Transfusion Therapy and Blood Components: Indications and Use

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Transfusion Therapy and Blood Components
Indications and Use

• C. J. Julius, M.D.
• Staff Pathologist
• St. Elizabeth Health Center
• Youngstown, Ohio
• Assistant Professor of Pathology
• Northeastern Ohio Universities College of
  Medicine
• Rootstown, Ohio

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EXPERT

• One who travels more than 50 miles with slides
  ercomputer disk
• A former pert
• Someone who travels (by phone) more than 50 miles
  for a talk
• One who imparts knowledge/educates
• ALL OF THE ABOVE

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INTRODUCTION

• PATIENTS HAVE GREATLY BENEFITED FROM COMPONENT
  THERAPY SINCE ITS INTRODUCTION IN THE
  1950S-1960S
• THIS THERAPY INVOLVES ADMINISTERING ONLY THE
  COMPONENT NEEDED
• THIS THERAPY INVOLVES THE MINIMUM FOR THE
  MAXIMUM

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INTRODUCTION

• PHYSICIANS SHOULD HAVE A GENERAL KNOWLEDGE OF
  BLOOD GROUPS AND ANTIGENS, PRE-TRANSFUSION
  TESTING, BLOOD COMPONENTS, AND COMPLICATIONS OF
  BLOOD TRANSFUSION

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BLOOD COMPONENT THERAPY

• Whole Blood
• Red Blood Cells
• Leukocyte-Reduced
• Washed
• Frozen, Deglycerolized
• Platelets
• Plateletpheresis
• Platelet concentrates
• Granulocytes

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BLOOD COMPONENT THERAPY

• Fresh frozen plasma
• Solvent Detergent
• Liquid Plasma
• Cryoprecipitate
• Other Issues
• Irradiation
• Filtration
• CMV
• Donors and donor issues

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BLOOD COMPONENT THERAPY

• What? (Definition)
• How? (Prepared)
• When? (Prepared)
• When? (Stored)
• When? (Guidelines, AABB Standards)
• Why? (Response Patient Response)
• AABB (New)
• Nuances

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BLOOD COMPONENT THERAPY

• COMPONENTS
• PREPARATION
• CHARACTERISTICS
• INDICATIONS
• CONTRAINDICATIONS
• SIDE EFFECTS
• MONITORS
• MANIPULATIONS
• NEW (AABB)

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WHOLE BLOOD

• Composition RBC,plasma,WBC,platelets
• 500 ml
• ACD/CPD/CP2D 21 Days
• CPDA-1 35 days
• 1-6 C Storage
• 1-10 C Transport
• 1.4 ml solution to 10 ml blood

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WHOLE BLOOD

• Donor-specific transfusions, trauma, increase
  both RBC Mass and plasma volume (WBC and
  platelets NOT functional plasma deficient in
  labile clotting factors V, VIII)
• 3-5 increase in HCT 1-3 gm/dl increase in HGB
• AABB NEWFiltrationIrradiation
• NuancesType for type Type-specific

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RED BLOOD CELLS
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RED BLOOD CELLS (PREPARATION)

• CENTRIFUGAL FORCE OR GRAVITATIONAL SEPARATION
• CENTRIFUGATION (5 C)
• GRAVITATIONAL

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RED BLOOD CELLS (CHARACTERISTICS)

• AS-1 (300-350 ML)/HCT .60 (About)
• CPDA-1 AND CPD (MANIPULATION DEPENDENT)/HCT lt.80
• STORAGE 1-6 C
• AS-1 42 DAYS
• CPDA-1 35 DAYS
• CPD 21 DAYS

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RED BLOOD CELLS (CHARACTERISTICS)

• RBC reduced plasmaWBC
• 250 ml - packed CPDA-1 350 AS-1
• CPDA-1, AS-1 (less plasma)
• ACD/CPD/CP2D 21 days CPDA-135 days AS-142
  days
• 1-6 C Storage
• 1-10 C Transport

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RED BLOOD CELLS (INDICATIONS)

• SYMPTOMATIC DEFICIT OF OXYGEN-CARRYING CAPACITY
• Chronic 6.0 or 7.0 gm/dl Acute or ill (COPD) 9.0
  gm/dl, cardiopulmonary complications, ICU
  patients 9.0 gm/dl
• EXCHANGE TRANSFUSION
• TO RESTORE RBC MASS IN SYMPTOMATIC ANEMIA (NOT
  TREATED BY HEMATINIC THERAPY)

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RED BLOOD CELLS (CONTRAINDICATIONS)

• USE AS A VOLUME EXPANDER
• AS AN ALTERNATIVE TO HEMATINIC THERAPY
• WHEN NO SYMPTOMS ARE PRESENT
• LOOK GOOD ON PAPER
• TWO UNIT MARTINI

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RED BLOOD CELLS (SIDE EFFECTS)

• DISEASE TRANSMISSION
• BACTEREMIA (Beware the autologous unit)
• TRANFUSION REACTIONS (Besides bloody platelets
  and granulocytes - the only crossmatched
  component)

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RED BLOOD CELLS (MONITORS)

• HEMOGLOBIN AND HEMATOCRIT LEVELS
• CAVEATS
• 10 GM/L INCREASE AND .03 HCT INCREASE
• EFFECTS OF VOLUME STATUS AND FLUID REPLACEMENT
• LAG PERIODS FLUID EQUILIBRATION Not
  necessarily in the volume-replete!
• CLINICAL ASSESSMENT ABOVE ALL!
• One unit is O.K.!

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Red Blood Cells

• Wiesen, AR et al. Equilibration of Hemoglobin
  Concentration after Transfusion in Medical
  Inpatients Not Actively Bleeding. ANN INTERN MED
  121, No. 4, p. 278, 1994
• As early as 15 minutes post transfusion
• Hemoglobin equilibration after 15 minutes is
  virtually identical to 24 hour level in
  non-bleeding patients
• VOLUME REPLETE

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RED BLOOD CELLS (MANIPULATIONS)

• LEUKOCYTES REDUCED
• PRE OR POST STORAGE (85 RBCs)
• LEVELS lt 5 X 106 PER UNIT
• MOST FILTERS (3RD AND 4TH GENERATION) GUARANTEE
  LESS RED BLOOD CELLS (MANIPULATIONS)
• DEGLYCEROLIZED (gt80 RBCs)
• STORAGE 10 YEARS OR LONGER/Can RE-glycerolize -
  NOT a usual protocol
• WASHED (Almost ALL plasma removed)
• REJUVENATED RED CELL (lt3days exp)

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RED BLOOD CELLS (MANIPULATIONS)

• LEUKOCYTES
• FEBRILE REACTIONS
• HLA SENSITIZATION
• CMV TRANSMISSION
• DEGLYCEROLIZED
• POOR PERSONS LEUKOREDUCTION/ACTUALLY RICH
  PERSONS
• RARE BLOOD TYPES
• IGA DEFICIENCY (NOT)
• PNH (NOT)

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RED BLOOD CELLS (MANIPULATIONS)

• WASHED
• IGA DEFICIENCY
• PNH (NOT)
• REJUVENATED
• INOSINE, PYRUVATE - PRIOR TO FREEZING OR
  TRANSFUSION
• SALVAGE (AUTOLOGOUS)

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RED BLOOD CELLS (MANIPULATIONS)

• Leukocyte-reduced Pre-storage, post-storage,
  bedside 4th generation leukodepletion filter lt5
  X 106
• CMV
• HLA
• Transfusion reactions to WBC antigens
• Current debate (ALL OR SOME OF THE UNITS?)
• Washed - IgA deficiency

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RED BLOOD CELLS (MANIPULATIONS)

• Deglycerolized - IgA deficiency (Rich mans
  version)
• Rare donor registry (FROZEN BLOOD -without
  additive (lt6 days from collection) with additive
  (prior to the expiration date of the Red blood
  cells with rejuvenation (no later than 3 days
  after expiration)

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RED BLOOD CELLS (NEW)

• AABB NEW Apheresis Red blood cells - 180 ml
  packed RBC volume/unit, The donor of two-unit red
  cell apheresis collections shall meet specific
  HGB/HCT and weight requirements as outlined by
  FDA

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RED BLOOD CELLS (NEW)

• AABB NEW Low volume units - 300-404 ml (450
  /-45 ml)-No other components prepared
  Leukocyte-reduced - 85 original red blood
  cellslt 5 X 106 Irradiation - 2500 rads
• Nuances40 glycerol and 20 glycerol - 10 years

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PLATELETS
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PLATELETS (PREPARATION)

• PLATELET CONCENTRATES
• FROM WHOLE BLOOD DONATION
• LIGHT SPIN / 20-24 C
• HEAVY SPIN/ 20-24 C
• RESUSPENSION TIMES (1 HOUR)

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PLATELETS (PREPARATION)

• PLATELET PHERESIS UNIT
• ONE DONOR
• APHERESIS TECHNIQUES
• ONE UNIT COLLECTED

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PLATELETS (CHARACTERISTICS)

• PLATELET CONCENTRATES
• VOLUME 50-60 ML (PLASMA/ACD)
• PLATELETS gt5.5 X 1010/UNIT
• SHELF-LIFE 5 DAYS
• pH - gt6.2
• PLATELET PHERESIS UNIT
• VOLUME 200-300 ML (PLASMA/ACD)
• PLATELETS gt3 X 1011/UNIT Same for SPLITS
• SHELF-LIFE 5 DAYS

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PLATELETS (INDICATIONS)

• THROMBOCYTOPENIC BLEEDING
• THROMBOCYTOPATHY AND BLEEDING
• PROPHYLAXIS
• 50,000/UL TRIGGER (OPERATIVE)
• 20,000/UL TRIGGER (PROPHYLAXIS)
• 5,000/UL TRIGGER

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PLATELETS (CONTRAINDICATIONS)

• DO NOT USE IF BLEEDING UNRELATED TO PLATELET
  COUNT
• TTP, ? ITP

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PLATELETS (SIDE EFFECTS)

• DISEASE TRANSMISSION
• BACTEREMIA (5 VS. 7 DAY STORAGE)
• TRANSFUSION REACTIONS
• RBC ANTIGEN SENSITIZATION

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PLATELETS (MONITORS)

• 10 MINUTE, 15 MINUTE, OR 1 HOUR POST PLATELET
  COUNT
• HLA SENSITIZATION
• PLATELET ANTIBODY FORMATION
• CLINICAL ASSESSMENT
• Post platelet count-30-60,000/ul increase per
  single dose
• Refractory patients-HLA-, cross-matched yield
  better acute response/increment(s)

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PLATELETS (MANIPULATIONS)

• FILTRATION (lt 5 X 106 PER dose/pool/apheresis or
  lt8.3 X 105 platelet concentrate)
• BEDSIDE or MACHINE (HAEMONETICS)
• LEUKOCYTE-Reduced PRODUCTION
• COBE SPECTRA (PRODUCTION)
• PLASMA POORING
• INCOMPATIBLE PLASMA ISSUES
• HLA-MATCHED
• CROSS-MATCHED PLATELETS

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GRANULOCYTES
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GRANULOCTYES

• Theyre BACK!!!

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GRANULOCYTES (PREPARATION)

• Leukapheresis

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GRANULOCYTES (CHARACTERISTICS)

• gt 1.0 X 1010 granulocytes in at least 75 of
  units tested
• Also contain leukocytes, platelets and as many as
  25 ml of red cells in 200-300 ml of plasma
  depending on the collection procedure

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GRANULOCYTES (INDICATIONS)

• Severely neutropenic patients who have documented
  infection unresponsive to aggressive antibiotic
  therapy

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GRANULOCYTES (SIDE EFFECTS)

• Transfusion reactions

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GRANULOCYTES (MONITORING)

• Increased WBC count (GRANULOCYTES)
• Clinical symptoms controlled

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GRANULOCYTES (AABB-NEW)

• 20-24C storage and transport
• Expiration - 24 hours
• Irradiation - NO CHANGE in original expiration
  date

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GRANULOCYTES (NUANCES-DONORS)

• G-CSF being used for Harvest in apheresis donors
• Corticosteroids also used - Beware cataracts
  (long-term use in repeat/career donors)
• Ghodsi Z and Strauss R. Cataracts in neutrophil
  donors stimulated with adrenal corticosteroids
  TRANSFUSION 2001411464-1468.

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FRESH FROZEN PLASMA
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FRESH FROZEN PLASMA (PREPARATION)

• CENTRIFUGATION FROM WHOLE BLOOD (lt8 hours to
  -18C)
• SEDIMENTATION FROM WHOLE BLOOD
• SINGLE-DONOR PLASMA VS. FFP VS. PLASMA

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FRESH FROZEN PLASMA (CHARACTERISTICS)

• VOLUME - 180-300 ML
• STORAGE -18C OR LOWER (1 YEAR STORAGE)
• FREEZING TECHNIQUES TO DETECT THAW
• THAWED FOR INFUSION AT 37C

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FRESH FROZEN PLASMA (INDICATIONS)

• TREATMENT OF STABLE CLOTTING FACTOR DEFICIENCIES
  FOR WHICH NO CONCENTRATES ARE AVAILABLE
• WARFARIN REVERSAL (EMERGENT/BLEEDING)
• No magic dose (usual is 15-30 ml/kg) Only way
  to decrease the INR to 1.0 is ENDOGENOUS
  PRODUCTION Exogenous administration is only good
  for 6-8 hours

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FRESH FROZEN PLASMA (CONTRAINDICATIONS)

• VOLUME
• NUTRITION
• IMMUNOGLOBULIN THERAPY
• FACTOR CONCENTRATES

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FRESH FROZEN PLASMA (SIDE EFFECTS)

• DISEASE TRANSMISSION
• BACTEREMIA (RARE)
• TRANSFUSION REACTIONS
• VOLUME OVERLOAD

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FRESH FROZEN PLASMA (MONITORS)

• COAGULATION FACTORS
• PT, PTT-Mostly monitor PT-10-30 minutes after
  dosing (PEAK DRUG LEVEL)
• Factor VII (6 hour half-life) (shortest other
  than Protein C)
• NEVER can ATTAIN a PT of 1.0 INR EXOGENOUSLY!
• CLINICAL STATUS

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FRESH FROZEN PLASMA

• Low-dose vitamin K (1.0, 2.0, 5.0 mg), good liver
  function and 12 hours-the ONLY full correction
• FFP for immediate (as best as possible given the
  time and urgency) therapy for bleeding/surgery in
  the face of abnormal coagulation status
  (prolonged PT)

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FRESH FROZEN PLASMA (MANIPULATIONS)

• SHELF-LIFE AND NAME CHANGE
• -18C - 12 months
• -65C - 7 years

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PLASMA (MANIPULATIONS-AABB NEW)

• FFP, Thawed - 24 hours (37C) (Stored 1-6C)
• FFP, Thawed, open system - 24 hours
• Cryoprecipitate - reduced plasma - 12 months
• Cryoprecipitate- reduced plasma, thawed - 24 hours

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PLASMA (MANIPULATIONS-AABB NEW)

• Solvent-detergent - 24 months (Standard volume)
• SD- Thawed - 24 hours
• PLASMA lt24 hours - 12 months
• PLASMA lt24 hours, thawed - 24 hours or stored up
  to 5 days 1-6C

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PLASMA (MANIPULATIONS-AABB NEW)

• Liquid Plasma - Preparation and transfusion - 5
  days after expiration of the RBCs (1-6 C)
• OR PLASMA - if frozen (5 years after date of
  collection) FFP relabelled as PLASMA 4 years
  frozen storage

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PLASMA (MANIPULATIONS - AABB NEW)

• Thawed Plasma - 5 days (From FFP or lt24 hour
  plasma)
• FFP - donor retested - 90 days HOLD
• Recovered Plasma Source plasma (SINGLE-DONOR
  PLASMA)- plasmapheresis/ Recovered is from Plasma
  and Liquid plasma Sent for fractionation and
  further processing and treatment and manipulation

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CRYOPRECIPITATE
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CRYOPRECIPITATE (PREPARATION)

• FROM FRESH FROZEN PLASMA (UP TO ONE YEAR)
• THAW FFP AT 1-6C
• FROZEN AT -18C OR LOWER

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CRYOPRECIPITATE (CHARACTERISTICS)

• 15-20 ML OF PLASMA
• COLD-INSOLUBLE PRECIPITATE
• 1 YEAR STORAGE
• FACTOR VIII, FIBRINOGEN, FACTOR XIII,
  FIBRONECTIN, vON WILLEBRANDS FACTOR
• 80 U OF FACTOR VIII/UNIT and gt150 mg/dl FIBRINOGEN

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CRYOPRECIPITATE (INDICATIONS)

• CONTROL OF BLEEDING ASSOCIATED WITH
• FACTOR XIII DEFICIENCY
• vON WILLEBRANDS FACTOR DEFICIENCY
• SEVERE vON WILLEBRANDS DISEASE UNCONTROLLED BY
  OTHER MEANS INCLUDING EXOGENOUS FACTOR

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CRYOPRECIPITATE (INDICATIONS)

• FIBRINOGEN DEFICIENCY
• USUALLY DIC
• CONGENITAL DEFICIENCY STATES

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CRYOPRECIPITATE (CONTRAINDICATIONS)

• DO NOT USE THIS COMPONENT UNLESS LABORATORY
  RESULTS INDICATE A SPECIFIC HEMOSTATIC DEFECT FOR
  WHICH THIS PRODUCT IS INDICATED
• FACTOR VIII DEFICIENCY (AS ROUTINE
  THERAPYEXPLANATION)
• COAGULATION FACTOR REPLACEMENT

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CRYOPRECIPITATE (SIDE EFFECTS)

• DISEASE TRANSMISSION (POOLED COMPONENT)
• TRANSFUSION REACTIONS

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CRYOPRECIPITATE (MONITORS)

• FIBRINOGEN LEVEL/COAGULATION ASSAYS
• Increment30-60 mg/dl increase of Fibrinogen from
  starting level(s)
• PEAK level (10-30 minutes) after dosing-PEAK DRUG
  LEVEL
• CLINICAL ASSESSMENT

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CRYOPRECIPITATE (MANIPULATIONS)

• POOLED COMPONENTS (PRIOR TO STORAGE)
• 4 HOUR OUTDATE
• CRYO-(FIBRIN) GLUE - ONE UNIT CAN BE AUTOLOGOUS

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CRYOPRECIPTATE (AABB-NEW NUANCES)

• AB cryoprecipitate - highest Q.C. values for
  Factor VIII
• O cryoprecipiate - lowest Q.C.values for Factor
  VIII
• Howard PL et al -1990-1991 TRANSFUSION
  Fibrinogen levels are NOT affected with 1-6 C
  storage of thawed cryopreciptate - FUTURE effect
  on AABB Standards?

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COMPONENTS

• BLOOD AND BLOOD COMPONENTS ARE BIOLOGIC PRODUCTS
• BLOOD AND BLOOD COMPONENTS ARE DRUGS
• JUDGEMENT BASED ON CLINICAL EVALUATION DETERMINES
  THE SELECTION OF COMPONENTS, DOSAGE, THE RATE OF
  ADMINISTRATION, THE EVALUATION OF EFFICACY

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COMPONENT THERAPY

• MINIMUM FOR THE MAXIMUM EFFECT
• MANY SERVED/SAVED FROM ONE DONOR/DONATION
• 15 MILLION DONATIONS FROM 5 OF THE ELIGIBLE
  DONOR POPULATION
• NEED KNOWLEDGE OF PREPARATION, POTENCY,
  MONITORING, DOSAGE, EFFICACY, MANIPULATION,
  ALTERNATIVES

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THANK YOU ALL VERY MUCH
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CASES
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Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

91
Cases/Questions

• Which component is used for SEVERE TYPE 3 von
  Willebrand disease?

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Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

93
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

94
Cases/Questions

• Plasma is separated from a whole blood donation,
  frozen within 4 hours, kept for 1 year AFTER the
  donation, and is to be RE-labeled and stored
  frozen. What is it re-labeled as?

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Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

96
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

97
Cases/Questions

• The appropriate product for a patient with
  aplastic anemia (chronically transfused) awaiting
  bone marrow transplant?

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Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

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Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

100
Cases/Questions

• Product indicated for MILD hemophilia A patient?

101
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

102
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

103
Cases/Questions

• Type-specific ONLY is released from the blood
  bank for a given patient?

104
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

105
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

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Cases/Questions

• Can be used for TTP exchange transfusions BUT NOT
  von Willebrand Disease treatment?

107
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

108
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

109
Cases/Questions

• Patient requiring a RARE donor red blood cell
  unit would most likely receive this?

110
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

111
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

112
Cases/Questions

• Indicated for PNH patients?

113
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

114
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

115
Cases/Questions

• Which is which?
• Which plasma is allowed to be thawed and stored
  at 1-6 C for 24 hours without a name change?
• Which plasma component is kept thawed for 5 days
  at 1-6 C?

116
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

117
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

118
Cases/Questions

• Concentrate of Fibrinogen and Factor VIII?

119
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

120
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

121
Cases/Questions

• Indicated product for a patient with warfarin
  toxicity (Not bleeding) who is need of a catheter
  placement in 5 days?

122
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

123
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

124
Cases/Questions

• IgA deficiency patient in need of Red blood cell
  transfusion?

125
Cases

• Whole blood
• Red blood cells, washed
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

126
Cases

• Whole blood
• Red blood cells, washed
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

127
Cases/Questions

• Plasma WITH Factors V and VIII?

128
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

129
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

130
Cases/Questions

• Plasma without labile factors?

131
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

132
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• None of the above

133
Cases/Questions

• What you NOW feel confident about?

134
Cases

• Whole blood
• Red blood cells
• Red blood cells, leukocyte reduced
• Red blood cells, deglycerolized
• Platelets, pheresis
• Granulocytes
• Fresh frozen plasma

• Plasma, S.D.
• Plasma, lt24 hours
• Liquid plasma
• Thawed plasma
• Source plasma
• Cryoprecipitate
• ALL OF THE ABOVE

135
EXPERT

• One who travels more than 50 miles with slides
• One who travels more than 50 miles with computer
  disk
• One who travels more than 50 miles by phone
• One who imparts knowledge/educates
• ALL OF THE ABOVE

136
THANK YOU