Blood components
&
Diseases transmitted by Blood
transfusion
DR VASUDEV PRABHU
ASSISTANT PROFESSOR
DEPT OF PATHOLOGY
YMC
Specific learning objectives
Know the various blood components and their
uses
Method of separation of various blood components
from whole blood
Storage of the components in the blood centre
Know and describe the diseases transmitted by
blood transfusion
Screening methods of TTI
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Introduction
It is possible to separate different components of blood from a
single unit of whole blood.
These components can be used individually to help more than
one patient for many purposes.
Thus, red cells can be transfused to an anemic patient and
plasma to a burn patient.
This also ensures that only the required components are
transfused
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Types of blood components include ….
blood components
Red cells
concentrate or Fresh frozen plasma
Platelet concentrates Plasma Cryoprecipitate
packed red blood (FFP)
cells (PRBCs)
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Whole blood
First
centrifugation
Method of
centrifugatio Packed Cells (PC) or Red Cell
Concentrate
Platelet Rich Plasma (PRP)
n from
Whole Blood Second
centrifugation
Fresh plasma or Platelet
Platelet concentrate
Poor plasma
Fresh Frozen Plasma Cryoprecipitate
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
PREPARATION OF BLOOD COMPONENTS
Centrifugation
Apheresis
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Centrifugation
• Separation of components from the original whole blood unit is
performed by using a centrifuge.
• PRP (platelet-rich plasma) is separated from whole blood by
“light spin” centrifugation.
• the platelets are concentrated by “heavy spin” centrifugation
• light spin =short time and low RPM
• heavy spin= longer spin, high RPM and concentrates component
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Apheresis
• Apheresis is the process of removing normal (from a donor) or
abnormal (from patient) blood constituents from circulating
blood.
• The whole blood is removed from the donor/patient and passed
through an apparatus that separates out one (or more) particular
blood constituent.
• Then the desired (or unwanted) components are retained and
the remaining constituents are returned to the donor/ patient's
circulation.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Red Cells Concentrate or Packed Red Blood Cells
• Red blood cells remaining after the removal of most of the plasma
from whole blood.
• Transfusion of PRBCs increases the mass (PCV) of circulating red
cells
• Used in acute or chronic blood loss (e.g., hemorrhage, anemia).
• In packed red cell unit, hematocrit is between 55% and 65%.
• the volume given is only 200 mL
• One unit of packed RBCs increases hemoglobin by 1 g/dL.
• Packed red cells are obtained by centrifugation of whole blood
and the plasma is transferred to another bag
• Shelf life : 35-42 days
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Packed red cells
Preparation and Characteristics
• Volume: Approximately 250–300 mL per unit.
• Hematocrit: High concentration of RBCs ($55\%\text{--}80\%$).
• Additive Solutions: Solutions like SAGM (Saline, Adenine,
Glucose, Mannitol) are added to extend shelf life and reduce
viscosity.
• One Unit Effect: In an average adult, 1 unit of PRBCs raises:
• Hemoglobin (Hb) by 1 g/dL.
• Hematocrit (Hct) by 3%.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Storage and Shelf Life
• Temperature: Stored in a specialized blood bank
refrigerator at 2 degree-6 degree C
• Shelf Life:
• 35 days (if collected in CPDA-1).
• 42 days (if collected with SAGM additive).
• Post-Issue: Once removed from the refrigerator,
transfusion should start within 30 minutes and must be
completed within 4 hour
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Modifications of PRBCs
Leuko-reduced: Irradiated: Washed:
• WBCs are removed to • Used for • RBCs are washed with
prevent Febrile Non- immunocompromised saline to remove
Hemolytic Transfusion patients to prevent remaining plasma
Reactions (FNHTR) and Transfusion- proteins; used for
CMV transmission. Associated Graft-vs- patients with IgA
Host Disease (TA- deficiency or severe
GvHD). allergic reactions.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Indications for use of packed red cells
Anemia
Hemolytic
Hypovolemia
anemia
due to
hemorrhage
especially in
(trauma) aplastic
crisis
Indications
for use of
Severe anemia
of any cause to
packed red
reduce the
chances of
blood cells. thalassemia
major
circulatory
overload
Hypoplastic
anemia: Sickle cell
Aplastic anemia
and anemia of anemia in
chronic renal
DR VASUDEV
crisis
disease PRABHU, DEPT OF PATHOLOGY , YMCH
Platelet concentrate
Platelet concentrate may be obtained from a
single donor or pooled plasma.
Each unit of platelets can raise platelet count
by 5,000 to 10,000/cu mm.
Platelets can also be obtained from a single
donor by platelet apheresis.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Types of Platelet Concentrates
Random Donor Platelets (RDP):
There are two
primary
methods of
preparation:
Single Donor Platelets (SDP) /
Apheresis:
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Types of Platelet Concentrates
• Random Donor Platelets (RDP):
• Prepared from a single unit of Whole Blood.
• Volume: ~50–60 mL.
• One unit increases platelet count by 5,000–10,000/µL.
• Single Donor Platelets (SDP) / Apheresis:
• Collected from one donor via an apheresis machine.
• Volume: ~200–300 mL (equivalent to 6–8 units of RDP).
• One unit increases platelet count by 30,000–60,000/µL.
• Benefit: Reduced donor exposure and lower risk of HLA alloimmunization.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Storage and Shelf Life
Temperature: Stored at 20–24°C (Room Temperature).
Agitation: Requires continuous gentle agitation (Platelet
Agitator) to prevent aggregation and maintain gas exchange.
Shelf Life: Only 5 days (highest risk of bacterial
contamination among all blood products).
pH: Must be maintained at >6.2 to preserve viability.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Indications of platelet concentrate
Bleeding due to:
• severe Thrombocytopenia, (platelet count <20,000/mm3)
• •Chemotherapy, radiation therapy induced
• Leukemia
• Dilutional (e.g., massive transfusion with stored blood)
• Hypoplastic anemia
• Viral disease associated (e.g., dengue)
• Abnormal platelet function
• Disseminated intravascular coagulation (DIC)
• Bone marrow transplant patients immediately after transplantation
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Indications can also be classified into ….
Prophylactic:
• Stable patients: Transfuse if count is <10,000/µL.
• Patients with fever/infection: Transfuse if <20,000/µL.
Therapeutic (Active Bleeding):
• Maintain count >50,000/µL.
Surgical Procedures:
• General surgery: Aim for >50,000/µL.
• Neurosurgery/Ocular surgery: Aim for >100,000/µL
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Administration Details
Compatibility:
ABO-identical is preferred (plasma in the concentrate contains
antibodies).
Rh-negative females of childbearing age should receive Rh-negative
platelets to prevent sensitization from contaminating RBCs.
Infusion:
Should be administered rapidly (usually over 20–30 minutes) through a
standard blood component filter (170 microns)
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Contraindications
Platelet transfusion is generally avoided or
contraindicated in:
• TTP (Thrombotic Thrombocytopenic Purpura): May "fuel the
fire" of microthrombi.
• HIT (Heparin-Induced Thrombocytopenia): High risk of
thrombosis.
• ITP (Immune Thrombocytopenic Purpura): Only transfuse if
life-threatening bleeding occurs (platelets are destroyed rapidly
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Complications
• Bacterial Sepsis: Highest risk because of room
temperature storage.
• Febrile Non-Hemolytic Transfusion Reaction
(FNHTR): Most common reaction.
• HLA Alloimmunization: Leading to Platelet
Refractoriness (where counts don't rise after
transfusion).
• TRALI: Due to anti-HLA antibodies in donor plasma.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Fresh frozen plasma
• Prepared by freezing the plasma.
• FFP is plasma separated from whole blood (along with
anticoagulant, placed at 18°C or lower (frozen) within 6–8 hours
after collection.
• Contents :
• →plasma proteins: albumin
• →all coagulation factors
• →protein C and S, antithrombin
• →von Willebrand factor.
• Each unit of FFP raises coagulation factors by about 2%.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Indications of FFP
replacement of coagulation factors in acquired
coagulation factor deficiencies
• Coagulopathy of liver diseases
• Vitamin K deficiency
• Disseminated intravascular coagulation (DIC
• Antithrombin deficiency
• Microangiopathic hemolytic anemia including thrombotic
thrombocytopenic purpura (TTP),
• Hemolytic Uremic Syndrome, Elevated Liver enzymes, and Low Platelet
count (HELLP) syndrome
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Dosage & Administration
• Standard Dose: 10–15 mL/kg body weight.
• (In an average adult, this is roughly 3–5 units).
• Target: Aim to increase factor levels to at least 25–30% of normal.
• Compatibility: * Must be ABO compatible.
• *Note: FFP does not need to be cross-matched because it contains
no RBCs,
• but it contains antibodies that must be compatible with the
recipient's antigens.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Complications & Precautions
• Infections: Risk of transfusion-transmitted infections (Hepatitis B,
C, HIV) is the same as a single unit of FFP.
• Allergic Reactions: Urticaria or, rarely, anaphylaxis.
• TRALI: Transfusion-Related Acute Lung Injury (rare)
• Note: It should never be used for volume expansion or for treating
deficiencies of factors other than those listed in its composition.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Contraindications (Common Pitfalls)
Do NOT use FFP for:
Simple Volume Expansion: Use crystalloids or colloids instead.
Nutritional Support: Use albumin or amino acid infusions.
Minor Prothrombin Time (PT) elevations: Not indicated if the INR is
<1.5 and there is no active bleeding.
Specific Factor Deficiencies: Use specific concentrates (e.g., Factor
VIII concentrate) if available to avoid volume overload.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Cryoprecipitate
A concentrated subset of FFP (Fresh Frozen Plasma) proteins.
The "Cryo" Process: It is the cold-insoluble precipitate that forms when FFP is
thawed at 1°C to 6°C.
Storage: Kept frozen at –18°C or colder for up to one year.
Once thawed, it must be used within 4 to 6 hours.
Thawed : meaning : become liquid or soft as a result of warming up.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Contents of CRYO
Factor VIII: 80–150 units
(Procoagulant activity).
Fibrinogen: 150–250 mg
(The primary reason it's
One unit (approx. 10– used today).
15 mL) contains high von Willebrand Factor
concentrations of: (vWF): Significant
amounts.
Factor XIII: 40–60 units
(Fibrin stabilizing factor).
Fibronectin: Involved in
cell adhesion and
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
opsonization.
Clinical indications of CRYO
Disseminated
Hypofibrinogenemia: Massive
Intravascular Coagulation
(Most common use) Hemorrhage/Trauma: Part
(DIC): When bleeding is
Triggered when fibrinogen of massive transfusion
associated with low
levels are <100 mg/dL. protocols.
fibrinogen.
Historical Uses: Previously
Uremic Bleeding: To used for Hemophilia A and
improve platelet von Willebrand Disease
dysfunction in renal failure (now largely replaced by
(when other therapies fail). recombinant factor
concentrates)
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Administration & Dosage
• Standard Adult Dose: 10 units (often called a "pool").
• Expected Result: 10 units should raise the fibrinogen level by
approximately 50–100 mg/dL in a 70kg adult.
• Compatibility:
• ABO-compatible is preferred but not mandatory (due to low
volume of plasma/isohemagglutinins).
• Rh typing is not required (it is a cell-free product).
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
FFP vs. Cryoprecipitate
Feature Fresh Frozen Plasma (FFP) Cryoprecipitate
Factors All factors (V, VII, IX, X, etc.) Fibrinogen, VIII, XIII, vWF
Primary Use Multiple factor deficiency Fibrinogen deficiency
Volume Large (~250 mL) Small (~15 mL)
ABO Matching Essential Preferred but not mandato
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Transfusion transmitted infections
Blood is a life saving resource and blood components should be tested so that it
makes them extremely safe
TTD is the infectious complication of blood transfusion.
A variety of infectious agents including bacteria, viruses, parasites and prion
pathogens (very rare) can be effectively transmitted through blood transfusions.
If they are not detected in the testing process, it can cause harm and even death
MODERN BLOOD TRANSFUSION PRACTICES HAVE EFFECTIVELY REDUCED THE
RISK OF TTI AND HAVE MADE BLOOD COMPONENTS EXTREMLY SAFE TO USE
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Classification of TTIs
• TTIs are broadly classified into four categories:
• Viral Infections: (Most common and clinically
significant).
• Bacterial Infections: (Often related to storage
conditions).
• Parasitic Infections: (Geographically dependent).
• Prions: (Rare; e.g., variant Creutzfeldt-Jakob
Disease).
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Major Viral Infections (The Big Three)
• These are mandatory screening tests in most global
guidelines:
• Hepatitis B Virus (HBV): The most common viral TTI
globally. Screened via HBsAg and often anti-HBc or
HBV DNA.
• Hepatitis C Virus (HCV): Significantly reduced since
the introduction of Nucleic Acid Testing (NAT).
• HIV-1 and HIV-2: Causes AIDS. The window period is
the primary concern for transmission.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Other Viral Pathogens
• Human T-Cell Lymphotropic Virus (HTLV-I/II):
Associated with adult T-cell leukemia and myelopathy.
• Cytomegalovirus (CMV): Primarily dangerous for
neonates and immunocompromised patients.
Managed by using "Leukoreduced" blood.
• Hepatitis A and E: Rare via blood (usually fecal-oral),
but can occur during the viremic phase.
• Parvovirus B19: Can cause aplastic crisis in patients
with hemolytic anemias (e.g., Thalassemia).
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Bacterial Infections
• Bacterial contamination is more common in Platelets due
to room temperature storage (20-24 Deg C)
• Gram-Positive (Skin Flora): Staphylococcus epidermidis,
Staphylococcus aureus. Usually from improper
venipuncture.
• Gram-Negative (Cryophilic/Cold-loving): Yersinia
enterocolitica, Pseudomonas, E. coli. These can grow in
RBCs stored at 4 deg C and may cause Endotoxic Shock.
• Treponema pallidum: Causes Syphilis. The spirochete
usually dies after 72 hours of refrigeration (4 Deg C)
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Parasitic Infections (Geography dependent)
• Malaria (Plasmodium species): Transmitted via
infected RBCs. In endemic areas, donors are screened
for history or via malarial parasite (MP) tests.
• Chagas Disease (Trypanosoma cruzi): Prevalent in
Central and South America.
• Babesiosis: A tick-borne parasite that can survive blood
storage.
• Leishmaniasis: Rare but possible in endemic zones.
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Prevention and Screening Strategies
How to keep blood products safe ?
• Stringent history • Proper cleaning of • Collecting the first • ELISA/CLIA for
taking and "Self- the venipuncture 20-30mL of blood antibodies and
Exclusion" site. (which may antigens.
options. contain skin
plugs) into a
separate pouch.
Aseptic Serological
Donor Selection: Diversion Pouch:
Technique: Testing:
• Directly detects • Removing WBCs
viral RNA/DNA, to reduce CMV
drastically risk and febrile
shortening the reactions.
window period.
Nucleic Acid
Leukoreduction:
Testing (NAT):
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Screening Blood Donors for Transfusion- Transmitted Infections
• Once a donor passes the medical screen and donor questionnaire, the
serologic tests should be performed for the TTD.
• Performing these tests can make blood transfusion safer
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Blood products that can and cannot transmit HIV
Blood products that CAN transmit Blood products which CANNOT
HIV transmit HIV
• Whole blood • Hyperimmune gamma globulin,
• packed RBCs • hepatitis B immunoglobulin,
• platelets • plasma-derived hepatitis B vaccine,
• leukocytes • Rho immunoglobulin
• plasma
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
FDA approved mandatory screening tests
HBsAg,
Mandatory Screening Tests
HIV Ab,
The five tests that are mandatory
as per the Food and Drug
HCV Ab,
Administration (FDA) for the
donated blood units are
VDRL,
malarial parasites
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Nucleic acid testing (NAT) or nucleic acid amplification test
(NAAT)
• general term used for molecular-based methods of screening for
infectious agents.
• nucleic acid test is a method useful to detect a particular genetic material
(nucleic acid) of a virus or bacteria that acts as a pathogen in blood, tissue,
urine, etc.
• NAT differs from conventional tests in that it detects genetic material
rather than antigens or antibodies.
• It detects very low numbers/levels of RNA or DNA of the pathogens (e.g.,
HIV, HBV, HCV) in the bloodstream even before the appearance of
antibodies.
• It detects infection earlier than conventional methods thereby narrowing
the window period
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Assignment questions
Enumerate the different blood components and their uses
Enumerate the different Transfusion Transmitted Infections
Enumerate Screening methods of Transfusion Transmitted Infections
Short answer on Nucleic Acid Amplification Test in TTIs
Short notes on FFP
Short notes on Platelet Concentrate
Short notes on Cryoprecipitate
Indications/ uses of Packed Red cells
DR VASUDEV PRABHU, DEPT OF PATHOLOGY , YMCH
Thank
You