A. Whole blood
1. Preparation. Normally, approximately 450 mL of blood are collected into a bag con- taining 63 mL of anticoagulant, usually CPD or CPDA-1.
2. The shelf life of whole blood collected in CPD is 21 days when stored between 1◦C and 6◦C. The shelf life is extended to 35 days when the blood is collected in CPDA-1 anticoagulant. A unit of blood must be transfused within 24 hours if the seal on the bag is broken to remove plasma. If the blood is not transfused in that time period, it must be disposed.
3. Therapeutic uses. Each unit of whole blood should increase the hematocrit from 3% to 5%, or the hemoglobin from 1 to 1.5 g/dL. There are few clinical indications for whole blood transfusions, although they may be appropriate for patients with rapid blood loss when increased volume, as well as increased RBC mass, is needed. Whole blood may also be used in exchange transfusions, especially in neonates.
B. Packed RBCs
1. Preparation. Each unit of packed RBCs contains approximately 250 mL. Packed cells are prepared by removing approximately 200 to 250 mL of plasma from a unit of whole blood. The cells may be prepared in an open system by allowing the cells to sediment, then removing the plasma. A closed system may also be used in which multiple bags are attached to the unit, and the plasma is expressed into one of the satellite bags. The hematocrit of RBCs separated by these methods should not exceed 70% to 80%.
2. Shelf life. Cells separated in an open system must be transfused within 24 hours. If the cells are separated in a closed system, they have the same expiration date as the original unit of whole blood. RBCs separated in a closed system with an additive bag
Table 6–5 Blood Component Therapy
Component Indication for Use
Whole blood Rapid blood loss
Neonatal exchange transfusion
Packed RBCs Symptomatic anemia
Deglycerolized RBCs Avoid febrile or allergic transfusion reactions Washed RBCs Avoid febrile or allergic transfusion reactions Leukocyte-poor RBCs WBC antibodies
FFP DIC
Vitamin K deficiency Massive transfusions
Platelets Thrombocytopenia
DIC ITP
Plasma Volume expander
Cryoprecipitate Hemophilia A
Factor XIII deficiency Hypofibrinogenemia
Granulocytes Neutropenia
Sepsis
DIC=disseminated intravascular coagulation; FFP=fresh frozen plasma; ITP=immune thrombocytopenia purpura; RBCs= red blood cells; WBC=white blood cell.
can have a second preservative solution added that will extend the shelf life to 42 days.
They should be stored between 1◦C and 6◦C.
3. Therapeutic uses. The increase in hemoglobin and hematocrit in response to a unit of packed RBCs is the same as for whole blood. Packed RBCs are used to increase the RBC mass in patients who have symptomatic anemia.
C. Deglycerolized frozen RBCs
1. Preparation. RBCs to be frozen are collected in CPD, CPDA-1, or other additive systems and normally should be frozen within 6 hours. The cells are warmed and mixed with high molar concentrations of glycerol, then frozen at−65◦C. Frozen units must be stored for up to 10 years. The cells must be deglycerolized before they can be transfused.
Deglycerolization begins with thawing the cells at 37◦C, then washing multiple times in a gradient concentration of saline, beginning with hypertonic concentrations and ending with an isotonic saline solution containing glucose. One unit of deglycerolized RBCs contains approximately 180 mL of cells.
2. Shelf life. Deglycerolized RBCs are stored between 1◦C and 6◦C and must be transfused within 2 hours of deglycerolization.
3. Therapeutic uses. The increase in hemoglobin and hematocrit in response to a unit is the same as for whole blood or packed cells. Freezing cells allows for long-term storage of rare donor units or autologous units. Transfusing deglycerolized RBCs also minimizes febrile or allergic reactions.
D. Washed RBCs
1. Preparation. Plasma is removed from whole blood after centrifugation, and the re- maining RBCs are washed three times with 0.9% saline.
2. Shelf life. Washed RBCs have a shelf life of 24 hours after the original unit is opened, and they should be stored between 1◦C and 6◦C.
3. Therapeutic uses. One unit of washed RBCs increases the hemoglobin and hemat- ocrit by the same amount as do unwashed cells. Washing RBCs removes most of the leukocytes and plasma from a unit of blood, which greatly reduces the risk of febrile or allergic (anaphylactic) reactions in susceptible patients. Washed RBCs are used for the rare patient who has anti-IgA antibodies because of IgA deficiency.
E. Leukocyte-poor RBCs
1. Preparation. Leukocyte-poor RBC preparations have at least 70% of the original white blood cells (WBCs) removed, and at least 70% of the original RBCs are left. There are several different methods of obtaining leukocyte-poor RBCs, including centrifugation, filtration, and washing.
2. Shelf life. If a closed preparation system is used, the shelf life is the same as the original unit of blood. The shelf life is reduced to 24 hours if an open system is used.
Leukocyte-poor RBCs should be stored between 1◦C and 6◦C.
3. Therapeutic uses. In addition to increasing RBC mass, leukocyte-poor RBCs also minimize febrile transfusion reactions in patients who have leukocyte antibodies as well as reducing CMV transmission.
F. Fresh frozen plasma (FFP)
1. Preparation. Plasma is separated from whole blood and frozen within 6 hours of collection. Plasma can be removed from whole blood using a double bag collection system to preserve a closed system. The plasma is immediately frozen at or below
−18◦C.
2. Shelf life. After freezing, the plasma should be stored at or below−18◦C. FFP has a shelf life of 1 year after collection of the original unit of blood. It should be thawed at 37◦C and transfused within 24 hours of thawing. Thawed FFP should be stored between 1◦C and 6◦C if it is not transfused immediately.
3. Therapeutic uses. Because FFP contains all of the coagulation factors, it can be used to treat patients who have liver failure, vitamin K deficiency, and dissemi- nated intravascular coagulation (DIC), or to patients who have received massive trans- fusions.
G. Platelets
1. Preparation. Platelet-rich plasma is separated at room temperature by centrifugation from RBCs within 6 hours of collection of whole blood. The platelet-rich plasma is then centrifuged, and the resulting platelet-poor plasma supernatant is removed, which leaves approximately 50 mL of plasma with the platelet concentrate.
2. Shelf life. Platelets are stored at room temperature with continuous gentle agitation and have a shelf life of 3 to 5 days, depending on the type of bag used. If several units of platelets are pooled, the shelf life is reduced to 4 hours following pooling.
3. Therapeutic uses. Platelet concentrate is used to treat patients who have thrombocy- topenia, dysfunctional platelets, DIC, and idiopathic thrombocytopenia purpura (ITP), or to patients who have received massive transfusions. Each unit of platelet concentrate should increase the platelet count by 5,000 to 10,000/μL in a typical 70-kg human.
H. Plasma derivatives
1. Preparation. Plasma other than that prepared as FFP may be separated from whole blood at any time during the unit’s shelf life up to 5 days after the expiration date.
The plasma may be pooled, purified, or fractionated into albumin or plasma protein fraction.
2. Shelf life. Plasma derivatives have a shelf life of 5 years when stored between 1◦C and 6◦C.
3. Therapeutic uses. Plasma derivatives such as albumin are used primarily as volume expanders.
I. Cryoprecipitate
1. Preparation. Cryoprecipitate is the insoluble fraction of plasma. Each unit contains 80 to 120 units of factor VIII and approximately 150 to 250 mg of fibrinogen, as well as significant amounts of factor XIII and fibronectin. Each unit of cryoprecipitate contains approximately 15 mL. It is prepared from FFP that has been partially thawed between 1◦C and 6◦C, centrifuged, and has had the supernatant removed. The remaining cryoprecipitate is immediately frozen at or below−18◦C.
2. Shelf life. After freezing, the optimal storage temperature is at or below−30◦C, and the shelf life is up to 12 months following the collection of the original unit.
3. Therapeutic uses. Cryoprecipitate is used in the treatment of hemophilia A, factor XIII deficiency, and hypofibrinogenemia.
J. Granulocytes
1. Preparation. Granulocyte preparations may be prepared by leukapheresis or from a freshly drawn donor unit.
2. The shelf life of granulocyte preparations is 24 hours after separation when stored at room temperature. However, granulocytes should be transfused as soon as possible because their half-life is only 6 hours.
3. Therapeutic uses. Granulocytes have been given to severely neutropenic patients or patients who have overwhelming sepsis. Success has been limited.
K. Irradiation of blood products. The immunologically active lymphocytes present in most blood components can create special problems for immunocompromised patients. Graft- versus-host disease (GVHD) is an especially serious complication for these patients. Irra- diating blood products can help reduce the risk of GVHD and other related complications.
1. Indications for use. Irradiated blood products may be indicated for:
a. Patients receiving chemotherapy or radiotherapy
b. Organ transplantation recipients who have been immunosuppressed c. Low-birth-weight neonates
d. Patients with genetically deficient immune systems 2. Irradiation
a. Blood components should be irradiated immediately before transfusion.
b. Doses of 1,500 to 5,000 rad are usually used.
c. Expiration date of 28 days from the date of irradiation or the original outdate of the unit, whichever is sooner.