transfusion of blood product history: 1920:sodium citrate anticoagulant(10 days storage) 1958:...

TransfusionTransfusionofof

Blood ProductBlood Product

History:History:1920:Sodium citrate anticoagulant(10 days storage) 1958: Plastic bag of transfusion 1656: Initial theory

and methods (UK)1665: Dog to dog transfusion1667:Animal to human transfusion(20 times)by

Denys ;one case expired with anaphylaxis in third transfusion

1975: Blood banking and blood products

Major Indication for Major Indication for Blood Product Blood Product Transfusion:Transfusion:

Restore Blood VolumeMaintain oxygen carrying capacityMaintain hemostasisMaintain leukocyte function

Blood Donors:Blood Donors:Healthy volunteersHealthy volunteersUsually over the age of 17 years17 years At least 110 pounds110 pounds in weight.Each donor is initially screened

through a detailed medical detailed medical historyhistory

Blood Test:Blood Test:

1. Antibodies to HIV-1 and HIV-2 (AIDS),

2. Antibodies to HBc produced during and after infection with Hepatitis B Virus

3. Antibodies to HCV produced after infection with the Hepatitis C virus

4. Antibodies to HTLV-I/II produced after infection

5. Antibodies to HBsAg produced after infection with Hepatitis B

6. HIV-1 p24, a test for the HIV (AIDS) antigen

7. For blood type (ABO) and Rh factor

8. Tp, the agent that causes syphilis

9. ALT,Coombs,CMV 10. NAT

NAT (Nucleic Acid Testing):NAT (Nucleic Acid Testing):

A new technology that can detect the genetic material of Hepatitis C

and HIV.

Packed Cell Platelet Concentrate Plasma

Red Blood Cells:Red Blood Cells:

40-50% Blood VolumeOxygen carrying Store till 42 days in 4-8 CThe most commonly blood

product

Platelets:Platelets:

Platelets account for a small percentage of whole blood volume

Control bleeding Often transfused in

multiple dosesmultiple doses Platelets must be

stored at room stored at room temperaturetemperature

Only a five dayfive day shelf life

Plasma:Plasma: A watery substanceA watery substance in which proteins

that trigger blood clotting mechanisms are suspended.

Plasma is used as a raw material raw material ““Fractionated”Fractionated” into its different

protein components Factor VIII, and other factors Plasma can be stored frozen for up to up to

one yearone year

ContraindicationContraindication of of Blood Product Blood Product TransfusionTransfusion

No Absolute Indication of Blood Product Transfusion

The The most important most important factorfactor for blood for blood

transfusion:transfusion:

Patient’s clinical conditionPatient’s clinical condition

(Not a laboratory results)

Questions that need to be Questions that need to be asked prior to a blood asked prior to a blood

transfusion?transfusion?1)Will the patient’s conditionpatient’s condition be improved by a

blood transfusion?2)Do any alternative therapiesalternative therapies to blood transfusion

exist?3)Do the benefitbenefit of a blood transfusion outweigh

the potential risks?

Criteria for viability of red Criteria for viability of red blood cells on the final day of blood cells on the final day of

storage in particular storage in particular anticoagulant:anticoagulant:

1)A mean of 75%survival 24 hours after transfusion

2)Less than 4% hemolysis3)Normal survival after 24 hours

Indication for Packed Indication for Packed Cell Transfusion in Ill Cell Transfusion in Ill

Patient who Admitted in Patient who Admitted in ICU:ICU:

HCT<35-40%In Neonate HCT<40-45%

Hct( Post transfusion)Hct( Post transfusion)==

(BW*80*Hct-P)+(R-Vol.*Hct-C)(BW*80*Hct-P)+(R-Vol.*Hct-C)BW*80BW*80

BW=Body Weight(Kg)Hct-P=Pretransfusion HematocritR-Vol.=Volume of red cell transfusionHct-C=Hematocrit of transfused cell

Whole BloodWhole Blood ( <10 Days Storage): ( <10 Days Storage):

Those undergoing cardiac surgery cardiac surgery Acute blood loss Acute blood loss

( no suitable product is present)

Shelf LifeShelf Life of of

Red Cell Products:Red Cell Products:CPD: 21 DaysCPD-A: 35 DaysAdsol(AS-1): 42 DaysNutricel(AS-3): 42 DaysOptisol(AS-5): 42 Days

Red Cell Products:Red Cell Products:Whole BloodFresh Whole BloodFrozen Deglycerolized Packed CellsPacked CellsLeukoreduction of Red CellsIrradiation of Red Cells

Whole Blood:Whole Blood:

Massive Transfusion

(Cardiac surgery)Exchange Transfusion

Fresh Whole Blood:Fresh Whole Blood:Non refrigerated fresh blood administered by

exchange transfusion within 4-6 hours of drawing can deliver a sufficient number of viable leukocytes.

The dose required is 1x109 PMN/Kg (1½Blood Exchange Transfusion)

Frozen Deglycerolized Frozen Deglycerolized Packed CellsPacked Cells

Antigen matched transfusionNeonatal transfusion

Filtered Red Cells:Filtered Red Cells:

Prevention of febrile non hemolytic reaction

Irradiation of Red Cells:Irradiation of Red Cells:

NeonatesImmuno-compromised recipients

Massive Transfusion:Massive Transfusion:

Replacement of more than one blood volume within 6 hours period

Causes of Massive Causes of Massive Transfusion:Transfusion:

Neonatal exchange transfusionCardiac surgeryTraumaLiver transplantation

Complications of Complications of Massive Transfusion:Massive Transfusion:

Citrate toxicity AlkalosisHypokalemiaCoagulopathy

Indication for Packed Indication for Packed Cell Transfusion in Ill Cell Transfusion in Ill

Patient who Admitted in Patient who Admitted in ICU:ICU:

HCT<35-40%In Neonate HCT<40-45%

Criteria of Platelet Criteria of Platelet Transfusion:Transfusion:

Platelet count<5,000-10,000/LMinor or Major surgery<30,000-60,000/LBrain or Ophtalmic Surgery<50,000LMassive Transfusion<30,000/L

Platelet Transfusion Platelet Transfusion Dose:Dose:

One unit platelet will increase the platelet by 10,000/L for each square meter of body surface

Corrected Count IncrementCorrected Count Increment(CCI):(CCI):

1 Hour CCI<7,5001 Hour CCI<7,500 1)Alloimmunization 2)Autoimmunization 3)Blood Banking24 Hour CCI<4,50024 Hour CCI<4,500 1)Sepsis 2)Fever 3)DIC

General Principles of Plasma General Principles of Plasma Protein Transfusion Therapy:Protein Transfusion Therapy:

Accurate diagnosisIn vivo volume distribution of plasmaHalf life of the infused proteinConcentration of the coagulation

factor in product

Dose of Coagulation Dose of Coagulation Factors Requirement:Factors Requirement: