4 Blood Components

4 BLOOD COMPONENTS

A listing of the description, action, indications, side effects, dosage and

administration of blood components may be found in the "Circular of

Information for the Use of Human Blood and Blood Components and the

Circular for the Use of Cellular Therapy Products." This circular is available on

patient care units, and may also be obtained from the Blood Bank. The label of

each component, except Cryoprecipitated Antihemophilic Globulin, contains

the anticoagulant or preservative solution used for that component. A

description of the various anticoagulant and preservative solutions for blood

components may be found in Appendix B. A list of component abbreviations

used on the patient's medical record may be found in Appendix C. If additional

information is required, please consult the Blood Bank medical or supervisory

staff. Not included in this chapter are peripheral blood progenitor cells or bone

marrow used solely for bone marrow transplantation purposes.

Beginning May 1, 2006, requests for CMV seronegative blood components will

be filled with prestorage leukocyte-reduced blood components. 5/1/06

Red Cell ComponentsWHOLE BLOOD

This component is not available. Requests for Whole Blood will be referred to

the Blood Bank Medical Staff for review. When exchange transfusion of a

neonatal patient is required, the Blood Bank will provide Red Blood Cells

resuspended in Fresh Frozen Plasma.

RED BLOOD CELLS, Leukocyte-Reduced

Crossmatch: Required

Approximate

Volume:

340-400 mL AS-1 or AS-3 Additive sol.

200 mL ACD-A Apheresis

Outdate: 42 days (AS-1 or AS-3 additive solution)

35 days CPDA-1

21 days ADC-A

Hematocrit:

55-65 % Additive solutions

70-80 % CPDA-1

56-59% ACD-A Apheresi

Storage

Conditions:1-6°C in a monitored blood refrigerator

Minimum

Preparation

Time:

20 minutes

Dose Adult: 1 unit per 1 gm Hgb rise desired

Pediatrics: 5-15 mL/kgm body weight

Description: Contains red cells from one unit of whole blood plus a small

amount of plasma and anticoagulant, and for AS-1 and AS-3 and AS-5 units,

approximately 110 mL of additive solution. Apheresis Red cells contain red

cells, and either anticoagulant ACD-A or sodium citrate. The transfusion of one

unit of red cells is expected to increase the hemoglobin 1-1.5 g/dL in the 70 kG

patient. All Red Blood Cells routinely issued have reduced leukocyte content

through prestorage filtration by our blood supplier. Such processing reduced the

risk of CMV transmission, febrile transfusion reactions and platelet transfusion

refractoriness. Beginning May 1, 2006, requests for CMV seronegative blood

components will be filled with prestorage leukocyte-reduced blood

components. 5/1/06

Indications: Patients whose symptomatic deficit of oxygen carrying capacity

cannot be corrected by alternative therapy. A hemoglobin or hematocrit should

be measured before each transfusion except in the case of severe hemorrhage.

Usually indicated when the Hgb is <6 g/dL. Rarely indicated when the Hgb is >

10 g/dL.

RED BLOOD CELLS, Washed


Appriximate

Volume:220 mL

Outdate: 24 hours after washing

Storage


Minimum

Preparation

Time:

12-24 hours. Longer time intervals will be necessary if the

component is ordered at night or on weekends. This

component is ordered specially from the blood supplier.



Description: A unit of Red Blood Cells that has been washed and resuspended

in a saline solution. If RBC Washed are ordered for a patient and subsequently

canceled, Blood Bank personnel will attempt to allocate the component to

another patient

Indications::Prevention of severe allergic reactions to plasma proteins, as for

patients with anti-IgA antibodies.

RED BLOOD CELLS, FROZEN DEGLYCEROLIZED


Approximate

Volume:200 mL

Outdate: 24 hours after deglycerolization

Storage


Minimum

Preparation

Time:

12-24 hours. Longer intervals will be necessary if the

component is ordered at night and on weekends.



Description: A unit of Red Blood Cells that was once frozen in glycerol and

has subsequently been thawed, deglycerolized and resuspended in a dextrose-

saline solution. Only indate units may be frozen.

Indications:: The provision of blood for patients with antibodies requiring rare

units. The use of Frozen Deglycerolized Red Blood Cells to prevent febrile

transfusion reactions has been supplanted by the use of Leukocyte Reduced Red

Blood Cells.

Plasma ComponentsPLASMA: SDPL, SDPL1, SDPL2, SDPL3, SDPL4 (6/25/07)

Crossmatch:Not required, a blood sample may be required to determine

patient ABO and Rh type

Approximate

Volume:200-275 mL SDPL

Outdate: 5 days after thawing

Storage

Conditions:

After thawing, 1-6°C in a monitored blood refrigerator;

Return to Blood Bank immediately if not needed

Minimum

Preparation

Time:

45 minutes unless processing of a blood specimen is

required. Thawed plasma is available in 22 minutes, Of

available, prethawed plasma is available in 15 minutes.

Dose: 10-15 mL/kg body weight

Description: Each unit of Plasmacontains the equivalent plasma obtained by

centrifugation and separation from one unit of whole blood. Plasma has the

same risk of disease transmission as Red Blood Cells. Plasma contains ABO

anitbodies. While the levels of Factors V and VIII in thawed Plasma decreases

slightly over 5 days, this is not clinically significant. Normal levels of

coagulation factors including fibrinogen (300-500 mg/unit) are present.

Indications::Plasma is indicated for patients with a documented deficiency of

coagulation factor for which there is not specific concentrate available. Patients

requiring coagulation factor VIII are best treated with coagulation factor VIII

concentrate (available from the pharmacy) or cryoprecipitated antihemophilic

globulin.

Plasma may be used for correction of coagulation factor deficiencies,

Warfarin® reversal and microangiopathic hemolytic anemia such as thrombotic

thrombocytopathic anemia.

Plasma is indicated for patients with coagulopathy due to massive transfusion

and replacement of specific plasma proteins.

Contraindications:Plasma is not indicated for prophylactic use when the INR is

< 1.5 and the APTT is <1.5 times the upper linit of normal.

Infusion Instructions:

Rate: 10 mL/minute

Plasma components must be administered through a standard blood infusion

The usual volume of Plasma is between 175 and 250 mL

Previously frozen plasma does not contain red blood cells. Plasma from Rh

positive donors may be given to patients who are Rh negative.

PlateletsPLATELETS LEUKOCYTE REDUCED (PPLR), Prepooled Platelets,

Leukocyte Reduced (PPLRP and PLP5)

Revised 10/9/07, 7/28/2008

Crossmatch: Not required; a blood sample may be required

Approximate

Volume:

45-60 mL/unit; usually dispensed as a pool of 5 units for a

total volume of -225 to325 mL

Outdate:

Single units or Prepooled-5d outdate five days after the date

of collection

4 hours after pooling on-site.

Return component to Blood Bank immediately if component

is no longer required

Storage

Conditions:

20-24°C (room temperature), with constant, gentle

agitation. DO NOT REFRIGERATE. Do not store on

patient units or in the operating room.

Minimum

Preparation

Time:

10 minutes if prepooled, 20 minutes if pooled; 2 hours if

volume reduced or washed

Dose Adult: 5 units

Pediatrics: 10-15 mL/kg body weight

Description: A minimum of 5.5 x 10 10th platelets harvested from one unit of

fresh whole blood in approximately 50 mL of donor plasma. Pooled platelets

usually represent a pool of five platelet units and contain 3.0 to 5.0 x 10 11th

platelets in approximately 300 mL of plasma .The product is leukocyte-reduced

at the time of preparation by the blood supplier. This results in the infusion of

less than 8.3 x 105 white blood cells per component. Prepooled platelets are

prepared in a standard dose of 5 units per pool and are tested for bacterial

contamination by a culture method. Individual whole blood platelets are tested

for bacterial contamination on site by the pH method.

Platelet Counts: A 10 minute or 1 hour and a 24-hour post-transfusion platelet

count is recommended to assess patient response.

Indications:: Treatment of thrombocytopenia or defects of platelet function.

Requests must be substantiated by appropriate coagulation tests and clinical

data. Prophylactic use of this component for a thrombocytopenic patient who is

not bleeding is not indicated if the platelet count exceeds 10 x 10 9th/L.

Patients undergoing major operative procedures generally should have platelet

counts above 70 x 10 9th/L for effective hemostasis. Each unit of random donor

platelets will raise the platelet count of an adult approximately 5-10 x 10 9th/L

under optimal conditions, although clinical response to platelet transfusions is

diminished by fever, hypersplenism, infection, DIC, some drugs and preformed

antibodies to platelet antigens. Rarely indicated if the platelet count is >100,000

unless there is platelet dysfunction. Persistent failure to respond to the

product may indicate a refractory state.

Contraindications:: Transfusion of platelets to patients with thrombotic

thrombocytopenic purpura (TTP) or heparin-induced thrombocytopenia is

absolutely contraindicated, except in cases of life-threatening hemorrhage,

because fatal intravascular coagulation may occur. Transfusion of platelets in

idiopathic thrombocytopenic purpura (ITP), posttransfusion purpura, and highly

alloimmunized patients is ineffective because of their shortened intravascular

survival time, although they may be used at the time of splenectomy or to treat

active bleeding.

Availability: Requests for platelet pooled components should be made only if

the component is to be transfused immediately. To ensure maximum benefit

and avoid unnecessary component loss, Pooled Platelets should be transfused as

soon as available. Platelets must not be refrigerated.

Compatibility: ABO and Rh compatible platelets will be selected and released

for transfusion. If this is not feasible because of limited inventory and/or

emergent need for the component, ABO and/or Rh incompatible platelets may

be issued.

Rh Incompatibility:It may be advisable to administer Rho (D) immune globulin

to selected Rh-negative patients who receive platelets from Rh- positive donors,

since sensitization to red cell antigens may occur from the few red cells present

in platelets.

PLATELETS, PHERESIS (Single Donor Platelets)

Crossmatch: May be required. See crossmatched platelets.

Appriximate

Volume:200-350 mL

Outdate: 24 hours or 5 days depending on collection system

Storage

Conditions:

20-24°C (room temperature) with constant, gentle

agitation. DO NOT REFRIGERATE

Minimum

Preparation

Time:

24-48 hours after initial order, Pathology review required

Dose Adult: 1unit

Description: Each unit of this component is obtained by automated apheresis

from one donor and contains a minimum of 3 x 10 11th/L platelets (the

equivalent of the number platelets contained in 5units of random donor

platelets) plus 200-350 mL of plasma with acid citrate dextrose (ACD) as the

anticoagulant. Leukocyte reduced Single Donor Platelets contain less than 5 x

10 6th residual leukocytes.

Indications:: For aplastic anemia and clinical refractoriness. Most surgical

patients do not require platelet transfusion on a long-term basis and can be

transfused successfully perioperatively with random donor platelets.

HLA-Matched Platelets: HLA-matched Single Donor Pheresis Platelets are

available through the Southeastern Michigan Red Cross Blood Center. The

patient's HLA type must be determined prior to or concurrent with the initial

order. The diagnosis of this refractory state is based on both clinical

considerations and the lack of the anticipated increase in the initial platelet

count 10 minutes or l hour and 24 hours after transfusion with random platelets.

Ordering Procedure: Requests for HLA platelets require a Pathology consult

and approval.

CROSSMATCHED PLATELETS, PHERESIS

Crossmatch: Performed at the Southeastern Michigan Red Cross.

Approximate

Volume:200-350 mL

Outdate: 24 hours or 5 days depending on collection system

Storage

Conditions:

20-24°C (room temperature) with constant, gentle

agitation. DO NOT REFRIGERATE

Availability: 24-48 hours after initial order

Description: Each unit of this component is obtained by automated apheresis

from one donor and contains a minimum of 3 x 10 11th/L platelets (the

equivalent of the number platelets contained in 5units of random donor

platelets) plus 200-350 mL of plasma with acid citrate dextrose (ACD) as the

anticoagulant. Leukocyte reduced crossmatched platelets contain less than 5 x

10 6th residual leukocytes. Crossmatched platelets are selected by a solid phase

technique that tests the patient's serum against donor platelets. Only platelets

considered non-reactive are issued as crossmatched platelets.

Indications:: For patients refractory to platelet transfusions. The diagnosis of

this refractory state is based on both clinical considerations and the lack of the

anticipated increase in the platelet count 10 minutes or l hour and 24 hours after

transfusion with random platelets.

Ordering Procedure: Requests for crossmatched platelets require a Pathology

consult and approval.

GRANULOCYTES, PHERESIS (GRAN)


Approximate

Volume:250-350 mL

Outdate: 24 hours

Storage

Conditions:20-24°C (room temperature) DO NOT REFRIGERATE

Minimum

Preparation

Time:

24-48 hours

Dose: 1 unit per day until afebrile or WBC is >0.9 x109

Description: Each unit contains approximately 1 x 10 10th granulocytes

obtained from a single donor by automated apheresis. This component also

contains 20-50 mL of red cells and may contain 2-3x10 11th platelets.

Indications:: Selected infected leukopenic patients with a granulocyte count of

less than 0.5 x 109/L who have not responded to more than 48 hours of

appropriate antibiotic therapy. Consult the Blood Bank before ordering

granulocytes.

Contraindications:HLA alloimmunization, transfusion reactions to

granulocytes. In some patients, granulocytes need to be collected from CMV

seronegative or HLA matched donors. Granulocyte transfusions should be

discontinued when the patient becomes afebrile, at the onset of transfusion

reactions, when the granulocyte count exceeds 1.0 x 10 9th/L or in the absence

of a clinical response after 14 days. Except in unusual circumstances,

granulocyte transfusions are not indicated when there is no expectation that the

patient's bone marrow will recover sufficiently to produce an adequate number

of endogenous granulocytes to sustain life.

Ordering Procedure: Requests granulocytes require a Pathology consult and

approval. Granulocyte transfusions must be ABO compatible with the recipient.

Availability: This component will not be available for transfusion until late

evening or after midnight, yet should be transfused as soon as available to

ensure maximum benefit.

Infusion rate:Over 3-4 hours

Administration Instructions:

Do not administer through a leukocyte- reduction or microaggregate blood

filter. Administer through a Standard blood filter (Abbott No. 1871 or

equivalent filter).

Granulocytes MUST NOT be transfused within 4-6 hours of IV amphotercin

or flucanazole administration.

Premedication with an antipyretic (acetaminophen is recommended) to

avoid the need to discontinue transfusion due to a severe febrile reaction.

Infuse SLOWLY over 4 hours. The rate of infusion is ultimately dictated by

the recipient's ability to tolerate the component volume and by adverse

reactions

Monitor the patient closely for moderate to severe symptoms such as

urticaria, hives, wheezing, dyspnea, severe headache, cyanosis, hypotension,

agitation and tachycardia.

If such symptoms develop, stop the transfusion, keep the IV line open and

notify the patient's physician and the Blood Bank physician on-call for further

instructions.

Document vital signs every 15 minutes during the entire procedure, every 30

minutes for four hours after the transfusion and then every four hours for 24

hours

CRYOPRECIPITATED ANTIHEMOPHILIC GLOBULIN (CRYO)

(CRYOT) (CRYOP) (PTCRY)

(PTCR5)

Revised 3/22/07, 12/27/07

Crossmatch: Not required, a blood sample may be required

Approximate

Volume:

5-10 mL per bag; may be dispensed as single units for

neonatal patients and children or as pools for adults. As of

January 2008, the prepooled dose is 5 per bag. For adults,

two pools of 5 (PTCR5) are dispensed for the standard adult

dose of 10 unit. . PTCRY (prepool of 10) has been

discontinued by the blood supplier.

Outdate:For Coagulation factor VIII: 6 hours after thawing;

P pooled CRYO: 4 hours after pooling

Storage

Conditions:

20-24°C Do not store, transfuse immediately; DO NOT

REFRIGERATE

Minimum

Preparation

Time:

45 minutes for thawing and pooling

Dose: Fibrinogen replacement: adult dose 10 pooled units

Pediatrics: 5 mL/kg body weight

Description: CRYO is Cryoprecipitated protein derived from the fresh plasma

separated from a unit of whole blood. Each individual unit (bag) has

approximately 100 units of Factor VIII activity, as well as 150-250 mg of

fibrinogen, suspended in 5-23 mL of plasma.A pool of 5 units is expected to

raise the fibrinogen level 25 to 50 mg/dL.

Indications:: Treatment of patients with Von Willebrand's disease and the

treatment of Factor XIII deficiency. Factor VIII concentrate, available from the

Pharmacy, is the product of choice for most hemophiliacs.

CRYO serves as a therapeutic source of fibrinogen. It may be indicated when

the fibrinogen is less than 100 mg/dL. It may also be of value for surgical

patients with a hemorrhagic diathesis due to uremia. Consultation with the

Blood Bank Medical Staff is required in these instances. CRYO may also be

used to prepare "surgical fibrin glue" for topical hemostasis.

Pooling: Prepooled CRYO (PTCR5) is a standard dose of 5 units of CRYO as

of January of 2008. If prepooled doses are not available CRYO is thawed and

pooled by Blood Bank personnel before issue for the convenience of nursing

staff and to ensure nearly complete transfer of the component to the patient.

CRYO components must be transfused as soon as possible after thawing to

ensure maximum patient benefit.

Infusion Instructions:

CRYO from Rh positive donors may be given to patients who are Rh

negative.

Infusion Rate 10 mL per minute.

Use either a standard blood administration set or a special blood component

administration set.

Do not use a leukocyte-reduction filter.

DO NOT REFRIGERATE CRYO as this causes reprecipitation and loss

of Factor VIII activity.

At the completion of transfusion, approximately 20-30 mL of isotonic saline

should be fed into the cryoprecipitate bag to rinse product adherent to the walls

of the bag. CRYO does not contain red blood cells.

Clinical response to the component can be measured with post-transfusion

coagulation studies.

PARTIAL UNITSRED BLOOD CELLS, ALIQUOTS (RBC Divided, RBC Half)

Crossmatch: Required for patients older than 4 months of age

Approximate

Volume:

1/2 units: 100-150 mL/unit;

syringes: 10 - 50 mL

Outdate:35 days (CPDA-1 anticoagulant)

4 hrs if dispensed in a syringe

Hematocrit:55% AS-1 or

70-80%, CPDA-1

Storage


Minimum

Preparation

Time:

45 minutes

Description: Red Blood Cells prepared from a unit of whole blood that is

further divided into smaller volumes (aliquots). The hematocrit of each

individual unit ranges from 55 to 80% depending on the anticoagulant.

Availability: Orders for partial units of Red Blood Cells should specify the

volume required for transfusion. When components are packaged in syringes,

unless otherwise requested, an additional 10 mL of component will be added

routinely to the syringe to allow for transfusion tubing "dead space". The

maximum volume to be contained in a syringe is 50 mL.

Only group O blood is routinely available in syringes. A limited number of

prestorage leukocyte-reduced, sickle cell negative units are available for

newborn infants. Partial units may also be ordered for patients with congestive

heart failure when transfusion of a whole unit would be problematic.

PLASMA, ALIQUOTS (FFPT1-3, FFPHA-D, SDP1-2, SDPA)

Crossmatch: Not required, a blood sample may be required

Approximate

Volume:

variable; 50-100 mL in bags;

50 mL maximum in syringes

Outdate:4 hours after thawing;

4 hrs after dispensing into a syringe

Storage

Conditions:After thawing, 1-6°C in a monitored blood refrigerator

Minimum

Preparation

Time:

15-30 minutes for thawing and unit preparation

Description: Many partial units of Plasma are prepared from group AB donors

lacking anti-A and anti-B. The plasma is frozen within eight hours of collection

to preserve coagulation factors V and VIII (see Fresh Frozen Plasma).

Indications:: When prepared from AB donors this component is suitable for

transfusion to all neonates regardless of ABO type whenever a small volume of

plasma is required. It can be made available for other pediatric patients by

special request.

RESUSPENDED LEUKOCYTE REDUCED WHOLE BLOOD

Crossmatch: Required in some circumstances

Approximate

Volume:350-500 mL

Outdate: 24 hours after resuspension

Hematocrit: 42 or 50%

Storage


Minimum

Preparation

Time:

1 hour

Description: Red Blood Cells from which the supernatant storage solution has

been removed and resuspended in Fresh Frozen Plasma Liquid to

approximately a 50% hematocrit.

Indication: Exchange transfusion of a neonate. Resuspended whole blood will

not be prepared for other purposes unless approved by the Blood Bank Medical

Staff.

Rho(D) IMMUNE GLOBULIN (RHIG, WRHO, RHIV )(1/12/11)

Dose: 300 micrograms anti-D

Storage

Conditions:2-8°C

Description: A concentrated solution of gamma globulin with a high level of

anti-D activity. Both an intramuscular and intravenous preparations are

available. Both preparations are latex and thimerisol free.

Indication: Prevention of alloimmunization of Rh-negative women due to fetal

maternal hemorrhage of Rh positive fetal cells, to prevent sensitization of an Rh

negative patient who received Rh positive platelets,or to prevent sensitization

due to the inadvertent administration of a small volume of Rh positive Red

Blood Cells. A sterilization procedure immediately postpartum is not a

contraindication to the administration of the product, if it is otherwise clinically

indicated.Indications for RHIG include abortion, antepartum fetomaternal

hemorrhage, amniocentesis, genetic amniocentesis, chorionic villus sampling

(CVS), percutaneous umbilical blood sampling (PUBS), at approximately 26-

28 weeks gestation and after delivery. The product circular should be consulted

for additional indications. The component is administered intramuscularly

within 72 hours of the potentially sensitizing event. It is generally appropriate

to administer the product even if this 72-hour period has elapsed.It is necessary,

on occasion, to administer platelets from Rh-positive donors to Rh-negative

patients. Although the platelets themselves do not carry antigens of the Rh

system, the component inevitably contains small amounts of donor red cells

that may sensitize of the recipient to the D antigen. In some patients,

particularly those who are young and non-immunosuppressed, it may be

advisable to administer RHIG when such a situation occurs. Consultation with

Blood Bank Medical Staff should be considered.

Intravenous Rh Immune Globulin (WRHO, RHIV)is indicated for the treatment

of ITP in Rh positive adults and children. The product circular should be used

for dosage and administration guidelines.

Specimen Requirements: Cord Blood Samples: When available, a cord blood

sample from the fetus or infant will be tested for the presence of the D antigen.

Maternal Samples: All pregnant women should have their Rh type determined

at the University of Michigan Hospitals Blood Bank. A blood specimen is

required for all Rh-negative women prior to the issuance of RHIG. A maternal

specimen collected one hour post procedure should be obtained for spontaneous

or therapeutic abortions after the 20th week of pregnancy, after hypertonic

solution pregnancy termination, or following delivery, in order to recognize the

rare patient with a massive fetomaternal hemorrhage. Antepartum blood

samples are satisfactory for spontaneous and therapeutic abortions before the

20th week of pregnancy.

For the treatment of ITP: The Rh type of the patient must be determined. If Rh

is not known, a venous specimen in a pink top tube is reuqired..

Determination of Dose: The Blood Bank routinely performs a screening test for

massive fetal-maternal hemorrhage postpartum to determine if additional

testing is required to establish the appropriate dose of RHIG. On request, this

screening test will be performed on specimens from antepartum patients.

VariZIG (TM) Varicella Zoster IgG

Crossmatch: Not required; no patient sample required

Approximate Volume: 125 international units/vial

Dose: 1 vial per 10 kg body weight to a maximum of 5 vials

Administration: administered intramuscularly within 72 hours of exposure

Indication: Indicated for immunosuppressed patients with a recent exposure to

chicken pox.

This product is available only to patients who particiapte in research study. It is

not stocked and must be ordered and shipped as needed. Release, consent and

study forms are required. Refer to Pharmacy Web

pag

ehttp://ummcpharmweb/di/DispensingProcedures/VariZIGDispensingProcedur

es.pdf for information on ordering.

AUTOLOGOUS COMPONENTS

Crossmatch: Required for RBC components

Outdate: 21 days to 42 days depending on the anticoagulant

Storage


Minimum

Preparation

Time:

Donations must be scheduled and units collected at least four

days in advance of proposed date of use. At least two week

prior donation is recommended.

Description: Whole Blood or Red Blood Cells collected from a patient/donor

and stored for future use.

Requirements: Patient with a hemoglobin of at least 11 gm/dL (33%

hematocrit) who is not bacteremic and who has an anticipated blood need

greater than 2 units during the dating period of the component may donate.

Patients should be given oral iron therapy.

Indication: Patient request when there is some reason to believe that there is a

risk of blood transfusion for an up coming operative procedure. In rare

circumstances autologous blood may be collected when it is difficult to find

compatible blood due to antibodies directed at red cell antigens.

Collection Sites:

The University of Michigan Hospitals does not collect Autologous Whole

Blood. Donations may be made at any licensed or registered blood donor center

in Michigan, at any hospital in Michigan that routinely collects donor units, or

any U.S. hospital or donor center outside the state of Michigan that is licensed

by the Office of Biologics, Food and Drug Administration (allows for the

interstate shipment of blood). In order to coordinate shipping, payment and

tracking of units, the University of Michigan Hospitals Blood Bank must be

notified in advance that the patient is donating autologous blood.

There are additional fees assessed by the agency collecting the blood. These

fees are charged regardless if the unit is transfused and are not generally

reimbursed by healthcare insurance programs.

In rare circumstances autologous blood may be frozen and stored off site for up

to three months. There are additional fees for freezing and deglycerolization.

DIRECTED DONOR COMPONENTS

Units shipped from donor centers may not be prestorage leukocyte-

reduced. Such units will be issued with a leukocyte-reduction filter to be

used for transfusion of the components. 5/1/06

Crossmatch: Required for RBC components

Outdate: 21 days to 42 days depending on the anticoagulant

Storage


AvailabilityFour working days from the time of donation must be

allowed for processing and shipping of units

Indications:

There are few, if any, indications for the use of directed donor blood

components. Directed donor units are collected for patients with an anticipated

blood need, at the request of the patient (parent or guardian) and the patient's

physician. Directed Donor units must be fully processed, and only donor units

meeting American Association of Blood Banks and Office of Biologics, Food

and Drug Administration requirements may be used for transfusion.Due to the

special handling, an additional service fee is charged per unit donated.

These additional are not covered under most health insurance plans. In

addition, there are additional fees for directed donor units as they must be

irradiated to prevent posttransfusion graft-versus-host disease.

Donations for patients being treated at the University of Michigan Hospitals

may be made at any licensed or registered blood donor center in Michigan, at

any hospital in Michigan that routinely collects directed donor units, or any

U.S. hospital or donor center outside the state of Michigan that is licensed by

the Office of Biologics, Food and Drug Administration (allows for the interstate

shipment of blood). In order to coordinate tracking, payment and shipping of

units donated at other centers, the University of Michigan Hospitals Blood

Bank must be notified in advance that the patient has selected his/her own

donors.

IRRADIATED BLOOD PRODUCTS

Outdate:

Red Blood Cells and Whole Blood outdating reduced to no

more that 28 days past the date of irradiation or the original

outdate, whichever is sooner. The outdate of platelet

components does not change with irradiation.

Preparation

Time:

An additional 15 minutes is required to prepare irradiated

components

Description: Blood components exposed to approximately 2500 cGy. All

components except progenitor cell components, previously frozen plasma and

cryoprecipitate should be irradiated.

Indications: Patients who are at high risk of graft-vs-host disease. This includes

patients who are congenitally immunodeficient, have altered immune status

secondary to malignant neoplasms, or are neonates who have received an

intrauterine transfusion. It may also be indicated for bone marrow transplant

recipients or patients undergoing treatment with chemotherapeutic agents.

Directed donor units are irradiated to prevent graft-vs-host disease.

Contraindications: Irradiated Red Blood Cells have an increased plasma

potassium and decreased in vivo survival

Availability: The physician must indicate irradiated components in the order for

blood components.

OTHER PLASMA DERIVATIVES

Plasma derivatives such as serum albumin solutions, coagulation factor

concentrates and other immune serum globulins are available by prescription

from the Pharmacy.

Special Leukocyte-reduction Filters

Follow the manufacturer's instructions contained on the filter packaging for

priming the filter.

Use infusion pumps only if the manufacturer's instructions indicate that

infusion pumps may be used. Inappropriate use of such pumps may result in

loss of filter effectiveness or filter material being infused especially if the pump

rate exceeds the flow rate of the filter.

Documents

4 Blood Components