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Principles of Blood Transfusion

Principles of Blood Transfusion

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Published by Emhemed2012
blood transfusion basic facts
blood transfusion basic facts

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Published by: Emhemed2012 on Jul 06, 2013
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Principles of Blood Transfusion & Applications Principles of Blood component/ Pr oduct replacement Principle 1 Identify cause of deficien cy 2 Replace only

deficiency compone nt 3 Blood produ ct should be as safe as posible Blood compone nts & plasma derivatives Whole blood is collected into plastic bag (contain anti-coagulant, preservative) Citrate Bind plasma Ca2+ Prevent activation of coagulation cascade Phosphate Maintain red cell 2,3-DPG Dextrose Substrates for metabolic processes of cellular comp onent Blood component = a product separated from a single unit of whole blood Plasma derivative = blood product separated from large volume of pooled plasma Blood compone nts Blood pr oducts Not 100% safe – HIV window period Manufactured, Safer, No microorganisms Red cell conce ntrates Coagulation factor concentrates Platelet concentrates • Factor VIII (8) concentrates Fresh frozen plasma (Hemophilia A) • Factor IX (9) concentrate (Hemophilia B) Cryoprecipitate Albumin Cryosupernatant Immunoglob ulin Preparation of blood components from whole blood Pretransfusion Tests – for RBC transfusion From patient From donor ABO, Rh ABO, Rh Antibody screening Antibody identification Ordering Blood

jslum.com | Medicine

Cross-matching GXM GSH

Screen 4 HIV Hepatitis B,C Syphilis Malaria/ Parasite (not compulsory) Blood loss – signs, symptoms, indications for transfusion Volume Lost Clinical signs Preparation of choice mL Total Blood Volume 500 10% None No transfusion or crystalloid solution 1000 20% Tachycardia Crystalloid solution or colloid or RBC if necessary 1500 30% BP ↓ Crystalloid solution + Colloid + RBC or blood if available 2000 40% Shock Crystalloid solution + Colloid + RBC or blood if available Patient & Donor RBC - selection by ABO, Rh type Patient A B AB O Rh +ve Rh –ve Patient & Donor Plasma - selection by ABO Recipient O A B AB

Plasma Derivatives (Blood products) Human albumin solutions 5%, 20%, 25% Indication • Replacement fluid in therapeutic plasma exchange • Diuretic-resistant oedema treatment (in hypoproteinaemic patient – nephrotic syndrome) • Volume replacement • Burns • Hypoalbuminaemia Coagulation Factors Factor VIII concentrate Factor IX concentrate Prothrombin con centrate (PCC) Immunogloblin Intramuscular use Anti-RhD IV use (IM) Immunoglobulin (Anti-D RhIG) Specific antibodies to Prevention HDN in ITP/ other immune infectious agents RhD negative mothers disorders • Hepatitis B • Rabies • Tetanus Immune de ficiency Immune de ficiency state state Hypogammaglobulinaemia HIV-related disease

Donor A,O B,O A, B, AB, O O Rh +ve, Rh –ve Rh -ve

Donor O, A, B, AB A, AB B, AB AB

cJD) • Anaemia responsive to haematinic • For volume expansion • Post operative Hb > 8g/dL Platelet concentrate (from whole blood) Content Volume – 50-60 ml Platelet – 55x10ଽ Leukocytes – 0. continous agitation) Dose – 4-6 units in adult OR 1 unit/10 kg body weight Increment – 5-10 x 10ଽ per unit platelet Plateletpheresis Volume – 150-300 ml Platelet – 300 x10ଽ (6 single donations) No RBC contamination Minimal WBC contamination 1 unit = 1 therapeutic dose Role of platelet . White cells a.Whole Blood 1 unit = 450 ml + 63 ml anticoagulant Storage – 2-6 °C Life span – 35 days Changes occur during storage 1. Red cells a. FFP is thawed in water bath Thawed plasma should be used < 2h Contains all coagulation factors Factor VIII Sodium Potassium Glucose Citrate Indications Replacement of single coagulation factor deficien cy (when specifi c factor con centrates not available)(Factors II. myelofibrosis Haemolytic anaemia Prevent Paroxysmal (rare.02 x10ଽ /L Storage . Aggregates of aged platelets. VII.5gm/dl per unit Types Red cell concentrate Leukocyte γ irradiated Washed red reduced red cell red cell blood cells Symptomatic Prevent nonPrevent TASevere allergic anaemia haemolytic GVHD (bone reaction febrile marrow following Iron.3-DPG 2. transfusion deficiency anaemia (rare. leucocytes. Prolonged PT only.05 x10଺ /L RBC contamination – 0. Do not lose antigenic properties i. white cells & neonate) Angina. Lose ATP b. ↑ H+ 6. congenital procoagulant. fibrin strands formed b. XIII) Vitamin K deficiency with bleeding episodes (haemorrhagic disease of newborn) Acute disseminated intravascular coagulation Thrombotic thrombocytopenic purpura (at least 3L/ day) Microvascular bleeding (following massive blood transfusion) Not indicated in Volume expander/ nutritional supplement Albumin supplementation Hypogammaglobulinaemia correction Haemophilia. Biochemi cal changes a. vWD. anticoagulant factor deficiency (virally inactivated. recombinant factor conce ntrates are preferred) Bleeding only. MDS. Capable of sensitizing recipient ii. Cause non-hae molytic febrile transfusion reaction 3. Folate. Lose 2. Lose haemostatic fun ction (within 48h) 4. except in reaction (due to immune elderly patients with antibodies to compromised. ↑ K+ b. XI. CCF) platelets in Hypoproliferative Hypersensitive recipients anaemia to plasma exposed to • Malignancy previous • Chemotherapy transfusion. except sensitization nocturnal anaemia poorly (marrow haemotolerated & Hb < transplantation) globinuria 7g/dL) Not indicated in ↓ Transmission of disease • Undiagnosed/ asymptomatic (cytomegalovirus anaemia . Platelets a. Coagulation factors a. X.com | Medicine Fresh Frozen Plasma (FFP) Prepare within 6h of collection Freeze at -30°C for 1 year Properties Volume – 200 ml Prior to use. bactericidal properties (after 4-6h collection) b. Factor V & Factor VIII lose coagulant activity (50%) (within 4872h storage) 5. Prolonged APTT only Cryoprecipitate Obtained from 1 single donation of fresh plas ma Rapid freezing within 6h of collection Subsequent thawing at 4-8 °C Removal of cryosupernatant Properties Volume – 20 ml Contain • Factor VIII • Fibrinogen • Factor XIII • vWF Storage -30°C (1 year) Administration – need to be thawed in water bath & used within 2h Involves preparation of fibrin glue Indications Von Willebrand’s disease Hypofibrinogenemia DIC . / radiotherapy pregnancies) • Aplastic anaemia. Cause transfusion related lung injury (TRALI) Indication Exchange transfusion in infants for haemolytic disease of new born Acute hypovolemia (haemorrhagic shock)/ Blood loss >30% Massive transfusion Red cell concentrate (Packed cell) Prepare by removing 200ml of plasma from Whole Blood after centrifugation Storage – 2-6 °C Half life – 35 days Increment – 1-1. Granulocyte – lost phagocytic. Microaggregates a.<5 days (22°C.1° homeostasis Normal platelet count – 140-450 x10ଽ /L Indication Treatment of bleeding (thrombocytopenia/ abnormal platelet function) Prophylactic platelet transfusion (based on platelet count) < 100 x૚૙ૢ /L <50 x ૚૙ૢ /L < 10 x૚૙ૢ /L Undergoing major Newborn state Prophylactic use with surgery minor bleeding/ stable Plasma coagulation patients abnormality Surgery within previous Fever/ Severe infection 48h Minor surgical procedure/ invasive procedure Not indicated Idiopathic thrombocytopenia purpura (u nless life threatening bleeding) Thrombotic thrombocytopenic purpura jslum. B12 transfusion transplant.

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