Westminster Blood Products

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Blood preservation

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Citrate is both anticoagulant and preservative
Citrate does not systemically anticoagulate
Maintain cell viability-goal-75% of RBCS remain in circulation 24 hours after transfusion

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02 Delivery

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2-3 DPG (2-3 diphosphoglycerate) levels 50% of normal within 24 hours of storage. It diminishes the oxygen affinity of hemoglobin. This is essential in enabling hemoglobin to unload oxygen in tissue capillaries.
No preservation technique to date has improved this.
Clinical significance-levels restored within 24 hours of transfusion-healthy patient can increase cardiac output during those 24 hours to maintain 02 delivery. Non-healthy patient?

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Filters

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Standard Filter-(170-200 micron)
Microaggregate filter- 20-50 microns-do not use for platelets, removes 70-90% of leukocytes

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Filters-ASA

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“During storage, microaggregates consisting of platelets, leukocytes and fibrin form in red blood cell products.
These microaggregates can pass through 170 mm filters and lodge in the pulmonary circulation. However, use of microaggregate (20 to 40 mm) filters has not been proven to reduce the incidence of respiratory distress syndrome in patients receiving multiple transfusions.
There is no indication for the use of microaggregate filters during routine transfusions, even when large volumes of blood (massive transfusion) are administered.
However, they are used during cardiopulmonary bypass (arterial inflow cannulae) when microaggregates can enter the systemic circulation.”

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“During storage, microaggregates consisting of platelets, leukocytes and fibrin form in red blood cell products.
These microaggregates can pass through 170 mm filters and lodge in the pulmonary circulation. However, use of microaggregate (20 to 40 mm) filters has not been proven to reduce the incidence of respiratory distress syndrome in patients receiving multiple transfusions.
There is no indication for the use of microaggregate filters during routine transfusions, even when large volumes of blood (massive transfusion) are administered.
However, they are used during cardiopulmonary bypass (arterial inflow cannulae) when microaggregates can enter the systemic circulation.”

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CPDA-1 anticoagulant
Shelf Life 35 days (1° to 6°C)
510cc-450 cc blood, 63cc CPDA-1
Within 24 hours-platelets, WBCs non-functional
Other than labile clotting factors V and VIII, plasma in whole blood contains normal levels of other coagulation factors

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PRBCs

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Volume of 1 U of red blood cells- 250-300 mL- Hct of 65 to 80%.
Euvolemic patient without ongoing hemorrhage- transfusion of 1 U of red blood cells raises hemoglobin level approximately 1 g/dL.
One unit of red Blood cells (RBC) contains approximately 180ml(range 150 to 210 ml) of red cells,
100ml of Optisol® or 63 cc CPDA-1, and
Approximately 30ml (range 10 to 50 ml) of plasma.
No viable platelets or WBCs, clinically insignificant amount procoagulants-reduced plasma volume in unit

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Frozen RBCs

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Add cryoprotectant glycerol to RBCs followed by appropriate freezing (-65°C or lower) allows storage of RBCs for 10 years.
When Cells needed, unit thawed and washed with saline to remove glycerol. Washing “enters” storage bag-unit can be stored for only 24 hours at 1° to 6°C after thawing.
Used primarily to maintain supplies of uncommon RBC phenotypes needed by patients with alloantibodies against frequently occurring RBC antigens
Military uses to maintain emergent blood supplies.

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Use of RBCs in Massive Transfusion

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If 50-75% blood volume replaced by type 0 Blood (10 U RBCS in adult)-
May need to continue with type 0 blood-
“Otherwise, risk of major cross-match reaction increases.
Patient may have received enough anti-A or anti-B antibodies to precipitate hemolysis if A,B, or AB units subsequently given”

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Autologous Blood

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Pre-op donation
Acute normovolemic hemodilution
Intra-op and post-op salvage
Typical patients- scheduled for orthopedic, vascular, cardiac, thoracic, radical prostatectomy
Most common procedure for pre-donation- Open-heart

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Contraindications autologous transfusion

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Infection-risk of bacteremia
Unstable angina
Active Seizure disorder
MI or CVA within 6 mo of donation
Significant Coronary or pulmonary disease without medical clearance for surgery
Cyanotic heart disease
Uncontrolled HTN

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Autologous Blood

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No immunologic consequences of foreign cells
No storage lesion (Intraoperative salvage)
Conservation of blood resources
Only practical source of fresh whole blood
More expensive

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Intraoperative salvage cell saver

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Cell washing devices can provide up to the equivalent of 12 allogenic units of cells/hr
Vacuum setting of no more than 150 torr to reduce hemolysis
Usually restricted to clean surgical field, non-oncologic procedures
Need to recover at least two units in order to be cost-effective

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Intraoperative salvage cell saver

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Scavenged, heparinized blood collected in reservoir
Centrifuged to remove plasma and debris
Saline added, re-centrifuged to remove debris, plasma, free Hgb and heparin
Processing time ~ 3min
Final product-volume ~225cc,Hct 50%, free of plasma, clotting factors, plts

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FFP

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Collected by centrifugation of whole blood, or by apheresis as a single donor unit (taken for plasma, or as a byproduct of RBC or platelet apheresis)
Must be frozen within 6 hours of collection, (FFP) or within 24 hours of collection (F24-common in U.S.) can be kept frozen for a year, takes 20-30 minutes to thaw, is then kept at 1-6° and transfused within 24 hours
Need ABO Compatibility, but Rh Neg patients can receive Rh Pos FFP

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FFP

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Goal- to raise level of clotting factor to 30% of normal
Takes 10-15 cc/kg
Rapid reversal of coumadin-5-8cc/kg FFP (Vitamin K would take 12-18 hours)

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Cryoprecipitate

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Cryoprecipitate—
Fibrinogen, factors VIII:C, VIII:vWB, XIII, fibronectin
10 to 20 mL/Unit- contains 80 units/mL of factor VIII, 200-300 mg fibrinogen)
Shelf life-Frozen: 1 yr (<–30°C)Thawed: Give within 6 hours
Preferable to be ABO compatible (AABB) May have RBC fragments that can sensitize Rh-D neg patients