4th year medical students Blood Component Therapy Salwa I Hindawi MSc FRCPath CTM Director of Blood...

4th year medical students

Blood Component Therapy

Salwa I HindawiMSc FRCPath CTM

Director of Blood Transfusion Services

KAUH . Jeddah


RBC AgglutinationRBC Agglutination


ABO type Pt Cells Pt Serum

vs vs anti-A anti-B Acells Bcells A + 0 0 + 40% B 0 + + 0 11% AB + + 0 0 4% 0 0 0 + + 45%


BLOOD COMPONENT THERAPY

It is the transfusion of specific blood components required by the patient.

Principles Use blood products only when it is

essential. Replace only the deficient component, if

possible. Identify the cause and nature of the

deficiency and if possible, treat it.


Whole blood

Plateletsrich

plasma

1stcentrifugation

Platelets

concentrateWhole bloodWhole blood

2nd centrifugation

Fresh plasma

FFP for clinical use

FFP for fractionation

Optimal additive solution

Red cells in OAS

Cryoprecipitate

RedCell

concentrate


Blood COMPONENTS AVAILABLE FROM THE BLOOD BANK

Whole blood Packed RBCs Platelets Single donor platelets (Apheresis) Fresh Frozen Plasma (FFP) Cryoprecipitate


Indication for Red Blood Cells Transfusion

Red blood cells are component of choice to maintain an adequate supply of oxygen to meet tissue demands.One unit increase the haemoglobin level by 1g/dL in a 70kg recipient.


Indication for Transfusion of Whole Blood

Fresh whole blood<5 days old is often used for exchange transfusion in newborns.

Stored whole blood can be used in actively bleeding patients who have lost > 30-40% of their blood volume.


Indication for red blood cells Transfusion

Symptomatic anaemia Acute blood loss>30-40% of blood volume. Pre-operative Hb< 8g/dl and operative

procedure associated with major blood loss.

Evidence of inadequate oxygen delivery.


Administration and Dose

Red blood cells transfusion has to be grouped specific & Rh specific, if not one of alternative compatible group.

This component must be administered through a suitable transfusion set (170 mM filter).

Dose of 4ml/kg raises venous Hb by about 1g/dl.


Specifications

Whole blood volume 450mls+63mls of CPD-A1 anticoagulant.

Packed RBCs volume 250mls±50mls. Hct=0.55-0.75. Anticoagulant CPD-A1 store at 4c°±2c° for 35

days. SAG-M for 42 days.


Indication for Platelet Transfusion

Decrease platelet production (Bone marrow failure)

Therapeutic:for patient who are bleeding associated with BMF caused by either disease, therapy or irradiation.

Prophylactic: >10x 109/L to decrease morbidity in patients with thrombocytopenia due to B.M.F.


Cont, Platelet Transfusion

In acute D.I.C (Disseminated intravasculr coagulation).

In neonatal alloimmune thrombocytopenia (NAIT) from donor known to be negative for the appropriate HPA or mother platelet.

Platelet function disorders or thrombocytopenia <50x 109/L going for invasive procedure, for operation in critical sites such as the brain or eyes the platelet count should be raised to 100x109/L.

In massive blood transfusion, the platelet count to be maintained above 50x109 /L.


Administration of Platelet Concentrate:

ABO compatible platelet are preferred but not necessary.

Platelet concentrate should be transfused as soon as possible after reaching the ward with standard blood transfusion sets with 170 mm filters.

The transfusion should normally be completed within 30 minutes.

Observation during platelet transfusion should include pulse& temperature before& after transfusion.


Indications For The Use Of FFP

Definite indication: Replacement of single factor deficiencies Immediate reversal of warfarin effect Vitamin K deficiency Acute disseminated intravascular coagulation Thrombotic thrombocytopenic purpura Inherited deficiencies of inhibitors of

coagulation:at, protein S, protein C. CI esterase inhibitor deficiency


Conditional uses of FFP

FFP is only indicated in the presence of bleeding and disturbed coagulation.

Massive transfusion Liver disease Cardiopulmonary bypass surgery Special Paediatric indications: sever sepsis, DIC.


Administration of FFP

1unit of FFP= APPROXIMATELY 200 ML Dose = 12-15 ml/kg Should be administered within 2 hours of thawing. PT & PTT used for monitoring in addition to the clinical

assessment. ABO compatible FFP should be used. Compatibility

testing is not required. Group O should only be given to group O recipient. Group A or B FFP can be given to group O recipient. Group AB FFP should be reserved for group AB

recipients and for emergencies.


Indications for The Use Of Cryoprecipitate

1-congenital or Acquired Fibrinogen Deficiency.

2-Haemophilia A, vonWillebrand’s Disease.

3-factor X111 Deficiency

4-disseminated intravascular coagulopathy(DIC).


Administration of Cryoprecipitate

1 unit of cryo= approximately 10-20ml Adult dose equivalent to 10 units of cryo For factor replacement the dose can be calculated

according to the volume of the factor in the concentrate.

Fibrinogen 150-300mg/pack Von Willebrand factor 80-120u/pack Factor V111c 80-120u/pack Factor X111 20-30% of factor X111 present in the

FFP. Should be ABO compatible to avoid risk of

haemolysis caused by donor antiA or antiB. Should be administered within 4 hours of thawing.


Platelet, Apheresis

An adult dose of Platelets prepared from anticoagulated blood which is separated into

components by apheresis machine with retention of the platelets and a portion of the plasma.

The remaining elements may be returned to the donor


Specification

Volume 200 – 800 mlsPlatelet count > 240 x 109 / unitLeucocyte count < 5 x 108 / unit

PH at end of shelf life 6.4-7.4 Availability: On request.

Shelf life storage: 5 days at 22 2c gently agitated

4th year medical students Blood Component Therapy Salwa I Hindawi MSc FRCPath CTM Director of Blood...

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