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Use of blood preparations

Publisher/Author : Pacific Cross
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Authors:
1. Le Van Nhan MD., PhD., Director of Medical Services Department, Pacific Cross Vietnam, Lecturer of Pham Ngoc Thach University of Medicine
2. Tran Vinh Tai MD., MHEM, Lecturer of Pham Ngoc Thach University of Medicine
© 2019 Pacific Cross Vietnam All Rights Reserved
Modern hematology recommends giving patients the blood components they need blood products. Newly drawn blood unit, the blood will be separated into each component: red blood cells, platelets, plasma, coagulation. This technique allows maximum use of blood component. Blood preparations are used according to the different indications for treatment.
Whole blood
Is blood taken from the blood of a donor stored in a vial (bottle) containing an anticoagulant and a blood preservative. Currently, the common blood preservative is CPDA (citrate-phosphate-dextrose-adenine), including citrate, phosphate, dextrose, adenine. Each 250 ml unit of whole blood contains approximately 30 to 40 g of hemoglobin. In Vietnam, there are 250 ml, 350 ml and 450 ml blood units. There are also smaller capacity units (50, 100, 150 ml) for children. It is stored at 2-60C, the maximum storage time is 42 days (with a preservation solution is CPDA). Whole stored blood contains the main component of erythrocytes, if newly acquired, there are platelets and certain clotting factors. White blood cells are quickly destroyed and release intermediaries. In addition, the whole blood unit also contains lymphocytes and plasma elements.
Whole blood is indicated for transfusion in the event of blood loss ≥ 1/3 of body blood and should not be used in patients with renal impairment, heart failure, only anemia alone.
High-density erythrocyte count (residual red blood cell)
The high-density erythrocyte count refers to the remaining part of the whole blood which is centrifuged to separate the plasma or settled as sediment without being gone through any therapy process. It is stored at 2-60C and is indicated for anemia. However, this red blood cell is slow to transfer, especially at the beginning of the transfer to the patient, there are still many white blood cells, so it can cause a blood transfusion reaction and cause early hemolysis due to the release of leukocytes and plasma contains antibodies.
Preservative-added erythrocyte count
Preservative-added erythrocyte count refers to the high-density erythrocyte count supplemented with the erythrocyte preservative solution in order to improve the quality of erythrocyte. It is also stored at 2-60C and is indicated in case of anemia due to heart failure, renal failure.
Erythrocyte count with a decreased number of leukocytes
The erythrocyte count with a decreased number of leukocytes refers to the red blood cells centrifuged to remove more than 70% of white blood cells contained in the initial unit of whole blood and is indicated for simple anemia.
Washed erythrocyte count
The washed erythrocyte count refers to the red blood cell count which has plasma removed by using the isotonic saline to wash it multiple times (at least 3 times) and is diluted with the isotonic saline or preservative solution or compatible plasma. They are kept at 220C for a maximum of 6 hours and at 20C – 60C for a maximum of 24 hours. Patients with autoimmune hemolytic anemia are indicated for washed erythrocyte count.

Leukocyte-filtered erythrocyte count
The leukocyte-filtered erythrocyte count refers to the red blood cell count in which the white blood cell is removed by the leukocyte filter. The filtration of leukocytes must be carried out within 72 hours from the blood collection time. These are stored between 20C and 60C for a maximum of 2 weeks from the date of irradiation, if a removable (open) membrane filter is used, do not wait more than 24 hours after filtration. Patients with anemia who have severe immunosuppression, especially patients who have had an organ transplant, patients preparing for transplantation will be assigned this mass of red blood cells.
Frozen erythrocyte count
The frozen erythrocyte count refers to the red blood cell count preserved in the glycerol freezing solution and stored at the temperature ranging from minus 600C (-600C) or less. Before being transfused into patients, the frozen erythrocyte count must be defrosted, washed, glycerol-removed and diluted with the isotonic saline or supplemented with the erythrocyte preservative solution. The shelf life shall be 10 years if it is preserved with the glycerol solution which has the content of 40% and at the temperature ranging from -800C to -600C or with the glycerol solution which has the content of 20% and at the temperature ranging from -1500C to -1200C; the shelf life shall be 14 days from the date on which the frozen erythrocyte is defrosted, glycerol-removed in the closed system and supplemented with the erythrocyte preservative solution; the shelf life shall be restricted to 24 hours if it is stored at the temperature ranging from 20C to 60C, and 6 hours if it is stored at the room temperature from the date on which it is thawed and washed to remove the glycerol in the open system.
Platelet count prepared from the unit of whole blood
The platelet count contains most of platelets fractionated from the unit of whole blood and stored at the temperature ranging from 200C to 240C within 24 hours from the blood collection time. This type is indicated for diseases that cause thrombocytopenia, especially after the treatment of a malignant tumor.
Apheresis platelets collected from blood donors
Apheresis platelet refers to platelets collected directly from blood donors by automated apheresis machine, is stored at 220C in a continuous shaker, for a maximum of 5 days. This type is used for severe thrombocytopenia: dengue with severe thrombocytopenia, thrombocytopenia after chemotherapy, in myelosuppression, myelodysplastic disorders. For immune-induced thrombocytopenia, platelet mass during hemorrhage, risk of severe bleeding, or low platelet count (< 20 x 109/liter)
Leukocyte-filtered platelet count
Leukocyte-filtered platelet count refers to platelets prepared from the whole blood or by employing the apheresis method and leukocyte-removed by using the leukocyte filter system. As for platelets prepared in the closed system, the shelf life shall conform to instructions of the blood bag manufacturer, but be restricted to 05 days from the date of blood collection if it is preserved at the temperature ranging from 200C to 240C along with continuous shakes; as for platelets prepared in the open system: the shelf life is restricted to 06 hours from the date of preparation completion if it is stored at the temperature ranging from 200C to 240C along with continuous shakes.
Plasma and frozen plasma
Plasma refers to the liquid suspension which does not hold the blood cells and is prepared from the unit of whole blood or directly collected from the apheresis plasma donor. The plasma can be used immediately after being prepared or frozen (also known as the frozen plasma) within a maximum period of 8 hours from the start of the freezing process at the temperature of minus 250C (-250C) or less. Frozen plasma is used when patients lose plasma, lack of blood volume.
Fresh plasma and fresh frozen plasma
Fresh plasma refers to the plasma which has the content of unstable blood coagulation factors is maintained at the physiological content level, and is prepared from the whole blood or directly collected from the blood donor by employing the apheresis method. The fresh frozen plasma refers to the plasma freezing process takes place within 18 hours at the maximum from the time of blood collection or plasma apheresis. The shelf life is 1 year if stored at -250C and if stored < -250C can be stored for 2 years. This type is indicated in case of: plasma replacement, coagulation disorder, hemophilia A and B disease, accidental overdose of resistance to vitamin K, compensation of plasma components and volume, burn shock, loss of a lot of blood due to trauma, surgery (combination with red blood cells and a mass of platelets). Plasma also contains infectious factors, so it is possible to use chemicals or ultraviolet rays to inhibit the virus.
Cryoprecipitate
Cryoprecipitate refers to the blood product separated from the precipitate collected from the defrostation of the fresh frozen plasma at the temperature of 100C or less.

Cryoprecipitate can be further refined and virally inactivated by using chemicals or temperature. Cryoprecipitate is indicated in patients with coagulopathy, hemophilia A.
Neutrophil granulocyte count
Neutrophil granulocytes shall be collected directly from the blood donor by employing the apheresis or from units of whole blood stored at the temperature ranging from 200C to 240C within 24 hours from the blood collection time. Patients with severe infections, without granulocytes, without antibiotic treatment will be indicated for the infusion of neutrophilic granulocytes.
In short, from whole blood, hematologists will prepare for different blood products with different use of blood. Because blood is a special “biologic drug” that is both precious and rare, blood transfusions must follow proper instructions to achieve the highest level of therapeutic effect. In order to get more and more blood products, we have to participate in voluntary blood donation, because all the blood products used today come from donors./.
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References:
  1. Circular No 26/2013/TT-BYT dated September 16, 2013 on providing guidance on the blood transfusion
  2. Manual for Voluntary Blood Donation, Medicine Publishing House, 2013
  3. Website of National Institute of Hematology and Blood Transfusion: https://www.nihbt.org.vn/
  4. Website of Blood Transfusion Hematology Hospital: http://www.bthh.org.vn/
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