Chapter 2: Blood Components Flashcards
What components are whole blood donations separated into?
Cellular components:
1. RBCs
2. Pooled platelets
3. Apheresis platelets
4. Pooled platelets psoralen-treated
AND
Plasma components
1. FP
2. CSP
3. Cryoprecipitate
In the context of blood collection, what is a closed system? Why is this important?
Whole blood is collected directly from the donor into a collection pack with multiple connected bags. This is important because it allows blood to be transferred aseptically between bags.
Name the 2 possible configurations of a blood collection pack at CBS.
B1: buffy coat collection set
B2: while blood filtration set
What components are the B1 and B2 collection sets used to produce?
B1: RBC, platelets, plasma
B2: RBC, plasma components including cryoprecipitate
What preservative do blood collection bags contain at CBS? What purpose does this preservative serve?
CPD (Citrate -phosphate-dextrose)
Anticoagulant
How does apheresis technology work?
Automated process
Whole blood goes from donor into collection chamber
Centrifugation to separate cellular components from plasma
Eirher plasma or platelets suspended into plasma are collected into a bag
Remaining blood constituents are returned to the donor
What are the differences between the B1 and B2 manufacturing methods?
B1:
WB cooled to 18-24C then centrifugation then extraction of plasma, buffy coat, RBC finally, RBC leukoreduced/ filtered and buffy coat is made into PP
B2: WB cooled, but only to 1-6C
Filtration/leukoreduction occurs before centrifugation target than at the end, so platelets get removed
Final products are RBC and plasma
What additive is used in RBC units at CBS? What are the ingredients in this additive?
SAGM
Saline
Adenine
Glucose
Mannitol
What is the volume of a total RBC unit issued by CBS?
285 mL
How many grams of Hgb in a unit of red cells?
55 g
What is the average hematocrit of an RBC unit?
0.67%
What is the average residual WBC count in an RBC unit?
6 x 10*8
What types of testing, in general terms, does donated blood undergo at CBS?
ABO typing
RhD typing
Kell typing
Other clinically significant antibodies stuck as C, c, E, e, Jka, Jkb, Fya, Fyb, S, s (some units only)
What information is on a standard RBC unit label at CBS?
ISBT Donation number
Collection date/time
Expiration date/time
Product name/description
ISBT product code
ABO Rh blood group
Results of special/extended testing (e.g. antigen phenotyping)
What is the primary indication of a red cell transfusion?
To increase O2 carrying capacity of blood
E.g in anemic patients with evidence of impaired O2 delivery
What is the expected increment in hemoglobin following transfusion of one RBC unit?
10 g/L
(70kg non-bleeding adult)
What criteria must an unused RBC unit fulfill to be returned to inventory?
Bag intact
Visual inspection okay
Maintained at an acceptable temperature OR
Not out of temperature control for >60 min
What is the shelf like of a standard unmodified RBC unit?
42 days from collection
What modifications/factors shorten shelf life of an RBC unit?
Washing
Irradiation
Opening unit without a sterile connection device
What is the storage temperature for RBCs?
1-6C
What features or requirements must an RBC storage device have?
Temperature control
Alarm
Fan
Continuous monitoring device
Records to maintain traceability from source to disposition and to ensure appropriate conditions
What is the maximum transportation time for an RBC unit?
24 hours per ISBT
What is the required storage temperature for RBCs? Is there any difference for short (<24 hours) transportation times?
1-6C
Yes; 1-10C if transported for <24h
Disposition documentation purpose?
To record whether a unit was transfused or discarded
What manufacturing method is used to extract platelets?
B1 buffy coat
How is one unit of pooled platelets prepared?
4 ABO identical donations along with plasma from one of those donors (a male) are pooled then LR/filtered
When can a pooled platelets be labeled as Rh neg?
All 4 donors are Rh neg
When can a pooled platelets unit be labeled as low anti-A/B?
All 4 donors have anti-A and anti-B levels below a predetermined cutoff
Average volume of a pooled platelet unit?
320 mL
(Less if apheresis- 220 mL)
Average platelet count in a pooled platelet unit?
340 x10*9
Average platelet count in a pooled platelet unit?
340 x10*9
(Slightly less if apheresis - 333)
Residual WBC count in a pooled platelet unit?
5 x 10*8
(MORE if apheresis- 10)
Shelf life of a pooled or apheresis platelet unit?
7d from collection
When is platelet transfusion indicated?
Bleeding patient with thrombocytopenia or dysfunctional platelets
Prophylaxis in patients with thrombocytopenia or rapidly dropping platelet count due to chemo or bone marrow disorders
Are platelet transfusions useful in ITP, HIT, or TTP?
Not recommended for patients with rapid platelet destruction unless clinically significant and/or life threatening bleeding
Are platelet transfusions useful in ITP, HIT, or TTP?
Not recommended for patients with rapid platelet destruction unless clinically significant and/or life threatening bleeding
What is the expected count increment from one unit of platelets after 1 hour?
15-25x10*9/L
What are the storage conditions for platelets?
. 20-24°C under continuous agitation
What types of plasma products does CBS manufacture or provide?
- FP
- CSP
- Cryoprecipitate
- S/D plasma/ octaplasma
When might a plasma donation be discarded?
If any clinically significant Ab are detected on screening at CBS
How much time after collection is a plasma unit frozen?
within 24 hrs
What is the residual WBC count in a plasma unit?
<5x10*6/L
Why aren’t plasma units labeled as LR?
WBC levels can be highly variable
What Is FP-divided plasma & its volume?
smaller divided doses/Units for peds patients. Almost always group AB.
Volume 125-150mL
Why must plasma be frozen at -18°C or lower?
FV & FVIII are labile and not stable at refrigerated temperatures
According to Canadian standards, how much factor VIII must a unit of FP contain?
Minimum 0.52 IU/L in at least 75% of tested units
How is CSP/CPD (cryosupernatant plasma) produced?
FP is slowly thawed
Thawed FP is centrifuged to separate plasma from insoluble cryoprecipitate
Cryoprecipitate is refrozen
Plasma is refrozen and becomes cryosupernatant plasma
What is convalescent plasma? What is it used for?
Plasma collected from people who have recovered from an infection. The plasma contains neutralizing antibodies against the causative pathogen.
Experimental therapy for: SARS, Ebola, H1N1, COVID-19
For COVID, donors must have had positive COVID test in the past and must be free of symptoms for 28 days/4 weeks
What is the volume of an average FP unit?
283 mL
How much FVIII is in the average FP unit?
0.87 IU/mL
What is the average volume of a unit of CSP?
273 mL
What coag factors are in FP?
All, but slightly reduced amounts of FV and FVIII
What clotting factors are in CSP?
All, but reduced HMW VWF and fibrinogen
What is the volume of a typical octaplasma unit?
200 mL
How many g off human plasma proteins are in a unit of octaplasma?
9-14 g (45-70 mg/mL)
What is the minimum amount of each clotting factor in an octaplasma unit?
0.5 IU/mL
What steps does octaplasma undergo?
Solvent detergent
Immune neutralization
Sterile filtration
Purpose is to remove our inactivate pathogens, cells, allergens, antibodies
What is the indication for FP or S/D plasma?
Treatment or prevention of clinically significant bleeding due to coagulation factor deficiency even there is no appropriate alternative therapy
E.g. DIC
Severe liver disease
Patient on warfarin undergoing invasive procedure before vitamin K reversal can occur
TTP patients on PLEX
Reconstitution of whole blood
What are the indications for CSP?
PLEX for TTP
Patients with multiple factor deficiencies but don’t need fibrinogen replacement
Patient on warfarin bleeding or undergoing invasive procedures before vit K reversal, if pcc is unavailable or contraindicated
Is plasma indicated for hypovolemic patients as volume replacement?
No
User crystalloids: NS or RL
Are FP and SD plasma interchangable?
Yes
How do you thaw FP or CSP?
How do you thaw SD plasma?
12-30 min in water bath 30-37C for FP or CSP
30-60 min in water bath at 30-37C or in a dry tempering system for SD
Store at 1-6C for up to 5 days after thawing
What are the storage and transportation conditions for frozen plasma components?
-18C for up to 12 mos for FP and CSP
Up to 4 years for octaplasma!!!
Products can’t be out of a temperature controlled storage for >30 min
How much fibrinogen in a unit of cryoprecipitate?
365 mg
What is the volume of a unit of cryoprecipitate?
10+/-2 mL
Indication for cryoprecipitate?
Fibrinogen replacement
Advantage of fibrinogen concentrate over cryoprecipitate?
Fibrinogen concentrate is pathogen reduced and availablein freeze dried lyophilized form so it’s easier to reconstitute and administer
What fibrinogen level is an indication for replacement?
<1.0g/L
<1.5 g/L in non obstetric patients with massive bleed or APL
<2.0 g/L in bleeding obstetric patients
Is fibrinogen indicated in hemophilia A or VWD?
No, use fibrinogen concentrate
