What are the Blood components?

Whole blood:

1. Proper storage of the blood is crucial:
   1. Whole blood needs to be stored at a constant 4 °C (± 1 °C).
   2. At this temperature, bacterial growth and cell metabolism slow down.
2. Some researchers say that a temperature of 2 °C is better, but the disadvantages are:
   1. White blood cells and platelets become irreversibly clumped at this temperature.
   2. Also, at 2 °C, RBCs are swollen due to the presence of dextrose, become fragile, and may be hemolyzed.
   3. At temperature >10 °C:
      1. Bacterial growth is enhanced.
      2. Cell survival is decreased by around 20%.

What are the changes in stored blood?

1. Blood deterioration starts when stored in Citrate phosphate dextrose anticoagulant (CPD) or Acid Citrate Dextrose anticoagulant (ACD) within a few days of collection.
2. RBCs will lose their ability to metabolize glucose.
3. The cells lose K⁺ to the plasma.
4. The osmotic and mechanical fragility is increased.
5. There is a loss of membrane lipids.
6. What is the survival of the RBCs in vivo?
   1. 5% after the first week.
   2. 10% to 15% after 2 weeks.
   3. 15% to 30% after 3 weeks.
7. The addition of Adenine (Adenine + CPD) will prolong the shelf life of RBCs to 35 days.
8. In storage, there is a decrease in the 2,3-diphosphoglycerate (2,3-DPG) and Adenosine triphosphate (ATP).
   1. The concentration of the 2,3-DPG is better maintained in the CPD than in the ACD.
9. Blood stored at 4 °C stops the transport of Na+ and K+ across the red blood cell (RBC) membrane.
   1. If storage is continued, then:
   2. In that case, the intracellular and extracellular concentrations of Na+ and K+ are maintained.
   3. After a blood transfusion in CPD, sodium levels are corrected within 24 hours.
   4. However, the K+ level does not return to normal and takes more than 6 days.

10. What are the uses of whole blood?
    1. It is advised for patients with enough acute blood loss leading to hypovolemia.
    2. This may be given to patients with severe anemia, preferably by giving packed RBCs.

Fresh frozen plasma (Plasma):

1. Plasma is separated from the RBCs by centrifugation at 4°C and is frozen as quickly as possible.
   1. This is stored at -30 °C for a maximum period of one year.
   2. At -20 °C, it can be stored for 3 months.
2. In the storage of fresh frozen plasma, deterioration occurs for labile clotting factors.
3. What is the use of the fresh frozen plasma?
   1. It is used for the deficiency of labile coagulation factors.
   2. With concentrated RBCs and frozen plasma.
   3. Stored plasma is useful in treating protein replacement or increasing blood volume.
   4. Stored plasma is also used in the treatment of burns, hypovolemic shock, coagulation factor deficiencies (except factors V and VIII), and for reversing anticoagulants.

Packed red blood cells:

1. When Red blood cells are concentrated in a closed atmosphere, the sterility of the cells remains unaffected.
2. In this way, you can avoid bacterial proliferation.
3. These are used to avoid disturbing Hct and circulatory overload.
4. This will also prevent the reaction caused by the donor antibodies.
5. What are the uses of packed RBCs?
   1. This is indicated when the Hct needs to be increased without affecting blood volume, e.g., in anemia.
6. What are the advantages of Packed cells over whole blood?
   1. This will minimize circulatory overload.
   2. This will reduce the reaction due to the donor antibodies.
   3. It will reduce the quality of anticoagulants and electrolytes transfused in whole blood.
   4. It will minimize the reaction due to plasma components.

What is the difference between whole blood and packed cells?

 Cryoprecipitate:

1. Cryoprecipitate is prepared from fresh frozen plasma; the material does not become liquid when fresh frozen plasma is slowly thawed, and the major part remains in a solid state.
2. How is cryoprecipitate made?
   1. First, collect fresh frozen plasma.
   2. It is slowly thawed at 1 to 6 °C, allowing proteins to precipitate out.
   3. The precipitate is collected and frozen again for storage.
3. What are the indications for cryoprecipitate?
   1. It is given in low fibrinogen (hypofibrinogenemia).
   2. It is given in DIC.
   3. In liver diseases with low clotting factors.
   4. Patients with massive bleeding or hemorrhage.
4. What are the advantages of Cryoprecipitate?
   1. The significant advantage over fresh frozen plasma is the reduced volume of transfused fluid.
   2. Each unit contains around 150 mg of fibrinogen.
   3. Cryoprecipitate is suitable for treating von Willebrand’s disease and Hemophilia A.
5. What are the contents of cryoprecipitate?
   1. Cryoprecipitate contains 50% of the factor VIII and von Willebrand factor activity.
   2. Fibrinogen and factor XIII are approximately 20% to 40% of the total.

Human serum albumin:

1. This is prepared from normal human plasma.
2. Human albumin is prepared by cold ethanol plasma fractionation and is available in concentrations of 5% or 25%.
3. 25% albumin is stored at 2-8 °C and should not be frozen.
4. 5% albumin is stored at room temperature, and the temperature should not exceed 37 °C and should not be frozen.
5. The shelf life for both products is 3 years; expiry dates should not be ignored.
6. Storage has no effect if it is stored at the proper temperature and used before the expiry dates.
7. What are the uses of human albumin?
   1. It is used in the case of shock due to hemorrhage or surgery.
   2. This can be used as a fluid replacement during manual or automated therapeutic plasma exchange.
   3. In the case of neonatal hyperbilirubinemia.
8. What are the complications of human albumin?
   1. The patient may have a pyogenic or allergic reaction.
   2. There may be a hypotensive reaction.
   3. The above S/S disappears when the infusion is slowed down or stopped.
   4. The patients may have dilutional anemia.
   5. It should not be given to patients with contraindications, such as a rapid increase in the volume, which can affect their health.

Gamma Globulin (Immune Serum Globulin):

1. Immune serum globulins are stored at 2-8 °C for 2 years without any deterioration.
2. What are the uses of immunoglobulins?
   1. These are given to boost passive immunity (passive antibody) and protect against exposure to some diseases.
   2. In congenital immune deficiency disorders.
   3. These immunoglobulins are effective in:
      1. Measles.
      2. Hepatitis A infection.
      3. Hypogammaglobulinemia.

Antihemophilic factor (Factor VIII concentrate):

1. Factor VIII concentrate is obtained from the pooled fresh frozen plasma.
2. This is available in lyophilized form and should be stored at 2-8 °C, avoiding freezing.
3. This can be stored at room temperature for a short period.
4. Cruprecipitate factor VIII is prepared from a single donation of fresh blood by cold precipitation.
5. What are the uses of the antihemophilic factor VIII?
   1. This is used in the case of hemophilia A (congenital factor VIII deficiency).
   2. In the cases of acquired factor VIII inhibitors.

Platelet-rich plasma or platelet concentrate:

1. Platelet-rich plasma concentrate can be stored at room temperature for up to 72 hours with constant agitation.
2. What is the Effect of storage?
   1.  With time, there is a progressive decrease in hemostatic efficiency.
   2. After 72 hours, the pH falls to 6.0, at which point the platelets’ hemostatic activity is lost or decreased.
   3. Now, plastic bags (O2-diffusible) are available, allowing platelet activity to remain for 5 days.
3. What are the uses of platelet concentrate?
   1. It is used to treat or prevent thrombocytopenia.
   2. These are used to treat bleeding disorders due to platelet functional disorders.

What are the Blood components and their indications?