Blood Component Therapy

BLOOD COMPONENT THERAPY AND TRANSFUSION REACTIONS

Blood 
It is the fluid that circulates through the heart, arteries, capillaries, veins and carries the nutrients and oxygen to the body cells

Functions of Blood 
   O2 transportation Removal of CO2 Transport of nutrients Transport of waste products

Blood elements  Cellular component  Fluid component .

000-500.8-5.000/cmm 250.Cellular part Normal range Erythrocyte Leucocytes Life span M 4.75-5.000- .1 million/cmm 4.5 million/cmm 120 days 4.84000-11.000/cmm 400010 hr in peripheral blood 4~5 days in tissue 10 days Platelets 250.75F 4.

Fluid parts     Coagulation factors Antibodies Albumin hormones .

? Blood component therapy  Donated blood is separated into various component and specific component therapy is more effective and safe than whole blood.  Component therapy helps in making better use of blood. .

Donor Whole blood Separation of cellular plasma components by centrifugation Red cell concentrate (PCV) Plasma Frozen within 6 hrs centrifugation Albumin 5% Immunoglobulin Fresh frozen plasma Slowly defrost and removal of supernatant cryoprecipitate Platelet concentrate ( PRP ) .

Available blood components Components Major therapeutic effects volume. fibrinogen deficiency -DIC PCV Fresh Blood (within 36 hr of withdrawal from the donor Platelets Factor v Fibrinogen . RBC mass RBC mass Indications Whole blood Acute and severe hemorrhage -acute anemia -chronic anemia -Bone marrow failure -thrombocytopenia with hemorrhage -Factor v.

000/cmm *<75000 abnormal bleeding *<30.000 spontaneous bleeding -massive blood transfusion hypofibrinogenomia burns -severe hypoproteinaemia In renal and liver disease -after large volume paracentesis Cryoprecipitate Platelet rich plasma (PRP) Fibrinogen Fibrinogen Serum albumin 5% Plasma volume Serum albumin 20% Plasma proteins .Fresh Frozen Plasma (FFP) Plasma All the clotting factors Factor VIII Platelet -massive transfusion -liver disease -ITP Hemophilia -thrombocytopenia without hemorrhage < 50.

Blood group  Discovered by Landsterner in 1900  Differentiated into 4 distinct groups on the basis of antigens .

ABO system  This is blood group system because of naturally acquired IgM anti-A and anti-B antibodies antiantiBlood group O A B AB Antigen in RBCs Antibodies in plasma Nil Anti-A.antiA B A and B Anti-B AntiAnti-A AntiNil . anti-B Anti.

Rh system  This is blood group system because of high frequency of development of IgG Rh(D) antibodies in the Rh µD¶ negative individuals after exposure to Rh positive red cells following blood transfusions or during pregnancy  3 pairs of allele genes D & d. E & e  Presence or absence of D antigen determines the individual is Rh D positive or negative . C & c.

Rh µD¶ positive Rh µD¶ negative 85% 15% .

 Mother develops anti-Rh antibody during the antiperiod following delivery.Rh incompatibility  Sometimes seen when a Rh negative mother carries a Rh +ve foetus.  Next pregnancy²antibodies from mother pregnancy² pass from placenta into the foetus. can cause hemolytic disease of the newborn .

Blood transfusion  The safety of blood transfusion depends upon meticulous attention before. during and after the transfusion.  Prevention of severe hemolytic transfusion reactions almost all of which involve the ABO system .

Indications  To restore and maintain normal blood volume  To correct severe anemia  To correct bleeding and coagulation disorders .

Selection and cross-matching of crossblood for transfusion  ABO and Rh¶D¶ group of recipient is determined  Donor blood of same ABO and Rh¶D¶ as the recipient selected  Recipients serum is crossmatched against the donor red cells .

Transfusion reactions complications)  Immunological  Non immunological ( .

Immunological  Alloimmunization²risk of immunization by Alloimmunization² many antigens on the red cells. leucocytes. plasma proteins. --doesn¶t usually cause clinical problems on --doesn¶t first transfusions . platelets.

Incompatibility .

--donor cells are agglutinated by pre-exsting --donor preantibodies. usually due to IgM antibodies.  Diagnosis: confirmed by hemoglobinuria .Red cells  Immediate hemolytic transfusion reactions because of complement activation by Ag-Ab Agreaction. dyspnoea. renal failure. lumbar pain. --occurs in even <100ml of blood or cells --occurs transfusion  Signs: fever upto 103 °F. hypotension. wheezing.

 Signs: anemia and jaundice 1 wk after . Delayed hemolytic transfusion reaction: destruction of transfused cells by IgG antibodies.

chills and rigor.  Signs: fever upto 103 °F.Leucocytes and platelets  Non-hemolytic (febrile) transfusion reactions Nondue to anti-leucocyte antibodies in the antirecipients against the transfused leucocytes leading to release of pyrogens. flushing. post transfusion purpura .

Plasma proteins  Urticaria and anaphylactic reactions .

rapid infusion of mannitol 20% 100ml in an attempt to promote diuresis .Management  STOP TRANSFUSION ALWAYS  Re-checking of blood bag Re Re-cross matching and send new blood Resample of recipient to exclude hemolytic transfusion reaction  If hemolytic transfusion reaction is suspected.

anti-allergic drug ±avil anti( according to clinical manifestation) . Rapid administrationof RL solution and alkalinization by sodium bicarbonate infusion in an attempt to washout free hemoglobin present in the tubules and decrease renal tubular damage. Medications² adrenaline.  Medications²steroids (hydrocortisone).

NonNon-immunological complications .

Circulatory overload i.Transmission of infections Hepatitis C Hepatitis B ( 1 ml of blood infected contains 109 HBV particles ) HIV ( 1 ml of infected blood contain 50 HIV) Malaria Toxoplasmosis etc. hypotension iii. ii. . intense flushing. Blood contaminated with bacteria and toxins fever upto 103 °F.

iv. DIC -.for every 3 unit of whole blood²1 unit FFP blood² . Coagulation defect: thrombocytopenia.massive blood transfusion ( transfusion of volume of blood greater than the recipients blood volume in less than 24 hrs) -.for every 5 unit of blood-1 unit of fresh blood bloodtransfusion -.

during massive transfusion in elderly or osteoporotic patients where inadequate storage of calcium -.v. Citrate intoxication and decreased ionized Ca++( hypocalcaemia) -.calcium gluconate prior to whole blood transfusion for every 2 unit of whole blood .

vi. Hyperkalaemia In stored blood .May cause sudden cardiac arrest .Concentration of 2-3 DPG in cells decreased which 2reduces amount of O2 they can deliver to tissue Loss of cell membrane integrity due to hypoxia Potassium continue leaks from the erythrocytes .

Air embolism . Thrombophlebitis xi. Acidosis --Normal PH of blood 7. Hypothermia x.vii.4 --Normal --2 weeks old blood 6.5 --2 viii. Iron overload ix.

Autologous transfusion  Preoperative  Intraoperative  Preoperatively : donation of 2-4 units of 2blood ( 1 unit/week) .

Intraoperatively  Removal of 1-2 units of whole blood during 1induction of anesthesia with replacement of crystalloids reducing the hematocrit to 25-30% 25 Collected blood is transferred later.  Blood loss during operation aspirated. mixed with anticoagulant and using device ( solotrans) filtration done and again transferred to patients contraindication: infection and contamination with malignant cells .

Rh Nonnegative is transfused. .Emergency transfusion  Non-crossmatched blood group O. but always take pretransfusion sample so that retrospective cross match can be performed.

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