Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

Chapter 113: Transfusion Therapy and Biology

Pierre Tiberghien; Olivier Garraud; Jacques Chiaroni

INTRODUCTION

Transfusion encompasses the use of blood components (BCs) to prevent or treat anemia, hemorrhage, and bleeding disorders. Occasionally, BCs may be used to treat infection or relapse of malignant blood diseases after allogeneic hematopoietic transplantation. BCs comprise mainly red blood cell concentrates (RBCCs), platelet concentrates (PCs), and plasma for transfusion use (as opposed to plasma for fractionation into medicinal products such as albumin and immunoglobulin). Alongside transfusion safety, ensuring BC quality, assessing in vivo efficacy, and promoting evidence-based transfusion practices are critical aspects of transfusion medicine.

Blood collection and donor medicine do not fall within the scope of this chapter. Although the processes used are particularly safe, blood donations can cause adverse reactions, among which are fainting reactions and iron deficiency. These risks require preventive approaches and appropriate treatment when needed.

BLOOD COMPONENTS

BC collection and manufacturing processes are described in Table 113-1. Most common BCs are collected as whole blood or directly as components by apheresis. The vast majority of BCs are homologous. Autologous BCs, sometimes collected ahead of planned surgery, are now exceptional as they present little to no evidence-based advantage over homologous BCs. Nevertheless, such donation may still be of benefit in the presence of a rare blood group phenotype.

TABLE 113-1Blood Components: Collection and Manufacturing Processes
View Table||Download (.pdf)
TABLE 113-1 Blood Components: Collection and Manufacturing Processes
BLOOD COLLECTION INITIAL PROCESSING BLOOD COMPONENT ADDITIONAL COMPONENT PROCESSING (OPTIONAL TO MANDATORY) RATIONALE VOLUME AND CONTENT STORAGE CONDITIONS AND DURATION
Whole blood

Separation into RBCCs and platelet-rich plasma (PRP) by slow centrifugation, followed by high-speed centrifugation of the PRP to yield one unit of platelets (most often subsequently pooled) and one unit of plasma.

Or

Separation into a PRBC, a plasma, and a “buffy coat” containing leukocytes and platelets by high-speed centrifugation, followed by pooling and slow-speed centrifugation of the buffy coat to produce a pooled platelet unit. Alternatively, the buffy coat may undergo high-speed centrifugation to produce a granulocyte unit that will be subsequently pooled.

 RBCC from whole blood or from apheresis

Deleukocytation to <1–5.106 leukocytes per unit: initial whole blood filtration or RBC elective filtration (highly recommended; mandatory in several international jurisdictions)

Reduction of posttransfusion fever and chills

Reduction of intracellular pathogens (including CMV infections)

Reduction of alloimmunization

250–300 mL (including additive solution, no more than 40–50 mL of plasma)

Hemoglobin: 22–40 g/dL

Hematocrit: 50–70%

Hemolysis ≤0.8% at issuing

4 +/– 2°C

Duration depends on the additive solution: 25–42 days; some solutions aim to extend shelf life to 56 days

After irradiation: 24 h

After plasma reduction: 24 h to 10 days depending on reduction methodology
  Irradiation: X-ray or gamma, ~25–35 Gy; most often units no older than 28 days after collection GVHD prevention in immunosuppressed patients or intrafamilial transfusions    
  Plasma reduction Prevention of allergic reactions in patients with prior severe ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close