Blood Components and Component Therapy

Question 1

Basic concept of “component therapy”

Answer 1

1. Allows for more efficient and effective use of products by giving a patient specifically what he needs and minimizing what he doesn’t need.
2. Made possible by advent of plastic bags around 1950.
3. Single unit may be made into numerous components (see figure below representing typical US method).

Question 2

Anticoagulant/preservative solutions

Answer 2

1. Allows blood to be stored for extended periods without drastic effects on most metabolic and therapeutic qualities
2. Red cell storage defined by demonstrating 75% survival of transfused cells at 24 hours after transfusion
3. Traditional anticoagulant/preservatives

a. Citrate-phosphate-dextrose (CPD) and citratephosphate-dextrose-dextrose (CP2D)

1) Allows 21 days of RBC/whole blood storage
2) Used before additive solutions

b. Citrate-phosphate-dextrose-adenine (CPDA-1)

1) Very similar to CPD but with 17.3 mg of adenine (no adenine in CPD)
2) Allows 35 days of RBC/Whole Blood storage

4. Additive solutions (“Adenine Saline” additives)

a. Increases shelf life of RBCs to 42 days
b. Most common types

1) AS-1 (Adsol®)
2) AS-3 (Nutricel®)
3) AS-5 (Optisol®)

c. Specifics vary, but all add more dextrose and adenine to increase blood shelf life.
d. AS-1 and AS-5 also contain mannitol.
5. Rejuvenation solution (“Rejuvesol”)

a. Restores ATP and 2,3-DPG levels in older RBCs
b. Used from day 3 of storage to day 3 after expiration
c. Contains inosine, phosphate, pyruvate, and adenine
d. Approved for CPD and CPDA-1 red cell units
e. After rejuvenation, RBCs must be washed before infusion and either transfused or frozen within 24
hours.

6. Know storage details for various products (Table 1)

Table 1: Storage Details for Various Blood Products

WBCs 24 hours; 20-24 C (no agitation)
PRBCs /
Whole blood
35 days (CPDA-1)
42 days (Additives)
1-6 C
Frozen RBCs 10 years; –65 C
24 hours after thaw
Fresh
Frozen
Plasma
1 year; –18 C OR
7 years, –65 C
24 hours at 1-6 C
Washed after thaw
RBCs
24 hours; 1-6 C
Platelets 5 days; 20-24 C
(gentle agitation)
CRYO 1 year at –18 C
6 hours at 20-24 C
after thaw (4 hours
if pooled)