blood & blood products only
TRANSCRIPT
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 1/54
Dr . Prasad Ingley.Junior Resident IJunior Resident I I I
NKP Salve Institute of Medical Sciences & L.M.H. Nagpur, India.NKP Salve Institute of Medical Sciences & L.M.H. Nagpur, India.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 2/54
Historical AspectsHistorical AspectsPeople have always been fascinated by blood,
y A ncient Egyptian bathed in it.
y Ar istoc rats d r ank it.
y Au tho r s & play r ights u sed it as themes.
y Mode r n Hu manity t ransf u se it.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 3/54
HISTORYHISTORY
y
1492 B
lood was taken f rom th
ree yo
ung men & given toPope Innocent VII to c ur e him.
y 1616 - W illiam Ha r vey ,descr ibed how blood is ci rcu lated
thro
ugho
ut the body.
y 1667 - F ir st su ccessf u l hu man blood t ransf u sion.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 4/54
HISTORYHISTORYy A fter mu ch r esea r ch, saline was developed as a plasma
volu me expande r.
y Significant b r eakth r ou gh - 1883 cr eation of Ringe r ssolu tion.
y W or ld W ar I, a gu m-saline sol u tion containinggalactoso- gl u conic acid was u sed to extend plasma - hadsome negative health effects.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 5/54
Why did success elude experimentersWhy did success elude experimentersso long ?so long ?
y B raxton Hicks 1869 Sodiu m Phosphate as a nontoxicanticoag u lant.
y Kar l Landsteine r 1901 A BO blood g r. System.
y W or ld W ar II - establishment of blood banks by the
A me r ican Red C ross in 1947.
Clotting was the principle obstacle to overcomeClotting was the principle obstacle to overcome.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 6/54
Approved Anticoagulant PreservativeApproved Anticoagulant PreservativeSolutionsSolutions
Stor age TimeStor age Time
Name A bb reviation DaysName A bb reviation Daysy A cid citr ate dext rose A CD 21y Citrate-phosphate - dext rose CPD 21y Citrate-phosphate - dext rose-
adenine CPD A -1 35
y Citrate-phosphate - do u bledext rose CP2D 21
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 7/54
Preparation of blood componentsPreparation of blood componentsis possible due tois possible due to
y Mu ltiple plastic packs systems.y Ref r igerated cent r if u ge.y Different specific g ravity of cellu lar components:
R B
C 1.08 -1.09
Platelets - 1.03 1.04
Plasma - 1.02 -1.03
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 8/54
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 9/54
C lassification of Blood Products:C lassification of Blood Products:
y Whole Blood
y components - Cellular -Plasma
y Plasma derivatives
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 10/54
Blood Component
A Constit u ent sepa r ated f r om whole blood, by diffe r ential cent r if u gation
of one donor u
nit or
by aphaeresis.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 11/54
Cellular componentsCellular components
y Red cell concent r ate.
y Platelet concent rate.
y Gr anu locyte concent rate.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 12/54
P lasma ComponentsP lasma Components
y F resh f rozen plasma ( FF P)
y Cr yoprecipitate
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 13/54
P lasma DerivativesP lasma Derivatives
y A lbu min 5% & 25%y Plasma P rotein F ractions.y Facto r VIII concent rate.y Imm u noglob u lins.y F ibr inogen.y O the r coagu lation facto r s.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 14/54
WHOLE BLOODWHOLE BLOOD
Fr esh b lood ( B lood less than 24 h r s old )
y Premat ur e newbo r ns with respi r ato r y dist ress synd rome andseverely dec reased 2,3 DPG levels.
y Patients who a re per sistently hypotensive, poo r ly per f u sed, &acidotic and who need la rge amo u nt of blood.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 15/54
W hole Blood (CPDA-1)B lood collected into an app r oved containe r containing ananticoag u lant p reser vative solu tion.
Total Vol m- 350 ml. of whole B lood & 49 ml. A nticoag u lant.
Hb app roximately 12 g/ml.Haematoc r it 35% - 45%.
No f u nctional platelets .No labile coag u lation facto r s (V & VII)Shelf live 35 days in (CPD A -1)
Stor age :-B etn + 20c and + 6 0c in app roved blood bank ref r iger ato r,
fitted with a temp.cha r t & alar m.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 16/54
I ndications :-
Red cell replacement in ac u te blood loss with hypovolaemia.Exchange t r ansf u sion.Pts needing red cell t ransf u sions whe re red cell concent rates
or su spensions a r e not available.
A dminist r ation:Mu st be A BO & Rh-D compatible with the r ecipient.Never add medication to a u nit of blood.Complete t ransf u sion within 4 h r s. of commencement.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 17/54
Loss of viability of R B CS.
Loss of A TP.
Depletion of 2-3 DPG.
Loss of granu locyte f u nction.
Decrees in p H of blood.
Inc rease in plasma K+ Level.
Decrease in facto r VII level.
For mation of mic roaggregates.
What are the changes which occur inWhat are the changes which occur instored Bloodstored Blood
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 18/54
WHOLE BLOODWHOLE BLOODy Eff ects:
1u
nit of whole blood ( 350ml) - Hb by abo u t 0.75 gm/dl.( 450ml) - Hb by
abou t 1 gm/dl.
In pediat r ic patients, 8ml/kg of W .B . - Hb by abou t 1 gm/dl.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 19/54
P acked Red Cells
Red Cells in additive solution
Leucocyte P oor red cells
Washed red ± Cells
Frozen red Cells
Irradiated red cells.
Red CellsRed Cells
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 20/54
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 21/54
Red Blood Cells
y Hb < 6 gm/dl in the absence of disease.
y Hb between 8-10 gm/dl with disease.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 22/54
Red BloodC
ellsRed BloodC
ellsI ndicationsI ndications --y B .M. produ ction - Le u kemia.
- A plastic anemia.y R B C sur vival - Hemolytic anemia.
-Thalassemia
y Excessive B leeding -s ur gical (anticipated blood loss>1000ml)-t rau matic .
y O the r s - A nemia associated with incipient/established ca rdiac failur e.
-F u ll te r m p regnancy with Hb val u e
<7 gm/dl.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 23/54
RedRed Cell concentrateCell concentrate(P acked red Cell, P lasma reduced blood)
Red Cells from which most of P lasma removedRed Cells from which most of P lasma removed .
250 ml packed red Cells (150 ml red cells + 100 ml P lasma)
Hb appro. 20 g/100 ml (Not less than 4 5 g\unit) Haematoerit 55% -75%Raises Hb by 1 Gm % & heamatocrit by 3 % (Rise detected
after 24 hours.) Storage temp 2-6 0c
Shelf life 3 5 days in C PDA -1
Indications : Replacement of red cells in anemic patients. Acute& massive blood loss (along with crystalloid or colloid)
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 24/54
Red Cell suspensionRed Cell suspension(Red cells in additive solution)
Commonly used additive solution is SA GM (S aline, adenine, glucose &Commonly used additive solution is SA GM (S aline, adenine, glucose &mannitolmannitol) )
150 -200 ml red cells with minimal residual plasma. Hb approx. 15gm/ 100 ml
Haematocrit 50% - 70% .
Advantage of this methodMax amount of plasma removed for preparation of plasma
components.Red cells with improved viability obtained, shelf life
increases from 3 5 to 4 2 days. Flow of infusion is improved due to reduction in viscosity.
Contraindicated for exchange transfusion in neonate.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 25/54
LeucocyteLeucocyte ± ± poor depleted redpoor depleted red cellscells A red Cell suspension or containing less than 5*106 white cells/bag, prepared by filtration
through a leucocytes depleting filter.
Hb & haematocnt depend on whethe r the p rodu ct is whole blood,red cell concent r ate o r red cell s u spension.Leu cocyte depletion significantly r edu ces the r isk of t ransmission
of CMV.Indications:
To avoid sensitization to HL A antigen in patients with seve reaplastic anaemia who a r e likely to r eceive allogenic bone ma rr ow
transplant.Patients who have expe r ienced two o r mo re previou s febr ile
reactions to red cell t ransf u sion.To redu ce the r isk of t ransmission of CMV.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 26/54
W ashed red cellsW ashed red cellsPacked red cells can be washed with normal saline to remove
plasma proteins, white cells & platelets.
Use of such red cells is restricted for Ig A ± deficient individualswho have developed anti Ig A antibodies.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 27/54
Fr z
Fr z r r llllRed ce lls c e st r ed fr zen t 10 ea rs.
To r even t aemo l sis of r ed ce lls du ring fr ee zing t aw ing , a cr op r ote ctive agen t s uc a s gl ce r ol is added .
onor r ed ce lls wit r a r e lood gr oup s c an e st or ed fr ozen .
Red cells can be sto red f rozen fo r f ur the r au tologo u s tr ansf u sion if blood g rou p is rare.B efore tr ansf u sion red cells a r e thawed & glyce r ol removed
gradu ally.
Su ch red cells a re vir tu ally f ree f rom le u cocytes, platelets & plasma& thu s thei r u se is associated with lowe r r isk of non- haemolytictransf u sion reactions.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 28/54
Irr i tIrr i t llllTr an sf usion of gamma irr ad ia ted r ed ce lls is i nd ica ted f or
pr even tion of gr a ft Vs ost disea s e in s usc ep ti le ind ividua ls like Immunode ficien t ,
atien ts r e ce iving lood fr om first deg r ee r e la tive s.L mpho c te s fr om dono r lood r ea ct aga inst t he tiss ue s of the
r e cipien t .
amma irr ad ia tion (25Gamma irr ad ia tion (25 -- 00 GyGy ) inh i its r ep lica tion of dono r ) inh i its r ep lica tion of dono r lympho cyte s.lympho cyte s.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 29/54
Advantages of transfusion of redAdvantages of transfusion of redcells over Wh ole bloodcells over Wh ole blood
y Redu ce r isk of circu lato r y over load.
y Less sever ity & incidence of alle r gic reactions.
y A BO antibodies a re r edu ced.
y Removed plasma can be u sed fo r pr epa r ing FF P &Cr yoprecipitate
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 30/54
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 31/54
PlateletsPlatelets
Tw o Methods :y Differential cent r if u gation of a u nit of whole blood.
( Platelet concent rate )y Plateletphe r esis
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 32/54
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 33/54
StorageStorage
y U p to 72 ho ur s at 20 240c with constant agitation.
y Max. pe r iod of sto rage is 3 to 5 days.
y Mu st not be ref r iger ated as this will redu ce platelet
f u nction.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 34/54
Platelet concentratePlatelet concentrateI ndications I ndications
y Platelet co u nt <5000 / µl regardless of clinical condition.
y Platelet co u nt 5000 -10000/ µl- if the r e is inc reased r isk of
bleedingy Platelet co u nt 10,000 -20,000/ µl- if th rombocytopenicbleeding.
y PC <20,000/ µl- if dec reased p rodu ction chemothe rapy. Riskof bleeding p rophylactically.
y < 50,000/ µl- if dest ru ction (DIC)y <50,000/ µl- if Platelet dil u tion (massive T/ F )y < 70-80,000/ µl- majo r sur ger y
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 35/54
Platelet concentratePlatelet concentrateyy Dosage :Dosage :1u nit /10kg body weight (The u su al dose is 4- 6 u nits)
or
1.50u nits/10kg body weight in cases of Inc reased dest ru ctionof platelets.
y Single dono r u nit in a vol u me of 50-60 ml of plasma sho u ldcontain
a) A
t least 55 A
t least 55 ××101099
plateletsplateletsb) < 1.2< 1.2 ××101099 red cellsred cellsc) < 0.12< 0.12 ××101099 leu cocytes.leu cocytes.
y Pooled u nit sho u ld contain at least 240240 ××101099 platelets.platelets.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 36/54
Platelet concentratey A BO compatibility between dono r & recipient is of
mino r impo r tance in platelet t ransf u sion.
y Rh (D) negative female patient of child bea r ing agesho u ld be given platelets f rom Rh (D) negative dono r.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 37/54
Platelet concentratePlatelet concentrate
y e ff ect - (by the clinical resu lts & platelet co u nt obtained 1 h r late r )each u nit of P.C. will raise platelet co u nt app roximately by
y A du lts : ( 5000 -10000/ µl.) in 70 kg weight.
y Child : (20000/ µl ) in 18 kg body weight.
y Infants : (75000-100000/ µl ).
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 38/54
Platelet concentratePlatelet concentrate
y Risk associated with platelet t r ansf u sion :
- A
lloimmu
nisation.
-Platelet ref r acto r y state (less than 20 % of the expectedinc rease).
-Infections.
-Graft ver su s host disease
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 39/54
Plateletp heresis
y A por tion of dono r s platelet and some plasma isremoved with the retur n of dono r s R B Cs, WB Cs andremaining plasma.
y A rou tine p r oced ur e takes 1 to 1.5 hour s.
y The p rodu ct is p repa red in closed system and can besto r ed fo r 5 days.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 40/54
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 41/54
Relative merits of Relative merits of plateletp heresisplateletp heresisand random donor plateletand random donor platelet
PlateletpheresisPlateletpheresis Random donor plateletRandom donor platelet
Average > 3x10 Average > 3x10 1111 plateletsplateletsPlasma volume 200 mlPlasma volume 200 mlLeucocytes < 5.5 x 10Leucocytes < 5.5 x 1066
obviate the need of filtrationobviate the need of filtrationRed cellsRed cells-- tracestraces
pHpH-- 6.0 or more6.0 or moreExposes a patient to one donorExposes a patient to one donor
Less exposure to infectionsLess exposure to infections
5.5 x105.5 x101010 plateletsplatelets5050--60 ml60 ml101088 in each unit, filtration isin each unit, filtration is
requiredrequiredMoreMore
pHpH-- 6.0 or more.6.0 or more.Exposes a patient to multipleExposes a patient to multiple
donors.donors.More exposure to infectionsMore exposure to infections
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 42/54
F res h frozen plasmaF res h frozen plasma
I ndications :I ndications :y Congenital o r acqu ir ed coag u lation facto r deficiency
with - A ctive bleedingLiver disease, DIC, Coag u lopathy in massive
tr ansf u sion.y
Deficiency of factors II, VII, IX & X.y W ar far ine ove r dose r ever sal.
y Th r ombotic th r ombocytopenic p ur pur a.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 43/54
F res h frozen plasmaDosage Dosage 15ml/kg of body weight (thawed at 30 -37 0 C)
Compatibility test- is not necessa r y.
Rh positive plasma sho u ld not be given to Rh negative women in the r ep r odu ctive age g r ou p.
Eff ectEff ectB y A PTT , PT & fibr inogen assay.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 44/54
Difference Between Ap heresis FF P
And Wh ole-blood Derived FF P AFF P AFF P WBD WBD--FF PFF P
T otal volume T otal volume 540 ml540 ml 200 ml200 ml
solute lasmasolute lasma 486 ml486 ml 160 ml160 ml
nticoagulantnticoagulantCPD/CPD 1CPD/CPD 1
4% sodium citrate4% sodium citrate 3% sodium citrate3% sodium citrate
nticoagulant/ lasmanticoagulant/ lasma 1:101:10 1:51:5
Citrate/100ml lasmaCitrate/100ml lasma 0.4 g 0.4 g 0.6 g 0.6 g
GlucoseGlucose 100mg/dl100mg/dl 400400--715 mg/dl715 mg/dl
Cryo reci itateCryo reci itate MoreMore LessLess
Residual latelet &Residual latelet &
WBCs WBCs
Less than WBDLess than WBD--
FFPFFP
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 45/54
C ryoprecipitateC ryoprecipitate
y Prepa red by slowly thawing 1 u nit of FF P at 4-6 0 c & thenresu spending it in 10-20 ml plasma.
y The u nit is then ref rozen -25 0 c or coole r & can be sto red fo r 1 year at this temp.
yy Contains Contains facto r VIII 80 100 iu /packF ibr inogen 150 300 mg/pack.Facto r XIII & fibronectine.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 46/54
Cryoprecipitate
Cryoprecipitate
(factorVIII, fibrinogen , Von- W illebrands factor, F ibronectin & factor XIII)
Indications :y Haemophilia A
y Von W illebr ands disease.y Congenital o r acqu ired fib r inogen deficiency.y A
cqu
ired facto
rVIII deficiency.y Facto r XIII deficiency.
y Sour ce of fibr in glu e u sed as topical haemostatic agent.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 47/54
P lasma DerivativesP lasma DerivativesHu man A lb u min sol u tions :Hu man A lb u min sol u tions :
y
A lbu min p repa red by cold ethanol f r actionation of pooledplasma.
y A vailable as 5%,20%,25% solu tions.
y A lbu min sol u tions a r e heat t reated at 60 0 c for 10 hour s.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 48/54
Factor VIII
Concentrate
Factor VIII
Concentrate
y F VIII concent rate p repa red by f ractionation f rom la rge pools of donated plasma.
y Treated with heat o r chemicals to dest roy lipid enveloped vi ru ses.
y Stored at 2 to 6 0 c.
y Vials f reeze d r ied p rotein labelled with content, u su ally abo u t250 iu of F VIII / vial.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 49/54
Factor IX
Concentrate
Factor IX
Concentrate
y B oth plasma de r ived & recombinant F IX concent rate a reavailable fo r treatement of Haemophilia B .( Chr istmasdisease ).
y U nit of iss u e : Vials of f r eeze d r ied p rotein labelled withcontent, u su ally abo u t 350 600 iu of Facto r IX.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 50/54
Prot h rombinProt h rombin C omplex C oncentrateC omplex C oncentrate(PCC )(PCC )
y Contains F II , IX , X & sometimes also F VII.
y Immediate co rr ection of p rolonged PT.
y Cont raindicated in patients with live r disease & th r ombotictendancy.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 51/54
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 52/54
M ust before transfusion
y Disposable ste r ile t r ansf u sion sets.y 170 to 200 micron filte r s.y B y physician o r qu alified n ur sey B lood g rou ping.y Cross matching & compatability testing.y Inspection of blood / blood p rodu ct bag.
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 53/54
8/9/2019 Blood & Blood Products Only
http://slidepdf.com/reader/full/blood-blood-products-only 54/54
Th ankTh ankyouyou