Dr. rasel cme final

Welcome To CME Presentation
Presented by:
DR . MD. MOSTAFA-AL-RASEL
Indoor Medical Officer
Medicine Unit - 5
ShSMCH

Blood and Blood Products
Tranfusion, Hazard & Managment

FAQ about Blood Transfusion….
Isn’t it possible to donate fraction of my blood (eg
Only Platelet, or only Clotting factors)? If Yes, then
How?
How long can I preserve blood & blood products in
blood bank?
Is the storage temperature same for all blood
products?
What will be the speed of transfusing different blood
products?
When should we commence transfusing after getting
them out from blood bank?

How long should it take to transfuse a bag of blood
or blood product?
Warm blood or cold blood which should we prefer?
From whom should we take blood- relative or
others?

Introduction
Earlier Whole blood was exclusively used for
transfusion, but currently the patient are
administered only that component in which the
patient is deficient.
Patients who are treated with specific component
in which they are deficient will get maximum
benefit at minimum risk because of avoiding the
risk of sensitization to the other components,
also reducing risk of volume overload.

Blood Components used
Whole Blood
Blood Products
Cellular Components- Red Cell Concentrates
Platelet Concentrates
Granulocyte Concentrate
Plasma Components- Fresh Frozen plasma
Cryoprecipitate
Plasma Derivatives- Albumin
Immunoglobulin
Coagulation Factors

Fresh Whole Blood (Heavy
Spin, 4 ̊C, within 8 hours)
Packed Red Cells Fresh Plasma
Freeze -80 ̊C
immediately
Store at ≤-18 ̊C
Store in 1-6 ̊C

Fresh Whole Blood (Light Spin,
22 ̊C, within 8 hours)
Packed Red Cells Platelet Rich Plasma(Heavy
Spin,22 ̊C)
Platelet Concentrate Fresh Plasma
Store at 22 ̊C
Freeze (FFP)

CCCryoprecipitate Cryoremoved
Plasma
Freeze -80 ̊C
immediately
Stored at≤-18 ̊C
Store at ̊-18 ̊C
Fresh Frozen Plasma (Thaw at
4 ̊C & heavy Spin)

Apheresis
• Apheresis (aphairesis, "a taking away") is
a medical technology in which the blood of a person
is passed through an apparatus that separates out
one particular constituent and returns the remainder
to the circulation. It is thus an extracorporeal
therapy.
• They are of 5 types-
1. Plasmapheresis,
2. Erythocytapheresis,
3. Plateletapheresis
4. Leukapheresis,
5. Stem cell harvesting.

How long can Blood Components be Stored?
Red Cells : 42 days, collected in CPD
35 days, collected in CPDA₁
Platelets : 5 days with continuous agitation
Cryoprecipitate: 12 months at -18 ̊C or
4 hours after thawing
Plasma : 12 months at -18 ̊C or
24 hours after thawing

Changes during storage
RBCs metabolize glucose to lactate, hydrogen
ions accumulate, and plasma pH decreases.
RBCs lose K+ and gain Na.
The osmotic fragility of RBCs increases and some
cells undergo lysis, resulting in increased plasma
Hb levels.
Progressive decreases in RBC concentrations of
ATP and 2,3- DPG

Whole Blood
450 ml of blood
63 ml of anticoagulant solution
Hct: 35-45%
No components have been removed
Store at +2 to +6 ̊C
Shelf life:
1. Citrate Phosphate Dextrose (CPD)- 21 days
2. Citrate phosphate dextrose adenine (CPDA-1)-
35 days
Infuse within 4 hours of issue

Whole Blood
Drawbacks:
1. After storage for 24 hours, Platelets and WBC are˃
non-functional
2. Factor V and Factor VIII decrease with storage
3. Fluid overload
Indications:
1. Acute blood loss 25% TBV˃
2. Exchange Transfusion
3. Major surgery
Contraindication:
1. Risk of volume overload: Chronic Anaemia
Cardiac Failure

Whole Blood
Administration:
1. Must be ABO and RhD compitable
2. Never add medication to a unit of blood
3. Use blood administration set
4. Complete transfusion within 4 hours of commencement.
Dosage:
Every 6ml/kg whole blood transfusion increase 1 gm/dl Hb
%.

Packed Red Cells
Preparation, preservation and storage:
 produced by removing between 150-200ml of
plasma from a unit of whole blood.
 After the plasma is removed from the whole blood,
the additive solution is added to the red cells
 Infection risk & storage temp are same as for whole
blood.

Packed Red Cells
Transfusion Criteria: ABO/Rh specific and
compatible.
Indication:
1. Replacement of red cells in anaemic
patients
2. Use with crystalloid or colloid solutions in
acute blood loss
Dosage: 10-15 ml/kg
Every 4 ml/kg PRBC transfusion increase 1
gm/dl Hb%.

Special RBC Preparations
Leucocyte depletion
Gamma irradiation
Washed RBC
Granulocyte Concentrate

TA-GVHD
Transfusion-associated graft-versus-host
disease is a rare complication of blood transfusion, in
which the donor T lymphocytes mount an immune
response against the recipient's lymphoid tissue.
Donor lymphocytes are usually identified as foreign and
destroyed by the recipient's immune system.
The incidence of TA-GvHD in immunocompromised
patients receiving blood transfusions is estimated to be
0.1 - 1.0%, and mortality around 80 - 90%.
Mortality is higher in TA-GvHD than in GvHD
associated with bone marrow transplantation,

However when the recipient is-
Immunocompromised(inborn immunodeficiency,
acquired immunodeficiency, malignancy, receiving
chemotherapy),
or when the donor is homozygous and the recipient
is heterozygous for an HLA haplotype (as can occur
in directed donations from first-degree relatives),
the recipient's immune system is not able to destroy
the donor lymphocytes. This can result in graft-
versus-host disease.

Treatment is only supportive, as no available form of
therapy has proven effective in treating TA-GvHD.
Prevention includes gamma irradiation of the lymphocyte-
containing blood products. This procedure should be
performed in transfusions when:
The recipient is immunocompromised.
The blood components are from a family donor.
HLA-matched platelets are transferred.

Platelet Rich Plasma(PRP)
It is prepared from the whole blood within six hours
of collection , preferably stored at room temperature
of 20 - 24 C.⁰

Platelets Concentrate(PC)
Shelf life : 5 days in platelet incubator &
agitator.
Storage temp. : 200
C – 240
C.
Volume : 30 to 50 ml.
Dosage : 1 unit of PC per 10 kg body weight.
• Effect : 5-10 ml/kg dose should increase
platelet counts by 50000-100000/mm3
.

Indications :
• Platelet count <10000; irrespective of
bleeding manifestation
• Thrombocytopenia with some condition
pc <20,000 with septicemia
pc <50,000 with minor procedure
pc <100,000 with major surgery
• Platelet function disorder eg.
Thrombosthaenia
• Any low Platelet count with Bleeding

Preparation :
 Random donor platelet
 Single donor platelet

Random Donor Platelets
Differential centrifugation from freshly drawn
blood units.
Volume – 50 ml.
Content : >5.5 x 1010
platelets/unit.
Stored at 200
– 240
C with constant & gentle
agitation.
Dosage : 10 ml per kg.
Use within 5 days.

Single Donor Platelets
Obtained by apheresis technique.
Volume : 300 ml.
6 – 8 times as many platelets as in a random
donor unit.
Content : > 3 x 1011
platelets/unit.
Dosage : Usually 1 pack of SDP = 1 therapeutic
dose.
Leukoreduced because of apheresis collection.

Apheresis Platelets
Apheresis platelet means process of separation
of only platelet component from the donor and
reinfusion of remaining constituents to the
donor.
This component is equivalent to six random
donor platelet units. One unit contains
3x10¹¹ Platelets.

Plasma component
Fresh Frozen Plasma
Frozen Plasma
Cryoremoved plasma
Cryoprecipitate

Fresh Frozen Plasma
Plasma along with anticoagulant preservative
Volume 250 – 300 ml
Prepared from blood within 8 hrs of donation
Maximum level of labile and non-labile clotting
factors (about 1 IU/ml) V & VIII, protein C and S,
complement and immunoglobins
Good for 24 hrs post thaw

Fresh Frozen Plasma
Fresh frozen plasma contains coagulation factors
and other plasma protein (per unit or bag)
Volume 200 -250 ml
Factor VIII - 0.6 IU/ml
Factor IX - 0.9 IU/ml
Fibrinogen-250-300 mg/bag
Protein -Albumin, globulin etc
Shelf life - One year

Fresh Frozen Plasma
Indications
1. Clinically significant deficiency of Factor II,
V, X, XI
2. DIC
3. Plasma exchange
4. Immunodeficiencies
5. Massive transfusion of stored blood
6. Liver disease
7. Urgent reversal of warfarin therapy

Fresh Frozen Plasma
Indications
8. Correction of known coagulation factor deficiencies for
which specific concentrate are unavailable
9. Correction of microvascular bleeding in the presence of
elevated (>1.5 times normal) PT or APTT
10. Correction of microvascular bleeding secondary to
coagulation factor deficiency in patients transfused with
more than one blood volume

Fresh Frozen Plasma
Precaution:
1. Acute allergic reaction are common
2. Anaphylactic reaction may occur
3. Hypovolemia alone is not an indication for
use

Frozen Plasma
• Plasma which separate from whole blood at any
time during storage
• Contain all non-labile coagulation factors
• Indications:
Treatment of stable coagulation defeciencies

Frozen Plasma
Contraindication:
1. Volume expansion
2. Immunoglobulin replacement
3. Nutritional support
4. Wound healing

Single donor plasma
• Prepared from stored blood
• Poor in coagulation factors
• Cannot be used to correct coagulation factor
deficiencies
• Effective as volume expander

Cryoprecipitate
Cryoprecipitate contains precipitated proteins of
plasma, rich in Factor VIII and fibrinogen,
obtained from FFP prepared within 6-8 hrs of
collection, subsequent thawing at 4-6o
C and
removal of supernatant.
Also the advantage of cryoprecipitate is that we can
administer large amount of factor VIII without
overloading the recipient, especially in paediatric
patient

Cryoprecipitate
• Cryoprecipitate contains ( 1 unit )
Volume : 10 - 20 ml
Factor VIII –C : 80 - 120 IU
Factor VIII R; Ag : high level
Factor VIII vWF : high level
Fibrinogen : 150 – 200 mg/bag
Factor XIII : 20 -30% of original
level

Cryoprecipitate
• Indication
 Quantitative and Qualitative Fibrinogen
Deficiency : DIC
 Von Willebrand Disease
 Factor XIII deficiency
 Uremic Coagulopathy
 Factor VIII deficiency ( Haemophillia A )

Plasma derivatives
Factor VIII Concentrate
Factor IX Concentrate
AT - III Concentrate
Factor XIII Concentrate
Albumin
IV Immunoglobulin
Rh Immunoglobulin

Rules to follow for transfusion:
ALWAYS take a completed patient documentation
label
MATCH the details on the blood request form
against the blood compatibility label (tag)
If everything matches, sign out the unit with the date
and time.
If there is any discrepancy, DO NOT sign out the
unit; contact the staff member of the blood
transfusion department immediately
When receiving the unit of blood in the clinical area,
check that it is the right unit for the right patient.

Check points for signs of deterioration in blood and plasma

 The blood unit must be discarded if:
It has been out of the refrigerator for longer than 30
minutes, or
The seal is broken, or
There is any sign of haemolysis, clotting or
contamination.
 Once issued by the blood centre, the
transfusion of whole blood, red cells, platelet
concentrate and thawed fresh frozen plasma
should be commenced within 30 minutes of
removal from the optimal storage conditions.

Don’t
wait for
someone
else to do
your
duty,
because it
may cost
you huge

• Suggested rates of transfusion
• Duration times for transfusion

 Massive blood transfusion may be defined as
the replacement of one blood volume (equivalent to
10 units of blood) in any 24 hour period, or half of
the blood volume (5 units of blood) in any four hour
period in an adult.
Replacement of a blood volume equivalent within 24
hours.
>10 units within 24 hours.
Transfusion >4 units in 1 hour.
Replacement of 50% of blood volume in 3 4 hours.‐
A rate of loss >150 ml/hour.

Guidelines for recognition and management of
acute transfusion reactions
Signs Symptoms Possible cause
Localized cutaneous:
Urticaria
Rash
Pruritus Hypersensitivity
(mild)
Category 1: Mild reactions
 Immediate management of Category 1: Mild
reactions
• Slow the transfusion.
• Administer antihistamine IM.
• If no clinical improvement within 30 minutes or if
signs and symptoms worsen, treat as Category 2.
• If improved, restart transfusion slowly.

Category 2: Moderately severe reactions
Signs Symptoms Possible cause
Flushing
Urticaria
Rigors
Fever
Restlessness
Tachycardia
Anxiety
Pruritus
Palpitations
Mild dyspnoea
Headache
Hypersensitivity

 Immediate management of Category 2:
Moderately severe reactions
 Stop the transfusion and keep IV line open with normal
saline in another site.
Return the blood unit with transfusion
administration set, freshly collected urine and new
blood samples (1 clotted and 1 anticoagulated), drawn
from a vein opposite to the transfusion site, to the blood
transfusion centre for laboratory investigations.
 Administer antihistamine IM and oral or rectal
antipyretic. Avoid aspirin in thrombocytopenic patients.

Give IV corticosteroids and bronchodilators
if there are anaphylactoid features (e.g.
bronchospasm, stridor).
 If clinical improvement occurs, restart transfusion
slowly with new blood unit and observe carefully.
 If no clinical improvement within 15 minutes or if
signs and symptoms worsen, treat as Category 3.
If available, a leucocyte reduction filter (WBC
filter) may be used in repeated transfusion.

Category 3: Life threatening reactions‐

 Immediate management of Category 3: Life‐
threatening reactions:
Stop the transfusion and keep IV line open with
normal saline in another site.
Maintain airway and give high flow oxygen by mask.
Give adrenaline (as 1:1000 solution) 0.01
mg/kg body weight by slow intramuscular injection.
Give IV corticosteroids and bronchodilators if
there are anaphylactoid features.
Give diuretic: e.g. frusemide 1 mg/kg IV or
equivalent.

Notify the superior or senior doctor
Send blood unit with transfusion set, fresh urine sample
and new blood samples (1 clotted and 1 anticoagulated),
drawn opposite the infusion site, to the blood transfusion
centre for investigation.
Assess for bleeding from puncture sites or wounds. If
there is clinical or laboratory evidence of DIC,
give platelets (adult: 4 6 units) and either cryoprecipitate‐
(adult: 12 units) or FFP (adult: 3 units).
Reassess.

If urine output falls or there is laboratory evidence of
acute renal failure (rising K+, urea, creatinine):
– Maintain fluid balance accurately.
– Give further diuretic: e.g. frusemide 1 mg/kg IV or
equivalent.
– Consider dopamine infusion, if available.
– Seek expert help: the patient may need renal dialysis.
If bacteraemia is suspected (rigor, fever, collapse, no
evidence of a haemolytic reaction), start a broad‐
spectrum antibiotic IV.

Take Home Message
Transfusion of blood and products should be
undertaken only to treat a condition that cannot
be prevented or managed effectively by other
means.
There is no evidence that warming blood is
beneficial to the patient when transfusion is slow.
Routine use pre medication like anti histamines,‐ ‐
steroids or other medication before transfusion
is not recommended
Do not use 1st degree relatives as donors, unless
gamma irradiation of cellular blood components is
carried out to prevent the proliferation of
transfused lymphocytes.

There is no justification in transfusing whole blood to
stop bleeding due to coagulopathies in adult. Specific
components like FFP, PCs or cryoprecipitate, are the
treatments of choice.
Acute reactions may occur in 1% to 2% of transfused
patients. Rapid recognition and management of the
reaction may save the patient’s life.
In an unconscious or anaesthetized patient,
hypotension and uncontrolled bleeding may be the only
sign of an incompatible (mismatched) transfusion.

In a conscious patient undergoing an acute severe
haemolytic transfusion reaction, signs and symptoms
may appear within minutes of transfusion of 5 10 mL‐
of blood. Close observation at the start of the
transfusion of each unit is therefore essential
Severe reactions most commonly present during the
first 15 minutes of a transfusion.
The transfusion of each unit of the whole blood or red
blood cells should be completed within four hours of
the start of the transfusion. If a unit is not fully
transfused within four hours, discontinue its use and
dispose of the remainder through the clinical waste
system.

Dr. rasel cme final

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