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THE RATIONAL USE OF BLOOD AND BLOOD PRODUCTS

To discuss the following:
• • • •

The various components available from blood The rational use of blood and its components Problems faced Proposals for improved blood product usage

tissues and organs waste products from various sites  Keeps  Provides  Removes . Blood is an amazing fluid us warm nutrients for cells.

     Packed red blood cells(PRBC) Platelets ( PRP ) Fresh Frozen Plasma (FFP) Cryoprecipitate ( CP ) Cryo poor plasma ( CPP) .

 1 unit of blood theoretically gives    1 unit FFP 1 unit PRBC’s 1 random donor unit Platelet .

Rational Use of Blood RATIONAL • Right product • Right dose • Right time • Right reasons .

Inherent risks involved in transfusion therapy 1 in 2 million gets HIV • Scientifically appropriate Haematinic in nutritional anemia .(Rationale behind Rational use of blood) • Economy -Scarcity of resource 1 in 4 get blood component Logic • Safety .

A blood transfusion should never be ordered unless it is worth the risk therapeutic benefit • Single unit transfusion – has no significant • Use of fresh blood .Guidelines For Promoting Component Therapy • Definite indication .should be avoided because of increased risk of infections (TTI) .

1. Give only what is needed Red cells O2 carrying capacity (Anemia) Thrombocytopenia Multiple clotting factor deficiency Hemophilia A Platelets FFP CRYO .

Red cells FFP/CPP Temp.2.400 C 1 Year . Different Storage Conditions Comp. 4-60 C .40 0 C Shelf life 35 days 1 year Platelets CRYO 22-240 C on platelet agitator 5days .

. Conservation of Scarce Resource •Separation of whole blood in 3-4 components •Benefits more than one patient at a time.3.

viscosity of medium. flexibility of the cells which are temperature dependent 30/11/49 MD-3-49 12 .Centrifugation Principle Sediment of blood cells depend on their size as well as the difference of their density from that of the surrounding fluid.

5 gm/dl Same as PRBC Packed red cells 200 – 240 ml 1 -1.5 gm/dl Same as WB No No ++++ ++++ ++++ ++++ Yes No No + + + + No .Parameter Volume Increment in Hb Red cell mass /ml Viable platelets Labile factors Plasma citrate Allergic reactions FNHTR Risk of TTI Waste of components Whole blood 350 – 450 ml 1 -1.

30oC + 2 – 80C .Why whole blood not rational • Maximize blood resource Whole blood Component therapy one patient four patients thalassemia liver disease / burns thrombocytopenia hemophilia packed red cells plasma platelets cryoprecipitate Specific storage requirements of components Whole blood Components platelets cryoprecipitate & FFP red cells + 4 0C + 20 – 24 oC .

Requirement of platelets to raise count from 20 to 50.000/ul fresh whole blood 5 units 1750 ml random platelets 5 units 250 ml apheresis platelets 1 unit 200 ml • Decreased cost of management except for the cost of bag.Why whole blood not rational • Better patient management • concentrated dose of required component • avoid circulatory overload • minimize reactions eg. other expenses remain same .

HTLV) survive in leukocyte in fresh blood  syphilis transmission Treponema can not survive > 96 hours in stored blood  malaria transmission malarial parasite can not survive > 72 hrs in stored blood .“Fresh blood” – a misconception What is “fresh blood”?  unit kept at 4oC for 4 hours is no longer “fresh”  storage lesions in different constituents due to storage temp Increased risk of disease transmission  intracellular pathogens (CMV.

“Fresh blood” – a misconception Immunological complication due to WBCs in fresh blood TA-GvHD – 90% fatality TA-immunomodulation  alloimmunization Logistics  no time for component preparation  less time for infection screening  increased chances of error .

The clinician should. accurately label blood sample tubes 3. check the identity of the patient. the product and the documentation at the patient’s bedside before transfusion. 1. . complete all required details on the blood request form 2.

•No evidence that warming blood is beneficial to the patient when infusion is slow .

3. 2. 5.Summary 1. 4. No place for Whole Blood in clinical medicine Discourage single unit / fresh blood Component preparation and use is the demand of time Promotion of judicious use of blood / components Promote autologous use of blood .

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