BLOOD BANK, SGMH

RATIONALE USE OF BLOOD &

BLOOD PRODUCTS

DR. P C PRABHAKAR
BLOOD BANK OFFICER
 National Guidelines on
‘Clinical use of Blood’
Blood shall be used only when necessary. Blood and blood products
shall be transfused only to treat conditions leading to significant
morbidity and mortality that cannot be prevented or treated effectively
by other means.
Transfusion is only one part of management
Patients Hb value although important, should not be the sole deciding
factor
Clinician should be aware of the risk of transfusion –transmissible
infection
Transfusion should be prescribed only when the benefits to the patients
are likely to outweigh the risk
  What is Blood ?
 Human blood is covered under the definition of “Drug” under Sec. 3(b) of
Drugs & Cosmetics Act, 1967, under schedule F part XII B.
 Type of Blood and Blood Products.

1. Whole Blood – Un separated blood collected into an approved container

containing an anticoagulant – preservative solution.
2. Blood component – A constituent of blood, separated from whole blood,
such as:-
• Red cell concentrate
• Plasma
• Platelet concentrates
3. Human plasma proteins prepared under pharmaceutical manufacturing
conditions, such as:-
• Albumin
• Coagulation factor concentrates
• Immunoglobulin's.
 Whole Blood
1 unit or pack contains 350 ml or 450 ml
Storage - Between +2 C and + 6 C.
Transfusion Indication – Red cell replacement in Acute blood loss
with Hypovolemia
Exchange transfusion
Where red cell concentrate not available
Contraindication-
Risk of volume overload in patients with:
Chronic anemia
Cardiac Failure

Administration of whole blood?

1 unit of whole blood raises hemoglobin by 1-2 gm /dl
Never add medication to a unit of blood
Complete transfusion within 4 hrs.
 Red Cell Concentrate (Packed red cells)

1 unit contains 150-200 ml red cells with plasma

Storage - Between +2 C and + 6 C.
Indications – Replacement of Red Cells in anemic
patients
In acute blood loss with crystalloid replacement
fluids.
• 1 unit of whole blood raises hemoglobin by 1-2 g /dl.
 FRESH FROZEN PLASMA
• Plasma separated from whole blood donation with in 6hrs
and stored at more than -25 C
Storage – At more than -25 C for up to 1 year
• Before use, should be thawed between 30 C to 37 C.
• Indication –
• Coagulation factor deficiencies:-----
 Liver disease, warfarin ovrdose, coagulation factor depletion.
 Disseminated intravascular coagulation (DIC)
• Thrombotic thrombocytopenic purpura (TTP)
Administration - Use within 24 hrs of thawing
• Must be ABO compatible
 PLATELET CONCENTRATE
Prepared from whole blood donation : 50-70 ml.
Storage – upto 5 days at 20 C- 24 C with agitation
•Do not store at 2 C – 6 C.
Indication – Treatment of bleeding due to:
• Thrombocytopenia
• Platelet function defects
-Prevtionen of bleeding because of thrombocytopenia like in Bone marrow failure
Contraindication – Prophylaxis of bleeding in surgical patient.
• ITP
•TTP
•Untreated DIC

• How to Administration of Platelet Concentrate?

•1 Unit of platelet concentrate raises the platelet count by 5-10 thousand.
 TIME LIMITS FOR INFUSION
Start infusion Complete

Whole blood or red cells With in 30 minutes Within 4 hrs.

of removing pack
from refrigerator

Platelet concentrates
Immediately With in 20 minutes

Fresh Frozen plasma As soon as possibleWith in 20 minutes

 Precautions during transfusion:
 Blood should never be warmed in a bowl of hot water.
 Try to keep the patient warm not the blood being transfused.
 Infusion more then 100ml per minute may contribute to cardiac arrest.
 Blood transfusion rate
Adult- 50ml/kg/hr
Children- 15 ml/kg/hr
 Adverse effects of transfusion
•Acute reaction may occur in 1% to 2%.
•Close observation is must while Transfusion
- In Unconscious Patient, look for Hypotension &
uncontrolled bleeding : sign of incompatible transfusion.
-In a Conscious Patient, a severe hemolytic transfusion
reaction may show signs & symptoms within minutes of
infusing 5-10 ml of Blood.
Technical Errors
•Bacterial contamination in red cells and platelet
concentrates because of
-Improper storage at wrong temperature.
-Re issuing the same bag to second patient (in case of
Pediatric )
• Acute febrile reactions
. Transfusion transmitted infections:
 HIV I&II: 0.1%
 Hepatitis B: 1.6%
 Hepatitis C: 0.18%
 Syphilis: <0.89
 Malaria , <0.04
 Filarial infestation
 Cytomegalovirus
Recognition and acute transfusion
reactions
MILD REACTION Management
 Localized cutaneous reactions: Slow the transfusion.
 Urticaria Administer antihistamine (IM)
 Rash

MODERATE REACTION Stop the Transfusion

 Flushing Replace the transfusion set
 Urticaria Notify the doctors
 Rigors Send Blood unit with infusion set
& a fresh blood sample to blood bank.
 Fever Collect the urine sample and new
 Restlessness blood sample
 Tachycardia Manage the patient clinically
Collect the Urine for next 24 hrs. for
evidence of any Hemolysis
SEVERE REACTION
Rigors
Fever
Restlessness
Hypotension (fall Of 20% in systolic BP)
Tachycardia (rise of 20% in heart rate)
Hemoglobinuria (red urine)
Unexplained bleeding (DIC)
PRE TRANSFUSION CHECKS :

1) PATIENT’S IDENTITY
2) BLOOD BAG DETAILS ON THE BAG
3) COMPATIBILITY LABEL
4) SIGNATURE OF THE PERSON PERFORMING
THE
PRE TRANSFUSION IDENTITY CHECK
a)TYPE AND VOLUME OF EACH PRODUCT
b)DONATION NUMBER
c) Blood Group
d) TIME AT WHICH THE TRANSFUSION COMMENCED.

5)SIGNATURE OF THE PERSON

ADMINISTERING THE BLOOD
COMPONENT
6)MONITORING OF THE PATIENT
BEFORE, DURING AND AFTER
THE TRANSFUSION

7) ANY TRANSFUSION REACTIONS

Role of Blood in Obstetrics and Gynaeclogy
Pregnancy :-
The blood is rarely required in pregnancy if the Hb is
more than 10 g/dl.
Blood loss during delivery
About 200 ml of blood during normal vaginal delivery.
Up to 500 ml during Caesarean section.
Transfusion does not treat the cause of anemia or
correct the non-hematological effects of iron
deficiency.
Transfusion guideline for anemia in
pregnancy
Pregnancy <36 weeks.
Heomoglobin <5 g/dl
Heomoglobin between 5 & 7 g/dl with the presence of cardiac failure.
 Pneumonia
 Malaria
 Pre-existing heart disease
Pregnancy >36 weeks
Heomoglobin below 6 g/dl
Heomoglobin between 6 & 8 g/dl with the presence of cardiac failure.
 Pneumonia
 Malaria
 Pre-existing heart disease
Elective Caesarean section
Heomoglobin below <8 g/dl
2 units blood should be available .
Heomoglobin between 6 & 10 g/dl.
Prepare for transfusion if required.
At term, blood flow to the placenta is approximately 700
ml per minute. The patient’s entire blood volume can be
lost in 5-10 minutes.
TRANSFUSION IN DISSEMINATED
INTRAVASCULAR COAGULATION (DIC)

If DIC is suspected, do not delay treatment while waiting for the

results of coagulation tests. Treat the cause and use blood
products to help control hemorrhage.
If the PT or APTT is prolonged
 Administer the freshest whole blood if avialable
And
 Give fresh frozen plasma.
 4-5 packs per person
If fibrinogen is low
 Give cryoprecipitate for fibrinogen and factor VIII.
If Platelet is less then 50 thousand
 Give platelet concentrate, 4-6 packs.
TRANSFUSION IN PAEDIATRICS
 INDICATION:
 Hemoglobin <4g/dl or Haematocrit <12%
 Hemoglobin 4-6g/dl or Hct 13-18%,
- If Clinical features of Hypoxia i.e. Acidosis or impaired consciousness
- Hyperparasitemia >20%
Hereditary diseases like Thalassemia, Sickle cell disease.
Use Paediatric Blood Bags else use Blood Bag only once.
NEVER REUSE SAME BAG.
DURING TRANSFUSION
Transfusion rate 5-10 ml/kg
Give diuretic i.e. frusemide to prevent cardiac failure & pulmonary oedema like
complications.
TAKE HOME MESSAGE
* Healthy Donor
*Proper Donor Counselling.
*Blood Component Therapy.
*Transfusion avoidance strategies.
*Avoidance of fresh Blood transfusion
*Avoidance of single unit transfusion
*Autologous Blood transfusion.
*Reducing number of donor exposures.
THANK YOU