• Red Blood Cells

• Platelets
• Fresh Frozen Plasma (FFP)
• Granulocytes
Benefit several different patients.
Patients recieve only the component(s) necessary.
Reduces the risk of transfusion reactions.
Storage conditions can be optimized.
Offers logistic, ethical and economic advantages.
 Safe.
 High quality:”the purer the better”.
 Reproducible composition.
 Prolonged storage with maintenance of quality in vitro.
 Good increments and efficacy in vivo.
 Ensured traceability.
 Minimal number of adverse reactions.
Leukoreduction
Irradiation
HLA or HPA matched
Specific infection-Free
Leukoreduction to below
5 x 106 will :
 Diminish alloimmunization (HLA),
 Prevent platelet refractoriness,
 Improves the quality of the blood,
 Reduce transmission of viruses
such as CMV and HTLV and prions
(vCJD).
• A dose of 25 Gray (Gy;J/ kg) is commonly used.
• To inactivate viable T cells to prevent graft-vs-
host disease.
• The most frequent encountered antigenic targets
of antibodies in patients with alloimmune
platelet refractoriness are the class I major
histocompatibility antigens, HLA-A and HLA-B.
• Patients with alloimmune refractory
thrombocytopenia are best managed with
platelet transfusions from donors who are HLA-
A, HLA-B or HPA antigen selected.
Pediatric patients are susceptible:
1) Infection and toxic effect of
transfusion.
2) Long-term transfusion side effects.
3) Heavier acute side effect.
Martina Nathan and Karen Selwood.__
Martina Nathan and Karen Selwood. __
 Need for Transfusion
Should always be based:
• on a careful assessment of clinical and
laboratory indications
• To save life or prevent significant morbidity.
 Factors Determining the Need for
Transfusion
• Blood loss
• Hemolysis
• Cardiorespiratory state and tissue oxygenation
 “It’s CONTRAINDICATED,
if no strong indications of Blood Transfusion”
Appropiate Use of Red Blood Cells
Constant supply
Theof oxygen
overall to the
Supply of tissues
oxygendepend
to the
to: tissues depend to:
• Oxygen transfer from lung to plasma
 Hb concentration

• Oxygen storage on hemoglobin

 Degree of saturationmolecules
of Hb with
• Oxygen transport
oxygen to the tissues
• Oxygen release
 Cardiac
from output
blood to tissues
Appropiate Use of Red Blood Cells
• Blood component therapy should only be given when the
expected benefits to the patient are likely to outweigh the
potential hazards.

• The decision to transfuse red blood cells should be based on

clinical assessment of the patient and his or her response to
any previous transfusion as well as the haemoglobin level.
Appropiate Use of Red Blood Cells
• Use of red blood cells is likely to be
inappropriate when Hb>100g/L unless there
are specific indications.
Appropiate Use of Red Blood Cells
• Use of red blood cells may be appropriate
when Hb is in the range70–100g/L. Should be
supported by the need to relieve clinical signs
and symptoms and prevent significant
morbidity and mortality
Appropiate Use of Red Blood Cells
• In some patients who are asymptomatic
and/or where specific therapy is available,
lower threshold levels may be acceptable.
Appropiate Use of Red Blood Cells
Appropiate Use of Platelets
Appropiate Use of Platelets
Appropiate Use of Platelets
Contraindication of platelet
transfusions
• Immune-mediated platelet
destruction
• Thrombotic Thrombopenic Purpura
• Hemolytic Uremic Syndrome
• Drug induced, or cardiac bypass
thrombocytopenia without
haemorhage
 Appropiate Use of
Fresh Frozen Plasma (FFP)
• Replacement of single factor deficiencies,
for which commercial concentrates are not
available. e.g. Factor V.

• Replacement of multiple factor

deficiencies in clinical situations where
there is abnormal bleeding with PT/APTT
exceeding 1.5 times the reference value.
 Appropiate Use of
Fresh Frozen Plasma

• Reversal of Warfarin effect, for emergency

situations where the antidote effect of Vitamin
K1 is considered too slow.

• Replacement in massive transfusion (l or

more blood volume in 24 hours), but only
when there is abnormal bleeding with
PT/APTT exceeding 1.5 times the reference
value.
 Appropiate Use of Fresh Frozen
Plasma
• Adjunctive treatment for Antithrombin III
deficiency and Immunodeficiencies where
commercial preparations of the concentrate
are not available.

• Treatment of thrombic thrombocytopenic

purpura.
 FFP should not be Used
• Circulatory volume expansion
• Nutrition
• Reconstitution of wholeblood
• Treatment of GI bleeding,or trauma related
bleeding
Pediatric Patients
 Remarks

 Pediatric transfusion have its specificities

 Appropriateness of component usage is very
considered