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How Do Blood Components Work? - Uses, Side Effects, Drug Names

How Do Blood Components Work?

How Do Blood Components Work?

Blood components are the different substances that constitute whole blood, and each of the components performs a specific function. Blood components are extracted and isolated from whole blood obtained from donors. Whole blood or a specific component may be used for treatment depending on the type of a patient’s blood disorder.

Blood and blood component products used for transfusion include:

Whole blood

In the U.S., fresh whole blood is not commonly available any longer and is primarily used for transfusion in individuals with severe blood loss, who generally require all the blood components. Whole blood may also be reconstituted using stored plasma, red blood cells (RBCs) and platelets, usually used for cardiovascular surgeries and exchange transfusions in newborn babies.

Plasma

Plasma is the liquid component of blood, a straw-colored fluid that helps the other components reach all the body organs. Plasma constitutes approximately 55% of the total blood volume and 92% of plasma is water. Plasma maintains blood volume, blood pressure and biological stability (homeostasis).

Plasma helps transport nutrients such as electrolytes, minerals, amino acids, vitamins, proteins, enzymes, hormones, organic acids and other substances to the cells, and the metabolic wastes to the lungs, kidneys and liver for excretion. Plasma also contains specialized proteins that regulate clotting and clot-dissolving processes.

Plasma is available in the following forms:

  • Liquid plasma: Fresh plasma administered within 8 hours after separation from whole blood.
  • Fresh frozen plasma (FFP): Liquid plasma that is frozen within 8 hours after collection.
  • P24 plasma: Liquid plasma that is frozen between 8 and 24 hours after collection.
  • Thawed plasma: FFP or P24 plasma that is thawed for use. It must be immediately administered or may be stored at 1 to 6 degrees Celsius for up to 24 hours. Thawed plasma is discarded if not used within that period.
  • Solvent-detergent treated pooled plasma: Plasma pooled from donors and treated with solvent-detergent agents to inactivate any enveloped viruses present.
     

Platelets

Platelets, also known as thrombocytes, are small cell fragments of large bone marrow cells known as megakaryocytes and derive their name from their plate-like shape. Platelets clump together as the first step in the process of blood clot formation to stop bleeding and to heal wounds. Low platelet count (thrombocytopenia) heightens the tendency to bleed which can result in uncontrollable bleeding.

Platelets may be derived from pooled whole blood from several donors or directly from a single donor using a process known as apheresis. Platelets are extracted by centrifugation which removes 98-99% of the plasma constituents, and the plasma is replaced with normal saline or a plasma substitute. Platelets are administered in the following forms:

  • Standard platelets: Platelets derived from pooled whole blood.
  • HLA-matched platelets: Human leukocyte antigens (HLA) are proteins on the surface of most cells. HLA-matched platelets are used to reduce the risk of development of antibodies to the donor platelets by the recipient’s immune system.
  • HPA-1a negative platelets: Human platelet antigen-1a (HPA-1a) platelets are used in newborns who have acquired antibodies against platelet specific antigens, to prevent immune reaction to the donor platelets. HPA-1a is the most common platelet specific antigen implicated in neonatal alloimmune thrombocytopenia.

Cord blood hematopoietic progenitor cells (HPC-C)

Cord blood is the blood that remains in the placenta and umbilical cord after childbirth. Cord blood contains stem cells, also known as hematopoietic progenitor cells (HPC-C), that can turn into any kind of blood cell. The stem cells are extracted from the cord blood and frozen.

Once administered, the stem cells migrate to the recipient’s bone marrow, divide and mature into different types of blood cells which are released into the bloodstream. Stem cell transplants are used in the treatment of blood cancers, anemias and many other diseases to fully or partially restore blood counts and functions, including immune function.

Red blood cells

Red blood cells (RBCs), also known as erythrocytes, give the blood its red color. RBCs transport oxygen from the lungs to all the tissues for conversion into energy, and carry back the released carbon dioxide to be exhaled by the lungs. RBCs are administered to increase oxygen delivery in patients with low tissue oxygen due to bleeding or anemia.

Red blood cells may be washed using centrifugation to remove 98-99% of the plasma constituents. Washed red blood cells are typically used in patients who have recurrent severe allergic transfusion reactions which do not respond to antihistamines or corticosteroids.

Granulocytes (neutrophils)

Granulocytes are types of immune cells that play a major role in fighting bacterial and fungal infections. Granulocytes contain granules of enzymes that they release at the infection site. Granulocytes include neutrophils, eosinophils and basophils, among which neutrophils are the most abundant. Granulocytes are administered to patients with low neutrophil count (neutropenia) or refractory bacterial or fungal infection.

Hemin

Hemin is a substance derived from red blood cells, used to treat certain types of porphyria. Porphyria is a group of inherited disorders caused by a buildup of porphyrin, a substance that plays a key role in the synthesis of heme. Heme is a vital component of iron-carrying proteins, including hemoglobin, the protein that carries oxygen in red blood cells.
 

Human prothrombin complex concentrate

Prothrombin complex concentrate contains vitamin-K dependent coagulation factors II, VII, IX and X, together known as prothrombin complex, and anti-clotting (antithrombotic) protein C and protein S. These coagulation factors and the antithrombotic proteins regulate the processes of clot formation and the dissolution of clots.

Prothrombin complex concentrate is administrated for urgent reversal of acquired coagulation factor deficiency induced by anticoagulant medications (vitamin K antagonists) such as warfarin. The concentrate is used in combination with vitamin K in adults with acute major bleeding or in need of an urgent surgery or invasive procedure.

Cryoprecipitate

Cryoprecipitate is an extract obtained from thawed plasma by centrifugation and contains coagulation factors XIII, VIII, von Willebrand factor, and fibrinogen, all of which play important roles in blood clot formation. Cryoprecipitate is administered to patients who are deficient in these factors and are bleeding or at an increased risk of bleeding.

Plasminogen

Plasminogen is a protein synthesized by the liver and circulates in blood. Plasminogen is a vital component of the clot dissolving process and removal of fibrin, the insoluble fibrous protein derived from fibrinogen. Fibrin is the primary structural component of a clot.

Plasminogen is vital for wound healing, cell migration, tissue remodeling, new blood vessel formation (angiogenesis) and embryo development (embryogenesis). Plasminogen is administered as replacement in patients with plasminogen deficiency.

Other blood products

Blood and blood components may also be selectively chosen or treated to suit specific requirements of certain patients:

CMV-negative blood and components

Cytomegalovirus (CMV) is a common virus found in over half the population. A healthy person’s immune system can usually prevent the virus from causing serious illness and most people have no symptoms. CMV, however, can cause serious symptoms in newborn babies and CMV-negative people with compromised immune symptoms.

The patients at high risk for disease from CMV are usually given whole blood and blood components collected from donors who are tested for CMV and found negative.

Irradiated blood and components

Blood and components are irradiated to prevent the proliferation of any lymphocytes present in the blood products. Irradiated blood and components are used in vulnerable recipients to prevent transfusion-associated graft-versus-host disease (TA-GVHD), a condition in which the donor white cells attack the recipient’s tissue.

Leukoreduced blood and components

Leukoreduced blood and components are products from which white blood cells (leukocytes) are removed to the maximum possible extent using special filters. Leukoreduced blood products are used to reduce the incidence of transfusion reactions, the risk of CMV transmission to CMV-naive or negative people, and sensitization to HLA antigens.

How Are Blood Components Used?

Blood and blood components are injected or infused intravenously. Uses of blood products include the following:

Whole blood:

Reconstituted whole blood:

Plasma:

Platelets:

  • Thrombocytopenia
  • Platelet dysfunction
  • Platelet related bleeding or risk of bleeding

HLA-matched platelets:

HPA-1a negative platelets:

  • Neonatal alloimmune thrombocytopenia (NAIT)

Cord blood hematopoietic progenitor cells (HPC-C):

  • Stem cell transplantation

Red blood cells:

  • Insufficient tissue oxygen delivery due to active bleeding or symptomatic anemia

Washed red blood cells:

  • Recurrent severe allergic transfusion reactions

Granulocytes:

  • Neutropenia
  • Refractory bacterial or fungal infections

Hemin:

Human prothrombin complex concentrate:

Cryoprecipitate:

  • Fibrinogen replacement
  • Factor XIII replacement
  • Factor VIII replacement
  • von Willebrand factor replacement

Plasminogen:

CMV-negative blood and components:

Irradiated blood and components:

  • Prevention of transfusion-associated graft-versus-host disease (TA-GVHD)

Leukoreduced blood and components:

  • Decrease incidence of febrile transfusion reactions
  • Reduce risk of CMV transmission
  • Reduce sensitization to HLA antigens

What Are the Side Effects of Blood Components?

The side effects of whole blood and the blood components plasma, platelets, red cells, granulocytes and cryoprecipitate include the following:

  • Hemolytic transfusion reactions that destroy red blood cells
  • Feverish (febrile) non-hemolytic reactions
  • Transfusion-transmitted infections and septic reactions
  • Transfusion related acute lung injury (TRALI)
  • Transfusion-associated graft-versus-host disease (TA-GVHD)
  • Transfusion-associated circulatory overload (TACO)
  • Allergic reactions such as:
  • Severe allergic reaction (anaphylaxis)
  • Post-transfusion bruising (purpura)

Side effects of the other blood products include:

Cord blood hematopoietic progenitor cells

Hemin

  • Inflammation of vein (phlebitis) with or without high white cell count (leukocytosis) and high temperature (pyrexia)
  • Reversible kidney shutdown

Prothrombin complex concentrate

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

What Are Names of Some Blood Components?

Generic and brand names of blood components include:

  • CMV negative blood and components
  • CRYO
  • cryoprecipitate
  • FFP
  • fresh frozen plasma
  • granulocytes
  • HemaCord
  • hematopoietic progenitor cells, cord blood
  • hemin
  • HLA-matched platelets
  • irradiated blood and components
  • Kcentra
  • leukoreduced blood and components
  • neutrophils
  • Octaplas
  • Panhematin
  • plasminogen
  • plasminogen, human-tvmh
  • platelet specific antigen negative platelets (HPA-1a negative platelets)
  • platelets
  • prothrombin complex concentrate, human
  • RBCs
  • red blood cells
  • Ryplazim
  • washed red blood cells
  • whole blood
References
https://reference.medscape.com/drugs/blood-components

https://www.ahn.org/services/medicine/bloodless-medicine/faq/what-is-hemin

https://health.ucdavis.edu/blog/lab-best-practice/reconstituted-whole-blood-transfusion-exchange-in-neonatal-hyperbilirubinemia/2021/09

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926728/

https://transfusionontario.org/wp-content/uploads/2020/06/Patient-Fact-Sheet-HLA-Matched-

Platelets.pdf

https://www.cryo-cell.com/cord-blood-banking

https://medlineplus.gov/genetics/condition/porphyria/