1500’s to 1800’s

• Not known when or by whom the idea of transfusing Introduction to Transfusion came was developed • 1492 ?first transfusion to Pope Innocent VIII Medicine • 1616 description of circulation William Harvey • 1600’s – Animal to Animal Transfusion Jeffrey S. Jhang, MD – Animal to Human Transfusion/First Hemolytic Transfusion Assistant Director, Transfusion Reaction • 1818 Human to Human: James Blundell (studied post- Medicine partum hemorrhage) • Mid 1800’s First transfusion in United States

Anticoagulation Discovery of Blood Groups Plastic Bags and Components • 1900 Landsteiner ABO groups (ABC); later AB • Early devices directly connected donor to recipient by DeCastello and Sturli • Blood Clotting prevented storage of components • 1939 Levine and Stetson • Calcium is needed for blood to clot – Hemolytic Disease of the Newborn • 1915 Sodium Citrate • 1940 Landsteiner Weiner • ? First used for transfusion • 1950 Plastic Bags Carl Walter – Rh Blood Group (D antigen) – Separation of Components using multiple connected plastic bags • Mid 1940’s C,E,c,e of – collection and storage • Other Blood Groups • 1955 Lewisohn Landsteiner Award for citrate work – MNSs, Duffy, Kidd, Kell…… • 1960’s anti-Rh prevents alloimmunization

Modern Blood Banking History

• 1932 Leningrad First • Fractionation of Coagulation Factors • Development of recombinant factors • Cook County Hospital first in USA to store • Understanding of Hemolytic transfusion reactions refrigerated blood and other adverse transfusion events • Improved preservation medium • US Army Group used sodium citrate in • leukocyte and platelet antigen systems glass bottles during World War I and II • technology • Hospital and Community Blood Banks • Automation established across the world • Infectious disease screening testing • Cellular Therapies

1 The Red Defender What do we do? US Blood Supply System • Blood and Blood Component Collection, Processing and Storage • Blood Banking • US Blood Supply provided by different organizations – Pre-transfusion testing – American Red Cross (25% of centers) – Transfusion practices – Transfusion Reaction Evaluation – Community Blood Centers (e.g. New York Blood – Quality Assurance Center); Hospital based Blood Centers (e.g. NYUMC) – Regulatory Compliance: CAP, AABB, FDA, NYSDOH, JCAHO • Exporting and Importing Blood Centers • Stem Cell/Cellular Therapy – Processing and Cryopreservation and Storage – Manages Inventory and Distribution – Novel Cellular Therapies • Professional Blood Bank Associations • Therapeutic Apheresis – AABB, ABC, ABRA – Plasma exchange, red cell exchange, leukapheresis, platelet pheresis • Stem Cell Collection • Regulation – Peripheral blood – Food and Drug Administration Regulates as a – Cord pharmaceutical • Continuing Education – Quality Assurance!

Donor Evaluation Collection of Blood

• Blood Containers • Protect Donor and Recipient • Phlebotomy • Treatment of Adverse Donor Reaction – Donor History Questionnaire/Physical Exam – Nausea/Vomiting – Donor Testing (Infectious Disease Markers) – Syncope – Hyperventilation –Hematoma • See handout of Donor Questionnaire – More Serious • Meets FDA regulations

2 Infectious Disease Markers and Testing • ABO/Rh; antibody screen • Hepatitis B (1 in 63,000) • Hepatitis C (1 in 1.6 million) • HIV (1 in 1.9 million) • HTLV (1 in 641,000) •WNV •STS •CMV

Component Production

• Collect in ACD • Soft Spin and take off platelet rich plasma • Red cells finished add adsol Æ Fridge • Platelet rich plasma hard spin • Express off plasma Æ freeze as FFP • Platelet concentrate Æ RT • Freeze FFP, thaw at 4C, express off supernatant Æ cryopoor plasma,

Apheresis Technology Red Cells • Homologous • Single Donor (6-8 U) • Autologous • Double Plt • Packed Red Cells • Frozen thawed • Double Red • Irradiated • FFP and Red • CMV negative But need HES • Antigen Negative • Sickle negative • Leukoreduced

3 Plasma Platelets • Repletion of all known • Random vs Apheresis clotting factors • kept at room • Short half-life of coagulation factors (some temperature increasing <4 hours) risk of bacterial • Takes 1 hour to thaw contamination • Good for 24 hours post • 5 day outdate thaw • Always in short • 200-300 ml per unit supply • 4-6 units is the appropriate • Apheresis SDP is 200- dose (large volume load!) 400 ml (6-8 units) • Vitamin K! •TRALI

Cryoprecipitate Blood Bank • Fraction of blood that does • Pretransfusion Testing: not dissolve on thawing at – Blood Typing 4 degC – Antibody Screening • Consultative Services and Identification • Rich in fibrinogen, factor – Rare Blood and Red VIII, vWF, fibronectin – Direct Antiglobulin Cell Antibodies Test • 15ml/unit; dose is 10 – Difficult Transfusions – Indirect Antiglobulin units; NOT concentrated Test – Appropriate Component Therapy plasma!; • Transfusion Services • Responsible for Quality • Treats low fibrinogen – PRBC, PLT, FFP, Assurance Cryo..etc (↑50-100g/dl) • Meets regulations (FDA, • Can be used to treat – Autologous Program NYSDOH, AABB, CAP, uremic thrombocytopathy – Directed Blood JCAHO) – RhoGAM, Novoseven, Factors

Apheresis Stem Cell Processing and • Collections Transplantation – Single Donor Platelets; FFP; Red cells • Volume Reduction – Peripheral Blood Stem Cell Collections • T-cell depletion • Therapeutic • CD34 Selection – ABO/XM incompatible transplants • Cryopreservation – Myasthenia Gravis • Thawing – Thrombotic thrombocytopenic purpura • Washing – Guillain-Barre – Sickle Cell Disease • Novel Therapies – – Dendritic Cell Vaccines, Immunotherapy, – Thrombocytosis Mesenchymal and Tissue –etc Stem Cells

4 Cord Blood Collection and Transplants

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