DONOR SCREENING AND

COMPONENT
PREPARATION

CHAPTER 13
 PRE-TEST
• 1. An allogeneic blood donor must
weigh at least_______
• 2. The pulse rate of potential blood
donor should be between
____________
• 3. The hemoglobin/hematocrit of an
allogeneic blood donor should be
_____
 PRE-TEST
• 4. Deferral period for persons who have
been treated with malaria following
therapy
• 5. Persons who had blood transfusions
must be deferred for _____
• 6. Leukocyte reduced RBC must contain
an absolute leukocyte count of ________
• 7. Single donor platelet must contain
____platelets
 PRE-TEST
• 8. FFP shelf life at -18°C
• 9. Cryoprecipitate were prepared from
which blood component? PRBC, FFP,
Platelet concentrate
• 10. One random-donor platelets can
increase a platelet count in 70 kg adult by
________
 BLOOD DONATION
• Voluntary collection of blood for blood
transfusion of whole blood or its
component
• To ensure the safety of the donor and
recipient
– For the donor- blood donation procedure
– Recipient- blood is not infectious
 GOVERNING AGENCIES
• U.S Food and Drug Administration
– Blood is regarded as biologic and drug
– CBER (Center for Biologics Evaluation and Research)
was formed
• Regulating the collection of blood and blood
components used for transfusionand for the
manufacture of pharmaceuticals derived from blood
and blood components
• AABB international association of blood centers,
transfusion and transplantaion services
• DOH provide inspection and accreditation
 DONOR SCREENING
• Medical history of the donor
• Mini physical examination of the donor
• Serological testing of the donor blood
• First 2 are designed to answer 2 questions
– 1. Will a donation of approximately 450 mL of
whole blood at this time be harmful to the donor
– 2. Could blood drawn from this donor at this time
potentially transmit a disease to the recipient
 REGISTRATION
• Confirmation of donor identity and linking the donor to
existing donor records
• Requiring the donor to have at least 2 photographic
identification
• Name, Date and time of donation, Address, Telephone
number, Gender
• Age or date of birth = 16 or 17 years old
• Consent to donate = inform the donor about the
procedure and the potential risk
• Additional information like the recipient of the blood,
race of the donor for unique phenotype, and CMV
status
 MEDICAL HISTORY
QUESTIONNAIRE
• Essential to ensure protection of the donor and
benefit to the recipient
• Can be self-administered by the donor or maybe
administered by a trained donor historian
• If self administered must be reviewed by the
trained personnel in a secluded area
• The interviewer must be familiar with the
questions
• Designed to answer yes or no and can be
elaborated if needed
 MEDICAL HISTORY
QUESTIONS
• 1. Are you feeling healthy and well today?
– No sign and symptoms of colds, flu or other
illness
• 2. Are you currently taking an antibiotic or taking
any medication for an infection?
– 14 days deferral if taking any antibiotics or until
the prescribed antibiotic regimen completed or
the infection cleared up
– 7 days if undergone dental surgery or tooth
extraction
– If tetracycline is used for treating acne acceptable
for blood donation
MEDICATION DEFERRAL LIST
• Deferral for 1 month
– Proscar for prostate enlargement
– Propecia for baldness
– Accutane for severe acne
• Deferral for six months
– Avodart prostate enlargement
• Deferral for 3 years
– Soroiatane for severe Psoriasis
• Permanent deferral
– Tegison for severe Psoriasis
– Growth hormone from human pituitary glands
 MEDICATION DEFERRAL LIST
• Indefinite
– Insulin from cows- Mad Cow’s Disease
• 12 months
– Hepatitis Immune Globulin
– Experimental medication or unlicensed vaccine
• 2 days
– Feldene non steroidal anti-inflammatory drugs if for
platelet pheresis, if whole blood not deferred
• 14 days
– Plavix and Ticlid reduce chance of heart attack or
stroke
– 14 days for platelet, no deferral for whole blood
 MEDICAL HISTORY
QUESTIONS
• Have you read the educational material?
• In past 48 hours have you taken aspirin or
anything with aspirin? – 3 days if for platelet
donation
• In the past 6 weeks have you been pregnant?
– 6 weeks deferral after termination of pregnancy
– 12 months if received blood transfusion during
pregnancy
– For first or second trimester miscarriage or
abortion no deferral
– For WHO abortion deferral for 6 months
 In the past 8 weeks
• Donated blood, platelets or plasma
– Donors participated in apheresis donation deferral for 48
hours
– Infrequent plasma pheresis 4 weeks deferral
– 16 weeks for double unit of red cells using apheresis
• Had any vaccinations or shots
– 2 weeks for live attenuated or bacterial vaccine such as
measles, mumps, oral polio, typhoid
– 4 weeks for live attenuated German measles or chicken
pox
– No deferral for killed or toxoids or synthetic viral,
bacterial and rickettsial vaccines ( diptheria, Hepatitis A,
hepatitis B, influenza
– 21 days for small pox vaccine
 12 months deferral
• Had blood transfusion, transplant of organ, tissue,
bone marrow, or graft such as bone and skin
• Come in contact with someone else’s blood,
needle stick injury, had a tattoo, had ear or body
piercing
• Had a sexual contact with anyone who has
HIV/AIDS or had a positive test for HIV/AIDS
• Had a sexual contact with prostitute or anyone else
who takes money or drugs or other payment for
sex
 12 MONTHS DEFERRAL
• Had sex with anyone who has ever use a needle to
take drugs or steroids or anything not prescribed by
doctors
• Had sex with anyone who has hemophilia or has
used clotting factor concentrates
• For female donor, had sexual contact with a male
who has a sexual contact to another male
• Had a sexual contact with a person who has
hepatitis, living with a person who has hepatitis
• Treated for syphilis or gonorrhea
– T.pallidum may live for 1-5 days in cold storage
In juvenile detention, lock up or prison for more
than 72 hours
In the Past 3 Years Outside the
US or Canada
• Malaria- I year from departure in endemic
area according to CDC (travellers)
– 3 years for immigrants; refugees, citizens or
live there for 5 consecutive years
• CJD and vCJD- transmissible spongiform
encephalopathies or prion disease
• Leishmaniasis- endemic in Middle East,
Mediterranean coast, Africa, Central and
South America and Asia
 INDEFINITE
• Positive for HIV/AIDS
• Used needles to take drugs, steroids or anything not
prescribed by doctors
• Positive for HCV
• Positive for HBV- after 11th birthday
• Had Chagas disease or American trypanosomiasis
– Endemic in Central and South America and Mexico
• Had Babesiosis- Babesia microti-vector Ixodes
scapularis –incubation oeriod 2-8 weeks
• graft
 INDEFINITE
• Receive dura mater
• Had cancer, leukemia, SLE,
• Had any problems of the heart and lungs
• Had a bleeding condition or blood disease
• Been in Africa or had a sexual contact who
was born or lived in Africa
 Other deferral
• Malaria for positive 3 years after complete
treatment; travel to endemic area 12 months
• Dengue and Chikungunya 6 months after
recovery; 28 days after returning from endemic
area
• Tuberculosis 2 years after recovery
• Hepatitis A and E 12 months after recovery
• WN virus deferral for 6 months after recovery
• Brucellosis deferred permanently
 TYPES OF DEFERRAL
• Temporary
– Unable to donate blood for a limited period of
time
• Indefinite
– Unspecified period due to current regulatory
requirements
• Permanent
– Never eligible to donate for others
 Physical Examination
• General appearance
• Weight = 53 kgs or 115 lbs/ 50 kg/110 lbs
• Temperature = less than or equal to 37°C or
99.5°F
• Pulse rate= 50-100 bpm
• BP = systolic 90-140 mmHg; diastolic 60-
100mmHg
• Hemoglobin not less than 12.5 g/dl
– For autologous 11g/dL
• Skin lesion
 Adjusted volume of blood
• Volume to collect= donor’s weight in kg/50
X 450 ml
• Reduced volume of anticoagulant
– Volume to collect/450 X 63
• Amount of solution to be removed
– 63- reduced volume of anticoagulant
WHOLE BLOOD COLLECTION
• Donor Identification = alpha numeric or numeric
system to linked the donor record to pilot tube, blood
container and all components made from original
collection
• Aseptic Technique scrub the site of puncture from
center to outward (4 cm) for 30 seconds
• Collection Procedure
• Post donation instructions
• Donor Reactions
WHOLE BLOOD COLLECTION
PROCEDURE
• 1. Identify the donor, make him/her comfortable
• 2. Using a tourniquet select a large, firm vein in the
antecubital fossa space that is free from lesion or
scarring , inspect both arms
• 3. Prepare the site using povidone iodine, when
finished cover the site with sterile gauze
• 4. Inspects the blood bags for any defects and
discoloration
• 5. Ensure the balance system is adjusted to the
volume being withdrawn ensure the counterbalance
is level. Place hemostats on the tubing to prevent
the air from entering the line
 cont
• 6 Reapply the tourniquet to increases vein distention
• 7. Remove the gauze , perform the venipuncture,
check the position of the needle, tape the tubing to
the donor’s arm to hold the needle in place. Cover
with sterile gauze
• 8. Release the hemostat and ask the donor to open
and close the hand for every 10-12 seconds during
collection procedure
• 9. Monitor the donor througout the entire collection
process. The donor should not be left unattended.
Mix blood and anticoagulants for every 45 seconds
during the procedure
 Cont.
• 10. When the primary bag tipped the scale, the
donor can stop close and open, clamped the tubing
with hemostat. A unit contatining 405 to 550 ml it
should weigh 429 to 583 g ( 1.06g/ml). If low volume
is collected label the unit “low volume unit” cannot
be used for FFP inadequate clotting factors
• 11. Before removing the needle in the donors arm
pilot tubes are filled
• 12. Remove the needle, apply pressure over the
puncture site, and ask the donor to raise his arm
continuing to exert pressure. When the bleeding
stopped the donor can lower his arm and bandage
 cont
• 13. Discard the assembly needle in
appropriate biohazard receptacle. Stripped
the tubing to allow mixing of blood and
anticoagulants
• 14. Heat seal the filled tubing, and apply
appropriate identification to one segment
and detach it to the main blood bag for
storage. Place the blood at appropriate
temperature
 POSTDONATIONS
INSTRUCTIONS
• 1. Contact the blood center if any illness arises after
blood donations, if you developed a fever or if you
become diagnosed with West Nile Virus infection
and if you have a question about your donation or if
you remember any medical or personal therapy
• 2. Do not smoke for one-half hour
• 3. Eat and drink before leaving
• 4. Do not leave until released by the donor
technician
• 5. Drink fluids than usual in the next 4 hours,
especially fruit juices
 cont
• 6. Leave the bandage for a few hours, and then
you may remove, if there is any bleeding on the
puncture site raise arm and apply direct
pressure
• 7. If you feel faint or dizzy, lie down or sit down
with head between the knees
• 8. Do not perform strenuous activities or engage
in critical work
• 9. If any symptoms persist return to blood center
or see your doctor
 DONOR REACTIONS
• Mild reactions
• Moderate reactions
• Severe Reactions
• Hematomas
MILD REACTIONS
• Syncope or fainting, nausea or vomiting,
hyperventilation, twitching, and muscle
spasm.
• Sweating, pallor, dizziness or convulsions
• Syncope: Remove the tourniquet and
withdraw the needle, place a cold
compress on the donor’s forehead, raise
the donor’s legs above the level of the
head, loosen tight clothing and secure
airway and monitor vital signs
MILD REACTIONS
• Muscle spasm or twitching- have a
conversation to the donor, ask the donor
to breath in paper bag (hyperventilation)
• Nauseated/vomiting
– Instruct the donor breath slowly
– Apply cold compress to forehead
– Turn the donor’s head on one side and
provide an appropriate receptacle
– The donor may be given water after vomiting
has ceased
 MODERATE REACTIONS
• Any mild reactions with decrease pulse
rate, may hyperventilate and may exhibit a
fall of systolic pressure to 60 mmHg
• Check vital signs frequently
• Administer 95% oxygen and 5% carbon
dioxide
 SEVERE REACTIONS
• Convulsions- cerebral ischemia, marked
hyperventilation, or epilepsy
– Cerebral ischemia- vasovagal
syncope/reduced blood flow to the brain
– Marked hyperventilation- marked depletion of
carbon dioxide
• Call for help; notify blood bank physician
• Try and restrain the donor to prevent injury
to self or to others
• Ensure an adequate airway
 HEMATOMA
• Localized collection of blood under the
skin, resulting in bluish of the skin
• Needle going through the vein with
subsequent leakage of blood into the
tissue
• Remove the tourniquet and needle from
donor’s arm, apply pressure with sterile
gauze pads for 7-10 minutes with the
donor raising his arm above the heart,
apply ice to the area for 5 minutes
 DONOR RECORDS
• Must be retained by blood collection
facility for a period of 5 to 10 years
– Donor ABO/Rh
– Donor antibody screen
– Informed consent
– Physical examination
– Medical history information
– Identification number of donor
– Viral marker testing results
– Quarantine of donor unit
 DONOR PROCESSING
• ABO/Rh Malaria
• Antibody screen Platelet bacterial
• HBsAg detection
• Anti-HBc
• Anti-HCV and NAT
• Anti-HIV 1/2 and NAT
• Anti-HTLV I/II
• WNV RNA
• Syphilis
• T. cruzi
COMPONENT PREPARATION
 WHOLE BLOOD
• Contains RBC and plasma
• Approximately hematocrit is 38%
• Provide oxygen carrying capacity and volume
expansion
• Rarely used for transfusion except in autologous
• Platelets, WBC and labile factors rarely survive
during storage
• Can be irradiated to inhibit T-cell proliferation;
decreases the shelf life to 28 days
 IRRADIATION
• Dose is 25 Gy delivered at the cenetr of
the container and 15 Gy at any other point
of the container
• Celsium-137 or cobalt 60
• Stored at 1 to 6 °C for 28 days
 RED BLOOD CELLS
• Prepared from whole blood by sedimentation or
centrifugation
• Can be prepared anytime, except when needed
for other components as soon as blood donation
(within 8 hours of blood collection)
• Final volume is 165-275 mL (65 to 80% HCT)
– 50-80 g hemoglobin
– If CPD A1- 200-250 ml of plasma can be removed
• Used for increasing the RBC mass and oxygen
carrying capacity
• Prevent circulatory overload and cardiac failure
in patient with anemia
 RBC PRODUCTION USING
CENTRIFUGATION
1. Weigh and balance each unit
2. Load the unit into swinging bucket, make sure each unit is
balance
3. Centrifuge using heavy spin (5,000x g for 5 minutes in
refrigerated centrifuge). If also preparing for platelet
concentrates, initial spin is 3,200 rpm for 2-3 minutes
4. After centrifugation, express the plasma approximately 230
to 256. If additive is to be added remove all the plasma
5. Sealed the tubing. Stored at 4°C. The plasma is stored
depending on the product desired
6. Quality control on the hematocrit level is performed monthly.
75% of the samples must yield hematocrit of 80% or less
RBC ALIQUOTS
• Neonatal transfusion or infant less than 4
months old requiring transfusion
• Indication: anemia, or internal hemmorhage
• 10-25 ml
• Multi-pack system or a quad pack; original
outdate (close system)
• Syringe- 24 hours at 1-6°C
• CPD-A1 is the anticoagulant of choice
• Additive can be added except in exchange
transfusion
 RBC IRRADIATED
• For immunocompromised, receiving bone
marrow or stem cells transplant
• For intrauterine transfusions
• Blood from the relatives
• Prevent T-cells proliferation and subsequent
transfusion-associated graft versus host disease
(GVHD)
• Minimum doses of gamma irradiation 25Gy in
the center and 15% in the other parts of the
blood unit
• 28 days shelf life from the time of irradiation
RBCs LEUKOREDUCED
• Reduced WBC to 5x106 and 85% of the rbc
original mass
• Same as CPD-A1 shelf life- close system
• 24 hours open system
• Prevent febrile transfusion reaction
• Increase oxygen carrying capacity
• Prestorage – 99.9 % removal of leukocyte
• Poststorage- remove before issuing the blood or
at bedside
• Random-donor platelet cannot be performed
 PRESTORAGE
LEUKOREDUCTION
• Three methods
– An in-line filter attached to whole blood and
filtered via gravity (RBC and plasma)
– Plasma is removed then the packed cells are
passed through an in-line reduction filter
(random donor cannot be prepared)
– Sterile docking device attached a leukocyte
reduction filter to a unit of RBC
 LEUKOREDUCED RBC
• Centrifugation can reduced the leukocyte
by 5 x108 that can prevent febrile
hemolytic reactions
• Filter- 5x106
• Thawed RBC, frozen, deglycerolized can
reduced leukocyte
• Buffy coat removal- 1.9 x106
 FROZEN,DEGLYCEROLIZED
RBCs
• 10 years shelf life
• For rare phenotype, autologous transfusion and for
military used
• When thawed and glycerolized transfused within 24
hours
• Free leukocytes, platelets and plasma
• Used for patient with PNH and IgA deficiency
• With cryoprotective agent
– Penetrating agent (glycerol)
– Non-penetrating agent- HES and dimethylsulfoxide
 FROZEN DEGLYCEROLIZED
• High-glycerol (40% wt/vol)
– Initial freezing temp = -80°C
– Uncontrolled freezing rate
– Mechanical freezer
– Shipping requirements dry ice
– Maximum storage -65°C
• Low-glycerol (20% wt/vol)
– Initial freezing temp = -196°C
– Controlled freezing rate
– Liquid nitrogen - Freezer
– Shipping requirements liquid nitrogen
– Maximum storage -120°C
STEPS IN FREEZING RED CELLS
USING HIGH GLYCEROL
• Preparation
– Weigh the RBC
– Adjust to 260-400g 0.9% NaCl
– Prewarm RBC and glycerol at 25°C
– Set glycerol bottles in a water bath for 15 min
at 25-37°C
– Label the freezing bag with name of facility,
whole blood unit#s, ABO, Rh, date collected,
date frozen, cryoprotective agent, expiration
and red blood cells frozen
 Glycerolization
• Place cells on the shaker and add 100 ml
of glycerol
• Stop agitation and allow cells to equilibrate
5-30 mins
• Let partially glycerolized cells flow into
freezing bag; slowly add glycerol
• Maintain glycerolized cells at 24-32°C until
ready to freeze (not exceed for 4 hours)
• Freeze ≤65°C
 Deglycerolization
• Thawed for 30 minutes by immersing the units in
37°C waterbath
• Deglycerolize cells using a continuous flow
washer
• Wash the rbc with decreasing osmolarity (12%,
1.6%, 0.9% NaCl, + 0.2% dextrose
• Except in donor with sickle cell trait that will
hemolysed RBC upon suspension in hypertonic
solutions, omit 1.6%
• Stored at 1-6°C – 24 hours shelf life
 PLATELET CONCENTRATES
• 5 days shelf life with continuous agitation
either by random-donor platelets (WBD) at
20-24°C or by single-donor platelets
(apheresis) at 22-24°C
• Random donor contains 5.5x1010 platelets
with plasma of 40 to 70 mL to yield pH of
greater than or equal to 6.2. Requires
bacterial detection method
• Single-donor contains 3X1011 platelets (4
to 6 times of random-donor platelets)
300 mL plasma
 PLATELET CONCENTRATE
• Indication
– Actively bleeding with thrombocytopenia
– Preoperative thrombocytopenia
– Single- donor best for patient unresponsive to
random donor due to HLA
• Prepared from whole blood- must be
prepared within 4 hours after collection
• Irradiation can be done if HLA matched
 QC for Platelet Concentrate
• Platelet count
– 5.5 x1010 random donor, 3x1011 single donor
• pH - ≥ 6.2
• Volume 40-70 ml
• Detection or inactivate bacterial
contamination
 Preparing Random- Donor
Platelets from Whole Blood
• Maintain the WB at 20-24°C
• Set the centrifuge temperature at 22°C
• Short spin (2-3 min); light spin (3200 rpm)
• Should be done in close, multibag system
• Express platelet-rich plasma. 70% to 80% Hct
level must be maintain in the RBC bag
• Recentrifuge platelet rich plasma heavy spin
(3,600 rpm) 5 mins. Separate platelets from
plasma
• Express the majority of the plasma in the second
satellite bag, leaving 50 to 70 ml on the platelets
 Preparing Random- Donor
Platelets from Whole Blood
• Seal the tubing, make segments.
• Allow the platelets to rest for 1-2 hours at
20-24°C or until all platelet clumps have
been resuspended
• Once rested place in agitator
• Shelf life -5 days closed system
• 6 hours-open system
• 6-8 units of platelet concentrate- pooled
plasma
 PLATELET ALIQUOTS
• For neonatal transfusion, prepared from
single-donor
• Use of sterile docked connected quad bag
• Platelets count below 50,000/uL and
experiencing bleeding
 Preparation of Platelet Aliquots
for Neonates
• Select a unit. Either AB or group specific should
be selected
• For volume reduced centrifuge and removed the
plasma. Don’t disturb the platelets for 20-60
minutes at RT
• If platelets are shipped, rotate for 30 minutes at
RT following volume reduction
• Syringe is used with stopcock
• Label, indicate the volume
• 4 hours –shelf life
PLATELETS LEUKOREDUCED
• Prevent febrile non-hemolytic reactions
• Random-donor platelets can be used,
leukocytes must be less than 8.3 x105
• Single-donor must contain leukocytes less
than 5x 106
• Leukoreduction filter designed for platelets
 SINGLE DONOR PLASMA
• Fresh Frozen Plasma(FPP)
– Frozen within 8 hours after collection if CPD,CP2D or
CPDA-1, 6 hours if ACD
– Stored at -18°C for 1 year, -65°C for 7 years
– Contains both labile and stable clotting factors
• Plasma Frozen within 24 Hours (PF24)
– Frozen within 8 to 24 hours after collection, stored at -
18°C
– Contains stable factors, normal level of factor V, reduced
level factor VIII
• Plasma Cryo-precipitate reduced (cryo-poor plasma)
– Prepared after thawing the FFP, contains Factor II, V, VII, IX,X,XI
albumin , ADAMTS13 used in patients with TTP , cannot be a substitute
for FFP or PF24
 FFP/PF24
• Once thawed at temperature between 30 to
37°C stored for 24 hours at 1 to 6°C
• If not used within 24 hours change the label to
thawed plasma and can be stored for 5 days
• From WB collection must contain 150 to 250 ml
of plasma contains 400 mg of fibrinogen and 1
unit of activity/ml of clotting factors
• Apheresis contains 400 to 600 ml
 Indications for FFP/PF24
• Actively bleeding
• Multiple clotting factor deficiency
• Used in patient under warfarin when there is no
time to reverse it with Vitamin K
• For plasma exchange and transfusion in patient
with TTP
• Contraindicated if known or specific coagulation
disorder
• Not to be used as plasma expander
 Preparation of Plasma from
Whole Blood
• Maintain the WB at 20-24°C
• Set the centrifuge temperature at 22°C
• Short spin (2-3 min); light spin (3200 rpm)
• Should be done in close, multibag system
• Express platelet-rich plasma. 70% to 80% Hct
level must be maintain in the RBC bag
• Recentrifuge platelet rich plasma heavy spin
(3,600 rpm) 5 mins. Separate platelets from
plasma
• Place plasma in protective container and freeze
 Preparation of Plasma
• Must be frozen solid within 8 hours or 24
hours
• Shelf life- 12 months at -18°C
 THAWED PLASMA AND
LIQUID PLASMA
• Thawed Plasm°Ca
– Contains stable factor such as fibrinogen and
prothrombin
– Prepared from FFP and PF24 thawed at 30 to 37°C
and maintained at 1°C to° 6°C for 4 days

– Used to convert FFP and PF24 to prevent out date

• Liquid Plasma
– Before 5 days after expiration date of whole blood
– Stored at 1°C to 6°C 5 days after expiration of whole
blood
– Massive transfusion with concurrent coagulation
deficiencies
 CRYOPRECIPITATED
ANTIHEMOPHILIC FACTOR
• Cold precipitated concentrations of factor VIII
(antihemophilic factor)
• Prepared from FFP slowly thawed at 1°C to 6°C
• From single whole blood unit collected with
CPD-A1 or CPD
• 12 months shelf life frozen state
• 6 hours after thawing at room temp until
transfused
• Treatment of Factor XIII def. , fibrinogen source,
secondary treatment for Hemophilia A
 Cryoprecipitate
• Contains Factor VIII and part of fibrinogen
• Contains 80 units of AHF activity
• 150 mg of fibrinogen
• Thawed quickly at 37°C; stored at 22 to
24°C until transfused
 Indication of Cryoprecipitate
• Treatment of Factor XIII deficiency
• Source of fibrinogen
• Secondary treatment for classic
haemophilia and von Willebrand disease
 Preparation of Cryoprecipitate
• Venipuncture must not traumatic
• FFP then thawed slowly in refrigerator 1 to 6°C (14-16
hours). End point the plasma become slushy
• Centrifuge the plasma at 4°C hard spin
• Express the supernatant plasma
• Small white mass, leave 10-20 ml of plasma on the
precipitate
• Separate and refreeze cryoprecipitate must be within 1
hour
• Place in protective container
• Shelf life- 12 months at -18°C
 PLASMA DERIVATIVES
Prepared by manufacturers from pooled,
human source and recovered plasma
Than by recombinant DNA technology or
monoclonal antibody purification
 ACTIVATED FACTOR VII
(FACTOR VIIa)
• rFVIIa produced by recombinant DNA technology
• Treating patients with Hemophilia A but with
circulating antibodies against Factor VIII
• Patients with congenital Factor VII deficiency
• Used in massive transfusion, trauma, liver
transplantation and control bleeding like intracranial
bleeding
• Disadvantage increased risk of spontaneous
thrombosis and thromboemboli
• Expensive and should use with caution
 FACTOR VIII
CONCENTRATES
• Treat Hemophilia A replacing cryoprecipitate
completely
• Prepared from recombinant DNA technology or
pooled plasma(must be treated to prevent viral
contamination)
• Porcine Factor VIII made from porcine plasma
treat Hemophilia A in patients with antibodies to
human Factor VIII
• Recombinant Factor VIII
– human Factor VIII injected in baby hamster kidney
cell
FACTOR IX CONCENTRATES
• 3 FORMS
– Prothrombin complex concentrates
• Contains vit K dependent factors (II,VII,IX,X)
• Pooled plasma absorbed by barium sulfate or
aluminum hydroxide
– Factor IX concentrates
• Formed by monoclonal purification
• Contains 20-30% FIX, stored in refrigerator in
lyophilized form
– Recombinant FIX
• produced in Chinese hamster ovary cells
 FACTOR XIII
CONCENTRATES
• To treat Factor XIII deficiency
– Factor XIII is severe autosomal recessive
bleeding disorder associated with neonatal
hemorrhage and lifelong bleeding diathesis
Available in USA, JAPAN Europe
In UK named patient basis only
 IMMUNE SERUM GLOBULIN
• Concentrate of plasma globulins in an aqueous
solution
• Prepared from pooled plasma fractionation
• Either IM or IV preparations
• Half life of 18-32 days
• Indicated for patients with immunodeficiency
diseases, passive antibody prophylaxis against
hepatitis and herpes, ITP, Post transfusion
purpura, HIV related thrombocytopenia and
neonatal alloimmune thrombocytopenia
• Not to be used with IgA deficiency or with
anaphylactic reactions to IgA
 NORMAL SERUM ALBUMIN
(NSA)
• From salvaged plasma, pooled and fractionated
by cold alcohol process, then treated with heat
inactivation (60°C for 10 hours)
• 96% albumin 4% globulin
• Available in 25% or 5%
• Indicated in hypovolemic and hypoproteinemic
shock and burns
• 25% contraindicated in dehydration unless
followed by Normal saline
PLASMA PROTEIN FRACTION
• Same as NSA, contains 83% Albumin and
17% globulins
• 5% is available used in conjunction with
NSA
• Not to be used in cardiopulmonary bypass
procedures
• Stored same as NSA 5 years at 2°C to
10°C
 Rh0 (D) IMMUNE GLOBULIN
• Concentrated anti-D
• Use to treat ITP and prevention of Rh
HDN
• 50 ug dosage at the first 12 weeks of
pregnancy, followed by 300ug (full dose)
after 12 weeks, 120 ug after 34 weeks
 SYNTHETIC VOLUME
EXPANDERS
• Crystalloids- use in burn patients
– Ringer’s lactate- Na, Cl, K, Ca and lactate
ions
– Normal isotonic saline
• Colloids- volume expanders in
hemorrhagic shock and burn patients
– Dextran in 6 and 10% half life 6 hours
– HES 6% half life more than 24 hours
 ANTITHROMBIN III
CONCENTRATES
• AT use to treat patients with anti-thrombin
deficiency in connection with surgical and
obstetrical procedures and those suffering
from thromboembolism
• Inhibitor of Factors IX, X, XII,XI and
thrombin