COMPONENT THERAPY

Mikhail A. Valdescona, RMT, MPH

College of Medical Laboratory Science
Our Lady of Fatima University

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Blood Transfusion
- Taking of blood or blood base product from one individual and
inserting them to the circulatory system of another person

Reasons of Transfusion
1. Inadequate oxygen carrying capacity
2. Insufficient coagulation CHON to provide enough hemostasis

Types of Transfusion
a. Autologous transfusion
b. Allogenic transfusion

Methods of transfusion
a. Direct
b. Indirect
c. Exchange
d. Reciprocal
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CRITERIA FOR AUTOLOGOUS DONATION
1. No age requirement
2. No weight requirement
3. Hct: 33% Hb:11g/dL
4. Frequency: Blood maybe drawn every 3 days but last blood
collection should occur no sooner than 72 hours before scheduled
surgery to allow for volume repletion
• Iron supplementation: 320 mg ferrous sulfate/ferrous gluconate
(3x/day)
• Recombinant erythropoetin: a growth factor that stimulate RBC
production so that more units could be donated for a shorter time

CATEGORIES OF AUTOTRANSFUSION
1. Preoperative/Predeposit
2. Intraoperative collection
3. Postoperative collection

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COMPONENT THERAPY
• Transfusion of specific blood unit to a patient/recipient
• Requires a refrigerated centrifuge and plasma extractor

Blood components: products prepared from one unit of blood

Different speeds in preparation of blood components:

1. Hard spin: 5,000g for 5 minutes (packed RBC, platelet concentrate)
: 5000g for 3 minutes (cryoprecipitate, cell free plasma)
2. Light/soft spin: 2000g for 3 minutes (platelet rich plasma)

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 BLOOD COMPONENTS AND PLASMA DERIVATIVES
1. Blood components
a. whole blood f. frozen RBC
b. RBC (packed RBC/red cell concentrate) g. granulocyte conc.
c. RBC saline h. platelet conc.
d. RBC aliquots i. platelet conc.
e. washed RBC j. leukoreduced RBC

2. Plasma derived components

a. FFP
b. cryoprecipitate
c. Factor VII concentrate
d. Factor IX concentrate
e. anti-inhibitor complex
f. Immunoglobulin

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 HARD Whole blood SOFT
SPIN SPIN

Plasma RBC Platelet Rich

RBC
Plasma
DEEP
FREEZE HARD
SPIN

FPP Platelet
Plasma
concentrate
DEEP
THAW
FREEZE
FFP
Liquid plasma

Cryosupernate Cryoprecipitate

THAW THAW
Liquid Cryoprecipitate
cryosupernate in liquid state
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1. WHOLE BLOOD
• Common source of component production
• Clinical significance/indication
a. replace the loss of both RBC and plasma volume in
patient’s actively bleeding
b. transfusion of blood unit whole blood, increase Hb to 1-1.5 g/dL
Hct to 3-5% (1-3%)
2. PACKED RED BLOOD CELL
• Aka Red cell concentrate
• Preparation: 200-250 mL plasma is removed after hard spin using plasma extractor
• Clinical indication:
a. increase oxygen carrying capacity
b. patients with acute/chronic anemia
c. patients who cannot tolerate who cannot tolerate an increase in blood
volume (patient’s with congestive heart failure)

3. RBC ALIQUOTS
• For transfusion of neonates
• Several aliquots maybe prepared from a single donor unit
• Neonates only require small volume of RBC
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4. IRRADIATED RBC
• Irradiation is employed to RBC and platelets to reduce risk of transfusion
associated graft versus host disease in patients receiving allogenic bone marrow
transplants
• Minimum of gamma irradiation of 25 Gy
• Maybe performed with Cesium 137 and Cobalt 160

5. LEUKOCYTE-REDUCED RBC
• Products in which atleast 70% of original leukocytes have been removed and
atleast 85%of original RBC volume remains
• WBC count: <5x106/L to prevent HLA sensitization
• Can be achieved using 3rd generation leukocyte reduction filter

Leukocyte in RBC products should be reduced because donor leukocytes may cause:
1. Febrile non-HTR
2. HLA alloimmunization
3. TRALI
4. TGVHD

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6. WASHED RBC
• Removing plasma CHONS
• Used for rare patients with IgA deficiency and anti-IgA Ab

7. FROZEN DEGLYCEROLIZED RBC

• Red cell freezing for preserving red cell type and autologous units
• Add cryoprotective solution (glycerol)

8. GRANULOCYTE CONCENTRATE
• Prepared by cytopheresis from a single donor
• Must contain 1.0x1010 granulocyte (HES: hydroxyethyl starch)
• HES: sedimenting agent
- increases separation of WBC and RBC, thus facilitating recovery of buffy coat
• Contains 200-600 mL plasma at 20-25 without agitation
• Clinical indications
a. severe neutropenia
b. cases of fever
c. myeloid hypoplasia of bone marrow
d. septicemia/bacterial infection to unresponsive antibiotics

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9. PLATELET CONCENTRATE
• pH 6.0 during storage with constant agitation at 20-24˚C
• Platelets are important for the formation of the primary hemostasis clot
(maintenance of the clot)

How to prepare:
1. Whole blood is maintained at 20-24˚C, set refrigerated centrifuge at 22˚C
2. Light spin at 3,200 for 2-3 mins (products: pRBC and PRP)
3. Platelet rich plasmaà hard spin (products: PPP and aggregated platelet button)
4. Remove 200 mL of plasma, having approximately 50 mL of PPP

Closed system shelf-life: 5 days

Open system shelf-life: within 6 hours

2 methods of preparation
1. Random donor platelets: produced from WB within 8 hours of collection
: contain 5.5x1010 platelets
2. Single donor platelets : 5 days, prepared through pheresis
: contain 300 mL of plasma, 3.0x1011 platelets
* Transfusion should increase platelet count by 5,000-10,000/uL in typical 70 Kg man
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Indications
1. Thrombocytopenia
2. DIC
3. Massive transfusion

DETERMINATION OF EFFECTIVENESS AFTER 1 HOUR OF TRANSFUSION

Corrected platelet count increment = abs. platelet increment (uL) X body surface area
units of platelet given x 0.55

Abs. platelet count increment= post transfusion plt. Count – pre-transfusion plt. Count

% recovery = abs. platelet count increment x blood volume

approx. total of plt. Infused x 2/3

Example: A patient with 10,000/uL platelet count has a body surface area of 1.3m2 , 6
units of platelets are given. 1-hour post transfusion paltelet = 50,000 uL

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 Solution
Given: 0.55à no. of platelet in each unit concentrate expressed in 1011

Abs. plt count: 50,000-10,000 = 40,000

Corrected plt. Count increment: 40,000 X 1.3
6 X 0.55

Answer: 15, 758/uL

Interpretation: patient has good increment (answer is >10,000/ uL)

If <10,000 it indicates refractories (even you infuse 5 or 10 units, platelet

count do not increase)
 PLASMA DERIVATIVES

1. FRESH FROZEN PLASMA (FFP)

• Contains all coagulation factors
• Used in treatment of multiple coagulation deficiencies (pt. w/ liver failure, Vit.K
deficiency, DIC, Warfarin toxicity, Massive transfusion)
• Must be frozen 8 hours after collection

2. SINGLE DONOR PLASMA 24 (SDP-24)

• It must be frozen within 24 hours of collection and stored at -18˚C

3. PLASMA
• In liquid form (aka as liquid plasma or cryoprecipitate-poor plasma)
• Indications:
a. Used for treatment of stable coagulation deficiency especially Factor XI
b. Patients undergoing plasma exchange

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4. CRYOPRECIPITATED ANTI-HEMOPHILIC FACTOR

• Aka anti-hemophilic factor/ factor VIII

• Pooled precipitated concentration of Factor VIII
• Contains 80 units of Factor VIII, 50 units of vWF, 25% of Factor XIII, 200 mg of
fibrinogen as well as Fibronectin activity
• Wholebloodàhard spinà plasmaà deep freezeà FFPà thaw at 1-6Cà
centrifugeà remove plasma leaving only 10-15 mL of plasma + precipitate
• Clinical indications: treatment of Hemophilia A, VWD, Factor XIII def. and
Fibrinogen def.

DETERMINATION OF THE NUMBER OF BAGS OF CRYOPRECIPATE TO USE

No. of bags of cryoprecipitate = desired level of Factor VIII (%) X pt. plasma volume
needed 80

Ex. If the desired level of Factor VIII is 70% and the patients plasma volume is 2,500
mL. How many bags of cryoprecipitate are needed?

Solution: 0.70 X 2,500

80 Answer: 22 bags
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5. CRYOSUPERNATE
• Plasma left after separation of WB and of the cellular components of
cryoprecipitate
• Indications:
a. Treatment of bleeding disorders other than hemophilia and
hypofibrigenemia
b. Hypovolemia

6. FACTOR VIII CONCENTRATE

• Prepared through fractionalization and lyophilization of pooled plasma
• Derived from plasma through plasma pheresis
• Stored at ref temp
• Requires reconstitution using saline
• Indications: Hemophilia A

7. FACTOR IX CONCENTRATE
• Aka Prothrombin complex
• Contains Factor II, VII, IX, X
• Indications: Hemophilia B
• Same with Factor VIII-fractionalization and lyophilization of pooled plasma
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8. ANTI-THROMBIN III
• It is a protease inhibitor with activity toward thrombin
• Alternative sources: liquid plasma, FFP

9. ALBUMIN AND PLASMA PROTEIN FRACTION

• Prepared by chemical fractionation of pooled plasma
• To treat patient requiring volume replacement
• Used routinely as replacement in plasma apheresis
• Indication: burn patient

10. IMMUNE GLOBULIN

• Primarily is IgG prepared from pooled plasma
• IM or IV preparation
• Clinical Indications:
a. Patients with congenital hypoglobulinemia
b. Patients exposed to Hepatitis A and Measles
c. Treatment of immune thrombocytopenia and myasthenia gravis

11. Hyper Immune globulins

• Available for prevention of Hepatitis B, VZV, mumps, rabies
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12. RH IG
• To prevent immunization of Rh(-) mother with Rh (+) infant
• Commercially available as Rhogam

13. NORMAL SERUM ALBUMIN

• Prepared from salvage plasma pooled and fraction by cold alcohol process then
treated with heat activation
• Used together with colloid volume expander in patients

Volume expander:
a. saline
b. Ringer solution
c. Ringer lactate
d. Dextran
e. HES
f. balance electrolyte solution

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