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Preoperative Sequestration (PPP and PRP)
10-2
20077/021 US
X
TRA
Operator’s Manual
Enabling the Preoperative Sequestration Protocols
Whole blood separation with the X
TRA
system requires that at least one of the sequestration protocols
be enabled. These protocols may be enabled and disabled from the Protocol Set tab of the
Configuration Mode Screen. To enter the Configuration Mode Screen, follow the instructions in “How to
Enter the Configuration Mode” on page 8-2.
Overview of Preoperative Sequestration
The X
TRA
preoperative sequestration option enables the sequestering of plasma, plasma proteins, and
platelets from the patient’s own whole blood before initiating intraoperative red blood cell recovery.
The preoperative sequestration program is used preoperatively in cardiac surgical procedures and
other procedures in which bleeding may occur during the postoperative course, or in those procedures
in which platelets may be required postoperatively.
For a detailed description of each of the sequestration protocols shipped with the X
TRA
, refer to “The
Preoperative Sequestration Factory Protocols” on page 10-21.
Regardless of the active sequestration protocol, sequestration processing will be performed after the
preliminary collection of the patient’s blood into a transfer bag containing anticoagulant (the machine
is not involved in this collection). Whole blood separation consists of three steps:
• Collecting, anticoagulating, and storing the patient's blood. The anticoagulant of choice for plasma
sequestration is citrate (ACD-A).
• Processing the blood to separate platelets, plasma, and red blood cells.
• Returning the blood in the RBC bag and the plasma and platelets collected in the PPP and/or PRP
bags to the patient.
Preoperative sequestration is performed on the recommendation of a physician and is conducted
under close supervision by a trained operator. Blood is withdrawn from the patient through routine
hemodilution techniques and collected in a blood bag pre-filled with citrate, such as ACD-A. The
volume of blood obtained is determined by the physician and is dependent on the condition of the
patient, the patient’s hematocrit, and the amount of plasma desired. The patient’s hemodynamic
status and the sequestration procedure should be monitored closely by a physician.
Processing with the sequestration protocols is carried out through the execution of three phases, in
this sequence:
1. Fill Phase
2. Spill Phase (except with the PPP protocol)
3. Empty Phase
During the Fill phase, the blood is pumped into the spinning centrifuge bowl. Red cells are retained in
the bowl because of their higher density. During the initial phase of the sequestration process, the
centrifuge speed of 5600 RPM forces the red blood cells to pack tightly against the side of the bowl.
The plasma and plasma proteins are separated from the red cells by a thick white layer, known as the
buffy coat, which is rich in platelets and white blood cells (WBC).
As the blood fills the bowl, the plasma, which is of lower density, separates from the red cells and spills
into the PPP bag. (When using the PPP protocol, processing ends with the collection of this
platelet-poor plasma.)
When enough red cells have filled the bowl to push the buffy coat into a predetermined position, the
centrifuge is slowed to 2400 RPM, which enables a “soft spin” that gently releases the buffy coat from
the red cell pack. During the Spill phase, blood continues to fill the bowl and the second component, a
concentrated platelet product (PRP), spills into the bag (or into a separate PRP bag when the PRP2
protocol is active).
Since the young platelets extend beyond the buffy coat into the red cell layer, red blood cells are
collected with the platelet concentrate to maximize platelet yields collected.
At the end of the plasma/platelet collection phase, the red cells are emptied from the bowl into the
RBC bag. The fluid in the RBC bag consists of red cells, other formed elements, and some plasma. The