BLOOD COMPONENT THERAPY

Nandha kumar CRRI

Mahaadevan.S CRRI
CONTENTS/ OBJECTIVES
1. Understanding various Blood components
2. Indications and Use of blood components
3. Reactions and adverse events in blood component
therapy
BLOOD COMPONENTS
1. Whole Blood
2. Packed Red Blood Cells(PRBCs)
3. Platelets
4. Fresh-Frozen Plasma
5. Cryoprecipitate
6. Plasma derivatives- Albumin, IVIG, anti-thrombin,
coagulation factors
WHOLE BLOOD
1. Unprocessed into components-RBC + Plasma + white
cells+ platelets
2. 450 ml of donor blood + Anticoagulant solution
3. Has PCV of 30-40%
4. Stored at 4 degree C
5. Platelet and some coagulation factors degradation occurs
6. Decreased 2,3- BPG levels leading to decrease oxygen
delivery to tissues
7. Fresh whole blood only in emergency settings eg.military
8. Not readily available
PACKED RED BLOOD CELLS
1. Obtained by high speed centrifuge of whole blood
2. In a packed cell unit hematocrit is 55-75%
3. Available in 200-250 ml volume
4. It has RBCs with variable leukocyte content and
small amount of plasma – White cells are removed as
buffy coat.
5. On transfusion it increases hemoglobin by 1g/dl and
hematocrit by 3%
6. Stored at 4 C
7. Shelf life is 1 month.
PLATELETS
1. Obtained by centrifugation of Platelet rich
plasma(PRP).
2. May be obtained from a single donor or pooled plasma.
3. These are stored at 20-22C
4. Shelf life is 5 days
5. 1 unit of platelet concentrate raises platelet count by
5000/cu mm.
6. Platelets do not express Rh antigen
7. Rh negative persons should be given platelets from Rh
negative persons only to avoid reactions.
FRESH FROZEN PLASMA
1. Volume 200-300mL
2. Contains stable coagulation factors and plasma
proteins: Fibrinogen, anti-thrombin, albumin, protein
C and S.
3. An acellular component and does not transmit
infections.
CRYOPRECIPITATE
1. Prepared from FFP by freeze-thaw process.
2. Has cold insoluble plasma proteins
3. Volume of 5-15 ml
4. Contains 100 units of FVIII and about 200 mg of
fibrinogen.
5. Also has factors FIX, vWF and FXIII
COMPONENTS AND THEIR
INDICATIONS
WHOLE BLOOD 1.Patients who have sustained acute
hemorrhage of >/= 25% total blood
volume loss
2. Exchange transfusion
PACKED RED BLOOD CELLS 1. Thalassemia major
2. Sickle cell Anemia
3. Aplastic anemia
4. Severe anemia of any cause
5. Hypovolemia due to hemorrhage
6. Surgery
PLATELET CONCENTRATE Thrombocytopenia
Platelet count,10000/cu mm
Fresh- Frozen Plasma 1. Correction of coagulopathies
2. Rapid reversal of warfarin
3. Supplying deficient plasma
proteins
CRYOPRECIPITATE 1. Haemophilia A
2. Fibrinogen deficiency
3. Von Willebrand disease
ADVERSE REACTIONS TO BLOOD
TRANSFUSION
IMMUNE MEDIATED REACTIONS

1. Acute Hemolytic Transfusion rections

2. Delayed Hemolytic and serologic transfusion reaction
3. Febrile Non Hemolytic Transfusion rection
4. Allergic reaction
5. Anaphylactic reaction
6. Graft vs Host disease
7. Transfusion Related Acute lung Injury
8. Post transfusion purpura.
9. Alloimmunisation
Non immunologic reactions
1. Fluid overload
2. Hypothermia
3. Electrolyte toxicity
4. Iron overload
5. Hypotensive reaction
6. Immuno modulation
INFECTIOUS COMPLICATIONS
1. Viral infections
2. Bacterial contamination
3. Other infectious agents
FNHTR
Most frequent reaction associated with transfusion of
cellular components
Presents as chills and rigors, >/= 1C temp
diagnosis of exclusion
Ab against donor leukocyte and HLA Ag
Increased risk with multiple transfusion.
Acute Hemolytic Transfusion reaction
Recepient's performed antibodies( ABO
Isoagglutinins) lyse donor RBCs
Presents as hypotension, tachypnea, tachycardia, fever,
chills, hemoglobinuria, chest/flank pain.
Stop transfusion and report to blood bank
Management consists of diuresis with
Furosemide/mannitol and iv fluids
send for coagulation studies and platelet count
TRALI
MC cause of transfusion Related fatalities.
Presents as hypoxia and signs of non cardiogenic
pulmonary edena
Donor plasma containing high titer anti HLA class II
Ab that bind leukocytes and aggregate in pulmonary
vasculature that results in increased capillary
permeability
GVHD
Frequent complication of allogenic stem cell
transplantation
 Lymphocytes from donor attack and cannot be
eliminated by immunodeficient host
Transfusion related GVHD
Transfusion associated GVHD
characterised by Fever, characteristic cutaneous
eruption, diarrhea, LFT abnormalities
THANK YOU