30-50mL and some
WBCs
• Transfusion criteria : ABO/Rh specific and compatible
• Stored at 20-24 C and shelf life of 3 days in a platelet incubator
with constant agitation
• Dosage : one unit of Platelet concentrate /10 KG B.W
One unit of platelet concentrate raises 5000-10,000/ μL.
• The increment will be less in splenomegaly , DIC , septicaemia .

• ADVANTAGES : low cost, easy collection and processing

• DISADVANTAGES : Exposure to multiple donors in single
transfusion may lead to platelet refractoriness and risk of
infections.
 SINGLE DONOR PLATELETS (APHERESIS PLATELETS)
• These are obtained by plateletpheresis technique.
• 6-8 times more platelets as in Random donor unit.
• Larger volumes and HLA compatibility results in an increase of 30,000 to 60,000
platelets .
• Leukoreduced because of apheresis collection .
• ABO matching and Rh compatibility is IMPORTANT .
• Usually 1 SDP = 6 RDP = 1 Therapeutic dose to be transfused over 20-30mins.
• ADVANTAGES : Large doses from a single exposure
HLA matched platelets can be given .
Decreases risk of allo-immunization and transfusion
transmitted diseases.
• DISADVANTAGES :
1.Expensive
2.Time consuming

• INDICATIONS:
✓THERAPUETIC :
1.Counts must be kept above 50,000/mm3 in bleeding situations.
2.In DIC and CNS bleeding , cut off is 1,00,000/mm3
3.Bleeding in patients on anti-platelet medication .
✓PROPHYLACTIC :
1.PREPARATION FOR AN INVASIVE PROCEDURE :

Major surgery 50,000/mm3

Neuro or ocular surgery 1,00,000/mm3

Endoscopic procedures 50,000/mm3

20,000/mm3

Central line placement 20,000/mm3

Lumbar puncture 40,000/mm3

2.PREVENTION OF SPONTANEOUS BLEEDING :
Patients with bone marrow suppression : 10,000/mm3
Patients with septicemia : 30,000/mm3
ITP, TTP or HIT, transfusion is indicated only if they bleed
Hematological malignancies and chemotherapy : 10,000-20,000/mm3

• CONTRAINDICATIONS :

For the prophylaxis of bleeding in surgical patients .

 PLASMA COMPONENTS :

• FRESH FROZEN PLASMA

• FROZEN PLASMA
• CRYOPRECIPITATE
• CRYOREMOVED PLASMA
FRESH FROZEN PLASMA (FFP):
• Plasma is obtained from a single donor by normal donation or by
plasmapheresis .
• Volume : 250-300mL
• Prepared from blood within 8 hours of donation .
• Contents : contains all coagulation factors and plasma proteins
Factor VIII -0.6IU/mL
Factor IX -0.9IU/mL
Fibrinogen : 250-300mg/bag
Proteins – Protein C and S ,Albumin , globulin etc .
• Stored at 20 C or below with a shelf life of 1 year.
• Good for 24 hours post thaw but can be stored for 5 days as liquid plasma
(labile factors V and VIII decreased ), best if infused within 6 hours.
INDICATIONS OF FFP TRANSFUSION :
• DOSAGE : 10-15mL/Kg of FFP
For warfarin reversal , 5-8mL/Kg of FFP
• CONTRAINDICATIONS :
1.Volume expansion
2.Immunoglobulin replacement
3.Nutritional support
4.Wound healing .
• PRECAUTIONS :
Acute allergic reactions are common.
Anaphylactic reactions may occur
Hypovolemia alone is not an indication for use.
FROZEN PLASMA

• Plasma which is separated from whole blood at any point of time

during storage .
• It contains all non-liable coagulation factors.
• INDICATIONS :
Treatment of stable coagulation factor deficiencies .
• CONTRAINDICATIONS : Same as FFP .
OTHER TYPES :

Single Donor Plasma

Solvent Detergent Plasma
Donor Retested Single Donor Plasma
IgA Deficient FFP
 CRYOPRECIPITATE (C.P)
• Cryoprecipitate is the cold –insoluble portion of plasma that precipitates
when FFP is thawed between 1-6°C.

• Cryo precipitation is accomplished by rapid freezing of plasma and

slow thawing at low temperature.

• C.P contains precipitated proteins of plasma , rich in factor VIII ,

obtained from FFP within 6-8hours of collection , subsequent
thawing at 4-6°C and removal of supernatant.
• Each unit of C.P contains

VOLUME 10-20mL
FACTOR VIII -C 80-120IU
FACTOR VIII R :Ag HIGH LEVELS
FACTOR VIII vWF HIGH LEVELS
FIBRINOGEN 150-200mg/BAG
FACTOR XIII 20-30% OF ORIGINAL
LEVELS
• Stored at Frozen -20°C or less with a shelf life of 1 year if frozen and
6 hours if thawed .
• Criteria : ABO compatibility not required .

• INDICATIONS :
1.Quantitative and qualitative fibrinogen deficiency.
2.Von Willebrand deficiency.
3.Factor XIII deficiency
4.Uremic coagulopathy
5.Fibrin glue
6.Factor VIII (Haemophila A)
 FRESH FROZEN PLASMA

CRYOPRECIPITATE CRYO REMOVED PLASMA

FREEZE -80°C IMMEDIATELY

REFROZEN WITHIN 1HOUR
STORED AT <-18°C
STORE AT <-18°C
COMPONENT STORAGE :
• RED BLOOD CELLS : 1-6 °C
• PLATELETS : 22-24 °C WITH CONTINUOUS AGITATION
• PLASMA
FFP : <-18 °C AFTER THAWING @1-6 °C FOR 24 HOURS
FP : <-18 °C AFTER THAWING @1-6 °C FOR 24 HOURS
CSP : <-18 °C AFTER THAWING @1-6 °C FOR 24 HOURS

• CRYOPRECIPITATE: <-18 °C AFTER THAWING @1-6 °C FOR 24 HOURS

HOW LONG CAN BLOOD COMPONENTS BE
STORED ?
RED CELLS 42 DAYS, COLLECTED IN CPD/AS-3
35 DAYS , COLLECTED IN CPDA-1

PLATELETS 5 DAYS WITH CONTINUOUS AGITATION

CRYO 12 MONTHS AT 18°C OR 4 HOURS AFTER THAWING

PLASMA 12 MONTHS AT 18°C OR 24HOURS AFTER THAWING

PLASMA DERIVATIVES :

• FACTOR VIII CONCENTRATE

• FACTOR IX CONCENTRATE
• AT-III CONCENTRATE
• FACTOR XIII CONCENTRATE
• ALBUMIN
• IV IMMUNOGLOBULIN
• Rh IMMUNOLGLOBULIN
• ALBUMIN:

✓Prepared from large pool of plasma reconstituted in isotonic

electrolyte solution .
✓96% albumin and 4 % globulin and other protiens .
✓Heat treated to prevent viral transmission.
✓Available as 5% or 25% solutions.
✓Used for hypovolemia or hypoproteinemia
✓Can be given without regard to ABO blood type and cross
match
CMV - Negative Blood Products
• For pregnant women
• Newborns
• Immunocompromised.
Thank you