dic blood component therapy

7/27/2019 DIC Blood Component Therapy

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DIC & Blood component therapy

Gp Capt G S Sandhu


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DIC

DIC is a syndrome characterized by diffuse activationof the coagulation system leading to intravascular fibrindeposition.

Thromboplastins

endothelial cell activation - Activation of coagulation

Massive activation of coagulation - depletion ofcoagulation factors and platelets

(consumptive coagulopathy)

- hemorrhagic complications.

Microvascular fibrin thrombi - impair tissue circulationmulti-organ dysfunction


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Obstetric aetiology

Abruptio placentae Severe pre-eclampsia

Severe Sepsis

Amniotic fluid embolism

Prolonged IUFD Molar pregnancy

Placenta accreta

Intra-amniotic hypertonic saline

Acute Fatty Liver of pregnancy

Transfusion reactions

Large feto-maternal haemmorrhage

Severe trauma


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Patho-physiology of DIC


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Coagulation & Fibrinolytic Systems


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Severity of DIC


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Management principles

Assess derangement of function

Control hemorrhage

Replace blood loss, coagulation factors and

platelets as indicated

Supportive management to correct multi-

organ dysfunction

Treat underlying cause


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Massive blood loss

Loss of one blood volume within a 24 hr

period

50% blood volume loss within 3 hrs

Rate of blood loss 150 ml /min

Massive transfusion 10 units in 24 hrs or

> 50 ml / kg / hr in adults


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Blood product

Any therapeutic substance prepared from

human blood


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Blood component

A constituent of blood separated from

whole blood

Where resources are available use of blood

components allows optimal utilization of

donated blood


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Apheresis

It is a sterile process by which a specificcomponent is mechanically separated and

collected while components not required arere-infused back to the donor

Platelet pheresis : Collection of donorplatelets by apheresis

Plasma pheresis : Collection of donorplasma by apheresis


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Whole blood

Qty 450 ml donor blood + 63 ml anticoagulant

Anticoagulant preservative solution CPD, CPD-

A(Citrate, Phosphate, Dextrose, Adenine) or ACD Storage time 21 days (ACD, CPD) / 35 days

(CPD-A)

Start transfusion within 30 mins of issue

Complete transfusion within 4 hrs of starting


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Effects of storage of blood

pH

plasma K+

RBC content of 2, 3 DPG leading to

reduced release of oxygen at tissue level

Loss of platelets within 48 hrs of donation

in Factor VIII to 10 20% of normal

within 48 hrs of donation


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Indications of whole blood

transfusion RBC replacement in acute blood loss with

hypovolemia

Exchange transfusions

When RBC concentrates are not available

(Use of whole blood may sometimes be the

safest and most sustainable way of meeting

urgent transfusion requirements)


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Advantages : Whole blood

transfusion Simple inexpensive collection packs

No special processing

For patients with haemorrhage, supplies

RBC, volume and stable coagulation factors

(Factors IX and VII)

Disadvantage : Higher volume load


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RBC concentrate (Packed RBC)

Quantity 220340 ml (Generally 250 ml).

Contains 150200ml RBC

Prepared by gravity separation /centrifugation of whole blood

RBC concentrate also contains WBC

Storage time 21 days (ACD, CPD) / 35 days

(CPD-A)


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Indications of RBC concentrates

Replacement of RBC in anaemic patients

Along with crystalloids in acute blood loss


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Disadvantages of RBC concentrates

viscosity. Haematocrit 55 75%

WBC are cause of febrile non-haemolytic

reactions


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RBC suspension

150200 ml RBC + 110 ml Normal saline,

Adenine, Glucose and Mannitol solution

(SAG-M) as a Red cell nutrient medium. Less viscosity as compared to RBC

concentrates

Better flow rates during transfusion


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Indications of blood transfusion in

Obstetrics Replacement of acute blood loss

Pregnancy < 36 weeks

Hb 5.0 gm% or lessHb 5 to 7 gm%

Established or incipient cardiac failure or clinicalevidence of hypoxia

Pre-existing cardiac disorder Serious infection i.e. pneumonia

Malaria


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Indications of blood transfusion in

Obstetrics Pregnancy > 36 weeks

Hb 6.0 gm% or less

Hb 6 to 8 gm%

Established or incipient cardiac failure or clinical

evidence of hypoxia

Pre-existing cardiac disorder

Serious infection i.e. pneumonia

Malaria


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Fresh Frozen plasma

Volume 200300 ml (Generally 250 ml) Separated from whole blood and frozen at -250 C within

6 to 8 hrs of collection in order to preserve labile

coagulation factors (Factors V and VIII)

Supplies 150 mg fibrinogen / unit + other coagulation

factors

Can be stored for 1 yr

At - 250 C, Factor VIII levels maintained at 70% ofnormal fresh plasma levels

At 2 to 60 C labile clotting factor activity will decline to

1020% within 48 hrs


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Fresh Frozen Plasma : Indications

Replacement of multiple coagulation factor

deficiencies

DIC

Liver disease

Warfarin overdose

Dilutional coagulopathy (large volumetransfusions)


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Fresh Frozen Plasma

Not recommended as replacement fluid Expensive

Risk of transfusion transmitted infections

No benefit over use of crystalloids / colloids

Dose : Initial dose 15 ml / kg body wt

One unit FFP raises Plasma fibrinogen by 25 mg%

Must be thawed between 30 - 370 C before use

Should be used within 6 hrs of initiating thawing Infuse within 20 minutes

If not used immediately, store between 2 to 60 C for

maximum 24 hrs


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Cryoprecipitate

Prepared from FFP by collecting precipitateformed during controlled thawing and re-suspending it in 10 to 20 ml plasma

Rich in Fibrinogen(150300mg/ pack), FactorVIII (80100 IU / pack), von Willebrand factor,Fibronectin, Factor XIII

Storage at - 25

0

C for 1 yr Should be infused within 6 hrs of thawing

Infuse over 20 minutes


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Cryoprecipitate

Indications

Von Willebrands disease

Factor VIII deficiency (Haemophilia A)

DIC (as a source of Fibrinogen)


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Platelet concentrate

(Prepared from whole blood donation)

Single donor unit

Prepared from one donation

Contain 55 x 109 platelets

Pooled donor unit Prepared from 4 to 6 donor units pooled into one pack

Contains 240 x 109 platelets

Volume 5060 ml Storage at 200 to 240 C (with agitation) for up to 5 days

Bacterial contamination (with consequent risk of

septicaemia in recipient) occurs in 1% of pooled units


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Platelet concentrate

(Collected by Plateletpheresis) Platelet content 150500 x 109 platelets

Storage at 200 to 240 C (with agitation) for

up to 24 hrs

ABO compatibility important to prevent

haemolysis of recipient RBC


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Platelet concentrate Indications

Thrombocytopenia (< 50,000 / cu mm in a bleeding / surgical patient) Platelet function defects

Dosage

1 unit platelet concentrate / 10 kg body wt

A unit of random (pooled) donor platelets increases platelet count

by 5000 to 8000 / cu mm.

Infuse within 4 hrs of issue to reduce risk of bacterial contamination

Do not refrigerate

Infuse within 20 minutes of starting

Rh negative recipients should not receive platelet concentrates fromRh positive donors

ABO compatible platelet concentrates to be infused wheneverpossible

dic blood component therapy

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