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BLOOD TRANSFUSION AND BLOOD PRODUCTS By JOTHI SUSAN JOY

BLOOD TRANSFUSION AND BLOOD PRODUCTS By JOTHI SUSAN JOY. Transfusion of blood products may be needed when the patient

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BLOOD TRANSFUSION AND BLOOD PRODUCTS By JOTHI SUSAN JOY

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  1. BLOOD TRANSFUSION AND BLOOD PRODUCTS By JOTHI SUSAN JOY

  2. Transfusion of blood products may be needed when the patient has deficiency of blood constituents or constituent that cause symptoms or puts the patient at risk and a useful result is likely to result from temporary replacement of such a deficiency

  3. Blood Donation And Collection • Donor selection –health history • Donor testing -ABO group and Rh type • -red cell antibody screen • VDRL,HBsAg,anti-HCV,HIV • Blood collection • Anticoagulants-ACD-3 Weeks • CPD-3Weeks • CPDA-35 days • SAGM-42 days • 1-6degC

  4. STORAGE LESION .RBC-lactic and pyruvic acid ATP spheroechinocytosis loss of membrane lipids and proteins 2,3-BPG .WBC .PLATELETS .CLOTTING FACTORS .Ph-decreases .lactic acid increases .Potassium increases

  5. SEPARATION USING DOUBLE BAGS

  6. SEPARATION USING TRIPLE BAGS PRIMARY BAG SATELLITE BAG

  7. WHOLE BLOOD Slow centrifugation 1-6 o C centrifuged at high speed 35days 1-6oC . add SAGM - 42days -30oC 1 year thaw and 22oC 5days centrifuge -40oC PACKED RBCS(PRBC) PLATELET RICH PLASMA RANDOM DONOR PLATELET (RD) FRESH FROZEN PLASMA CRYOPRECIPITATE

  8. Apheresis • Using manual or modern cell separators it is possible to separate plasma from a donor and re-infuse the cells back into the circulation of the donor • It is used for collection of multiple units of platelets from a single donor the Single Donor Apheresis Platelets(SDAP) it is equivalent to 6 units of RD platelets

  9. AUTOTRANSFUSION • Transfusionof blood to self 1.PREOPERATIVE AUTOLOGOUS BLOOD TRANSFUSION • Contraindicated in patients with anemia, heart disease, renal and hepatic disease ,clotting disorders 2.PREOPERATIVE ISOVOLEMIC HEMODILUTION 3.BLOOD SALVAGE-contraindicated in patients with active infection, severe hypertension, unstable angina. Late cancellation will lead to wastage of blood, costly to maintain

  10. MASSIVE BLOOD TRANSFUSION • It defined as replacement of total blood volume by stored blood in 24 hours • -single transfusion of 2500ml or • -total transfusion of 5000ml in 24hrs • Various problems: • Circulatory overload • DIC • Acidosis • Hyperkalemia • Citrate toxicity • hypothermia

  11. Indications of blood transfusion 1.Restoration of circulatory volume 2.Improvement of oxygen carrying capacity 3.Correction of coagulation disorders

  12. Indications for Red Cell Transfusion • 1.Hypovolemia due to hemorrhage

  13. 7gm% is now taken as lower limit of Hb before surgery as when the patient is anemic the blood is less viscous and it is easier to pump blood around • Various other factors to be considered are • Duration of anemia • Type of surgical procedure • Probability of blood loss • Coexistent clinical features that may contribute to the morbidity • 2.Surgery

  14. 3.ANEMIA • If Hb<7gm% • Transfusion is given based on • Patients age • Cardiovascular and respiratory status • Activity level • Symptoms

  15. I. PRE TRANSFUSION TESTING • TAKING BLOOD FOR PRE TRANSFUSION TESTING TYPE AND SCREENING: FORWARD TYPE REVERSE TYPE CROSS MATCHING:NORMAL SALINE COOMBS SOLUTION ALBUMIN OR ENZYME II. ADMINISTERING BLOOD III. RECORD KEEPING AND OBSERVATION

  16. WHOLE BLOOD • Provides both oxygen carrying capacity and volume expansion • Ideal for patients who have sustained hemorrhage of >25% • A/c hypovolemia,massive transfusion, exchange transfusion • Platelet function and coagulation factors will degrade over time • It must be used within 1 week

  17. About 250ml of plasma is removed from the whole blood,it has a hematocrit of 70-80% It must be stored between 1-6OC and used within 35 days PACKED RED CELL If we add 100ml Of Adsol,Nutricel or Optisol we can store it for 42 days

  18. INDICATIONS • Chronic anemia that are symptomatic • Kidney failure • Malignancies • Patients under risk of volume overload e.g.CHF THERAPEUTIC EFFECT One unit of packed cell increase Hb by 1 gm/dl

  19. WASHED RED BLOOD CELLS leukocyte poor cells : - RBC can be washed with normal saline to remove most of plasma - also after centrifugation Buffy coat layer can be removed -another method is to use filters Given to those with repeated hypersensitivity reactions, transplant patients, immune deficient.

  20. Frozen red cells • Red cells frozen with added protective agents like glycerol or dimethyl sulfoxide (DMSO) • Cryopreserved red cells prolong the storage time upto 10 years

  21. PLATELET TRANSFUSION • Indications: • Prophylactic:when PC is below 5x109/L If the patient has fever, infection or drugs that affect platelet function it is given even if it is10x109/L • Therapeutically:-bleeding patients with thrombocytopenia due to platelet deficiency or dysfunction, marrow failure or sepsis or due to auto antibodies against platelets

  22. PLATELET RICH PLASMA • Volume=50ml • 5.5x1010 platelets • Thrombocytopenia • DIC • Platelet dysfunction

  23. FRESH FROZEN PLASMA • Plasma removed from fresh blood obtained within 6 hours is rapidly frozen by immersing in solid carbon dioxide and ethyl alcohol mixture. • stored at –30degC for one year • good source of all coagulation factors. even factors V and VIII If separated after 6hrs its called FVIII deficient plasma.

  24. INDICATIONS • Coagulation factor deficiencies with active bleeding or who is about to undergo an invasive procedure. • -thrombotic thrombocytopenic purpura - DIC -massive transfusion -liver diseases • For reversal of anti coagulant therapy

  25. THERAPEUTIC EFFECT • 1 ml of FFP per 2.2 pounds of weight will raise most clotting factors by approximately 1% • I unit=250ml=200 units of FVIII ,vWF 400mg of fibrinogen

  26. PLATELET CONCENTRATE • Obtained by centrifugation(RD) or by apheresis (SDAP) • Used to treat thrombocytopenia and abnormal platelet function • 1 unit-5x1010 platelets, storage time 5 days at 22degC • 1unit increases platelets by 5000-10000/ micronL • Clotting factors increase by 3-5% • Dose is 12-15ml/kg(4-6Unit in a 70kg man)RD PLATELETS or 1 unit of SADP

  27. CRYOPRECIPITATED AHF • Thawing the fresh frozen plasma at 4oC Rich in factor VIII, von Willebrand factor and factor XIII, fibrinogen 1 unit =15-20ml=80-120units of FVIII and 250 mg of fibrinogen • Used to prevent or control bleeding in Hemophilia and von Willebrand’s disease, fibrinogen deficiency states

  28. FACTOR VIII AND IX CONCENTRATES • Available in freeze dried form • Indicated in hemophilia A and hemophilia B respectively.

  29. FIBRINOGEN • Prepared by organic liquid fractionation of plasma stored in freeze dried form • 1 unit of FVIII raises the plasma FVIII by 2% • used in severe depletion of fibrinogen e.g.DIC or congenital afibrinogenemia

  30. Produced by repeated fractionation of plasma by organic liquids followed by heat treatment Rich in protein but free from danger of transmission of serum hepatitis Can be stored for several monthsin liquid form at 4oC Suitable for replacement of proteins e.g.following burns. available in two strengths 4.5% and 20% HUMAN ALBUMIN

  31. WHITE BLOOD CELLS • Granulocytes can be collected by aphaeresis or by centrifugation of whole blood • Transfused within 24 hours after collection • Used for bacterial sepsis unresponsive to antibiotic therapy • Effectiveness is still investigated

  32. IMMUNOGLOBULIN PRECIPITATES • Prepared by cold ethanol fractionation • Always given intramuscularly • Used in immune deficiency syndromes, agammaglobulinemia

  33. SYNTHETIC BLOOD PRODUCTS • PERFLUOROCARBON EMULSIONS • HEMOGLOBIN BASED OXYGEN CARRIERS • RECOMBINANT FACTORVIII • SYNTHETIC PLATELETS

  34. PERFLUOROCARBON EMULSION • CHEMICALLY INERT FLUORINE SUBSTITUTED HYDROCARBON • FEATURES -Increased oxygen solubility in plasma -Easy transfer of oxygen from red cells to tissues -Solubility of oxygen not subject to temperature,ph,2,3-BPG

  35. (HBOC) HAEMOGLOBIN BASED OXYGEN CARRIERS • STROMA FREE Hb SOLUTION • MODIFIED HUMAN Hb • BOVINE DERIVED Hb • ADVANTAGE:lack of isoagglutinating antigens • blood typing,screening not required • decreased chance of infection

  36. PLATELET SUBSTITUTES • SYNTHOCYTES • MICROCAPSULES LINKED TO FIBRINOGEN • USED IN THROMBOCYTOPAENIA • TARGETS THE SITE OF HAEMORRHAGE • PREVENTS BLEEDING

  37. COMPLICATIONS OF BLOOD TRANSFUSION IMMUNE MEDIATED 1.Acute hemolytic transfusionreaction-recipients antibodies lyses donors rbcs-mainly ABO isoagglutinins,Rh Duffy,kell 2. Delayed hemolytic and serological-patients sensitized to Rbc alloantibody 3.Febrile non hemolytic -Abs against donor leukocyte,HLA antigen 4.Allergicreaction-urticarial reactions due to plasma proteins administer 50mg diphenhydramine

  38. 5.Anaphylacticreaction-administer epinephrine (0.5-1 ml 1:1ooo s/c)- Iga deficient patients 6. Graft versus hostdisease-the donor T lymphocytes recognize host HLA antibodies as foreign and mount an immune response against them 7. Transfusion mediated lunginjury-anti HLA antibodies bind with recipients leucocytes aggregate in the pulmonary vasculature and release mediators 8.Post transfusion purpura 9.Alloimmunisation

  39. NON IMMUNOLOGICAL REACTION • 1.FLUID OVERLOAD • 2.HYPOTHERMIA • 3.ELECTROLTE TOXICITY • 4.IRON OVERLOAD • 5.HYPOTENSIVE REACTIONS • 6. IMMMUNOMODULATION • 7.INFECTIOUS COMPLICATIONS

  40. VIRAL INFECTIONS • HCV • HBV • HIVTYPE 1 • OTHER HEPATITIS VIRUS • CYTOMEGALO VIRUS • HTLV TYPE1 PARVO VIRUS B-19 • BACTERIAL CONTAMINATION • PSEUDOMONAS • GRAM POSITIVE BACTERIA • PARASITES • MALARIA • BABESIOSIS • CHAGAS FEVER • WESTNILE FEVER • LYME DISEASE • CREUTZFELD JACOB DISEASE

  41. Thank You

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