scholarly journals Quality Assessment of Established and Emerging Blood Components for Transfusion

2016 ◽  
Vol 2016 ◽  
pp. 1-28 ◽  
Author(s):  
Jason P. Acker ◽  
Denese C. Marks ◽  
William P. Sheffield
Keyword(s):  
Whole Blood ◽  
Blood Product ◽  
Standard Of Care ◽  
Blood Component ◽  
Industrialized Countries ◽  
Platelet Concentrates ◽  
Donor Blood ◽  
Additional Manufacturing ◽  
Blood Component Therapy ◽  
Nonstandard Conditions

Blood is donated either as whole blood, with subsequent component processing, or through the use of apheresis devices that extract one or more components and return the rest of the donation to the donor. Blood component therapy supplanted whole blood transfusion in industrialized countries in the middle of the twentieth century and remains the standard of care for the majority of patients receiving a transfusion. Traditionally, blood has been processed into three main blood products: red blood cell concentrates; platelet concentrates; and transfusable plasma. Ensuring that these products are of high quality and that they deliver their intended benefits to patients throughout their shelf-life is a complex task. Further complexity has been added with the development of products stored under nonstandard conditions or subjected to additional manufacturing steps (e.g., cryopreserved platelets, irradiated red cells, and lyophilized plasma). Here we review established and emerging methodologies for assessing blood product quality and address controversies and uncertainties in this thriving and active field of investigation.

II.—New Approaches to the Supply of Blood and Plasma

1972 ◽  
Vol 71 (S1) ◽  
pp. s7-s14
Author(s):  
John Wallace
Keyword(s):  
Blood Transfusion ◽  
Whole Blood ◽  
Blood Component ◽  
Clinical Use ◽  
Platelet Concentrates ◽  
Protein Solution ◽  
Fresh Blood ◽  
Donor Blood ◽  
Specific Immunoglobulin ◽  
Wrong Identification

SynopsisOne unit of donor blood may be used to treat several patients. Each recipient is given the appropriate blood component. Proper component therapy is more effective and less hazardous than whole blood transfusion. In addition, valuable human blood is conserved.Transfusion services require facilities to process fresh blood and separate otherwise labile components such as cryoglobulin precipitate and platelet concentrates. The production of large amounts of these components and of fractions such as plasma protein solution is facilitated by the clinical use of concentrated red cells rather than whole blood. Recurrent shortages of fresh donor blood are inevitable. Components which can be preserved for long periods should be stockpiled.Plasmapheresis, plateletpheresis and leukapheresis allow the frequent collection of selected components from individual donors. Some of these donors may be hyperimmunised by the injection of an appropriate immunogen, and a specific immunoglobulin IgG can be prepared from the donated plasma. Hazards such as wrong identification and protein depletion must be avoided by individual attention to plasmapheresis donors.Automation and modern transportation may increase the availability of blood. The importance of the blood donor to the health service and to the community should be fully recognised.

scholarly journals Blood Component Therapy

2018 ◽  
Vol 9 (2) ◽  
pp. 142-147
Author(s):  
Shanaz Karim ◽  
Ehteshamul Hoque ◽  
Md Mazharul Hoque ◽  
Syeda Masooma Rahman ◽  
Kashfia Islam
Keyword(s):  
Red Blood Cells ◽  
Whole Blood ◽  
Blood Cells ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Packed Red Blood Cells ◽  
Medical College ◽  
Blood Component Therapy ◽  
Fresh Frozen ◽  
Cellular Components

Transfusion medicine has undergone advancements since its initiation in the early 20th century. One of these was the discovery that blood can be divided into individual components and delivered separately. Today, blood transfusions nearly always consist of the ad-ministration of 1 or more components of blood. Whole blood transfusion is now limited to situations involving massive resuscitation (trauma ) The most familiar cellular components include packed red blood cells (PRBC), washed PRBC, leukoreduced PRBC and pooled or aphaeresis platelets. Plasma products such as FFP or cryoprecipitate, ant hemophilic factor (CRYO). The transfusion of red blood cells (RBCs), platelets, fresh-frozen plasma (FFP), and cryoprecipitate has the potential of improving clinical outcomes in perioperative and peripartum settings. These benefits include improved tissue oxygenation and decreased bleeding. However, transfusions are not without risks or costs. With the advent of blood component therapy, each unit of whole blood collected serves the specific needs of several, rather than a single patient.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 142-147

III.—New Developments in Large-scale Plasma Fractionation

1972 ◽  
Vol 71 (S1) ◽  
pp. s15-s34
Author(s):  
J. G. Watt ◽  
J. K. Smith ◽  
W. Grant ◽  
C. Turnbull
Keyword(s):  
Side Effects ◽  
Blood Transfusion ◽  
Large Scale ◽  
American Association ◽  
Blood Component ◽  
Blood Components ◽  
Donor Blood ◽  
New Developments ◽  
Blood Banks ◽  
Blood Component Therapy

‘Selective transfusion of appropriate blood components is preferable to the routine use of whole blood.’ (American Association of Blood Banks. Physicians' Handbook of Blood Component Therapy, 1969).The rational use of donor blood in the environment of modern blood transfusion revolves around a series of developments in the field of component therapy. The fractionation of plasma, i.e. the separation of plasma into a series of subdivisions each containing one or other of the constituent proteins in varying degrees of purity and concentration, was one of the first of these developments to become established.Early fractionation of plasma was applied in various ways to the purification of animal antisera; initially to antipneumococcal serum for therapeutic use. These sera frequently provoked reactions in patients until Sabin showed that absorption with Fullers earth could abolish these side-effects by removing complexed molecules.

scholarly journals Whole blood versus component therapy for haemostatic resuscitation of major bleeding: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e043967
Author(s):  
Anna E Ssentongo ◽  
Paddy Ssentongo ◽  
Emily Heilbrunn ◽  
Lacee Laufenberg Puopolo ◽  
Vernon M Chinchilli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Major Bleeding ◽  
Whole Blood ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Primary Data ◽  
Blood Component ◽  
Geographical Differences ◽  
Blood Component Therapy ◽  
Haemostatic Resuscitation

IntroductionThere is a renewed interest in the use of whole blood (WB) to manage patients with life-threatening bleeding. We aimed to estimate mortality and complications risk between WB and blood component therapy for haemostatic resuscitation of major bleeding.MethodsWe will conduct a systematic review and meta-analysis of studies published between 1 January 1980 and 1 January 2020, identified from PubMed and Scopus databases. Population will be patients who require blood transfusion (traumatic operative, obstetric and gastrointestinal bleeding). Intervention is WB transfusion such as fresh WB (WB unit stored for less than 48 hours), leukoreduced modified WB (with platelets removed during filtration), warm fresh WB (stored warm at 22°C for up to 8 hours and then for a maximum of an additional 24 hours at 4°C). The primary outcomes will be the 24-hour and 30-day survival rates (in-hospital mortality). Comparator is blood component therapy (red blood cells, fresh-frozen plasma and platelets given together in a 1:1:1 unit ratio). The Cochrane risk of bias tool for randomised controlled trials and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) for observation studies will be used to assess the risk of bias of included studies. We will use random-effects models for the pooling of studies. Interstudy heterogeneity will be assessed by the Cochran Q statistic, where p<0.10 will be considered statistically significant and quantified by I2 statistic, where I2 ≥50% will indicate substantial heterogeneity. We will perform subgroup and meta-regression analyses to assess geographical differences and other study-level factors explaining variations in the reported mortality risk. Results will be reported as risk ratios and their 95% CIs.Ethics and disseminationNo ethics clearance is required as no primary data will be collected. The results will be presented at scientific conferences and published in a peer-reviewed journal.

The Role of Thromboelastography in Directing Blood Product Usage in Infant Open Heart Surgery

2009 ◽  
Vol 4 (5) ◽  
pp. 282-290 ◽  
Author(s):  
Eric N. Mendeloff ◽  
George F. Glenn ◽  
Paul Tavakolian ◽  
Eugene Lin ◽  
Allison Leonard ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Open Heart ◽  
Product Usage ◽  
Blood Component Therapy ◽  
Fresh Frozen

Objective Thromboelastography (TEG) measures the dynamics of clot formation in whole blood and provides data that can guide specific blood component therapy. This study analyzed whether the implementation of TEG affected blood product utilization and overall hemostasis in infants (6 months and younger) undergoing open heart surgery. Methods TEG values measured include R (time to fibrin formation), angle (fibrinogen formation), and MA (platelet function). Blood product usage, TEG values, and operative parameters were collected during surgery on 112 consecutive infants (66 acyanotic) undergoing open heart surgery within the first 6 months of life. Controls consisted of chart data on 70 consecutive patients (57 acyanotic) undergoing the same surgical procedures before implementation of TEG (pre-TEG). Results Using TEG, the pattern of blood product utilization changed. Compared with the pre-TEG era, TEG era patients demonstrated a significant increase in fresh frozen plasma usage intraoperatively (4.74 vs. 1.83 mL/kg; P < 0.001) and reduced postoperative use of platelets (1.69 vs. 3.74 mL/kg; P = 0.006) and cryoprecipitate (0.89 vs. 1.95 mL/kg; P = 0.149). Chest tube drainage was significantly reduced at 1, 2, and 24 hours in the TEG group. TEG angle and MA measurements suggest that fibrinogen and platelets of cyanotic patients are more sensitive to hemodilution than the acyanotic patients. Conclusions TEG allows for proactive, goal-directed blood component therapy with improved postoperative hemostasis in infants undergoing cardiopulmonary bypass.

Diagnosis and Treatment of Trauma-Induced Coagulopathy by Viscoelastography

2020 ◽  
Vol 46 (02) ◽  
pp. 134-146 ◽  
Author(s):  
Jan Hartmann ◽  
Mark Walsh ◽  
Anne Grisoli ◽  
Anthony V. Thomas ◽  
Faisal Shariff ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Clinical Outcomes ◽  
Blood Product ◽  
Blood Component ◽  
Trauma Resuscitation ◽  
Rotational Thromboelastometry ◽  
Trauma Induced Coagulopathy ◽  
Coagulation Tests ◽  
Blood Component Therapy ◽  
Compare And Contrast

AbstractThis article explores the application of viscoelastic tests (VETs) in trauma-induced coagulopathy and trauma resuscitation. We describe the advantages of VETs over conventional coagulation tests in the trauma setting and refer to previous disciplines in which VET use has reduced blood product utilization, guided prohemostatic agents, and improved clinical outcomes such as the mortality of critically bleeding patients. We describe different VETs and provide guidance for blood component therapy and prohemostatic therapy based on specific VET parameters. Because the two most commonly used VET systems, rotational thromboelastometry and thromboelastography, use different activators and have different terminologies, this practical narrative review will directly compare and contrast these two VETs to help the clinician easily interpret either and use the interpretation to determine hemostatic integrity in the bleeding trauma patient. Finally, we anticipate the future of new viscoelastic technologies that can be used in this setting.

scholarly journals Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review

2021 ◽  
Vol 10 (2) ◽  
pp. 320
Author(s):  
Mark Walsh ◽  
Ernest E. Moore ◽  
Hunter B. Moore ◽  
Scott Thomas ◽  
Hau C. Kwaan ◽  
...  
Keyword(s):  
Whole Blood ◽  
Fixed Ratio ◽  
Narrative Review ◽  
Blood Component ◽  
Trauma Patients ◽  
Initial Resuscitation ◽  
Blood Component Therapy ◽  
Historical Developments ◽  
Comparative Trials ◽  
Selection Of

This narrative review explores the pathophysiology, geographic variation, and historical developments underlying the selection of fixed ratio versus whole blood resuscitation for hemorrhaging trauma patients. We also detail a physiologically driven and goal-directed alternative to fixed ratio and whole blood, whereby viscoelastic testing guides the administration of blood components and factor concentrates to the severely bleeding trauma patient. The major studies of each resuscitation method are highlighted, and upcoming comparative trials are detailed.

A Pilot Study of Stored Low Titer Group O Whole Blood + Component Therapy versus Component Therapy Only for Civilian Trauma Patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anaar E. Siletz ◽  
Kevin J. Blair ◽  
Richelle J. Cooper ◽  
N. Charity Nguyen ◽  
Scott J. Lewis ◽  
...  
Keyword(s):  
Pilot Study ◽  
Whole Blood ◽  
Blood Component ◽  
Trauma Patients ◽  
Civilian Trauma ◽  
Blood Component Therapy ◽  
Titer Group

scholarly journals Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

2022 ◽  
Vol 11 (2) ◽  
pp. 356
Author(s):  
James H. Lantry ◽  
Phillip Mason ◽  
Matthew G. Logsdon ◽  
Connor M. Bunch ◽  
Ethan E. Peck ◽  
...  
Keyword(s):  
Whole Blood ◽  
Blood Component ◽  
Trauma Centers ◽  
Blood Products ◽  
Massive Blood Loss ◽  
Initial Resuscitation ◽  
Blood Component Therapy ◽  
Resuscitation Strategy ◽  
History Of ◽  
Current Guidelines

Modern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy—especially in austere or challenging environments—is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival.

The physiology of blood in anaesthetic practice

2017 ◽  
Author(s):  
Hanane El Kenz ◽  
Philippe Van der Linden
Keyword(s):  
Blood Transfusion ◽  
Whole Blood ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Blood Components ◽  
Pathogen Inactivation ◽  
Septic Complications ◽  
Packed Red Blood Cells ◽  
Blood Component Therapy ◽  
Fresh Frozen

Following the discovery of the ABO blood groups by Landsteiner in 1901, Albert Hustin described the first transfusion of a whole blood unit in 1914. The modern transfusion era really begins in 1916 with the discovery of sodium citrate as an anticoagulant by the same physician, allowing blood conservation in dedicated packs. Since that time, many advances have been made especially over the past two decades in the storage, the conservation, and the laboratory testing of blood components and in transfusion medicine practice. Transfusion of whole blood has been replaced by blood component therapy, which consists of the administration of packed red blood cells, fresh frozen plasma, or platelets. Although blood transfusion is safer than ever, the risk of complications will never reach zero. The risk of infectious transfusion-transmitted diseases has been markedly reduced by the implementation of extensive infectious disease testing, donor selection, and pathogen-inactivation procedures. In countries with a high human development index, the leading causes of allogeneic blood transfusion-related deaths actually resulted from immunological and septic complications. The first section of this chapter describes the structure, function, and immunological aspects of the different blood components that are routinely transfused today. The second section details the composition of the different blood components, their indications, the pre-transfusion compatibility tests, and the main adverse effects associated with their transfusion.

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