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