November 2017 |1

BLOOD BANKING LECTURE

(COMPONENT PREPARATION and APHERESIS)

References:
Henrys Clinical Diagnosis and Management by
Laboratory Methods (22nd edition) by: McPherson and
Pincus

Modern Blood Banking and Transfusion Practices by:

Denise M. Harmening (6th edition)

Disclaimer: This handouts is to be used only AS A GUIDE AND NOT AS A SOLE

REFERENCE FOR YOUR LECTURE IN COMPONENT PREPARATION and APHERESIS
IN BLOOD BANKING. PLEASE READ YOUR REFERENCE BOOKS FOR A MORE
COMPLETE and DETAILED EXPLANATION OF YOUR TOPICS.

COMPONENT PREPARATION; APHERESIS TJ Rivera Jaula, RMT, IMLS(ASCPi)CM

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COMPONENT PREPARATIONS

A single blood donation can provide transfusion therapy to multiple patients in the form of
RBCs, platelets, fresh frozen plasma, and cryoprecipitate.

TERMS TO REMEMBER!

__________________________________
Blood collected BEFORE SEPERATION into components
__________________________________
PARTS OF THE WHOLE BLOOD that were seperated
__________________________________
A STERILE SYSTEM of blood collection
__________________________________
When a collection is EXPOSED TO AIR DECREASING EXPIRATION DATE
REMEMBER!
Components of whole blood are centrifuged:
LIGHT SPIN
SHORT TIME with LOW RPM
Aka: SOFT SPIN
__________________________________________
HEAVY SPIN
LONGER SPIN with HIGH RPM
Aka: HARD SPIN
___________________________________________

DIFFERENT BLOOD COMPONENTS

1. FRESH WHOLE BLOOD

Storage temperature: ____________________________________

Shipping temperature: ___________________________________
Shelf Life: 21, 35 or 42 days depending on the preservative.
Consists of RBCs, WBCs, Platelets and Plasma
Quality control:
Fresh Whole blood should have a Hct of _________________________________
Whole blood transfusions provide both _____________________________ and ________
______________________________
When is it used?
Patients who are ACTIVELY BLEEDING and has LOST MORE THAN 25% OF BLOOD
VOLUME
SYMPTOMATIC ANEMIA with LARGE VOLUME DEFICIT
EXCHANGE TRANSFUSION

COMPONENT PREPARATION; APHERESIS TJ Rivera Jaula, RMT, IMLS(ASCPi)CM

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Contraindicated in:
_____________________________________
1 unit of whole blood increases:
Hemoglobin value by ________________________________
Hematocrit by _______________________________________

2. WHOLE BLOOD MODIFIED

Whole Blood with ______________________________________________ REMOVED

3. WHOLE BLOOD IRRADIATED

Has ___________ EXPIRATION after irradiation or the __________________________,

whichever is sooner.
Irradiated to inhibit T-cell proliferation in the recipient.
Storage temperature: ______________________________

4. PACKED RBC (pRBC)

Prepared from whole blood by:

a) Centrifugation Centrifuge FWB using HEAVY SPIN for 5 minutes at 4C
b) Sedimentation
c) Directly by apheresis.
Storage temperature: ___________________________
Shipping temperature: ___________________________
Shelf Life: 21, 35 or 42 days depending on the preservative (Close System)
Once the unit is opened or spiked it has ___________________________________
Quality Control:
a) Hematocrit should be __________________________________________
b) ____________________________________________________________
CPDA-1 is used
c) Retain at least __________________________________
RBCs typically have a final red cell volume of ________________________________________
suspended in the residual plasma or additive solution
RBCs are usually given because of their hemoglobin content
They increases the mass of circulating red blood cells in situations where blood loss occurs.
Indications for use:
a) Oncology patients (chemotherapy/radiation)
b) Trauma victims
c) Cardiac, Orthopedic and other surgery
d) End Stage renal disease
e) Premature infants
f) Sickle cell disease
g) Symptomatic Anemia
One unit ________________________________________________________

5. RBC ALIQUOTS

Product most often transfused during the neonatal period or in infants younger than 4 months
of age.
Each pack retains the original outdate of the primary bag within a closed system. Blood is
placed in PEDIPAKS (__________________________)
Storage temperature: ____________________________
Shipping temperature: ___________________________
Indications:
1. Iatrogenic anemia
2. Twin to Twin transfusion
3. Fetomaternal hemorrhage
Each unit ______________________________________-

COMPONENT PREPARATION; APHERESIS TJ Rivera Jaula, RMT, IMLS(ASCPi)CM

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6. FROZEN DEGLYCEROLIZED RBC

Blood that can be stored for the longest period of time

Storage time ______________________ using a MECHANICAL FREEZER
Used for __________________________________ as a supply used for:
________________________________
Red cells having little/No plasma proteins, leukocytes or platelets.
Used for patients with
Paroxysmal nocturnal hemoglobinuria
IgA deficiency with circulating anti-IgA.

CRYOPROTECTIVE AGENTS (CRYOPROTECTANTS) used in freezing RBCs:

A. PENETRATING AGENTS
Examples: Glycerol, Dimethylsulfoxide (DMSO)
Small molecules enters the red cells and prevents dehydration as ice forms.
B. NON PENETRATING AGENTS
Examples: Hydroxyethylstarch (HES), Glucose, Polyvinylpyrrolidone (PVP)
Large molecules Does not enter the red cells Forms a shell around the red cells
thereby preventing loss of water.

METHODS OF FREEZING THE RED BLOOD CELLS

A. HIGH GLYCEROL METHOD (40%w/v final conc)

Slow uncontrolled freezing
MOST COMMONLY USED
Stored at -80C using a mechanical freezer
B. LOW GLYCEROL METHOD (20% w/v final conc)
Rapid and more controlled freezing
Stored at -120C using a liquid nitrogen freezer
C. AGGLOMERATION
Employs a deglycerolization technique where in which, in the presence of a low ionic
strength solution, the red cells agglomerate forming a large clumps that sinks to
the bottom of the bag
The supernatant can be removed and a wash procedure can be instituted.
Note!
DEGLYCEROLIZED/WASHED RBCs are __________________________________________

7. LEUKOCYTE REDUCED RBC

According to AABB Standards, leukoreduced red cells is a product in which the absolute WBC
count in the unit is REDUCED TO LESS THAN ___________ and contains AT LEAST ________ OF
THE ORIGINAL RBC MASS
Two categories:
1. Prestorage leukoreduction
2. Poststorage leukoreduction

1. PRESTORAGE LEUKOREDUCTION
Special filters procure at least a 99.9% removal of leukocytes by employing multiple layers of
POLYESTER OR CELLULOSE ACETATE NONWOVEN FIBERS that trap leukocytes and platelets but
that allow RBCs to flow through.
The impetus for prestorage leukoreduction involved __________________________________
____________________ released from leukocytes during storage of the component
BIOLOGICAL RESPONSE MODIFIERS (BRMS)
Promote _____________________________________

2. POSTSTORAGE LEUKOREDUCTION
Leukocytes are removed in the blood bank prior to issuing blood or at the bedside before
transfusion.

COMPONENT PREPARATION; APHERESIS TJ Rivera Jaula, RMT, IMLS(ASCPi)CM

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Removing leukocytes by centrifugation or filtration just before transfusion of blood should

PREVENT REACTIONS THAT ARE CAUSED BY LEUKOCYTE ANTIBODIES IN PATIENTS PLASMA
AND LEUKOCYTES PRESENT IN THE TRANSFUSED BLOOD; however, IT WONT PREVENT
REACTIONS CAUSED BY BRMS THAT ORIGINATE FROM THE LEUKOCYTES PRESENT

INDICATIONS FOR USE:

1. Patients who have received a lot of transfusions to __________________________________
______________________________
2. Patients who have REACTED TO LEUKOCYTES in the past
3. Prevention of ______________________
4. Prevention of ______________________
5. Prevention of ______________________
6. Reduction of CMV TRANSMISSION

9. WASHED RBCs

Used for patients with ______________ that may react with plasma proteins containing IgA
Used for the prevention of:
1. ALLERGIC TRANSFUSION REACTION
2. ANAPHYLACTIC REACTION
3. FNHTR

10. IRRADIATED RBCs

Used for _________________________________

Other indications:
1. Donor units from a blood relative
2. HLA matched donor unit
3. Intrauterine transfusion
4. Immunodeficiency
5. Premature newborns
6. Chemotherapy and irradiation
7. Patients who have received marrow or stem cells
Requires irradiation of ______________ to the central portion of the blood unit.
_________________ or _________________ are used in irradiating RBCs

11. PLATELET CONCENTRATE

Used for patients who are _______________________________________

NOT RECOMMENDED FOR PATIENTS WITH _______________ and ______________________
Stored at _______________ for ____________________________________
pH should be _______________________
Two types of platelet concentrate:
1. Random Donor Platelets (RDP)
2. Single Donor Platelets (SDP)

1. RANDOM DONOR PLATELETS (RDP)

From allogenic donors, processed from whole blood
Should contain ____________________ platelets/unit
___________________ plasma should be retained on the unit
How are RDPs processed?
Fresh whole blood Soft spin centrifugation Hard spin centrifugation
Each unit should elevate the platelet count by ________________________________________

2. SINGLE DONOR PLATELET

Donated using apheresis
Should contain _________________________ platelets/unit
_________________ plasma should be retained in the unit

COMPONENT PREPARATION; APHERESIS TJ Rivera Jaula, RMT, IMLS(ASCPi)CM

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Each unit of SDP should elevate the platelet count by ___________________________

PLATELET COUNT INCREMENT

Can provide response of recipient to platelet component
Get either a 10 minutes or 1 hour posttransfusion platelet count
> 10, 000/uL = Patient is NOT REFRACTORY against transfused platelet count

() ( )
( )

12. FRESH FROZEN PLASMA

Plasma that is frozen _________________________ (Within 6 hours if ACD is used)

Shelf Life:
1 YEAR at __________________
7 YEARS at _________________
FFP should contain
150 to 250 mL of plasma
400mg FIBRINOGEN
1 unit/mL of ALL COAGULATION FACTORS
FFP is thawed before transfusion
30 to 37C waterbath for 30 to 45 minutes
Stored at 1 to 6C and _____________________________
Needs to be ABO COMPATIBLE
Provides coagulation factors for:
Active Bleeding Patients
Abnormal clotting due to massive transfusion
Patients on warfarin who are bleeding
Treatment of TTP and HUS
Factor Deficiencies
AT III deficiency
DIC when fibrinogen is <100 mg/dL

13. PLASMA and LIQUID PLASMA

Can be used as _________________________

Also used for manufacturing of PLASMA FRACTIONATION PRODUCTS
Plasma Protein Fraction
NSA
ISG
Plasma can be separated during storage UP TO 5 DAYS BEFORE THE EXPIRATION DATE
-18C for 5 YEARS

14. CRYOPRECIPITATE

Cryoprecipitated antihemophilic factor (AHF) or Cryo is the ___________________________

that results after slowly thawing FFP at _________________
Should be suspended in 10 to 15 mL of plasma
Contains:
1. _________________________________
2. _________________________________
3. _________________________________
4. _________________________________
Same storage as FFP (Cannot be re frozen as FFP once it is separated)
If thawed, store at __________________________________
How to prepare cryoprecipitate?

COMPONENT PREPARATION; APHERESIS TJ Rivera Jaula, RMT, IMLS(ASCPi)CM

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1. FFP Thaw until it has a Slushy consistency Hard spin centrifugation

Cryoprecipitate formed is the Small whitish glue like precipitate at the bottom of the
bag Remove plasma leaving only 10 to 15 mL
2. The leftover plasma is called as CRYOPRECIPITATE REDUCED or PLASMA CRYO
Good for TTP
Quality control of cryoprecipitate:
1. 4 units are tested monthly
2. Volume should not exceed 25 mL
3. ________________________________________
Cryoprecipitate is used for:
1. Factor VIII deficiency (Hemophilia A)
2. Von Willebrands Disease
3. Congenital or Acquired Fibrinogen defects
4. Factor XIII deficiency
5. Hypofibrinogenemia

Note!
Cryoprecipitate is also used as a source of _______________________________________

15. FACTOR VIII CONCENTRATE

Used for the treatment of CLASSIC HEMOPHILIA

Prepared from
A. PLASMA POOLS (POOLED PLASMA)
Undergone
1. PASTEURIZATION
2. SOLVENT and DETERGENT TREATMENT
3. MONOCLONAL PURIFICATION
B. DNA TECHNOLOGY

DDAVP
_____________________________________________________
Used as an alternative in treatment of Classic hemophilia or vWD

DOSE OF FACTOR VIII needed to RAISE FACTOR VIII of PATIENT

Formula?

Example: A 70 kg hemophiliac patient with a hematocrit level of 30% has an initial factor VIII level of 4%
(4 units/dL; 0.04 units/mL). How many units of Factor VIII should be given to raise his factor VIII level to
50%?

16. FACTOR IX CONCENTRATE

3 forms:
1. Prothrombin complex concentrate

COMPONENT PREPARATION; APHERESIS TJ Rivera Jaula, RMT, IMLS(ASCPi)CM

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2. Factor IX concentrates
3. Recombinant factor IX
Use for TREATMENT OF HEMOPHILIA B
Should be given WITH CAUTION AMONG PATIENTS WITH LIVER DAMAGE

17. GRANULOCYTE CONCENTRATE

Although rare, it is useful for __________________________________

Prepared by HEMAPHERESIS
Should contain _____________________________________________
Maintained at ______________________________________
Indications:
_______________________________________________

APHERESIS

WHAT IS APHERESIS?
Withdrawing a small volume of whole blood from a donor or patient and separating into its
components.
One (or more) of the components is collected and retained, and the remaining components are
recombined and returned to the individual.
Can be performed on:
Donor to collect a specific blood component (DONOR APHERESIS)
Patient to remove a particular blood component for therapeutic purposes
(THERAPEUTIC APHERESIS)

CRITERIA FOR APHERESIS DONORS:

1. Height: __________ for males; ___________ for females
2. Weight: ______________ for males; ______________ for females
3. Hematocrit: ____________
4. Hemoglobin: ____________
5. Platelet count: ____________
6. WBC ct: ____________
7. Serum protein: ____________

METHODS OF APHERESIS
1. INTERMITTENT FLOW CENTRIFUGATION
Requires only ONE PUNCTURE SITE that will serve as both the OUTLET and INLET of blood
Blood apheresis machine collect the desired component Not needed components are
returned to the donor on the same site.
2. CONTINOUS FLOW CENTRIFUGATION
TWO PUNCTURE SITES
Faster method (maximum of 2 hours collection)

KINDS OF APHERESIS
1. ERYTHROCYTAPHERESIS
2. LEUKAPHERESIS
3. PLATELET APHERESIS
4. PLASMAPHERESIS
5. STEM CELL PHERESIS

ADVERSE EFFECTS ON APHERESIS DONORS

1. Citrate toxicity 4. Tingling sensation especially the face
2. Numbness of extremities 5. Seizures
3. Allergic reactions

COMPONENT PREPARATION; APHERESIS TJ Rivera Jaula, RMT, IMLS(ASCPi)CM