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Transfusion medicine

Transfusion medicine. A.Basi ADULT HEMATOLOGIST ,ONCOLOGIST IRAN UNIVERSITY OF MEDICAL SCIENCES. The standard donation is approximately 450 mL (within 10%) of blood collected into 63 mL of citrate phosphate dextrose anticoagulant, resulting in a final volume of 468 to 558 mL.

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Transfusion medicine

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  1. Transfusion medicine A.Basi ADULT HEMATOLOGIST ,ONCOLOGIST IRAN UNIVERSITY OF MEDICAL SCIENCES

  2. The standard donation is approximately 450 mL (within 10%) of blood collected into 63 mL of citrate phosphate dextrose anticoagulant, resulting in a final volume of 468 to 558 mL .

  3. Before being made available for transfusion, donated blood undergoes several tests involving red cell typing, antibody detection, and screening for transmissible diseases.

  4. ABO and Rh Typing • RBC typing is necessary so that the components can be labeled properly and selected for patients with appropriate ABO and Rh types. • Because of their clinical significance, these two blood groups are the only ones that are determined routinely.

  5. Blood Groups • Karl Landsteiner Nobel Prize in Physiology or Medicine in 1930

  6. Blood Groups • Blood Group systems: 1.major (ABO,Rh) 2.minor (100 systems with about 500 antigens)

  7. Red Blood Cell Blood Groups

  8. Blood Groups (Red cell Antigens) • Present on RBCs, GI tract and vascular endothelium • Specificity of the antigen is in its terminal sugar • galactosamine for A • galactose for B

  9. Selection by ABO type

  10. Rh system:D,d,C,c,e,e(Fisher-Race),Wiener

  11. Rh type • Rh blood group antigens are present only on RBCs • Rh positive means that the D antigen is present (85% on the population). • Rh negative means that the D antigen is absent (15% of the population). • the D antigen is highly immunogenic. • More than 80% of D negative persons receiving D positive blood are expected to develop anti-D.

  12. Rh Antibodies • The most common Rh antibody is anti-D. This is almost always an IgG, acts at 37ºC, and does not bind complement effectively. • but causes serious transfusion reactions and red cell destruction by accelerated clearance of cells through the mononuclear phagocyte system.

  13. Major Crossmatch (Compatibility testing) • Donor RBCs (unit of blood) are tested with recipient serum. • To detect unexpected recipient antibodies.

  14. Compatibility testing • ABO confirmation and Rh determination of the recipient's red cells. • ABO confirmation and Rh confirmation of the donor red cells if labeled as Rh negative. • Antibody screen of the donor serum to detect clinically significant antibodies. • Crossmatch of the recipient's serum with the donor red cells by a method which will detect ABO incompatibility and clinically significant antibodies.

  15. Blood Used on Emergency Basis • Blood used on Emergency Basis • for a patient that is bleeding out • and the blood type is unknown • Group O, Rh negative, uncrossmatched. • Recipient may have an unexpected antibody.

  16. Screening for transmissible diseases • Serologic Test for Syphilis • Hepatitis B Surface Antigen • Anti-HCV • Human Immunodeficiency Virus 1 and 2 Antibody • Human T-Cell Lymphotrophic Virus I and II Antibody

  17. Blood component WB PLT PRBC FFP

  18. Indication The availability of an adequate and safe supply of blood and its components is essential for: • Many surgical procedures, • Treatment of patients who experience acute or chronic blood loss, • Those with inadequate blood cellproduction, • Excessive destruction of their own blood cells, • Or an inherited defect of red cells or coagulation factors.

  19. Whole Blood • 450 ml of whole blood with 63 ml of anticoagulant • Need for oxygen carrying capacity and volume replacement • No viable platelets or WBC • Decreased labile coagulation factors (Factor V and VIII) • Not available since it is not efficient utilization of blood

  20. packed red cells or red cell concentrate • The commonly used red cell preservative solutions contain glucose, adenine, mannitol, and sodium chloride. • These preservative solutions allow storage of red cells for 42 days at 1º to 6ºC.

  21. packed red cells or red cell concentrate • Because red cell metabolism continues during storage, metabolites accumulate in stored red cell units and lead to biochemical changes. • Four of these changes are discussed: loss of ATP and viability, loss of DPG and function, accumulation of potassium, and hemolysis.

  22. Packed Red Blood Cells (PRBCs) • 200-250 ml of RBCs and 50 ml of plasma • Hematocrit 55-70% depending on anticoagulant • Shelf life 35 to 42 days depending on the anticoagulant • Treatment of symptomatic anemia where oxygen carrying capacity is needed

  23. Leukocyte Reduced RBCs • RBCs with 99.99% of WBCs removed by leukocyte reduction filter. • Prevents repeated nonhemolytic febrile transfusion reactions. • Prevents HLA class 1 alloimmunization. • Do not transmit cytomegalovirus infection • All cellular components are leukoreduced now.

  24. Indications for Leukocyte Reduced RBC continued • After second nonhemolytic febrile transfusion reaction. • Chronically transfused patients. • Potential transplant recipients. • CMV seronegative at-risk patients for whom seronegative components are not available.

  25. Frozen RBCs • Store RBCs for up to 10 years at -80C in 40% glycerol. • Glycerol is a cryopreservative solution • Used for: • Rare blood types for patients with multiple antibodies. • Autologous blood for a postponed operation. • Patients with IgA deficiency.

  26. Gamma Irradiated RBCs • RBCs and platelets are exposed to gamma irradiation at 2500 rads for 4.5 minutes. • This inactivates the T lymphocytes in the donor unit and prevents graft versus host disease in an immunocompromised recipient. • Reduced red cell viability and a leakage of potassium, decreasing the shelf life 28 days of total storage time.

  27. Indications for Gamma Irradiated RBCs • Bone marrow transplant recipients. • Congenital immunodeficiency syndromes. • Intrauterine transfusions. • Transfusions from all blood relatives.. • Neutropenic patient.

  28. Washed red cells The unit of blood can be washed immediately before infusion. • Patients with severe or recurrent allergic reactions (eg, hives) associated with red cell transfusion. • Certain patients with IgA deficiency when IgA deficient donors are not available. • In the rare patient with a complement-dependent autoimmune hemolytic anemia to prevent complement infusion.

  29. Fresh Frozen Plasma • FFP is the liquid portion of one unit of blood that has been centrifuged, separated, and frozen solid at -18ºC or colder within 6 hours of collection. • The unit of whole blood is usually centrifuged using techniques to prepare platelet-rich plasma This platelet-rich plasma is then centrifuged, and the plasma is removed and frozen, giving one unit of FFP and one unit of platelet concentrate.

  30. Fresh Frozen Plasma • FFP can be stored for up to 1 year at -18ºC or colder. • The unit of FFP has a volume of approximately 200mL and contains all the constituents of citrated normal plasma.

  31. Fresh Frozen Plasma (FFP) • 200-250 ml of plasma frozen at -18C within6- 8 hours of collection. • No platelets are present. • Contains all coagulation factors. • An unconcentrated source of fibrinogen. • use Cryo to correct a low fibrinogen level • Needs 20-30 min lead time to thaw prior to use.

  32. Indications for use of FFP • Replacement of isolated coagulation factor deficiencies when specific components are not available. Examples include factors V, VIII, IX, X, and XI. • Reversal of warfarin effect in patients actively bleeding or who require emergency surgery. • Antithrombin III deficiency in patients undergoing surgery or those who require heparin for treatment of thrombosis. • Treatment of thrombotic thrombocytopenic purpura (TTP), usually as part of plasma exchange.

  33. FFP Continued • Used in patients with multiple coagulation factor deficiencies: • liver disease • DIC • Massive transfusion (if plt<75000:plt transfusion) • Indicated when PT/PTT are >17/55 sec or>1.5 normal or fibrinogen level<100.

  34. Fresh Frozen Plasma • In an average-sized adult, five units of FFP would raise the level of coagulation factors approximately 30%, which is a level thought to provide hemostasis. • Because this would involve transfusion of approximately 1000 mL of plasma, the patient's blood volume and cardiovascular status must be considered.

  35. Cryoprecipitate • Cryoprecipitate is the material that remains insoluble when previously frozen plasma is thawed at 1º to 6ºC. • Each bag of cryoprecipitate contains approximately 100 U of factor VIII and 200-300 mg of fibrinogen,factor XIII, vwf and has a volume of approximately 10 mL. Thus, cryoprecipitate can be used to replace factor VIII or fibrinogen. • Cryoprecipitate can be stored for up to 1 year at -18ºC or lower.

  36. Random Donor Platelet Concentrates • A random donor platelet concentrate is prepared from a standard unit of whole blood. • Because cold temperatures damage platelets, the unit of whole blood is maintained at room temperature, and platelets are removed within 6 hours of collection.

  37. Random Donor Platelet Concentrates • Random donor platelet concentrates may be stored for up to 5 days at room temperature (20º to 24ºC).

  38. Random Donor Platelet Concentrates • Actually, satisfactory platelet function can be maintained for up to 7 days .but storage longer than 5 days allows bacterial proliferation in some concentrates . • This has been associated with transmission of infection.

  39. prophylactic platelet transfusion

  40. Single donor platelets (plateletpheresis) • Automated methods that permitted the collection of the equivalent of six to ten units of platelets (3 to 6 x 10(11) platelets) from normal donors in 1/5 to 2 hour procedure. • An individual can donate platelets as often as twice per week without becoming anemic or thrombocytopenic. • The clear advantage of single donor apheresis concentrates is reduced donor exposure.

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