Reasons for Transfusion Life threatening blood loss Restore blood volume and adequate supply of oxygen Whole

ole blood transfusion slowly replaced by components transfusion Whole Blood Components Benefits: Blood stored for less than 24hrs Economy of blood, cost effective 350ml(45-55kg)/450ml(>55kg) + anticoagulant, lifespan = 35days Single donation for different patient Red cells, granulocytes, platelet, plasma protein Minimizes hazard of whole blood transfusion Lack coagulation factors, factor VIII, V Specific comp. for specific disease Transfer of unnecessary &harmful substance avoided Blood products Descriptions Usage Red cells conc. (Pack 200-250ml plasma removed Severe anemia (prevent cell) overload) Preparation: sedimentation, Haemolytic anemia centrifugation Double/triple CPDA bag balanced, Aplastic anemia centrifuged @ 5k rpm (4-6 Cel) Less plasma protein : minimum Lifespan as whole blood, SAGManaphylactic rxn saline-adenine-glucose-mannitol (42 days) Leucocytes poor packed cell At least 70% leucocytes removed, minimal RBC loss Double centrifugation, filtration Washing RBC with saline Freezing and glycerolization Plasma separated from whole blood Frozen within 6hrs, stored @ -30 Cel Double CDPA bags cent. @ 5k rpm 5 min 4 Cel (heavy spin) 250ml, 70-80 units of factors VIII, IX, vWF Administration: o Transfused within 24hrs of thawing o After thawing, store @ 2-6 Cel o ABO compatible is used Insoluble portion of plasma after FFP is thawed at 4C After cent, supernatant plasma expressed into satellite bag leaving 15ml of cryoadhering to wall Packs of cryo are placed in cryobath at 25C for protein to dissolve Cryopooling- contains 100 units of factor VIII, 250mg of fibrinogen, 70% of vWF Severe/recurrent febrile nonhaemolytic TR Urticarial (allergic) rxn

Fresh frozen plasma

Multiple coagulation deficiencies (liver disease, DIC, massive blood transfusion) Drug therapy reversal Warfarin Sodium, Dicumarol Immunodef synd. (infant with protein losing enteropathy) Thrombotic thrombocytopenic purpura Haemophilia, vWD, congenital and acquired fibrinogen def. Storage: o 1 yr shelf life o -30c or below o Rapidly thawed on request o Transfusion must be completed in 4hrs o ABO compatibility needed

Cryo precipitate

Blood products PRP & platelet conc.

Descriptions Plasma from 1st satellite bag is centr @5k rpm 22 Cel Express platelet poor plasma leaving behind 50ml platelet conc. Stored @ 22 Cel, in agitator 5 days Plasma & buffycoat extracted in satellite bag, by centrifuge 20ml of granulocyte conc or 1.25x10^9 recovered per donation Radiated with 1500rads sufficient w/o any damage to platelet & RBCs

Granulocyte conc.

Irradiated comp.

Usage Thrombocytopenia assoc w leukemia & aplastic anemia Dilutional thrombocytopenia DIC 1 unit increase platelet cu by 10k/ul so 6-10 unit necessary Compatibility not necessary BM showing myeloid hypoplasia Severe neutropenia Neonatal septicaemia unresponsive to antibiotic therapy BM transplantation Immunodef syndrome Immunosupr to chemo/radio Prevent graft vs host disease

Anemias Nutritional, HA, Malaria Transfusion of red cells if Hb <7gms/dl Megaloblastic anemia Transfusion is dangerous due to poor myocardial function BMF Severe anemia- red cells transfusion Thrombocytopenia platelet trnfusion Sickel Cell Disease Maintain sufficient normal HbA 30 % in circulation

CLINICAL SETTINGS Surgery/Trauma Little justification in preoperative transfusion > 1 unit requirement Thyroidectomy, open heart surgery, resection of abd aorta. Aortic aneurysm, vascular surgery, AV malformation, total hip replacement Autologous transfusion minimise blood loss or salvage the blood loss

O&G Rarely necessitates transfusion Transfusion needed in IDA or short birth interval Transfusion not treating cause of anemia Does not correct the non haematological effects of Iron deficiency Pediatric- exchange, top up transfusions, platelet