LITMIR.BIZ

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5.1 Whole blood preparation and storage

      WB can be collected in 450‐ and 500‐mL bags that contain citrate–phosphate–dextrose (CPD), citrate–phosphate–double dextrose (CP2D), or citrate–phosphate–dextrose adenin‐1 (CPDA‐1). WB collected in CPD and CP2D is stored for 21 days, and blood collected in CPDA‐1 is stored for 35 days at 1–6°C. No additional manufacturing step is required prior to issuing of WB. WB can be leukoreduced. There is one platelet‐sparing leukoreduction filter available in the United States (Imuflex WB‐SP, Terumo BCT). In the military, warm fresh WB is used. It is collected and stored at 22°C up to 24 hours. It can be stored at 1–6°C up to 48 hours (cold fresh WB). It is not approved by the US Food and Drug Administration (FDA) in the civilian setting because the results of infectious disease testing are not available at the time of transfusion. To mitigate risks of transfusion‐transmitted infectious diseases, military personal is tested prior to deployment and every 90 days during their deployment.

Table 5.2 Components produced by blood banks and the medical use of these components.

Component	Medical use
Red blood cells	Oxygenation of tissues
Platelets	Prevention or cessation of bleeding
Fresh frozen plasma	Prevention and cessation of bleeding, plasma exchange, reversal of vitamin K antagonist if prothrombin complex concentrate is not available
Cryoprecipitate	Cessation of bleeding
Cryoprecipitate‐poor plasma	Plasma exchange
Granulocytes	Treatment of infection
Frozen red blood cells	Storage of rare blood
Leukocyte‐depleted red cells	Prevention of febrile non‐hemolytic transfusion reactions, prevention of certain diseases (e.g., CMV) and decrease in HLA alloimmunization

      CMV, cytomegalovirus; HLA, human leukocyte antigen.

Table 5.3 Some of the products manufactured from whole blood subject to licensure by the US Food and Drug Administration.

Red cell components	Red blood cells
	Red blood cells irradiated
	Red blood cells leukocytes removed
	Red blood cells leukocytes removed irradiated
	Red blood cells deglycerolized
	Red blood cells deglycerolized irradiated
	Red blood cells frozen
	Red blood cells frozen irradiated
	Red blood cells frozen rejuvenated
	Red blood cells frozen rejuvenated irradiated
	Red blood cells washed
	Whole blood CPD irradiated
	Whole blood cryoprecipitate removed
	Whole blood leukocytes removed
	Whole blood modified—platelets removed
	Whole blood platelets removed irradiated
	Cryoprecipitate AHF
Plasma components	Cryoprecipitate AHF irradiated
	Cryoprecipitate AHF pooled
	Fresh frozen plasma
	Fresh frozen plasma irradiated
	Liquid plasma
	Plasma
	Plasma irradiated
	Plasma cryoprecipitate reduced
	Plasma pathogen reduced
	Thawed fresh frozen plasma
	Thawed fresh frozen plasma irradiated
	Platelet‐rich plasma
Platelets	Platelets
	Platelets irradiated
	Platelets washed
	Pooled platelets
	Pooled platelets leukocyte reduced
	Pooled platelets leukocyte reduced irradiated
	Platelets pathogen reduced

      AHF, antihemophilic factor; CPD, citrate–phosphate–dextrose.

5.2 Preparation of blood components from whole blood

      Anticoagulant–preservative solutions

The beginning of red cell preservation can be traced to Peyton Rous, who was later awarded the Nobel Prize for his work with viruses. Rous [14] and Turner showed that glucose delayed in vitro hemolysis. During the period between World Wars I and II, Mollison [15] in England developed an acidified citrate and glucose solution for red cell preservation, variants of which are the mainstay of present‐day preservatives. These solutions are composed of citrate for anticoagulation, dextrose for cell maintenance, and phosphate buffers (Table 5.4). WB or RBCs can be stored in these solutions for periods ranging from 21 to 35 days.

During red cell preservation, adenosine triphosphate (ATP) loss generally correlates with poor red cell viability, and addition of adenine at the beginning of preservation increases ATP and improves red cell viability [16]. 2,3‐Diphosphoglycerate (2,3‐DPG) also declines in stored red cells, and this is associated with increased affinity of hemoglobin for oxygen [17–19]. Thus, there was considerable interest in developing solutions that would maintain both ATP and 2,3‐DPG while allowing removal of the maximum volume of plasma for production of derivatives. It is possible to extend the duration of red cell storage by placing the red cells in special “additive” solutions containing various combinations of saline, adenine, phosphate, bicarbonate, glucose, and mannitol [20–23] (Table 5.5). These solutions provide better nutrients that maintain red cell viability, red cell enzymes, and red cell function, allowing red cell preservation for 42 days (Table 5.6).

      Blood processing for the preparation of components

Because

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