BLOOD BANKING

PART 1

MLS 404
DONOR SELECTION
DONOR SELECTION
 PRIMARY OBJECTIVE:
 Ensure that the donation will not
harm the DONOR and the donated
blood will not harm the RECIPIENT.
 To minimize risks to both the donor
and the transfusion recipient.
BASIC QUALIFICATIONS
1. In good health condition
2. Age:
 18 YEARS OLD and above
 17 yrs and above: Henry's; Harmening
 Person below 18/17 years old may
donate blood provided that they will
present a written permission from
their parent or guardian.
 NO upper age limit
 *65 years old
BASIC QUALIFICATIONS
3. Weight:
 Must be at least 110 pounds or 50 kgs.
to donate a full 450 ml unit.
 Maximum blood donation:
 10.5ml/kg body weight
 Low
volume unit: 300-405ml
Do not use plasma!
MODIFICATIONS
 Amount of Blood to be Drawn
Donor’s weight (lb) x 450 ml
110 lb
 Amount of Anticoagulant Needed
Allowable Amount x 14
100
 Amount of Anticoagulant to Remove
63 ml – amount of anticoagulant
needed
BASIC QUALIFICATIONS
 Oral temperature:
 SHOULD NOT EXCEED 37.5˚C (99.5˚F)
 Pulse:

 50–100 beats per minute (bpm)

 without pathologic irregularities and
counted for at least 15 seconds
 <50 bpm is acceptable for athletes
 Blood Pressure:

 Systolic: 90-160 mmHg

 Diastolic: 60-100mmHg
BASIC QUALIFICATIONS
 Hematocrit:

 must be >38%
 Hemoglobin:

 According to DOH,
Women: 12.5 g/dL

Men: 13.5 g/dL

 According to AABB,
12.5 g/dl for both sexes

Note: Hgb can be measured via the copper

sulfate or spectrophotometric method
BASIC QUALIFICATIONS
Time interval of donation of WHOLE BLOOD
According to DOH,
 Males: EVERY 3 MONTHS
 Females: EVERY 6 MONTHS
According to AABB,
 Every 8 WEEKS or 56 DAYS for both sexes
 16 WEEKS after 2-unit red cell collection
 4 WEEKS after infrequent apheresis
 At least 48 HOURS after participation in
pheresis donation (plasma, platelet, or
granulocytes)
BLOOD COLLECTION
I. AUTOLOGOUS DONATION
 Donation of blood for his/her own use
 Donor is referred to as the DONOR-PATIENT

 TYPES:
1. Preoperative collection
2. Acute normovolemic hemodilution
3. Intraoperative collection
4. Postoperative collection
1. PREOPERATIVE COLLECTION
 Qualifications:
 Age: NO age limit
 Hemoglobin: 11 g/dL
 Hematocrit: 33%
 Advantages:
 NO risk of transmission of blood-borne
pathogens
 NO risk of transfusion reactions and
sensitization immunization from RBCs,
WBCs, platelets and plasma proteins
1. PREOPERATIVE COLLECTION
 Disadvantage:
 Risk of bacterial contamination when
sterility is compromised

IMPORTANT NOTES:
1. Donor-patient must be deferred
when there is risk of bacteremia
2. Must be collected no sooner than
72 HOURS or 3 days before the
scheduled surgery
3. CANNOT be crossed-over into
homologous inventory
2. ACUTE NORMOVOLEMIC
HEMODILUTION
 Involves removal of whole blood from a
patient with infusions of synthetic volume
expanders before surgical blood loss
 Volume expanders include:
Crystalloids: Ringer’s lactate and NSS

Colloids: Dextran and HES

 The "shed" blood may be reinfused during

or immediately following the surgery, but
within 8 hours of collection
3. INTRAOPERATIVE COLLECTION
 Involves collecting and reinfusing blood
lost by a patient DURING surgery, washing
it with saline, concentrating the residual
red cells and then reinfusing it back to the
px
 Contraindications:

 risk for bacterial contamination

 procoagulant is being used (risk for DIC)
4. POSTOPERATIVE BLOOD COLLECTION
 Blood is collected from a drainage
tube placed at the surgical site and
then reinfused back to the patient
with or without processing it via a
microaggregate filter
 Blood is characterized as being dilute,
partially hemolyzed and defibrinated
 Blood must be reinfused within 6 hours
of collection
II. DIRECTED (DESIGNATED)
DONATION
 Recipient selects the donors for themselves
rather than receiving blood from the
community supply due to perception of the
blood being safer
 Advantages:
 Blood group compatilibity for rare blood
groups system is resolved
 Donor exposure is minimized for patients with
long-term expected transfusion (aplastic
anemia and beta thalassemia major)
 Contraindications:

 Donation of plasma-containing
products from mother to baby
 Donation between close relatives for
hematopoietic progenitor cell
transplants because of the risk of
immunization to HLA and other
histocompatibility antigens which may
endager the graft
MUST KNOW!
 NEONATAL ALLOIMMUNE
THROMBOCYTOPENIA (NAIT)
 caused by antibodies specific for platelet
antigens inherited from the father but
which are absent in the mother
 MOTHER is the best source of compatible
antigen-negative platelets
 80% of its cases is due to platelet antigen
HPA-1a
 Affected patient will experience PLATELET
REFRACTORINESS if transfused with
antigen-positive platelets
DONOR REACTIONS
DONOR REACTIONS
 Any adverse reactions of a blood donor
as a result of the donation process
 Repeat donors are less likely to have
reactions than first-time donors
 Usually vasovagal

 May result from psychological influences

 sight of blood
 excitement
 fear
 apprehension
DONOR REACTIONS
1. MILD REACTIONS
 MOST FREQUENTLY ENCOUNTERED
 Donor exhibits signs of shock but DOES NOT
lose consciousness
2. MODERATE REACTIONS
 Similar to mild reactions but the donor has
LOST consciousness
3. SEVERE REACTIONS
 Characterized by shock, loss of
consciousness and presence of convulsions
or seizures
SEVERE REACTIONS
1. HYPERVENTILATION TETANY
• Earliest stage of convulsions caused

by hyperventilation
• Donor has NOT lost consciousness
with complains of stiffness or tingling
in the fingers
• The fingers and thumb may spasm
and assume unnatural position
• Progressing symptoms to more
pronounced convulsions
SEVERE REACTIONS
2. MILD CONVULSIONS
Short LAPSE of consciousness

Voice fadeout wit slight involuntary

movement of the arms and legs

3. SEVERE CONVULSIONS
Rigid body and tightly clenched teeth

Temporary loss of breathing, followed by

rasping or stertorous breathing
Slight involuntary movement of the arms
and legs
MUST KNOW!
 Mildrxns = signs of shock
 Moderate rxns = signs of shock + syncope

 Severe rxns = signs of shock + with or w/o

syncope + seizures
 Hyperventilation tetany = shock + tingling of
the fingers
 Mild convulsions = shock + lapsing syncope +
stiffness of arms and legs
 Severe convulsions = shock + rigidity and
clenching of teeth + stiffness of arms and legs
MUST KNOW!
 HEMATOMAS

 Common complication
 Occurs if the needle is not seated
properly and there is leakage of
blood around the entry site into the
tissue or if the needle went through
the vein and punctured the back
wall
 An indication of POOR phlebotomy
DEFERRALS
TYPES OF DEFERRAL
 TEMPORARY DEFERRAL
 Prospective donor is unable to donate for a
limited period of time
 INDEFINITE DEFERRAL

 Prospective donor is unable to donate blood for

an unspecified period of time due to current
regulatory requirements
 Donor would not be able to donate until the
current requirements change
 Donor is still eligible for autologous donation!
 PERMANENT DEFERRAL

 Prospective donor will NEVER be able to donate

blood.
 Donor is still eligible for autologous donation!
TEMPORARY DEFERRALS
 72 HOURS (3 DAYS)
 ingestion of medications that irreversibly
inhibit platelet function such as ASPIRIN,
PIROXICAM or its analogues
 Note:
• Platelet concentrates from donors who
have ingested aspirin is NOT allowed to
be used as a SOLE source of platelets
for the recipients
• Platelets from these donors MAY be
used as PART of pooled platelet
components
2 WEEKS
 Recipients of live attenuated vaccines:
(TMOMYS)
 Typhoid
 Measles
 Oral Poliomyelitis
 Mumps
 Yellow fever
 Smallpox
 NOTE:
 No deferral for toxoids or killed or synthetic viral,
bacterial or rickettsial vaccines if the donor is
symptom-free and afebrile
4 WEEKS DEFERRAL (VRIF)
 Varicella Zoster vaccines
(chickenpox)
 Rubella vaccine (German measles)
 Isotretinoin (Accutane®)
Given for severe acne
 Finasteride (Proscar®, Propecia®)
Given for prostate enlargement and
baldness
6 WEEKS
 Pregnancy
 NO deferral for first or second
trimester abortion or miscarriage

6 MONTHS DEFERRAL
 Dutasteride (Avodart®)
Given for prostate enlargement
 12 MONTHS DEFFERAL
 Blood transfusion or any surgery where transfusion
of blood is required
 Tatooes, ear or skin piercing or acupunctures
 Needle sticks and mucous membrane contact
with blood
 Cohabitation with someone with viral hepatitis
 Rabies, Hepatitis B Immunoglobulin and unlicensed
vaccines
 Those who TRAVEL in the area in which malaria is
endemic.
 History of syphilis, gonorrhea or other STDs after
completion of therapy
 Incarceration in a correctional institution for longer
than 72 consecutive hours
 12 MONTHS DEFFERAL
 Persons who have engaged in sex with
men and women who engaged in sex for
money and drugs since 1977
 Female who have sex with a male who
has had sex, even once with another male
since 1977
 Persons who have had sex with anyone
who is a past or present IV drug user
 Persons who have had sex with any person
with hemophilia or related blood disorder
who have received factor concentrates.
 Persons who have had sex with any person
who was found to be HBsAg positive or HIV
positive or with any person at risk
3 YEARS DEFERRAL
 Those who are DIAGNOSED WITH
MALARIA and become
asymptomatic
 Those who LIVED in the area for 5
CONSECUTIVE YEARS in which malaria
is endemic.
 Acitretin (Soriatane® or Neotigason®)
for treatment of severe psoriasis.
PERMANENT DEFERRALS
 Men and women who have
engaged in sex for money or drugs
since 1977
 Males who have sex with another
male, even once since 1977
 Sex with anyone since 1977 who
was born in Cameroon, Central
African Republic, Chad, Congo,
Equatorial Guinea, Gabon, Niger or
Nigeria (widespread use if nonsterile
needles in this country)
PERMANENT DEFERRALS
 Historyof viral hepatitis after the 11th
birthday
 Confirmed positive test for HBsAg
and repeatedly reactive test for anti-
HBc on more than one occasion
 Present or past clinical laboratory
evidence of infection with HCV, HTLV
or HIV
PERMANENT DEFERRALS
 History of cardiovascular, coronary or
rheumatic heart disease, however, in the
absence of disability or restrictions by the
physician, the donor may be accepted
on a case-by-case basis.
 Active pulmonary tuberculosis or other
pulmonary disease
 Diseases of the blood such as
hemophilia, von Willebrands disease,
sickle cell anemia, thalassemia, Kaposis
sarcoma, polycythemia or history of
receiving clotting factor concentrates
PERMANENT DEFERRALS
 Transfusion of blood positive for
Hepatitis, HIV or HTLV
 History of babesiosis or Chagas’ disease
 Evidence of or obvious stigmata of
parenteral drug use
 Use of a needle to administer
nonprescription drugs
 Etretinate (Tegison®)
 for treatment of severe psoriasis (teratogenic)
 Use of bovine insulin manufactured in
the United Kingdom
PERMANENT DEFERRALS
 Cancer (any form) EXCEPT:
 Basal or Squamous cell cancer
 Carcinoma in situ of the cervix
 Papillary thyroid carcinoma
 Recipients of human-derived pituitary
growth hormone, brain covering graft or
organ/tissue transplant/graft
 Risk of vCJD transmission
 NOTE: Recipients of recombinant GH
are NOT subjected to permanent
deferral
DEFERRAL BY RISK
 Behavior suggestive of high risk for HIV
infection
 Alcohol intoxication or obvious
stigmata of alcohol habituation
 Lesions on the skin at the venipuncture
site: indication of IV drug usage
 Menstruation
DONOR PROCESSING
AND SCREENING
Infectious Diseases
BLOOD DONOR PROCESSING FOR
INFECTIOUS DISEASE
 ABO Grouping
 Rh Typing
 Antibody Screening (not done in Ph)
 Test for Syphilis
 Test for HbsAg
 Test for Anti-HCV
 Test for HIV1 and HIV2
 Test for Malaria
 Other tests for infectious disease
MUST DO!
 Study SYPHILIS, HEPATITIS B,C and D,
and HIV
 Study their corresponding
antigen/antibody markers
 Study the laboratory tests for their
diagnosis
(use your Immuno handouts/book)
 The following slides contain only
ADDITIONAL INFORMATION about
the abovementioned topics
HBSAG DETECTION
1. FIRST GENERATION
 Ouchterlony Double Diffusion
2. SECOND GENERATION
 Counterelectrophoresis
 Rheophoresis
 Complement fixation
3. THIRD GENERATION : MOST SENSITIVE
 Radioimmunoassay
 Reverse passive hemagglutination
 ELISA
 Reverse passive latex agglutination
LABORATORY TESTS FOR HEPATITIS C
 SURROGATE TEST FOR HCV
 Increased ALT/SGPT + Anti-HBc (+)

 SPECIFIC TEST FOR HCV

 Anti-HCV Antibody
ELISA
NAT
RIBA (Radioimmunoblot Assay):
CONFIRMATORY METHOD for HCV
HIV
 GP 120 requires CD4 receptor on the
surface of host cell to infect it and an
additional co-receptor (differs
depending on cell type) to penetrate
the cell
 CXCR-4: co-receptor on T cells
 CCR-5: co-receptor on macrophages
WESTERN BLOT:
STANDARD CONFIRMATORY TEST FOR HIV
Procedure:
1. Infectious agent lysed in solution with
SODIUM DODECYL SULFATE (SDS) to release
proteins
2. Lysate is placed into a trough of
POLYACRYLAMIDE slab gel
3. ELETROPHORESIS resulted in separation of
proteins based on molecular size and
charge
4. Proteins are transferred into a sheet of
NITROCELLULOSE
5. Nitrocellulose strip is cut into strips. Washing
removes nonspecific antibodies
7. ANTI-HUMAN ANTIBODY CONJUGATE is
added. Conjugate binds to antigen-
antibody complexes
8. Substrate for the enzyme is added.
Enzyme catalyzes the production of
colored product.
9. Detection of specific antibody is based
on enzyme-substrate colored reaction
product, which occurs in a band pattern
based on the position of the proteins on
the strip.
HIV
NOTE: confirmation of seropositive
blood
 PATIENT
SACCL (STD-AIDS Cooperative

Central Laboratory)
 DONORS
RITM (Research Institute for

Tropical Medicine)
HUMAN T-CELL
LYMPHOTROPHIC VIRUS
 HTLV-1
 cause of adult T-cell
lymphoma/leukemia
 HTLV-associated Myelopathy (HAM)
 HTLV-2
 cause of HAM
 HTLV-3
 found out to be identical to HIV)
LAB TESTS FOR MALARIA
 THICK AND THIN BLOOD SMEAR
 GOLD STANDARD
 QBC or Quantitative Buffy Coat Method
 Serologic test:

 ELISA
 IFA
THIN BLOOD SMEAR
 Utilized for SPECIES IDENTIFICATION
 prepared in the same manner as for
hematologic differential evaluation
 integrity of the blood cell membranes
is important for determining the
intracellular or extracellular nature of
the infection
 Platelets superimposed on RBCs
MOST COMMON artifacts on thin
films
THICK BLOOD SMEAR
Utilized for SCREENING purposes
1.Blood is concentrated in a small area SIZE
OF A DIME (1.5 cm) that is many cell layers
deep and allowing the blood to dry flat at
room temperature, usually overnight.

2.A proper thick film should be thin enough

that newspaper print may be read through
it. If it is too thick, the film may peel from the
slide. Excess heat may fix erythrocytes and
may prevent dehemoglobinization.
THICK BLOOD SMEAR
1.During staining, erythrocytes are
DEHEMOGLOBINIZED and only leukocyte
nuclei, platelets, and parasites (if present)
are visible

2.If blood is obtained via venipuncture, the

use of anticoagulant is DISCOURAGED since
it interferes with staining and cause
distortion of the parasite. However, if use of
anticoagulant is inevitable, EDTA may be
used.
THICK BLOOD SMEAR
5. The thick film is preferred for diagnosis
because it contains 16–30 times more blood
per microscopic field than does the thin film,
thus increasing the chances of detecting light
parasitemia and decreasing the time needed
for reliable examination.

6.Best staining results are achieved when using

GIEMSA STAIN because host cell and parasite
chromatin stains vividly but the hemoglobin in
erythrocytes appear only pale red, and this is
the only stain that allows visualization of the
erythrocyte stippling that occurs with infection
by certain malarial parasites. Stock Giemsa
must be diluted with PHOSPHATE-BUFFERED
WATER maintained at a pH of 6.8-7.2 to
achieve appropriate staining reactions.
THICK BLOOD SMEAR
6.Smear is examined carefully specially the
FEATHERED EDGE using 100X Oil immersion
objective (OIO).

7.An experienced microscopist should

examine at least 100 oil immersion fields
(requiring about 5 minutes) on the thick
blood film and 200 fields (requiring at least
15 minutes) on the thin film using the 100×
objective before issuing a negative report.
QUANTITATIVE BUFFY COAT METHOD
 Involves staining of the centrifuged and
compressed red cell layer with ACRIDINE
ORANGE and its examination under UV light
source.
 It is fast, easy and claimed to be MORE SENSITIVE
than the traditional thick smear examination.
 Uses QBC tube which is a high-precision glass
hematocrit tube, pre-coated internally with
acridine orange stain and potassium oxalate
 Tube is centrifuged at 12,000 rpm for 5 minutes.
Red cells containing Plasmodia are LESS DENSE
than normal ones and concentrate just below
the leukocytes, at the top of the erythrocyte
column. Since the parasites contain DNA which
takes up the acridine orange stain, they appear
as BRIGHT SPECKS OF LIGHT AMONG THE NON-
FLUORESCING RED CELLS.
CUT SECTION OF
QBC
CYTOMEGALOVIRUS
 Infection is asymptomatic among
immunocompetent individual
 In pxs with cellular immunodeficiency,
CMV can cause pneumonitis, hepatitis,
retinitis, and multisystem organ failure
 Blood for transfusion to infants must be
CMV-negative.
PARVOVIRUS B19
 Transfusion-transmitted parvovirus
infection has been implicated in causing
chronic anemia after bone marrow
transplantation and in thalassemia
 Affects erythrocyte precursors in the
bone marrow causing aplastic anemia
 Causative agent of "fifth disease"
 P antigen
 Receptor for Parvovirus B19
WEST NILE VIRUS

 Arrivedin the United States in 1999

 Donor screening for WNV:

 Nucleic Acid Testing (NAT)

implemented July 2003
BABESIOSIS
 Caused by Babesia microti
 Babesia spp. are endemic in North
American mammals and are transmitted
to humans by ticks of the genus Ixodes
 Reservoir: White-tailed deer or White-
footed mouse
 Vector: Ixodes ticks
 The parasite is CAPABLE OF SURVIVAL IN
REFRIGERATED RED CELLS.
TRYPANOSOMA CRUZI
 Causative agent of Chagas’ disease
 Vector: Triatoma bug/ Kissing bug/
Assasin bug
 In the Philippines:
 Triatoma rubrofasciata
TRANSMISSIBLE SPONGIFORM
ENCEPHALOPATHIES
 TSEs are cause by proteins called PRIONS
 Variant Creutzfeldt-Jakob disease (vCJD)

 human TSE that emerged from an

epidemic of bovine spongiform
encephalopathy (BSE) which may be
transmitted via blood transfusions
 Familial CJD blood transmission

 has not been observed up to date

BLOOD
PRESERVATION
Anticoagulant and
Preservative Composition
• Citrate - prevents clot by chelating
Ca++
• Dextrose - provides energy to cells
• Adenine - improves viability
• Sodium biphosphate - serves as a
buffer in storage
BLOOD PRESERVATIVES
PRESERVATIVE SHELF-LIFE
Heparin 2 days
ACD: Acid-citrate-dextrose 21 days
CPD: Citrate-phosphate-dextrose 21 days
CP2D: Citrate-phosphate-double 21 days
dextrose
CPDA-1: Citrate-phosphate- 35 days
dextrose-adenine
CPD-A2: Citrate-phosphate- 42 days
dextrose-double adenine
ADDITIVE SOLUTIONS
 Enhances RBC survival and function
 Extend expiry date to 42 days

 Must be combined with the RBC within 72 hrs

after phlebotomy
 Yield a final hematocrit of 60%

 Consists of SAGM:
AS-1 Adsol
 Saline
AS-3 Nutricel
 Adenine
AS-5 Optisol
 Glucose
 Mannitol: RBC membrane stabilizing agent
REJUVENATING SOLUTIONS
• Addition of PIGPA to regenerate ATP and 2,3 -DPG
• Pyruvate
• Inosine
• Glucose
• Phosphate
• Adenine
• REJUVESOL-the only FDA approved rejuvenating
solution in US; contains PIPA only
• Red cells are rejuvenated dor 1-4 hrs at 37°C
• Performed 3 days after RBC expiration or to fresh
RBC
• After rejuvenation, may be washed and transfused
within 24 hours or may be frozen by glycerolization
STORAGE
• Blood Bank refrigerator = 1-6 °C
• Room temperature = 22-24 ° C
• Ultra low freezer = -18°C or colder
BLOOD DONATION
1. Donor identification
2. Donor registration
3. Interview and Physical examination
❑ A physician or nurse must conduct the interview
4. Donation proper (Blood collection)
❑ A phlebotomist and the head of BB must be present
❑ Acc. To AABB, bleeding must be done within 7-10
mins only
❑ In the Phil, bleeding is done withing 15 mins
❑ If > 15mins, cryoprecipitate may not be used
❑ Unit must be labeled & agitated during collection
❑ Donor is required to rest before being allowed to
leave
5. Donor unit testing and screening
BIOCHEMICAL CHANGES
DURING RBC STORAGE
ANALYTE LEVEL
P: pH ↓
A: ATP ↓
D: 2,3 – DPG ↓
S: Sodium ↓
H: Hemoglobin ↑
K: Potassium ↑
P: iPO4 ↑
L: Lactate/Lactic Acid ↑
BLOOD COMPONENT PREPARATION
Centrifugation
Sedimentation
Filtration
Fractionation
Cohn Ethanol Fractionation
• Developed by Edwin Cohn in 1940
• Sequential precipitation of specific
proteins by ethanol and pH
• Fractions are harvested by
centrifugation or filtration
• Antiviral effects: physical partitioning
and anti-viral activity of ethanol
BLOOD COMPONENT PREPARATION
 LIGHT SPIN
 2000-2,300g for 3 minutes (PRP)
 for platelet concentrate: 20-24 °C
 for all other blood components: 1-6°C

 HEAVY SPIN
 5000g for 5 minutes
packed RBC, platelet concentrate

 5000g for 7 minutes

cryoprecipitate, cell free plasma

products
HEMA!
SPEED TIME PURPOSE
60 to 100 g 10 mins PRP
1,500 g 15 mins Buffy coat prep
2,000 g 10 mins PPP
2,000 to 2,300 g 30 mins Winthrobe’s Macrohct
10,000 to 15,000 g 5 mins Adam’s Microhct
 WHOLE BLOOD
INDICATION Provides blood volume
expansion and RBC mass in
acute blood loss
STORAGE 1-6° C (33.8-42.8°F)
TRANSPORT 1-10° C ( 33.8-50°F)
SHELF-LIFE Depends on the
anticoagulant/preservative
used
-ACD, CPD, CP2D: 21 days
-CPDA1: 35 days
-CPDA2: 42 days
-Heparin: 2 days
MUST KNOW!
 For
a 70-kg (155-lb) adult, each unit of
whole blood or RBCs should increase the
hematocrit level 3% or hemoglobin1 g/dL.

 RBCtransfusion is not to be used to

enhance general well-being, promote
wound healing, prevent infection, expand
blood volume when oxygen-carrying
capacity is adequate, or prevent future
anemia.
 PACKED RED BLOOD CELLS (pRBC)
INDICATION Increases RBC mass of
symptomatic, normovolemic
patients
STORAGE 1-6° C (33.8-42.8°F)
TRANSPORT 1-10° C ( 33.8-50°F)
SHELF-LIFE Closed system:
-ACD, CPD, CP2D: 21 days
-CPDA1: 35 days
-CPDA2: 42 days
-Heparin: 2 days

Open system:
-24 hours
TA-GVHD
 Blood components are irradiated with gamma
radiation to prevent transfusion-associated
graft-versus-host disease (a syndrome affecting
mainly skin, liver, and gut), which requires three
conditions to occur:
1. Transfusion/transplantation of
immunocompetent T cells

2. Histocompatibility differences between graft

and recipient (major or minor HLA or other
histocompatibility antigens)

3. Usually, an immunocompromised recipient

 IRRADIATED RBCs
INDICATION For the prevention of GVHD
STORAGE 1-6° C (33.8-42.8°F)
TRANSPORT 1-10° C ( 33.8-50°F)
SHELF-LIFE 28 days after irradiation or the original
outdate, whichever come first
REMARKS Blood is exposed to an ionizing
radiation
Sources of radiation:
-Cesium (137 Cs)
-Cobalt (60 Co)

FDA and AABB: 25 Gy on the central

portion of blood unit and 15 Gy on
any part of the unit
 LEUKOCYTE-REDUCED RBCs (LR-pRBC)
INDICATION Increases RBC mass in patients with severe
and/or recurrent febrile transfusion reactions
due to leukocyte antibodies
Increases RBC mass in patients at risk of HLA
alloimmunization to HLA antigens or
susceptible to CMV
STORAGE 1-6° C (33.8-42.8°F)
TRANSPORT 1-10° C ( 33.8-50°F)
SHELF-LIFE Closed System:
-ACD, CPD, CP2D: 21 days
-CPDA1: 35 days
-CPDA2: 42 days
-Heparin: 2 days

Open system:
-24 hours
REMARKS Must contain <5.0 x 106 WBC/ bag of pRBC
MUST KNOW!
 For
LR-platelet concentrate, WBC
must only be 8.3 x 105/ bag
Why reduce the leukocytes?
• Leukocytes may cause febrile non-
hemolytic transfusion reactions (FNHTR)
and transfusion related acute lung injury
(TRALI)
• In stored blood, granulocytes fragment
and release cytokines
• May transmit infectious agents like CMV,
EBV, HTLV-1
 WASHED RBCs
INDICATION Increases RBC mass of
symptomatic anemic patients with
history of allergic, febrile and
anaphylactic transfusion reactions
STORAGE 1-6° C (33.8-42.8°F)
TRANSPORT 1-10° C ( 33.8-50°F)
SHELF-LIFE 24 hours

FROZEN RBCs
INDICATION Storage of rare blood and
autologous units
STORAGE -65 to -120°C
SHELF-LIFE 10 years
METHODS OF FREEZING RBCS
1. High Glycerol (slow freezing)
-uses 40% glycerol
-frozen at -80 °C and stored at -65 °C in a
mechanical freezer
2. Low Glycerol (fast or rapid freesing)
-uses 20% glycerol
-frozen at -196 °C and stored at -120 °C
using liquid nitrogen
3. Agglomeration
-uses glycerol, glucose, fructose and EDTA
-frozen at -80 °C and stored at -65 °C in a
mechanical freezer
DEGLYCEROLIZATION
-removal of glycerol from the blood unit
-uses hypertonic solution followed by isotonic
solution
1. High glycerol:
12% NaCl > 1.6% NaCl > 0.9% NaCl
2. Low glycerol:
45% NaCl > 15% mannitol > 0.9% NaCl
3. Agglomeration:
50% glucose and 5% fructose > 0.9% NaCl
SHELF-LIFE:
-24 hours at 1-6°C
-14 days at 1-6°C
 PLATELET CONCENTRATE
(Random Donor Platelet/ RDP)
INDICATION For bleeding due to
thrombocytopenia or
thrombocytopathy
STORAGE 20-24 °C with agitation
SHELF-LIFE 5 days
REMARKS Must contain 5.5 x 1010
platelets/bag
(50-75 mL in volume)
Must raise the platelet count by
5,000-10,000/ uL
Therapeutic : 4-6 units
MUST KNOW!
 If
pooled or washed, platelet must be
administered within 4 hours (open system)
 PLATELET PHERESIS
(Single Donor Platelet/SDP)
INDICATION For thrombocytopenic patients
alloimmunized to HLA or platelet
antigen
Limits donor exposure in
thrombocytopenic patients who
acquire long term platelet transfusions
STORAGE 20-24 °C with agitation
SHELF-LIFE 5 days
REMARKS Must contain 3.0 x 1011 platelets/bag
(300 mL in volume)
Must raise the platelet count
20, 000-60,000/uL
1 SDP = 6-10 RDP units
Donor must be aspirin free for 3 days
MUST KNOW!
 Donor must have a platelet count of at least
150, 000/uL before being considered eligible for
platelet donation.

 PRACTICAL CONSIDERATIONS
 When exposed to low temperature, platelet
microtubules disassemble causing it to become
spherical and nonfunctional (normal shape:
discoidal)
 Platelet units must be placed in an agitator LABELED
PART FACING DOWN
 This is to allow better flow of gases (decreased

O2, and increased CO2 will cause pH to

decrease)
 Plt concentrates should have a pH of 6.2-6.4
 FRESH FROZEN PLASMA (FFP)
INDICATION Corrects multiple coagulation
factor deficiencies
Replaces isolated factor
deficiency when specific
component is not available
Reverses effects of Warfarin
(Coumadin) anticoagulant drug
STORAGE -18 °C or cooler
SHELF-LIFE 1 year
REMARKS Contains plasma, ALL
coagulation factors and
complements
NICE TO KNOW!
 PRACTICAL CONSIDERATIONS
 When in liquid form, FFP units should be placed in a
freezer HORIZONTALLY, LABELED PART FACING DOWN.
 The bubble form on its upper part can be used as an
indicator of temperature changes inside the freezer.
 Bubble will rise to the upper part of the bag when FFP has been
thawed.
 A rubber band may also be used as an indicator

 When FFP is already frozen, it may then be re-arranged

VERTICALLY for long term storage

NOTE: A RAPID/BLAST FREEZER (which can freeze a unit

within 5-15 mins) can also be used.
MUST KNOW!
 Beforetransfusion, FFP must be
thawed at 37°C. This should be
administered within 24 hours or stored
at 1-6°C for up to 5 days and labeled
as “thawed plasma"
 CRYOPRECIPITATE
INDICATION For treatment of fibrinogen
deficiency, hemophilia A, von
Willebrand’s disease and Factor
XIII deficiency
STORAGE -18 °C or cooler
SHELF-LIFE 1 year
REMARKS Contains:
-Fibrinogen (150-250mg)
-vWF (40-70%)
-Factor VIII (80 units)
-Factor XIII (20-30%)
-Fibronectin
MUST KNOW!
 Cryoprecipitate is NO LONGER considered the product
of choice for factor VIII deficiency or von Willebrand’s
disease → Factor VIII concentrate is now the 1st choice
 Cryo is used mainly as a source of FIBRINOGEN
 For preparation of cryoprecipitate:
 FFP→ thaw at 4°C → centri using hard spin (4°C) →
separate cryopoor plasma and leave15 mL of cryo
 Before transfusion:
 Cryo → thaw @ 37°C → may be stored at
1-6°C but should be administered within 6 hours
 For pooled cryoprecipitate
 Consists of around 5 units administered within 4
hours
 GRANULOCYTE CONCENTRATE
INDICATION For those with fever, neutrophil counts less than
500/μL, septicemia or bacterial infection
unresponsive to antibiotics, reversible bone
marrow hypoplasia
STORAGE 20-24 °C without agitation
SHELF-LIFE 24 hours
REMARKS Must contain 1.0 x 1010
granulocyte/bag
Can only be acquired using
apheresis
Corticosteroids can be administered
prior to donation to increase the
number of circulating granulocytes
Hydroxyethyl starch (HES), a
sedimentation agent, enhances
separation of WBCs and RBCs
SPECIAL COMPONENTS
 Cryoprecipitate-reduced plasma
(cryopoor plasma)
 the supernatant remaining from the production of
cryoprecipitate. Retains normal levels of the vWF-
cleaving metalloprotease ADAMTS 13
 May be used for treatment of patients with
thrombotic thrombocytopenic purpura
 Hematopoietic Progenitor Cells (HPCs)
 Prepared from mononuclear cells harvested
during apheresis
 Lymphocytes
 Prepared from mononuclear cells
 Used for induction of graft-versus-tumor effect
(donor lymphocyte infusion)
Commercially-prepared Blood Derivatives
FACTOR VIII CONCENTRATE
INDICATION Prevent or control bleeding in
hemophilia A patients; component of
choice for vW disease

STORAGE 1-6°C (lyophilized: reconstituted with

25 mL diluent prior to administration)

SHELF-LIFE 2 years
REMARKS Used for isolated factor deficiency

Note: It is prepared from plasma obtained from paid

donors by plasmapheresis or from volunteer whole
blood donors.
 FACTOR IX CONCENTRATE
INDICATION Prevent or control bleeding in
patients with hemophilia B or
with specific factor
deficiencies; component of
choice for patients with Factor
VIII inhibitors
STORAGE 1-6°C (lyophilized)
SHELF-LIFE 2 years
REMARKS Contains factors II, VII, IX and X
May contain activated
coagulation factors
MUST KNOW!
 Factor IX concentrate
administration may cause DIC in
patient with liver disease who are
not producing adequate amounts
of antithrombins
 ALBUMIN, PLASMA PROTEIN FRACTION
INDICATION Replace loss of colloids in
hypovolemic shock, severe
burns or for pressure support
duting hypotensive episodes
STORAGE 2-10°C
SHELF-LIFE 5 years
REMARKS Neither contains gamma
globulins, no ABO grouping
and compatibility testing is
required
Pathogen Reduction
• Applicable to blood derivatives such as albumin,
coagulation factor concentrates, and immunoglobulins
• Heating @ 60 C for over 24 hours
• PASTEURIZATION
– pressurized steam @ 60 C for 10 hours
– isolated by monoclonal factor VIII antibody affinity
column and then eluted
• SOLVENT/DETERGENT EXPOSURE (S/D)
– Dolvent: tri(n-butyl) phosphate
– Detergent: sodium cholate, Tween 80 or Triton X-100
– Inactivates viruses with lipid envelop
– Ineffective against nonlipid-enveloped viruses
– Destroys cell membranes hence not applicable to
cellular blood components
PATHOGEN REDUCTION
 Intercept®
 Uses PSORALEN compound which
intercalates between bases of RNA
and DNA and when exposed to UV
light forms covalent cross-links that
prevents replication
 Mirasol®
 Uses RIBOFLAVIN which causes strand
cleavage of nucleic acids when
activated by UV light
Anti-inhibitor Coagulation
Complex (AICC)
• Factor VIII Inhibitor Bypass Activity (FEIBA)
• Lyophilized product from pooled plasma
using fractionation
• Contains: Vitamin K-dependent factors (II,
VII, IX, X) and their precursors and kinin-
generating proteins
• Indication: It is used to stop bleeding
episodes in patient with high levels of Factor
VIII inhibitor
PPF (Plasma Protein Fraction)
and Albumin
• Colloid derivatives made from pooled
plasma by Cohn ethanol fractionation
• Viral inactivation
• Pasteurization at 60°C for 10 hours;
inactivates coagulation factor
PPF vs. Albumin
• PPF • Albumin
– 83% albumin – 96% albumin
– 17% alpha and beta – 4% alpha globulins
globulins – 250-500 ml in volume
– contains bradykinin – Shelf life:
– 250-500 ml in volume •3 years @ 20-24 C
– Shelf life:
•5 years @ 1-6 C
•3 years @ 20-24 C
•5 years @ 1-6 C
• Neither contains gamma globulins, no ABO
grouping and compatibility test is required
Indications
• Plasma expanders (hypovolemia
and shock)
• Used to raise the blood pressure in
therapeutic plasma exchange,
dialysis, shock and other
hypotensive situation
Immune Serum Globulin (ISG)
• a solution or lyophilized preparation
containing immunoglobulins
• prepared by fractionation
• available in intramuscular (IM) and
intravenous (IV) form
• also contain IgA, IgM and other
plasma proteins
ISG is used for replacement of
gammaglobulins in cases of:
• Agammaglobulinemia
• Common Variable
Immunodeficiency (CVID)
• Wiskott-Aldrich Syndrome
• Severe Combined
Immunodeficiency
NOTE: Half-life in the blood stream is
18-32 days
ADDITIONAL INFORMATION
 MASSIVE TRANSFUSION is defined as the
replacement of one or more blood
volume(s) within 24 hours, or about 10
units of blood in an adult.

 EMERGENCY TRANSFUSION warrants

group O RBCs when patient type is not
yet known.
“Hope is faith holding out its
hand in the dark.”
-George Iles