Blood and Blood Products

Every 2 seconds someone in the U.S. receives a blood transfusion. Blood and blood products, despite years of research, have yet to be replicated in a lab. Whole blood consists of living cells in a non-living matrix and makes up 8% of your total body weight.  Transfusions of blood products can only take place when donor blood is available.

The process of whole blood centrifuging occurs when fresh donor blood is placed into a centrifuge machine to be spun causing the blood to be separated by components.  The heavier elements (RBC's) collect at the bottom of the tube and the lighter elements stay at the top (WBC, Plt's, & plasma).  After centrifuge, three layers present in the blood tube:

Diagram of Blood Sample after Centrifugation

Erythrocytes (RBC's):

  • 45% total blood volume
  • carrie oxygen, carbon dioxide, and nutrients to the cells
  • living cells, bi-concave shape

Buffy Coat (leukocytes & platelets):

  • <1% total blood volume
  • fight infection & responsible for clotting
  • living cells and cell fragments

Plasma:

  • 55% total blood volume
  • 90% volume is water
  • 10% electrolytes, proteins, wastes, gases
  • regulates blood chemistry, acts as transport medium for RBC's, platelets, and leukocytes
  • non-living matrix

Blood Component Therapy

Warmed fresh whole blood (WFWB) is rarely transfused in the United States as it has an extremely short shelf life and must be transfused within hours of collection.  In order to decrease waste and individualize treatment, whole blood is centrifuged to produce four different blood components.

1. Packed Red Blood Cells (PRBC)
2. Platelets (PLT)
3. Fresh Frozen Plasma (FFP)
4. Cryoprecipitate

Each blood product has a specific purpose for transfusion.  Depending on the patient's clinical picture he/she may not need all the different components; that makes blood component therapy an ideal treatment plan for many different clinical pictures.

Read on for a description of each blood product's uses of administration, storage, and handling recommendations:

Packed Red Blood Cells (pRBC's)

  • Indications for use:
    • significant blood loss or hemorrhage
      • greater than 1500mL or 30% of blood volume
    • improve oxygen delivery to tissues
    • symptomatic anemia
      • clinical presentation of tachycardia, hypo-tension, shortness of breath, dizziness, nausea, vomiting, fatigue, weakness, etc.
    • acute sickle cell crisis
  • One unit (about a pint) of packed RBCs increases hemoglobin by 1 g per dL (10 g per L) and hematocrit by 3 percent
  • Refrigerated at a temperature of 1-6° C, never frozen
  • PRBC's must be used within 42 days of collection with proper storage
  • Transfusion must be COMPLETE within 4 hours of time issued from blood bank to prevent deterioration of living cells
Intravenous Drip by Emily Haasch from the Noun Project

Platelets (PLT)

  • Used to prevent hemmorhage in patients with thrombocytopenia or impaired platelet function
  • One unit of apheresis platelets should increase the platelet count in adults by 30 to 60 × 103 per μL (30 to 60 × 109 per L)
  • Must remain at room temperature
    • refrigeration or cooling of any kind causes premature clotting
  • All platelets are stored at room temperature (20-24ºC) with gentle agitation until issue
  • 5 day shelf life from the date of collection from donor
pltslide (1)

Fresh Frozen Plasma (FFP)

  • Indications for use:
    • reversal of anticoagulant (i.e. lovenox or coumadin) effects prior to surgery
    • during active bleeding
    • patients with an INR *international normalized ratio >1.6
  • Frozen plasma is maintained in the Blood Bank freezer at a temp ≤-18ºC until it is thawed (thawing takes up to 45 minutes)
  • Thawed plasma may be stored for up to 5 days at a controlled temperature of 1-6°C
  • FFP must be used within 1 year of collection
  • Transfusion must be COMPLETE within 4 hours of time issued from blood bank
FFPslide

Cryoprecipitate

  • hypofibrinogenemia (occurs during massive hemmorhage)
  • Prepared by thawing FFP and collecting the precipitate
  • Each unit will raise the fibrinogen level by 5 to 10 mg per dL (0.15 to 0.29 μmol per L)
  • The usual dose in adults is 10 units of pooled cryoprecipitate
  • Frozen Cryoprecipitate - The shelf life is 1 year from the date of collection.
  • Cryoprecipitate is stored in the Blood Bank freezer at a temp of ≤18°C until thawed
  • Must remain at room temperature (20-24°C) with no refrigeration/cooling of any kind once thawed
  • Expires 6 hours from time of thawing
  • Return to blood bank ASAP if unable to transfuse
cryoslide
Click here to read my post on blood typing and compatibility.  Check back for more about blood component therapy, transfusion procedure, and reactions.

2 thoughts on “Blood and Blood Products”

  1. Pingback: Transfusion Reactions - Nursing Considerations » Nurse/Forward

  2. Pingback: Nursing Care during a Blood Transfusion » Nurse/Forward

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