BLOOD PRODUCTS

Presenter :- Guide :-
Dr Anant Kahare Dr Ramakrishna Shenoi
Junior Resident (Guide, Professor and HOD)
OMFS Department of OMFS
CONTENTS
 Introduction
 Blood donors
 Blood components
 Blood components storage
 Blood Products: Red Cell Preparations
 Blood Products: Platelet and Granulocyte Preparations
 Blood Products: Fresh Frozen Plasma, Albumin concentrate
 Blood Products: Coagulation protein preparations
 Conclusion
 References
 INTRODUCTION
 A blood product is any therapeutic substance derived from human
blood, including whole blood and other blood components for
transfusion, and plasma-derived medicinal products (PDMPs).
 Medicinal (medical therapeutic) products derived from human
donations of blood and plasma play a critical role in health care.
Safe, effective and quality-assured blood products contribute to
improving and saving millions of lives every year.

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BLOOD DONORS
 Age range of 18 to 60 years - in good health.
 Not have undergone major surgery within 6 months of
donation.
 Blood containing not less than 12.5% w/v of hemoglobin.
 If females, not be pregnant
 The frequency of donations of whole blood shall not exceed
once every 3 months with a maximum volume of 1.5 L in
any consecutive 12-months.
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BLOOD
COMPONENTS

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 BLOOD COMPONENTS STORAGE

Components can be stored for

• Red cells: 35 days to maximum 42 days at 1-6 °C
• Platelets: 05 days with continuous agitation at 22-
24°C.
• Plasma: 12 months at -18°C or 24 hours after
thawing
 WHOLE BLOOD
Description:
• In most countries a unit of whole
blood contains approximately 500 ml
of anticoagulated blood.
• Whole blood, in addition to red cells,
also contains plasma, white blood
cells, platelets, anticoagulant, and
additives to support red cell
metabolism.

Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 7

 Indications:
-Acute hemorrhage
-Neonatal transfusion
-Exchange transfusion

Contraindications and Precautions:

• Whole blood should not be used in chronic anemias, which are better
treated with red cell concentrate (RCC), as whole blood may cause
cardiac overload.
• There is a significant risk of hemolytic transfusion reaction and
transmission of viral diseases

Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 7

 • Granulocytes and platelets present in stored whole blood
are non-functional.
• Whole blood is also deficient in labile clotting factors-
e.g. factors V and VIII. Hence, if there is a deficiency of
clotting factors, platelets or granulocytes, it is unlikely
that transfusion of whole blood will correct that
deficiency.
• One unit of blood is expected to increase the hemoglobin
level by 1 g/dl in an average adult.

Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 7

 RED CELL CONCENTRATE
Description:
• The average volume of RCC is 250-300
ml.
• It contains red cells from one unit of whole
blood together with a small amount of
plasma. The hematocrit reading of RCC is
greater than 70%.
• RCC also contains white blood cells and
platelets which are non -functional.

Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 8

 Indications:
It is the preparation of choice when the main purpose of blood
transfusion is to provide a means for the transport of oxygen.

Contraindications and Precautions:

• RCC carries the same risk of hemolytic transfusion reaction
and transmission of viral disease as does whole blood.
• The use of RCC reduces the amount of anticoagulant and
electrolyte transfused.

Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 8

 • It is the product of choice to increase red cell mass.
• There is no significant physiological impairment if the
hemoglobin level is more than 10 g/dl and blood transfusion
should be avoided
• Patients with a hemoglobin level of less than 6 g/dl will often
require blood transfusion.
• Patients with a hemoglobin level of between 6 and 10 g/dl will
need blood transfusion only if they become symptomatic.
• It is more viscose than whole blood and usually takes longer to
transfuse.

Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 8

LEUCOCYTE-POOR RED CELL PREPARATIONS

Description:
• These are red cell preparations from
which most of the white cells and
platelets have been removed.
• Several methods are available to
produce leucocyte-poor red cell
preparations. These include
sedimentation, centrifugation, washing
and filtration.

Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 9

Indications:
• to prevent transfusion reaction in patients with known white cell
antibodies
• to prevent sensitization to white cell antigens in patients requiring
multiple transfusions (thalassemia, hemolytic anemia, etc.) or in potential
bone marrow transplant candidates
• to transfuse patients who are allergic to plasma proteins

Contraindications and Precautions:

• They carry a risk of hemolytic transfusion reaction and transmission of
viral disease.
• Preparations made using open methods (washing, filtration, etc.) should
be transfused within 24 hours of preparation, as there is a chance that
these products may be contaminated.
Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 10
 • There is 10-40% loss of red cells during the process of white cell
depletion.
• The process of white cell depletion is costly and time consuming,
and often needs forward planning.
• In many patients it is possible to prevent febrile transfusion
reactions by use of microaggregate filters which remove 40-70% of
leucocytes. These are convenient and cheap, and can be used at the
bedside and should be tried in the first instance to prevent febrile
transfusion reactions

Ref- Handbook of Blood and Blood Products; Ch. 2; Pg.no. 10

RANDOM-DONOR PLATELET CONCENTRATE

Description:
• Each unit contains platelets harvested
from one unit of fresh whole blood.
• An average unit contains between 0.5
and 1 X 10 to the power 11 platelets
suspended in about 50 ml of plasma.
• It also contains some leucocytes and
red cells.

Ref- Handbook of Blood and Blood Products; Ch. 3; Pg.no. 15

 Indications:
• Prevention and treatment of bleeding due to thrombocytopenia
associated with bone marrow failure-i.e. due to chemotherapy,
leukaemia, aplastic anaemia, etc.
• Treatment of bleeding due to platelet function defects i.e.
Glanzmann's thrombasthenia, Bernard-Soulier disease, etc.
• Treatment of bleeding due to thrombocytopenia associated with
massive transfusion.

Ref- Handbook of Blood and Blood Products; Ch. 3; Pg.no. 15

 Contraindications and Precautions:
• Platelet transfusion is of doubtful benefit in thrombocytopenia
due to increased platelet destruction-i.e. idiopathic
thrombocytopenic purpura (ITP), disseminated intravascular
coagulation (DIC), hypersplenism, etc.
• Repeated platelet transfusion may sensitise the patient to HLA
and platelet specific antigens. This may cause febrile
transfusion reactions and may make the patient refractory to
further platelet therapy
• It also carries the risk of transmitting viral diseases.

Ref- Handbook of Blood and Blood Products; Ch. 3; Pg.no. 15,16

 GRANULOCYTE CONCENTRATE
(SINGLE-DONOR)
Description:
• Granulocyte concentrates are usually prepared
from a single donor by use of a centrifugal cell
separator.
• A standard preparation should contain more than 1
X 1010 granulocytes.
• It also contains a large number of platelets,
lymphocytes and some red cells.
• The volume of the product varies between 200-600
ml, depending on the method of collection.
Ref- Handbook of Blood and Blood Products; Ch. 3; Pg.no. 18
Indications:
• Granulocyte concentrate may be useful for selected patients with a
granulocyte count below 0.5 x 109/L in whom there is evidence of
infection unresponsive to appropriate antibiotic therapy.

Contraindications and Precautions:

• Granulocyte preparations often cause febrile transfusion reactions, and
it may be necessary to administer intravenous hydrocortisone (100 mg)
and/or antihistamine (chlorpheniramine 10 mg) before transfusion.
• Granulocyte preparations also contain a large number of
immunocompetent lymphocytes, and it is essential to irradiate the
product before transfusion to an immunocompromised patient, to
prevent graft versus host disease (GVHD).
Ref- Handbook of Blood and Blood Products; Ch. 3; Pg.no. 18
FRESH-FROZEN PLASMA (FFP)
Description:
• FFP is usually obtained from whole blood
donations.
• Plasma is separated within 6 hours of collection
and is frozen rapidly to preserve the labile
proteins, particularly the labile clotting factors
(factors V and VIII).
• FFP contains all the proteins normally present
in plasma.
• The volume of each unit is usually 200-250 ml.

Ref- Handbook of Blood and Blood Products; Ch. 4; Pg.no. 21

 Indications:
• Conditions resulting in multiple clotting factor deficiencies-i.e.
patients undergoing massive transfusion who develop a
bleeding tendency.
• Bleeding associated with liver failure.
• Coumarin anticoagulant (warfarin) overdose.
• Patients with factor V or factor XI deficiency and bleeding.

Ref- Handbook of Blood and Blood Products; Ch. 4; Pg.no. 21

 Contraindications and Precautions:
• Allergic reactions, particularly urticaria and febrile transfusion
reactions are frequent with FFP transfusion.
• Anaphylaxis, though rare, is often life-threatening.
• FFP carries almost the same risk of transmitting viral diseases
as does whole blood.

Ref- Handbook of Blood and Blood Products; Ch. 4; Pg.no. 21,22

Administration and Dosage:
• FFP is stored at -30 degree for a maximum period of 12 months.
• It should be thawed at a temperature between 35 and 37 degree. The
thawing process takes about 20 minutes. FFP must be administered
soon after thawing, preferably within 2 hours.
• FFP must be transfused through a standard blood filter at a rate not
exceeding 10 ml/min. The dosage of FFP depends on the clinical
situation and must be assessed for each individual case. An average
dose varies between 5 and 15 ml/kg body weight.

Ref- Handbook of Blood and Blood Products; Ch. 4; Pg.no. 22

ALBUMIN CONCENTRATE
Description:
• Heat-treated solution of albumin.
• The protein concentration of this preparation is
usually between 20 and 25%, more than 95% of
which is albumin.
• The sodium content of this product is the same
or slightly higher than that of plasma but the
potassium concentration is lower.

Ref- Handbook of Blood and Blood Products; Ch. 4; Pg.no. 23

 Indication:
• Hypoproteinemia associated with liver failure.
• Ascites associated with hypoproteinemia.
• In hemolytic disease of the newborn it can be used with
exchange transfusion to bind free bilirubin.
• Conditions in which the use of albumin concentration is of
doubtful benefit include adult respiratory distress syndrome
(ARDS), toxemia of pregnancy and septicemia.

Ref- Handbook of Blood and Blood Products; Ch. 4; Pg.no. 23,24

 Contraindications and Precautions:
• This preparation does not transmit viral diseases.
• Febrile transfusion reactions are rare but occasionally do occur.
• As this preparation is hyperosmotic, hemodilution occurs after
transfusion and may precipitate cardiac failure in patients with
poor myocardial function.
• It should not be used in dehydrated patients.

Ref- Handbook of Blood and Blood Products; Ch. 4; Pg.no. 24

 Administration and Dosage:
• The dosage of albumin is determined as the amount required to
keep the total plasma protein over 52 g/L.
• The amount can be calculated as follows:
dose of albumin in g = 2 (desired albumin level in g/l - actual
albumin level in g/1) X plasma volume in L
• If albumin concentrate is transfused to edematous patients, a
diuretic should be given to prevent hypervolemia.

Ref- Handbook of Blood and Blood Products; Ch. 4; Pg.no. 24

 CRYOPRECIPITATE
Description:
• Cryoprecipitate is cryoprecipitated protein from
fresh plasma.
• It is rich in factor VIII and fibrinogen.
• The product, derived from one unit of blood on
average, contains 70-120 i.u. of factor VIII, 150-
250 mg of fibrinogen and significant amounts of
factor XIII.
• The volume of each unit usually varies between
20 and 30 ml.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 29

 Indications:
• Hemophilia A
• von Willebrand disease
• Acquired or congenital hypofibrinogenemia, afibrinogenemia
and dysfibrinogenemia.
It is also occasionally used in the treatment of bleeding associated
with uremia and factor XIII deficiency, and in fibronectin
deficiency.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 29

 Contraindications and Precautions:
• Allergic and febrile transfusion reactions are common with
cryoprecipitate.
• It can also transmit viral diseases.
• As it contains large amounts of fibrinogen, administration of
large volumes of cryoprecipitate may cause hyper viscosity and
increased bleeding tendency.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 29

Administration and Dosage:
• Cryoprecipitate is stored frozen at -30 degree or at a lower temperature.
• It must be thawed at 37 degree before administration. It must be
transfused promptly after thawing, and in no case more than 3 hours
later.
• The rate of transfusion must not exceed 10 ml/min.
• The dose of cryoprecipitate for treatment of hemophilia A or von
Willebrand disease depends on the patient's body weight, the severity of
the disease and the clinical situation. On an average, one unit will
increase the factor VIII level by about 2% in an average adult.
• The corresponding fibrinogen level rise is usually between 50 and 75
mg/1.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 30

 FIBRINOGEN CONCENTRATE

Description:
• A product prepared by
fractionating pooled plasma.
• Each vial contains 1 or 2 g of
fibrinogen together with small
amounts of other proteins.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 33

 Indications:
• It is used in congenital or acquired afibrinogenemia,
hypofibrinogenemia and dysfibrinogenemia.

Contraindications and Precautions:

• It carries a high risk of transmitting viral diseases, particularly
hepatitis.
• It may also precipitate thrombotic problems, especially in DIC
patients.
• Allergic reactions are uncommon.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 33

 FACTOR VIII CONCENTRATE
Description:
• A preparation obtained by fractionation of pooled FFP. In
addition to a high concentration of factor VIII coagulation
activity (factor VIII), most preparations are also rich in von
Willebrand factor (vWF) and fibrinogen.
• The concentration of factor VIII also varies from preparation to
preparation. Intermediate purity concentrates contain between
10 and 20 units of factor VIII/ml and high purity concentrates
contain more than 20 units of factor VIII/ml.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 30

 Indications:
• Treatment of severe and moderately severe hemophilia A.
• For treating patients with factor VIII inhibitors.
• Intermediate purity concentrates can be used to treat von
Willebrand disease.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 30,31

 Contraindications and Precautions:
• As it is prepared from pooled plasma, it carries a very high risk
of transmitting hepatitis.
• At present almost all available factor VIII is heat-treated, which
virtually eliminates the risk of transmitting HIV infection and
may reduce the risk of transmitting other viral diseases.
• Administration in large doses may induce hemolysis. This is
due to the presence of anti-A and anti-Bin factor VIII
concentrate. High doses can also elevate fibrinogen levels and
induce bleeding.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no.31

 FACTOR IX CONCENTRATE
(PROTHROMBIN COMPLEX)
Description:
• This preparation is made from pooled plasma.
• In addition to factor IX, most preparations also contain factors
II, VII and X. Some preparations do not contain factor VII.
• The concentration of fibrinogen and other proteins in these
preparations is very low.
• The amount of each factor contained in different batches varies
and is stated on the label.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 31,32

 Indications:
• Treatment of patients with Christmas disease (hemophilia B).
• It can also be used to treat congenital deficiency of
prothrombin, factor VII or factor X.
• Acquired deficiency of vitamin K dependent clotting factors,
e.g. due to warfarin overdose, if it is not possible to transfuse
large volumes of FFP.
• Treatment of hemophilia A patients with inhibitor.
• Treatment of bleeding due to liver failure.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 32

 Contraindications and Precautions:
• Most of the preparations available at present are heat-treated
and the chance of transmitting HIV infection is very low, but
hepatitis can still be transmitted. It may be particularly
dangerous for patients whose liver function is already
compromised.
• Factor concentrates should not generally be used for acquired
deficiency of vitamin K dependent clotting factors or in liver
failure. These conditions can be effectively treated with FFP.
Allergic reactions such as urticaria, rash and flushing are
common, but more serious reactions such as anaphylaxis are
rare.

Ref- Handbook of Blood and Blood Products; Ch. 5; Pg.no. 32

 ARTIFICIAL BLOOD
• Blood substitutes (“artificial blood”), better termed as oxygen
therapeutic agents (OTAs), have been in development for many decades
• The development of OTAs has taken two main approaches:
1. perfluorocarbon-based substitutes and
2. hemoglobin-based oxygen carriers
• Currently, there are no Food and Drug Administration (FDA)-approved
OTAs given the toxicities of these agents, though some OTAs are used
clinically outside of the United States.
• It is possible to use OTAs in the United States via the FDA expanded
(compassionate use) access program for selected patients with severe
life-threatening anemia

Ref- Artificial Blood: The History and Current Perspectives of Blood Substitutes
Ref- Artificial Blood: The History and Current Perspectives of Blood Substitutes
Ref- Artificial Blood: The History and Current Perspectives of Blood Substitutes
Ref- Artificial Blood: The History and Current Perspectives of Blood Substitutes
 CONCLUSION
• An insufficient or unsafe blood supply for transfusion has a
negative impact on the effectiveness of key health services and
programs to provide appropriate patient care in numerous
acute and chronic conditions.
• Ensuring access of all patients who require transfusion to safe,
effective and quality-assured blood products is a key
component of an effective health system and vital for patient
safety.

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REFERENCES
• https://www.who.int/health-topics/blood-products
• https://openmd.com/guide/blood-components
• Handbook of Blood and Blood Products by S. Ghosh; Ch.
2,3,4,5.
• Artificial Blood: The History and Current Perspectives of
Blood Substitutes
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