2019 Modified Blood Components

MODIFIED BLOOD
COMPONENTS
Prof. Azza Sadek Eldanasoury

2019
MODIFICATIONS
Blood components may cause adverse
effects that range from mild allergy to fatal
reactions. Such reactions are usually
caused by leukocytes, plasma proteins,
red cell antigens and some pathogens
present in the component.
To avoid or reduce these complications,
blood products can be modified
MODIFICATIONS
Leucoreduction
Washing
Irradiation
Cryopreservation
Splitting
Pooling
Volume reduction
Rejuvenation
Leucoreduced Components
Leucocytes are considered a contaminant of blood
products.
Exposure to allogenic donor leucocytes results into
allo-immunization with formation of either HLA or
granulocyte-specific antibodies. These abs are
clinically significant and result into transfusion
associated adverse effects: FNHTR, TRALI and
transmission of some viruses (such as EB virus,
CMV)
The likelihood of such complications is reduced by
leucoreduction of red blood cells and platelets
Leucoreduced Components
A leukoreduced RBC unit or Platelet Concentrate should
contain….
- less than 5x106 leucocytes per unit, according to
American standards
- less than 1x106 leucocytes per unit, according to
European standards.
LeucoreducedRBCs contain at 85% of the original RBCs;
leucoreduced PCs contained at least 75% of the original
platelets
Leucoreduced components can be obtained by:
- Leucofiltration (for whole blood, packed RBCs, Platelet
concentrates).
- Apheresis
.
Leukoreduction
Filtration can be either pre-storage or post storage.
 Pre-storage leukoreduction:
Generally performed soon after WB collection and is always
performed within 5 days of collection
 Inline WB filters are integrated to the collection bag to
remove the leukocytes from the WB during collection.
- They permit preparation of Leucoreduced RBCs and FFP.
- NB: WB filters that spare platelets are now available.
 If WB is collected without the in-line leukocyte reduction
filter, a filter can be attached to the tubing by an FDA-
cleared sterile connecting device (closed system). If an
open system is used, the shelf life of the leukoreduced
product is only 24 hours at 2-6oC
Leukoreduction
The main advantage of prestorage leukoreduction is the
removal of leukocytes before they release their cytokines
during storage.
 Poststorage leucodepletion
 In blood bank before issuing (labside)
 At bedside before transfusion
Poststorage leukoreduction does not prevent the removal of
cytokines released from the leukocytes during storage
N.B.: Leukoreduced platelets are obtained by apheresis or
by using special leukocyte reduction filters. Leukoreduced
platelets are indicated to prevent FNHTRs, HLA
alloimmunization and CMV infection.
Mechanism of Leucofiltration
Barrier filtration + cell adsorption to surface of
filter
 Barrier filtration is the main: pore size of the filter
is sufficient for the passage of platelets and
deformable RBCs but not that of leukocytes.
Leucoreduction filters are available for red cells
and for platelets
NB: The surface of filters designed for platelet
leucoreduction is modified to decrease the binding
of platelets to the filter, because platelets are
naturally adhesive in a plasma environment.
Factors affecting effectiveness of
leukofiltration
Temperature during filtration
Performance is poorer when applied to room
temperature RBCs compared with refrigerated
RBCs
Speed of blood flow
Slow blood flow through filter allows blood to warm
and fails to meet minimum requirements for
leucoreduction.
Clinical impact of leucoreduced
blood components
 Prevention of FNHRs
 Reduction of platelet refractoriness
 Prevention of transfusion transmitted CMV
 Prevention of immunosuppression
Indications for leucoreduced
components
Multitransfused patients to reduce the rate
of alloimmunization
Patients with documented mild to
moderate or severe febrile non-hemolytic
transfusion reaction
Transplant or potential transplant patients
Patients receiving chemotherapy
Neonates and infants
Leucoreduced PCs
Filtration of whole blood removes > 2 logs of platelets
in addition to > 4 logs leukocytes
Only FFP and red cells can be produced from
leukocyte-depleted whole blood.
 Leukoreduced PCs are generally obtained by
apheresis
 Filtered PC are obtained from whole blood by
filtration after separation using special leukocyte
reduction filters (NB: filters for WB that spare
platelets are now available).
 Platelet leucodepletion results in leucocyte counts of
<5x106 with loss of 20-25% of platelets
 Indicated to prevent FNHTRs, HLA alloimmunization
and CMV infection.
Saline-Washed Red Cells
Saline-Washed Red Cells
 Packed red cells subjected to repeated wash
with normal saline to remove almost all of the
plasma (99%) and platelets
 In addition some red cells (about 20%) and
about 85-95% of the leucocytes are also
removed (not considered effective for
leukodepletion)
 Stored at 40C
 Washing should be accomplished by automated
machine. If an open system is used, the shelf life
of washed RBCs is 24 hours at 2-60C.)
Indications of washed red cells
 Patients experiencing reactions to transfused
plasma such as patients with IgA deficiency
anaphylactic reaction when exposed to plasma
containing IgA
 Patients who develop urticaria or allergic
reactions to plasma due to cytokines or
histamine
 ABO miss-matched solid organ transplant to
remove anti-A or anti-B
Irradiated Blood Components
Irradiated cellular products are required for
patients at risk of TA-GvHD
 TA-GvHD is a rare but fatal serious complication
that occurs due to survival and engraftment of
viable donor lymphocytes transfused to
susceptible patients
 Mostly in immunocompromised patients
 Can occur in immunocompetent patients when
transfused with blood from a relative that is
homozygous for an HLA class I haplotype
shared with the recipient.
Irradiation of components
 Irradiation damages the lymphocyte DNA and
inhibits proliferation of immunocompetent T cells
 Performed using a gamma irradiator (Cesium-
137 or Cobalt-60) with a minimum dose of
gamma irradiation of 25Gy targeted to the center
position of the container
 Irradiation damages the red cell membrane with
leakage of potassium during post irradiation
storage. Effect of increased potassium level
depends on speed and volume of transfusion as
well as the age of the blood. Irradiation also
causes decrease in ATP and 2, 3 DPG levels.
Indications of Irradiated
Components
 Intrauterine transfusion
 Premature or very low birth weight infants
 Bone marrow transplantation
 Hematologic malignancies
 Aplastic anemia receiving immunosuppressants
 Solid tumors receiving therapy resulting in
severe immune deficiency
 Congenital immune deficiency
 Directed blood donation from 1st degree relatives
 HLA compatible single donor platelets
Storage of irradiated components
Irradiation affects the shelf life of RBCs
 According to the national standards, red cell units
can be irradiated at any time from collection up to
14 days. Irradiated red cells expire 14 days after
irradiation. It is recommended to irradiate units
close to the time of transfusion.
 Irradiated red cells for transfusion for neonates or
pediatric patients should be transfused within 24
hrs of irradiation
Irradiation does not affect the shelf life of
platetets
Cryopreservation
Cryopreservation
 Packed red cells are frozen or cryopreserved
within 6 days of collection at -650C in the
presence of 40% glycerol as cryopreservative
 Frozen cells can be stored for up to 10 yrs
 Deglycerolization is performed by gradual
thawing, washing and centrifugation where the
loss of red cells is minimal
 Once deglycerolized, red cells are stored at 40C
for not more than 24 hrs
Indications
Red cell freezing is used for long term
storage of red cells from:
- Donors with very rare antigen
phenotypes and lack very high frequency
antigens
- Donors with combined absence of
several antigens
These donors can donate for general

allogeneic use or for their own use
Volume reduction
 Removal of excess donor plasma from cellular
components:
 in patients who cannot tolerate the full volume or
when large doses of platelets are to be used
 In patients receiving ABO incompatible platelets
 The excess plasma is removed from platelet units
by gentle centrifugation, left undisturbed at RT for
20-60min, then resuspended
 About 10% of the platelets are lost and the
extracentrifugation may cause some platelet
activation and loss of function
 Volume reduced platelets have a 4 hr expiration
date
Splitting
Aliquoted red cells
Several aliquots can be prepared from a single
donor unit to be transfused to neonates who
require only small volumes of RBCs
Pedi bags consist of 4 satellite 75 mL containers
Aliquoted platelets
Are prepared for neonates
PCs are withdrawn into syringes and the syringe
should be labeled properly and used 4 hrs from
aliquoting from the platelet unit
Rejuvenated Red Cells
These are red cells treated by solution containing
pyruvate, inosine, phosphate and adenosine to
restore 2,3 DPG and ATP to normal levels
Can be performed during storage of red cells and
up to 3 days after their expiry date
Rejuvenated red cells are stored at 2-60C and
used within 24 hrs. They are to be washed before
use
Rejuvenated red cells can be glycerolized and kept
frozen for longer.
CMV-ve/safe Blood
Components
Transfusion-transmitted CMV infection can
cause considerable mortality in immuno-
conmpromized population as neonates and
transplant patients
They should be transfused with CMV
seronegative products (limited availability)
Leucoreduction is an alternate “CMV-safe”
components: virus is tropic for leucocytes
mainly monocytes and macrophages which
are the principal sites for latent CMV
Azza Sadek

2019 Modified Blood Components

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2019 Modified Blood Components

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What are some of the modifications that can be done to blood components?

What is leucoreduction and what are its benefits?

MODIFIED BLOOD

Prof. Azza Sadek Eldanasoury

These donors can donate for general

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