All red cell concentrate produced in the Blood Bank is leukoreduced.

The Blood Bank has irradiated red cell concentrate in stock.

Exchange blood transfusion

The Blood Bank produces blood for exchange transfusion carried out in newborns.

For the production of blood for exchange transfusion, red blood cell concentrate and plasma are mixed in certain proportions to achieve the desired hematocrit for neonatal hemodialysis. The product is irradiated immediately after production, and its expiration time is 24 hours from irradiation. Blood for exchange transfusion is not available in stock but is prepared at the request of neonatal intensive care unit (NICU) physicians.

Infant units

Special infant units derived from leukocyte-filtered red cell concentrate. One unit of leukocyte-filtered red blood cell concentrate is divided into four smaller units. With this, infants can often receive more than one unit of red blood cells from the same donor. In special cases, the irradiated neonatal units are produced at the request of the neonatal intensive care unit (NICU) physicians.

From 15 June 2023, neonatal RBC concentrate is contained in DEHP free bags.

Storage

Red blood cell concentrates are stored for 6 weeks from the day of collection at 2-6°C in a specialized blood cabinet that has a temperature recording and/or is connected to an alarm system.

Irradiated red blood cell concentrate is stored for 14 days from the day of collection.

Neonatal units are kept for 14 days from the day of collection. Irradiated neonatal units are stored for 48 hours from the radiation.

Reminders

Red blood cell concentrate is used, e.g. for blood loss due to surgery, accidents, etc. or anemia due to disease or treatment.

For further information see:

Contraindications

When blood loss can be improved by other methods such as medication.

For further information see:

Ordering red blood cell conentrate

Concentrated red blood cells are ordered by request, by telephone or by electronic order through Heilsugátt. Prior to reservation of red blood cell concentrate, the patient must have been blood grouped twice from at least two separated samples. A crossmatch (BAS/BKS test) is also required for the patient. The duration of the reservation is 2 days.

Transport

Red cell concentrate is transported in special cases made for the transport. The have a stable temperature of 1-10°C. In longer transports the temperature is recorded with a thermometer.

The Icelandic Blood Bank has two production methods for platelet concentrate:

• Platelet concentrate from whole blood of 8 donors

• Platelet concentrate collected by apheresis from one donor

Since the fall of 2012, all platelet units produced in the Blood Bank have been pathogen inactivated.

Infant units

One platelet unit can be divided into 4 units for newborns and young children. Such platelet units are not available on stock but are produced on order.

From April 2023, DEHP free bags are in use for infant unit of platelets.

Storage

Platelet concentrates are stored at +20 to +24°C in continuous motion in special platelet cabinets that have temperature recording and an alarm system. Platelet concentrate is stored for 7 days.

Reminders

Platelet concentrate is used for antihemorrhagic, antiplatelet, and antiplatelet disorders. A single unit is considered to increase a patient's platelet count by 30 x 10⁹/l in adults (5-7 ml platelet concentrate / kg body weight).

For further information see:

Order platelet conentrate

Platelet concentrate is ordered by telephone or electronic order. Patients must have been blood grouped twice from at least two separate samples before blood platelet concentrate is reserved. Units shall be donated immediately upon receipt. The duration of the reservation is 4 hours.

Transport

Platelet concentrate transported over short distances is packed in soft paper in a special lined bag marked with the department and the patient's initials. If transport takes more than 30 minutes, platelets are packed in specially designed bags. The bags contain isolation plates that keep temperatures at 18-24°C. A thermometer is placed in the case to monitor temperature during transport.

The Blood Bank has two production methods for plasma.

• Plasma derived from whole blood from 5 donors

• Plasma collected by apheresis from one donor

The product is pathogen inactivated using amotosalen solution. See further under "Solutions used in the production of blood products"

Infants

Specific plasma units are not available for infants.

Storage

Plasma is stored for 2 years at -30°C. Storage in special plasma freezers with temperature recording and alarm system.

Reminders

Plasma is given at the time of e.g. lack of coagulation factors. For further information please see: .

Contraindications

Plasma should not be administered to increase the volume or to reverse anticoagulation in patients. For further information see:

Order

Plasma is ordered by telephone or electronically. The patient must have been blood grouped twice from separate samples before plasma is reserved for the patient. Thawing takes 10-15 minutes at the Blood Bank. Plasma is reserved for 24 hours after thawing.

Transport

The thawed plasma is transported in special blood cases that maintain the correct temperature of blood components during transport, i.e. 1-10°C. For longer journeys, temperature is recorded with thermometers placed in the bags.

Description

Hematopoietic stem cells are released from the bone marrow into the bloodstream by parenteral administration. They are then collected by apheresis. The stem cell unit content is different from normal whole blood because the platelet to red cell ratio is lower, but the white blood cell ratio is higher, including haematopoietic stem cells."

Additional solutions

DMSO (Dimethyl Sulfoxide, C2H6OS) is added to reduce ice crystal formation during freezing of units, which could lead to damage to cell membranes and increased cell death. Plasma is added to the units in the process. Plasma contains an anti-coagulant ACD-A. The added plasma is from the AB blood group and the appropriate RhD blood group.

Freezing and storage

After the stem cell unit has been prepared for freezing, it is frozen in a controlled rate freezer. Stem cell units are stored frozen (< -140°C) until administration or until they are disposed of in consultation with the patient's physician.

Transport and administration

The personnel of the Blood Bank will deliver frozen stem cell units, contained in a Cryogenic Dry shipper, to the haematology department on the designated day/time upon a request from the patient's doctor. There, the staff of the Blood Bank thaw the units in a 37°C water bath and deliver them to the Faculty of Haematology for administration to the patient.

Reminders

Autologus haematopoietic stem cells are usually given to patients in conjunction with high dose cancer therapy to accelerate haematopoietic progenitor formation after myelosuppression. Common indications include myeloma and lymphoma.

Ordering and reservation

The collection of autologous blood progenitor cells for a patient is on request from the haematology department and the stem cell units are only intended for that specific patient. Administration of autologous HPCTs to a patient is also performed upon request from a haematology unit and is generally conducted shortly after high-dose therapy on a specific day/time.

Circular of Information for the Use of Cellular Therapy Products

JACIE accreditation of the blood bank stem cell activities (https://www.ebmt.org/jacie-accreditation#home) requires that standard information on stem cell products and their use be accessible to users. Circular of Information for the Use of Cellular Therapy Products contains information that has been approved and published by the following organisations:

• AABB (formerly known as the American Association of Blood Banks)

• America's Blood Centers

• American Red Cross

• American Society for Apheresis (ASFA)

• American Society for Blood and Marrow Transplantation (ASBMT)

• College of American Pathologists (CAP)

• Cord Blood Association

• Foundation for the Accreditation of Cellular Therapy (FACT)

• ICCBBA

• International Society for Cellular Therapy (ISCT)

• Joint Accreditation Committee of ISCT and EBMT (JACIE)

• National Marrow Donor Program (NMDP)

• World Marrow Donor Association (WMDA)

From October 2012, all platelet concentrates are produced in the Blood Bank using a process that purges potential infectious agents from blood components, whether bacterial or viral. The processing method is called Intercept Blood System and is provided by Cerus. This new method replaces traditionally irradiated platelet concentrates. From May 2014, all plasma units produced in the Blood Bank are also purged with the same method.

In the process of pathogen inactivation, amotosalen (psoralen derivative) is added to the unit. Amotosalen causes cross-binding of DNA during UV illumination (UVA), but the cross-bound DNA is inactive. After UVA photography, the main part of amotosalen is removed from the unit. Intercept platelets also contain a new and improved platelet-nutrient solution (SSP+).

Intercept-treated platelet concentrates are in all respects processed in the same way as before, i.e., from the donor’s whole blood and with apheresis.

Benefits of Intercept

• Inactive bacteria and viruses that can be transmitted during transfusions

• Inactive white blood cells that may cause side effects

• Extends platelet survival from 5 days to 7 days

Replaces the irradiation of platelets and plasma

Various data (PDF):

You can find information on this topic on Intercept's website

Blood components are irradiated at 25 GRAY (2500 RAD). The shell life of red blood cell concentrate is reduced in radiation. Irradiated concentrated red blood cells are stored for 14 days from the day of collection.

Reminders

Administer to patients with inborn immunodeficiency or who are immunocompromised after treatment for bone marrow transplantation to reduce the risk of graft versus host disease.

For further information see:

Whole blood is collected using a CPD clotting warning agent, 63mL in 450mL of whole blood. Content in 1000 ml CPD:

• Citric Acid Monohydrate 3.27g

• Sodium Citrate Dihydrate 26.3g

• Glucose Monohydrate 25.5g

• Sodium dihydrogen phosphate dihydrate 2.51 g

• Water to injection to 1000 ml

For collection of platelet concentrate an ACD-A coagulation warning agent containing 100mL is used:

• Acidum citricum monohydricu, Ph Eur 0.8 g

• Natrii citras dihydricum Ph Eur 2.2 g

• Glucosum monohydricum Ph Eur 2.45 g

• Aqua ad iniectabilia Ph Eur ad 1000mL

A SAGMAN nutrient solution added to the concentrated red cells contains:

• Natrium chlorid 877 mg

• Dextros. monohydr. 900 mg

• Adenin. 16.9 mg

• Mannitol 525 mg

• Aqua ad iniect. ad 100mL

PASIII solution, SSP+, is used to produce platelet concentrate:

• Na3-citrate 2H2O: 3.18 g

• Na-acetate 3H2O: 4.42 g

• NaH2PO4 2H2O: 1.05 g

• Na2HPO4: 3.05g

• KCl: 0.37 g

• MgCl2 6H2O:: 0.30 g

• NaCl: 4.05g

• Aqua ad iniect. ad 1000 ml

• pH 7.2

For pathogen inactivation of platelet concentrate, amotosalen solution is used that contains:

• Amotosalen HCl 101 mg

• Natr. chlorid. 924 mg

• Aqua ad iniect. ad 100 mL

In plasma pathogenesis, amotosalen solution is used which contains:

• Amotosalen HCL 203 mg

• Natr.chlorid. 924 mg

• Aqua ad iniect. ad 100 mL

DMSO solution used in the stem cell units

• 99.9% Dimethyl Sulfoxide C2H6OS