1. Blood products. Preparation of blood components

2. Whole blood plasma Backed Red Cells 90% waterRBC10% plasma material Fresh frozen plasma Platelet concentrate Cryoprecipitate – VIII = AHF albumin Fibrinogen Immunoglobulin Others

3. Blood bags Single blood bag: Single blood bag: Whole blood Whole blood

4. Double bags: Double bags: Backed red cells Backed red cells plasma plasma

5. Triple bags: Triple bags: Backed cells Backed cells Plasma Plasma platelets platelets

6. Quarterly bags: Quarterly bags: Backed cells Backed cells Plasma Plasma Platelets Platelets Plasma factors Plasma factors

7. Special bags: Special bags: Frozen blood upto 2 years and store under (– 70- 90 c) Frozen blood upto 2 years and store under (– 70- 90 c) The bags should be sterile = no contamination. The bags should be sterile = no contamination. Patient information's: Patient information's: No of patients. No of patients. Name. Name. Others. Others.

8. Centrifugation This is the first step of blood preparation Depend on 2 factors: Depend on 2 factors: Relative centrifugation factor (RCF). Relative centrifugation factor (RCF). Duration of centrifugation. Duration of centrifugation. 1. Heavy spin 5000 /g / 7min = leukocyte-poor RBC, or cell free plasma. 5000 /g / 7min = leukocyte-poor RBC, or cell free plasma. 5000/g / 5min = backed cell and platelet concentrate. 5000/g / 5min = backed cell and platelet concentrate. 4170/ g / 10min = cryoprecipitate 4170/ g / 10min = cryoprecipitate 2. Light spin 4170 /g/2min = platelet rich plasma. 4170 /g/2min = platelet rich plasma. Centrifugation temp. Platelet = at 22c Platelet = at 22c Others = 1-6c Others = 1-6c

9. 1- Whole Blood: Contents RBC’s WBC’s Platelets Plasma Clotting factors Indications Acute loss of whole blood

10. 2- Packed Red Cells Contents RBC’s 20% Plasma Indications Replace O2 carrying capacity with less volume Severe anemia, slow blood loss, CHF

11. 2- Packed Red Cells - Preparation: Blood should be drawn in double bags. Usually 225 ml of plasma is removed. The Hct is about 70-80%. The blood should be used within the expiration date of the bags. Packed RBCs are ordinarily the component of choice with which to increase Hb.

12. 2- Packed red cells Indications depend on the patient. O2-carrying capacity may be adequate with Hb levels as low as 7 g/L in healthy patients, but transfusion may be indicated with higher Hb levels in patients with decreased cardiopulmonary reserve or ongoing bleeding. Indications depend on the patient. O2-carrying capacity may be adequate with Hb levels as low as 7 g/L in healthy patients, but transfusion may be indicated with higher Hb levels in patients with decreased cardiopulmonary reserve or ongoing bleeding. One unit of RBCs increases an average adult's Hb by about 1 g/dL and his Hct by about 3% of the pretransfusion Hct value. One unit of RBCs increases an average adult's Hb by about 1 g/dL and his Hct by about 3% of the pretransfusion Hct value. When only volume expansion is required, other fluids can be used concurrently or separately. When only volume expansion is required, other fluids can be used concurrently or separately.

13. 3- Washed red cells It’s convenient but expensive. It’s convenient but expensive. Washed RBCs are free of almost all traces of plasma, most WBCs, and platelets. Washed RBCs are free of almost all traces of plasma, most WBCs, and platelets. They are generally given to patients who have severe reactions to plasma (eg, severe allergies, paroxysmal nocturnal hemoglobinuria, or IgA immunization). They are generally given to patients who have severe reactions to plasma (eg, severe allergies, paroxysmal nocturnal hemoglobinuria, or IgA immunization). In IgA-immunized patients, blood collected from IgA-deficient donors may be preferable for transfusion. In IgA-immunized patients, blood collected from IgA-deficient donors may be preferable for transfusion.

14. 4- Leukocyte-poor red cells or WBC-depleted RBCs: Are prepared with special filters that remove ≥ 99.99% of WBCs. Are prepared with special filters that remove ≥ 99.99% of WBCs. The majority of febrile non-hemolytic reactions (FNH), can be alienate by transfusion leukocyte- poor red cells, so they are indicated for patients who have experienced nonhemolytic febrile transfusion reactions, and possibly for the prevention of platelet alloimmunization. The majority of febrile non-hemolytic reactions (FNH), can be alienate by transfusion leukocyte- poor red cells, so they are indicated for patients who have experienced nonhemolytic febrile transfusion reactions, and possibly for the prevention of platelet alloimmunization.

15. 3- Leukocyte-poor red cells or WBC-depleted RBCs: Can be prepared by several techniques: Can be prepared by several techniques: Double centrifuge Double centrifuge Heavy spin. Heavy spin. Filtration: passing the blood through a nylon filter which is an efficient method for removal of granulocytes. Heparin is the anticoagulant used for this procedure. In Europe the used the cotton for removal lymphocytes and granulocytes. Filtration: passing the blood through a nylon filter which is an efficient method for removal of granulocytes. Heparin is the anticoagulant used for this procedure. In Europe the used the cotton for removal lymphocytes and granulocytes.

16. 3- Leukocyte-poor red cells or WBC-depleted RBCs: Sedimentation: this method provides 90% of red blood cells and 10% of original no of platelet and leukocyte. Sedimentation: this method provides 90% of red blood cells and 10% of original no of platelet and leukocyte. Washing: is provides a good recovery of erythrocyte with low no of WBC and platelet. Washing: is provides a good recovery of erythrocyte with low no of WBC and platelet. Frozen deglycerolized red cells: when maximally leukocyte poor red blood cells needed. Frozen deglycerolized red cells: when maximally leukocyte poor red blood cells needed.

17. 5- Fresh frozen plasma (FFP) Contents Clotting factors Fibrinogen Prothrombin Albumin Globulins

18. 5- Fresh frozen plasma (FFP) Indications Volume expansion : FFP can supplement RBCs when whole blood is unavailable for exchange transfusion, but FFP should not be used simply for volume expansion. Fresh frozen plasma (FFP) is an unconcentrated source of all clotting factors deficiency, so indications also include correction of bleeding secondary to factor deficiencies for which specific factor replacements are unavailable, multifactor deficiency states (eg, massive transfusion, disseminated intravascular coagulation [DIC], liver failure)

19. 5- Fresh frozen plasma (FFP) Preparation: Preparation: Can be prepared by: Can be prepared by: Single heavy spin. Single heavy spin. Double centrifugation to prepare platelet conce. At the same time. Double centrifugation to prepare platelet conce. At the same time. Each unit contains about 225 ml of plasma. Each unit contains about 225 ml of plasma. Can protect bags within 6h. After collection by placing it in a dry ice-alcohol path or in freezer at -30c or below. Can protect bags within 6h. After collection by placing it in a dry ice-alcohol path or in freezer at -30c or below. FFP bags should be frozen in a horizontal position and store at vertical position. FFP bags should be frozen in a horizontal position and store at vertical position. Shelf life is 12 months when store at -18c or less. Shelf life is 12 months when store at -18c or less. When required FFP can be thawed with agitation in 37c in water path and used within 2h. When required FFP can be thawed with agitation in 37c in water path and used within 2h.

20. 6- Platelet concentrate Contents Platelets Platelets WBC’s WBC’s Plasma PlasmaIndications Low platelet counts (bleeding). Platelet concentrates are used to prevent bleeding in: asymptomatic severe thrombocytopenia (platelet count < 10,000/μL) asymptomatic severe thrombocytopenia (platelet count < 10,000/μL) For bleeding patients with less severe thrombocytopenia (platelet count < 50,000/μL) For bleeding patients with less severe thrombocytopenia (platelet count < 50,000/μL) For bleeding patients with platelet dysfunction due to antiplatelet drugs but with normal platelet count For bleeding patients with platelet dysfunction due to antiplatelet drugs but with normal platelet count For patients receiving massive transfusion that causes dilutional thrombocytopenia For patients receiving massive transfusion that causes dilutional thrombocytopenia And sometimes before invasive surgery. And sometimes before invasive surgery.

21. 6- Platelet concentrate Preparation: Preparation: Platelet-rich plasma is separated by light spin from erythrocyte. Platelet-rich plasma is separated by light spin from erythrocyte. Platelet conc. is then obtained by a heavy spin of platelet rich plasma. Platelet conc. is then obtained by a heavy spin of platelet rich plasma. Centrifugation should be done at 22c. Centrifugation should be done at 22c. Separation should be done within 4h. After the blood is drawn. Separation should be done within 4h. After the blood is drawn. Plasma portion can be frozen as FFP. Plasma portion can be frozen as FFP.

22. 6- Platelet concentrate Plasma should be frozen within 2h of separation at -30c or less. Plasma should be frozen within 2h of separation at -30c or less. When needed, Frozen plasma should then be thawed between 1-6c over night in a refrigerator or more quickly in a water path at 4c. When needed, Frozen plasma should then be thawed between 1-6c over night in a refrigerator or more quickly in a water path at 4c. One platelet concentrate increases the platelet count by about 10,000/μL, and adequate hemostasis is achieved with a platelet count of about 10,000/μL in a patient without complicating conditions and about 50,000/μL for those undergoing surgery. Therefore, 4 to 6 random donor platelet concentrates are commonly used in adults. One platelet concentrate increases the platelet count by about 10,000/μL, and adequate hemostasis is achieved with a platelet count of about 10,000/μL in a patient without complicating conditions and about 50,000/μL for those undergoing surgery. Therefore, 4 to 6 random donor platelet concentrates are commonly used in adults.

23. 6- Platelet concentrate Platelet concentrates are increasingly being prepared by automated devices that harvest the platelets (or other cells) and return unneeded components (eg, RBCs, plasma) to the donor. This procedure, called cytapheresis, provides enough platelets from a single donation (equivalent to 6 random platelet units) for transfusion to an adult, which, because it minimizes infectious and immunogenic risks, is preferred to multiple donor transfusions in certain conditions.

25. 6- Platelet concentrate Certain patients may not respond to platelet transfusions, possibly because of splenic sequestration or platelet consumption due to HLA or platelet-specific antigen alloimmunization. These patients may respond to multiple random donor platelets (because of greater likelihood that some units are HLA compatible), platelets from family members, or ABO- or HLA-matched platelets. Certain patients may not respond to platelet transfusions, possibly because of splenic sequestration or platelet consumption due to HLA or platelet-specific antigen alloimmunization. These patients may respond to multiple random donor platelets (because of greater likelihood that some units are HLA compatible), platelets from family members, or ABO- or HLA-matched platelets. Alloimmunization may be mitigated by transfusing WBC-depleted RBCs and WBC-depleted platelet concentrates. Alloimmunization may be mitigated by transfusing WBC-depleted RBCs and WBC-depleted platelet concentrates.

26. 7- Cryoprecipitated anti hemophilic factor ( AHF ) Contents Factors VIII and XIII, Fibrinogen and von Willebrand factor (vWF)v. It also contains fibronectin Factors VIII and XIII, Fibrinogen and von Willebrand factor (vWF)v. It also contains fibronectinIndications Hemophilia A Hemophilia A Fibrinogen deficiency Fibrinogen deficiency Factor XIII deficiency Factor XIII deficiency Disseminated intravascular coagulation Disseminated intravascular coagulation Rare factor XIII deficiency. Rare factor XIII deficiency.

27. Preparation: Cryoprecipitate is a concentrate prepared from FFP, it should be frozen within 4h and stored at -18c or less. Cryoprecipitate is a concentrate prepared from FFP, it should be frozen within 4h and stored at -18c or less. A bag of cryoprecipitate should be contain on the average about 80-100 units of AHF/unit. A bag of cryoprecipitate should be contain on the average about 80-100 units of AHF/unit. The shelf life is 12 month, when store at -18c or low. The shelf life is 12 month, when store at -18c or low. When requested, cryo precipitate may be thawed in a 37c water path and then should be maintained at room temp. And used as soon as possible or within 6h after thawing. When requested, cryo precipitate may be thawed in a 37c water path and then should be maintained at room temp. And used as soon as possible or within 6h after thawing. 7- Cryo-precipitated anti hemophilic factor ( AHF )

28. 6- Cryo precipitated anti hemophilic factor ( AHF ) In general, it should not be used for other indications. In general, it should not be used for other indications. A bag of cryo precipitate should be contain on the average about 80-100 units of AHF/unit. A bag of cryo precipitate should be contain on the average about 80-100 units of AHF/unit. The shelf life is 12 month, when store at -18c or lower. The shelf life is 12 month, when store at -18c or lower. When requested, cryo precipitate may be thawed in a 37c water path and then should be maintained at room temp. And used as soon as possible or within 6h after thawing. When requested, cryo precipitate may be thawed in a 37c water path and then should be maintained at room temp. And used as soon as possible or within 6h after thawing.

29. 8- WBCs: Granulocytes: Contents Contents WBC’s WBC’s 20% Plasma 20% Plasma Indications Indications Life-threatening decreases in WBC count Life-threatening decreases in WBC count Granulocytes may be transfused when sepsis occurs in a patient with profound persistent neutropenia (WBCs < 500/μL) who is unresponsive to antibiotics. Granulocytes may be transfused when sepsis occurs in a patient with profound persistent neutropenia (WBCs < 500/μL) who is unresponsive to antibiotics.

30. 8- WBCs: Important Notes: Granulocytes must be given within 24 h of harvest; however, testing for HIV, hepatitis, human T-cell lymphotropic virus, and syphilis may not be completed before infusion. Because of improved antibiotic therapy and drugs that stimulate granulocyte production during chemotherapy, granulocytes are seldom used.

31. 9- Immune globulins: Rh immune globulin (RhIg), given IM or IV, prevents development of maternal Rh antibodies that can result from fetomaternal hemorrhage. Rh immune globulin (RhIg), given IM or IV, prevents development of maternal Rh antibodies that can result from fetomaternal hemorrhage. Other immune globulins are available for postexposure prophylaxis for patients exposed to a number of infectious diseases, including cytomegalovirus, hepatitis A and B, measles, rabies, respiratory syncytial virus, rubella, tetanus, smallpox, and varicella. Other immune globulins are available for postexposure prophylaxis for patients exposed to a number of infectious diseases, including cytomegalovirus, hepatitis A and B, measles, rabies, respiratory syncytial virus, rubella, tetanus, smallpox, and varicella.

32. 10- Plasma Protein Fraction: Contents 5% Albumin/Globin in saline Indications Expand volume in burns Hemorrhage Hypoproteinemia

33. 11- Albumin: Contents 5% or 25% albumin Indications Replace volume in shock Burns Hypoproteinemia