BLOOD BANKING 1- BLOOD PRODUCTS 2- AUTOLOGOUS TRANSFUSION M. H. Shaheen Maadi Armed Forces Hospital

BLOOD COMPONENTS I- Red Cells: For oxygen carrying capacity II- Plasma : For coagulation proteins III- Platelets: For microvascular bleeding

RED CELL COMPONENTS 1- Whole blood 2- Red cell concentrates (Packed RBC) 3- Washed red cells 4- Leukocyte depleted red cells 5- Frozen red cells

WHOLE BLOOD Anticoagulant: CPDA-1 Shelf Life: 35 days At 1-6 * C Volume: 450 ml blood Plus 63 ml CPDA= 510 ml

Cont… WHOLE BLOOD Poor in coagulation proteins & platelets Corrects oxygen carrying capacity and volume simultaneously Indicated for the management of trauma and extensive blood loss One unit of whole blood increases Hct by 3% and Hb level by ~ 1 gm

FRESH WHOLE BLOOD Less than 5 days old Indications: - Exchange transfusion - Major surgery with massive blood loss - Liver transplantation - Open heart surgery in infants

2- RED CELL CONCENTRATES (Packed red cells) Production: from whole blood; Plt. & plasma are produced Shelf life: 35 days + nutrient= 42 days Volume: ~ 200 ml

Cont…. Packed Red Cells Indications: Correction of oxygen carrying capacity Chronic anemia Before major surgery Trauma and emergency transfusion

3- Leukocyte Depleted Red Cells Preparation: Nylon wool filters Indication: Non-hemolytic febrile reactions

4- Washed Red Cells Manual and automated washing systems Must be transfused before 24 hours Washing removes plasma proteins and reduce allergic transfusion reactions indicated in recurrent an/or sever reactions

4- Frozen Red Cells Production: Red cells + Cryoprotective Storage: Liquid nitrogen or Freezers Preparation prior to transfusion: Thawing washing and addition of glucose Transfusion: Within 24 after preparatoin Indications: - Rare blood groups - Subgroup antibodies

Appropriate Transfusion Practice of Red Cell Products in various surgical settings One unit of red cells : 3% increment in Hct increases Hb level by ~ 1gm Do not measure Hb &/or Hct before 2 hours Factors adversely affecting the benefit from transfused red cells: - Continued blood loss - Hemolysis; immune mediated & mechanical - Suppression of erythropoiesis

Red Cell Transfusion in Acute Blood Loss Blood loss of < 10% of total blood volume: No replacement therapy Loss Up to 20% : Replace by crystalloids Loss > 25% : Require red cell transfusion Preoperative Hb < 10 gm: Historical gold standard for red cell transfusion Each case must be evaluated individually

II- PLATELET PREPARATIONS 1- Platelet Concentrates 2- Apheresis Platelet Units

Appropriate Transfusion practice of Platelet Concentrates Unit of Platelet Transfusion: - Conventional requirement is 6 units of pooled platelet concentrate - Apheresis platelet unites are largely dependent on donor parameters Single donor (apheresis) platelets have low risk to recipients than do pooled platelets

Platelet Transfusion Dose Apheresis Platelets contains 3 x 10^ 11 Plts Six units of pooled platelet concentrate= 6 ( 5.5 x 10^ 10 ) Plts Appropriate transfusion requirement for normal size individual Post-transfusion increment of ; x 10^ 9 /L

Cont… Platelet Transfusion Dose Approximately one unit of platelet concentrate for each 10 kg body weigh Objective in the preoperative period: Platelet count > 60,000 x 10^ 6 /L Post-transfusion platelet survival: days

III- PLASMA DERIVATIVES Plasma products commonly requested: 1- Fresh Frozen Plasma (FFP) 2- Cryoprecipitate 3- Fibrin Glue Plasma and its derivatives represent a valuable source in transfusion practice Plasma production: Manually, Aphersis, Industrial fractionation

1- Fresh Frozen Plasma (FFP) Storage: 18 * C for up to 1 year Transfusion: Thawed over min Validity: 24 hours after thawing

Indications of FFP 1- Multiple acquired coagulation defects: Liver disease Massive transfusion DIC Rapid reversal of warfarin effect 2- Plasma Infusion or exchange: TTP HUS 3- Congenital coagulation defects

2- Cryoprecipiate Production: FFP thawed at 4* C Storage: At 18 * C for 1 year Properties: contains fibrinogen, F VIII and vWF Indication: Fibrinogen deficiency & hemophilia A

3- Fibrin Glue Topical hemostatic blood product Production: 1- Cryoprecipitate 2- Thrombin Cut, tailored and pasted Indication: Hemostatic and sealant in cardiac, vascular and other surgical procedures

AUTOLOGOUS BLOOD TRANSFUSION HISTORY: - Remote: 100 years ago - Recent: HIV In 1980 th.

ADVANTAGES Eliminates transfusion transmitted diseases (Hepatitis and HIV) Prevention of transfusion immunologic reactions Enhanced recovery from postoperative anemia High cost benefit LIMITATION: Risk of blood donation in some cardiac patients

Methods of Collection of Autologous Blood Donations 1- Preoperative 2- Intraoperative blood salvage 3- Intraoperative hemodilutionn

1- Preoperative Autologous Transfusion Autologous donation once a week - Normal erythropoiesis - Adequate iron supply Large volume if cryopreservation is available Well tolerated even in by some high risk donors Limitation: Anemia developing during the donation interval (Erythropoietin may help) In USA, less than 2% require allogeniec blood for elective surgery

2- Intraoperative Blood Salvage 1- Systems without washing: - Modified suction devices - Simple and cheap 2- Washing systems: - combined suction device and continuos flow centrifugal system - Processing of large blood volume - Save ~ 50% of allogeneic blood requirements

3- Intraoperative Hemodilution Collection of autologous blood just before the start of surgery Value in open heart surgery: - Saving of platelet number and function - Reduction of red cell loss - Improves tissue perfusion and oxygenation - Less expensive than preoperative donations