plasma components
TRANSCRIPT
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PLASMA COMPONENTSPresenter – Dr Sowmya.S.M
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2COMPONENTS OF BLOOD
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3 BLOOD COMPONENTS
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WHAT IS PLASMA??
Clear, straw-coloured liquid portion of blood that suspends all the other parts of the blood.
It is the single largest component of human blood, comprising about 55 percent.
It contains water, salts, enzymes, antibodies and other proteins.
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5COMPOSITION
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7 ACTIONS
Intravascular fluid part of extracellular fluid. Protein reserve. Solvent for nutrients, electrolytes, gases and other substances. Plays a vital role in an intravascular osmotic effect that keeps
electrolytes in balanced form and protects the body from infection and other blood disorders.
Helps maintain blood pressure and regulates body temperature.
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8 HOW IT IS SEPERATED??
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Different specific gravities of blood components. RBCs: 1.08 – 1.09 Platelets: 1.03 – 1.04 Plasma: 1.02 – 1.03
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10 DIFFERENT PLASMA COMPONENTS Fresh frozen plasma Frozen plasma Thawed plasma Cryoprecipitate-reduced Cryoprecipitate Coagulation factors – Factor VIII, IX, XIII and VIIa Albumin
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11 FRESH FROZEN PLASMA Plasma separated from whole blood. Frozen within 6-8 hours of collection. Rapid freezing of plasma preserves the
labile coagulation factors at maximum levels.
Stored at ≤ –20°C for up to one year Or at ≤ –65°C for up to 7 years
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12 PREPARATION OF FFP Whole blood - double/triple – CPD/CPDA or special bag system
with additive solution – SAGM
Balance the bags and placed in centrifuge.
Centrifugation – 5000 rpm for 5 min at 4°C (Heavy spin).
Separate plasma into satellite bag using plasma extractor.
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Label with unit number and blood group before separation.
Cut the tubing between two seals
Place the plasma at -20°C or lower within 6 hours of collection.
FFP from a standard donation of whole blood (450ml) usually measures 175-250 ml.
It contains 70-80 units/dl of Factor VIII, Factor IX, vWF and other plasma clottting factors.
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Weigh and balance the units and centrifuge
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Separated plasma Express plasma to satellite bag
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Seal the tubes and separate
Plasma stored at -20°C or lower
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17 BEFORE ISSUE…
Before transfusion, it is thawed over 20 to 30 mins at 30 to 37°C.
A water bath is used for thawing. The entry ports need to be protected from contamination
during this process. Transfused immediately or stored at 4°C (1–6°C) for 24 hours
– “FFP thawed” After 24 hours, the words “fresh frozen” should be removed
and labelled as “Thawed plasma”.
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18 INDICATIONS
Multiple coagulation factor deficiencies – liver disease, DIC, coagulopathies.
Reversal of coumarin drug effect. Use in antithrombin deficiency. Immunodeficiency syndromes. Raised PT and INR
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19 DOSE AND ADMINISTRATION
Accepted dose of FFP transfusion is 12-15ml/kg. However dose depends on the underlying clinical disease. Post transfusion assessment of patient’s coagulation
parameters like PT, aPTT or specific factor asssay is important for monitoring.
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20 FROZEN PLASMA
Separated from whole blood within 8 - 24 hours of collection. The level of the labile clotting factors, factors VIII and V is
lower in FP, than in FFP. Adequate – treatment of mild to moderate coagulation factor
deficiencies.
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21 SOLVENT/DETERGENT-TREATED PLASMA The thawed plasma is treated with solvent tri-n-butyl
phosphate (1%) and detergent Triton X-100 (1%) Removed after treatment and the sterile-filtered plasma is
refrozen. ADVANTAGES: Significantly inactivates the lipid enveloped
viruses (e.g. HCV, HBV, HIV). But not the non lipid enveloped viruses - hepatitis A and
parvovirus.
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22 CRYOPRECIPITATE
Precipitate of fresh frozen plasma (FFP) when it is thawed at 4°C (1°C - 6°C) and then centrifuged, collected, and refrozen.
It is rich in fibrinogen, factor VIII (80–100 u), vWF, fibronectin, and factor XIII.
It revolutionized the treatment of hemophilia and von Willebrand disease.
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It contains 80-100 units of F VIII, 100-250 mg of fibrinogen, 50-60mg of fibronectin and 40-70% of vWF and 20 – 30% F XIII.
Although this product contains small amounts of isohaemagglutinins, it is not necessary to perform compatibility testing prior to administration.
Neonates should receive only ABO-compatible cryoprecipitate.
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26 Each unit – 10 to 15ml.
SHELF LIFE: Frozen:1 yr Thawed: 6 hr STORAGE: 18°C or lesser
BEFORE ISSUE: Thawed over 20 to 30 mins at 30 to 37°C in water bath.
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27 INDICATIONS
Hemophilia A von – Willebrands disease Congenital fibrinogen deficiency Factor XIII deficiency Acquired Factor VIII deficiency – eg: DIC, massive transfusion Used as local/topical hemostatic agent.
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28USAGE
Dosage - relatively subjective Monitored by serial measurements of plasma fibrinogen. One unit will increase the fibrinogen by 5 to 10 mg/dl in an
average sized adult. Cryoprecipitate has been used with a source of thrombin as
a topical haemostatic agent as well
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29 CRYOPRECIPITATE-DEPLETED FRESH-FROZEN PLASMA(CRYOSUPERNATANT)
The remaining thawed plasma of FFP that is left after Cryoprecipitate is separated is called cryoprecipitate reduced (cryo-poor) plasma or cryosupernatant.
All the factors like fibrinogen, factor VIII, von Willebrand’s factor (vWF), factor XIII and fibronectin, are reduced in the cryo-poor plasma.
It is deficient in the pathogenic ultra-large multimers of vWF but contains vWF-cleaving metalloprotease.
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STORAGE: –18°C or colder. SHELF LIFE: one year from the whole blood collection date.
INDICATIONS: treatment of refractory thrombotic thrombocytopenic purpura
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31 FACTOR VIII CONCENTRATES
Prepared from large volumes of pooled plasma or in the form of recombinant FVIII using DNA technology.
When prepared from pooled plasma, techniques used to inactivate or eliminate viral contamination include pasteurization, solvent/detergent treatment, and monoclonal purification.
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32 Factor content per unit volume is 10 – 40 times greater than
plasma. Stored at 4°C in a home refrigerator.
INDICATIONS: Hemophilia A Hemophilia B Persons deficient in factor VIII.
02/11/2016
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33 FACTOR IX CONCENTRATES Prepared from pooled plasma. Available in three forms: Prothrombin complex
concentrates Factor IX concentrates Recombinant Factor IX.
02/11/2016
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INDICATIONS: Treatment of Factor IX deficiency or Hemophilia B Treatment of Factor XI Deficiency (Hemophilia C) Also contains Factor II, VII and X in concentrated form. Vials contains 500 units of Factor X.
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35 FACTOR XIII CONCENTRATES There are currently two plasma-derived virus inactivated
factor XIII concentrates. Fibrogammin P Factor XIII concentrate
Single-use vial contains 1000 – 1600 IU of lyophilised concentrate
STORAGE: AT 2 - 8°C SHELF LIFE: 36 months
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36 ALBUMIN Albumin is the quantitatively dominant plasma protein. MW - 66kDa, water-soluble protein. Synthesized in the liver at a rate of about 15 g/day. Half-life of around 25 days.
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37 PREPARATION Commercially available albumin preparations are obtained
from plasma fractionation, according to Cohn and Oncley or Kistler and Nitschmann.
Albumin is obtained as fractionV in Cohn process. These are subsequently pasteurized for virus inactivation.
These solutions contain either 3.5–5% or 20–25% albumin at a purity of 95–98%.
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Preservative: None Protein composition: ≥96% of the total protein in the
final product must consist of albumin.
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39 PLASMA FRACTIONATION PROCESS
The Cohn process: Based on the differential precipitation of plasma proteins by manipulation of ethanol concentration and ph of a low-ionic-strength solution maintained at a subzero temperature.
02/11/2016
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41 DOSE According to the American Hospital Formulary Service(AHFS)
Drug Information guide, a typical initial adult dose of albumin is 25 g.
Can be repeated in 15 to 30 minutes depending on the patient’s response.
Up to 250 g of albumin may be infused in a 48-hour period. The infusion rate should be based on the patient’s condition.
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42 ADMINISTRATION Albumin should be inspected for turbidity prior to
administration. Administration must begin within 4 hours of entry into the
container. Because blood group isohemagglutinins are removed from
albumin products, albumin is given without regard to ABO type
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43 INDICATIONS Hypoalbuminemia - liver dysfunction, malnutrition, and
malabsorption. Thyrotoxicosis Pancreatitis Protein-losing gastroenteropathy Nephrotic syndrome.
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44 FIBRIN GLUE AND SEALANTS This results from a mixture of fibrinogen source (FFP, PRP,
heterologous or autologous cryoprecipitate) with bovine thrombin.
The hemostasis is achieved with action of thrombin on fibrinogen. This is widely used during surgery to stop bleeding immediately.
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45-THANK YOU