Transfusion Products
Although fresh whole blood was the only product available in the early years of
transfusion, the advent of whole-blood fractionation techniques has allowed for more
efficient use of the various blood components. Fractionated transfusion products,
prepared in blood transfusion centers, include RBCs, platelets, FFP, and
cryoprecipitate. These products are transfused for different indications and each
addresses different pathologies.
Last updated: February 28, 2023
CONTENTS
Introduction
Transfusion Products
Indications for Transfusion of Blood Products
References
Introduction
The 1st human blood transfusion was in 1795.
Blood transfusions are a very common medical procedure.
21 million blood components are transfused each year in the United States.
Blood and its products are, at a minimum, screened for:
Hepatitis B
Hepatitis C
HIV
Human T-cell lymphotropic virus (HTLV)
Syphilis
Bacterial contaminants
Zika virus
Donations are ABO and Rhesus factor (Rh) typed and screened.
Types of blood products used:
Whole blood
Packed RBCs
Platelets
Plasma
Cryoprecipitate
A centrifuged tube showing the components in whole blood (plasma, RBCs, platelets, and
WBCs)
Image (https://philschatz.com/anatomy-book/contents/m46710.html): “The cellular elements of blood include a
vast number of erythrocytes and comparatively fewer leukocytes and platelets” by OpenStax College. License:
CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/)
Table: Blood group compatibility for giving and receiving blood
Blood Can give to individuals with Can receive from donors with
type blood type: blood type:
A+ A+, AB+ A+, A–, O+, O
A– A+, A-, AB+, AB– A-, O–
B+ B+, AB+ B+, B–, O+, O–
B- B+, B–, AB+, AB– B–, O–
O+ A+, B+, O+, AB+ O+, O–
O– Everyone O–
AB+ AB+ Everyone
AB– AB+, AB– AB–, A–, B–, O–
Transfusion Products
Packed RBCs
Created by removal of the majority of plasma from a unit of whole blood:
Each unit contains:
200 mL of RBCs
70 mL of plasma
100 mL of additives (citrate as an anticoagulant, phosphate, dextrose)
Hematocrit of 65%–80%
Volume of 250–300 mL
Can be stored up to 42 days
1 unit should:
↑ Hemoglobin by 1 g/dL
↑ Hematocrit by 3%
Additional processing to RBCs:
Leukocyte-reduced:
Filtered to remove 85%–90% of WBCs
↓ Risk of adverse patient reactions during transfusion
Irradiated:
Prepared by exposing the unit to 2500 cGy of radiation
Inactivates donor T cells
↓ Risk of a graft-versus-host reaction in recipient
Washed:
Washing RBCs with 0.9% NaCl depletes packed RBCs of most
plasma
Used for individuals with history of severe allergy to transfusion
Platelets
Platelets (thrombocytes) are small, colorless fragments derived from
megakaryocytes (precursor cells).
Involved in the formation of clots
Pooled platelets:
Separated from a unit of donated blood
4–6 units are pooled to allow an adequate number of platelets per
transfusion.
Advantages:
↓ Cost
Ease of collection
Disadvantages:
Each recipient is exposed to multiple donors.
↑ Risk of allergic reactions and infections
Apheresis platelets:
Platelets are selectively removed from blood taken from the individual and
then returned to the donor.
An apheresis platelet unit is equivalent to ≥ 6 units of platelets from whole
blood.
Plasma
Plasma is “pooled” in containers (separated from RBCs) and then fractionated.
Yellow liquid component of blood
Holds proteins and other constituents of whole blood in suspension:
Albumin
Blood clotting factors
Immunoglobulin
Globulins
Fibrinogen
FFP:
Frozen < 8 hours after collection
Contains all coagulation factors and proteins
Dose: 12–15 mL/kg, but varies on the basis of indication
Plasma frozen < 24 hours after phlebotomy (PF24): contains ↓ levels of factor VIII
and protein C
Thawed plasma:
Can be kept in refrigerator up to 5 days
↓ Levels of factor V and factor VIII
Liquid plasma: plasma that has never been frozen
Solvent/detergent (S/D): treated with viral inactivating agents prior to freezing
Cryoprecipitate reduced:
Cryoprecipitate has been removed.
Still contains all vitamin K–dependent clotting factors
Convalescent plasma: prepared from individuals who have recovered from
infection with a specific pathogen.
Cryoprecipitate
Derived from plasma that is frozen ≤ 8 hours after collection (FFP)
The plasma is thawed to between 1 and 6°C and subsequently centrifuged.
The fraction that precipitates out of solution is collected and refrozen to –
18°C.
This process creates 1 unit of cryoprecipitate.
A transfusion bag contains between 5 and 10 units of cryoprecipitate.
Each unit contains:
Fibrinogen: 150–300 mg of fibrinogen; half-life: 100–150 hours
Factor VIII: > 80 IU (range, 80–150); half-life: 12 hours
Factor XIII: 50–75 units; half-life: 150–300 hours
von Willebrand factor: 100–150 units; half-life: 24 hours
Fibronectin: in variable concentrations
Breakdown of the blood components
Table: Breakdown of the blood components
Blood Subcomponents Type Production site Main ta
components of the blood
Blood Subcomponents Type Production site Main ta
components of the blood
Plasma Water 92% Liquid Absorbed in GI Transp
43%–63% tract or made medium
during
metabolism
Plasma proteins Albumin 54%– Liver Main
7% 60% osmo
conc
Trans
lipid
mole
Globulins Alpha globulins: Transp
35%–38% liver mainta
osmoti
concen
Beta globulins: Transp
liver mainta
osmoti
concen
Gamma globulins Immun
(immunoglobulins respon
): plasma cells
Fibrinogen Liver Blood c
4%–7% during
hemos
Regulatory Hormones Various locations Regula
proteins Enzymes various
< 1% functio
Blood Subcomponents Type Production site Main ta
components of the blood
Other dissolved Nutrients Absorbed in GI Many d
substances 1% Gases tract functio
Waste Replacement
of cells in
respiratory
tract
Made in cells
Formed Erythrocytes Erythrocytes Red marrow Transp
elements 99% gasses
37%–54% some C
Leukocytes < Granular Red marrow Nonsp
1% leukocytes immun
Platelets < 1% Neutrophils respon
Eosinophils
Basophils
Agranular Lymphocytes: Lymph
leukocytes bone marrow specific
Lymphocytes and lymphoid immun
Monocytes tissue respon
Monocytes: red Monoc
marrow nonspe
immun
respon
Platelets < 1% — Megakaryocytes: Hemos
red marrow
Indications for Transfusion of Blood
Products
Indications for RBC transfusion
Individuals with Hb ≤ 7 mg/dL who are symptomatic:
Dizzy
Weak
Short of breath
Chest pain
Syncope
Hypotension
Postoperative individuals:
Hemodynamically stable individuals: Hb ≤ 8 g/dL
Presence of symptoms of inadequate oxygen delivery:
Chest pain of cardiac origin
Orthostatic hypotension
Tachycardia unresponsive to fluid resuscitation
Critically ill individuals:
Hb ≤ 7 mg/dL
Evidence of tissue hypoxia:
Central venous oxygen saturation: < 70%
Mixed venous oxygen saturation: < 65%
Lactate concentration: > 4 mmol/L
In individuals with acute coronary syndrome, Hb should be maintained at > 8–9
g/dL.
In individuals with traumatic brain injury, the target Hb should be 7–9 g/dL.
These rules do not apply to individuals with active bleeding.
Indications for transfusion of plasma products
INR > 1.6 and:
Inherited deficiency of anticoagulant factor II, V, X, or XI
Prophylactically in individuals on anticoagulant therapy before a
procedure
Active bleeding
Emergent reversal of warfarin
Acute DIC
Microvascular bleeding during massive transfusion (1:1:1 rule):
1 unit of plasma
1 unit of platelets
1 unit of RBCs
Hereditary angioedema: when C1 esterase inhibitor unavailable
Thrombotic microangiopathy: in combination with plasma exchange
Indications for transfusion of platelets
Platelets:
< 50,000/μL: major surgery or invasive procedure, no active bleeding
< 100,000/μL: ocular surgery or neurosurgery, no active bleeding
< 20,000/μL: preparation for central line insertion or lumbar puncture
< 80,000/μL: preparation for epidural anesthesia
< 10,000/μL: prophylactically even in asymptomatic individuals
Indications for transfusion of cryoprecipitate
Hemorrhage after cardiac surgery
Massive hemorrhage or transfusion
Surgical bleeding
DIC
Fibrinogen disorders associated with low or dysfunctional fibrinogen
Uremic bleeding
Bleeding in individuals with liver disease
An individual experiencing acute attacks of hereditary angioedema
Image (https://openi.nlm.nih.gov/detailedresult?img=PMC3439346_1471-5945-12-4-
1&query=hereditary%20angioedema&it=xg&lic=by&req=4&npos=2): “F1: HAE patient
experiencing HAE attacks” by Bygum A. et al. License: CC BY 2.0
(https://creativecommons.org/licenses/by/2.0/)
References
1. Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional
Advisory Committee. (2014). Blood donation. Retrieved July 16, 2021, from
http://www.transfusionguidelines.org/transfusion-handbook/3-providing-safe-blood/3-1-blood-
donation (http://www.transfusionguidelines.org/transfusion-handbook/3-providing-safe-blood/3-1-
blood-donation)
2. Sharma, S., Sharma, P., Tyler, L.N. (2011). Transfusion of blood and blood products: indications and
complications. Am Fam Physician 83:719–724. https://pubmed.ncbi.nlm.nih.gov/21404983/
(https://pubmed.ncbi.nlm.nih.gov/21404983/)
3. Silbergleid, A.J. (2021). Clinical use of plasma components. UpToDate. Retrieved July 16, 2021,
from https://www.uptodate.com/contents/clinical-use-of-plasma-components
(https://www.uptodate.com/contents/clinical-use-of-plasma-components)
4. Tobian, A. (2021). Clinical use of cryoprecipitate. UpToDate. Retrieved July 15, 2021, from
https://www.uptodate.com/contents/clinical-use-of-cryoprecipitate
(https://www.uptodate.com/contents/clinical-use-of-cryoprecipitate?
search=indications+for+cryoprecipitate+transfusions&source=search_result&selectedTitle=3%7E15
0&usage_type=default&display_rank=3)
5. Yaddanapudi, S., Yaddanapudi, L.N. (2014). Indications for blood and blood product transfusion.
Indian J Anaesth 58:538–542. https://pubmed.ncbi.nlm.nih.gov/25535414/
(https://pubmed.ncbi.nlm.nih.gov/25535414/)
6. Yuan, S., Goldfinger, D. (2021). Platelet transfusion: indications, ordering, and associated risks.
UpToDate. Retrieved July 15, 2021, from https://www.uptodate.com/contents/platelet-transfusion-
indications-ordering-and-associated-risks (https://www.uptodate.com/contents/platelet-
transfusion-indications-ordering-and-associated-risks)
7. Thiagarajam, P. (2020). Platelet disorders: overview of platelet disorders. Emedicine. Retrieved
August 5, 2021, from https://emedicine.medscape.com/article/201722-overview
(https://emedicine.medscape.com/article/201722-overview)
