4th year medical students

Blood Component Therapy

Salwa I Hindawi
MSc FRCPath CTM
Director of Blood Transfusion Services
KAUH . Jeddah

4th year medical students
RBC Agglutination
4th year medical students
ABO type
Pt Cells Pt Serum
vs vs
anti-A anti-B Acells Bcells
A + 0 0 + 40%
B 0 + + 0 11%
AB + + 0 0 4%
0 0 0 + + 45%

4th year medical students
BLOOD COMPONENT THERAPY
It is the transfusion of specific blood components
required by the patient.
Principles
Use blood products only when it is essential.
Replace only the deficient component, if
possible.
Identify the cause and nature of the deficiency
and if possible, treat it.

4th year medical students

Whole
blood



Platelets
rich
plasma


1
st
centrifugation
Platelets
concentrate
Whole
blood


Whole
blood

2
nd
centrifugation
Fresh plasma
FFP for
clinical use
FFP for
fractionation
Optimal additive
solution
Red cells in
OAS
Cryoprecipitate
Red
Cell
concentrate
4th year medical students
Blood COMPONENTS AVAILABLE
FROM THE BLOOD BANK
Whole blood
Packed RBCs
Platelets
Single donor platelets (Apheresis)
Fresh Frozen Plasma (FFP)
Cryoprecipitate

4th year medical students
Indication for Red Blood Cells
Transfusion
Red blood cells are
component of choice
to maintain an
adequate supply of
oxygen to meet
tissue demands.One
unit increase the
haemoglobin level
by 1g/dL in a 70kg
recipient.
4th year medical students
Indication for Transfusion of
Whole Blood
Fresh whole blood<5 days old is often used for
exchange transfusion in newborns.

Stored whole blood can be used in actively bleeding
patients who have lost > 30-40% of their blood
volume.
4th year medical students
Indication for red blood cells
Transfusion
Symptomatic anaemia
Acute blood loss>30-40% of blood volume.
Pre-operative Hb< 8g/dl and operative
procedure associated with major blood loss.
Evidence of inadequate oxygen delivery.
4th year medical students
Administration and Dose
Red blood cells transfusion has to be grouped specific
& Rh specific, if not one of alternative compatible
group.

This component must be administered through a
suitable transfusion set (170 mM filter).

Dose of 4ml/kg raises venous Hb by about 1g/dl.
4th year medical students
Specifications
Whole blood volume 450mls+63mls of CPD-A1
anticoagulant.
Packed RBCs volume 250mls50mls.
Hct=0.55-0.75.
Anticoagulant CPD-A1 store at 4c2c for 35 days.
SAG-M for 42 days.
4th year medical students
Indication for Platelet Transfusion
Decrease platelet production (Bone marrow failure)

Therapeutic:for patient who are bleeding associated with
BMF caused by either disease, therapy or irradiation.

Prophylactic: >10x 10
9
/L to decrease morbidity in
patients with thrombocytopenia due to B.M.F.
4th year medical students
Cont, Platelet Transfusion
In acute D.I.C (Disseminated intravasculr coagulation).
In neonatal alloimmune thrombocytopenia (NAIT) from
donor known to be negative for the appropriate HPA or
mother platelet.
Platelet function disorders or thrombocytopenia <50x 10
9
/L
going for invasive procedure, for operation in critical sites
such as the brain or eyes the platelet count should be
raised to 100x10
9
/L.
In massive blood transfusion, the platelet count to be
maintained above 50x10
9
/L.
4th year medical students
Administration of Platelet
Concentrate:
ABO compatible platelet are preferred but not necessary.
Platelet concentrate should be transfused as soon as possible
after reaching the ward with standard blood transfusion sets
with 170 mm filters.
The transfusion should normally be completed within 30
minutes.
Observation during platelet transfusion should include pulse&
temperature before& after transfusion.
4th year medical students
Indications For The Use Of FFP
Definite indication:
Replacement of single factor deficiencies
Immediate reversal of warfarin effect
Vitamin K deficiency
Acute disseminated intravascular coagulation
Thrombotic thrombocytopenic purpura
Inherited deficiencies of inhibitors of
coagulation:at, protein S, protein C.
CI esterase inhibitor deficiency

4th year medical students
Conditional uses of FFP
FFP is only indicated in the presence of bleeding
and disturbed coagulation.
Massive transfusion
Liver disease
Cardiopulmonary bypass surgery
Special Paediatric indications:
sever sepsis, DIC.
4th year medical students
Administration of FFP
1unit of FFP= APPROXIMATELY 200 ML
Dose = 12-15 ml/kg
Should be administered within 2 hours of thawing.
PT & PTT used for monitoring in addition to the clinical
assessment.
ABO compatible FFP should be used. Compatibility testing is
not required.
Group O should only be given to group O recipient.
Group A or B FFP can be given to group O recipient.
Group AB FFP should be reserved for group AB recipients and
for emergencies.
4th year medical students
Indications for The Use Of Cryoprecipitate


1-congenital or Acquired Fibrinogen Deficiency.

2-Haemophilia A, vonWillebrands Disease.

3-factor X111 Deficiency

4-disseminated intravascular coagulopathy(DIC).

4th year medical students
Administration of Cryoprecipitate
1 unit of cryo= approximately 10-20ml
Adult dose equivalent to 10 units of cryo
For factor replacement the dose can be calculated
according to the volume of the factor in the
concentrate.
Fibrinogen 150-300mg/pack
Von Willebrand factor 80-120u/pack
Factor V111c 80-120u/pack
Factor X111 20-30% of factor X111 present in the
FFP.
Should be ABO compatible to avoid risk of haemolysis
caused by donor antiA or antiB.
Should be administered within 4 hours of thawing.

4th year medical students










Platelet, Apheresis



An adult dose of Platelets prepared from
anticoagulated blood which is separated into
components by apheresis machine with retention
of the platelets and a portion of the plasma.
The remaining elements may be returned to the
donor

4th year medical students

Specification

Volume 200 800 mls
Platelet count > 240 x 10
9
/ unit
Leucocyte count < 5 x 10
8
/ unit
PH at end of shelf life 6.4-7.4
Availability: On request.
Shelf life storage: 5 days at 22 2c gently
agitated

4th year medical students