Blood & Blood Products Only

8/9/2019 Blood & Blood Products Only

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Dr . Prasad Ingley.Junior Resident IJunior Resident I I I

NKP Salve Institute of Medical Sciences & L.M.H. Nagpur, India.NKP Salve Institute of Medical Sciences & L.M.H. Nagpur, India.



Historical AspectsHistorical AspectsPeople have always been fascinated by blood,

y A ncient Egyptian bathed in it.

y Ar istoc rats d r ank it.

y Au tho r s & play r ights u sed it as themes.

y Mode r n Hu manity t ransf u se it.



HISTORYHISTORY

y

1492 B

lood was taken f rom th

ree yo

ung men & given toPope Innocent VII to c ur e him.

y 1616 - W illiam Ha r vey ,descr ibed how blood is ci rcu lated

thro

ugho

ut the body.

y 1667 - F ir st su ccessf u l hu man blood t ransf u sion.



HISTORYHISTORYy A fter mu ch r esea r ch, saline was developed as a plasma

volu me expande r.

y Significant b r eakth r ou gh - 1883 cr eation of Ringe r ssolu tion.

y W or ld W ar I, a gu m-saline sol u tion containinggalactoso- gl u conic acid was u sed to extend plasma - hadsome negative health effects.



Why did success elude experimentersWhy did success elude experimentersso long ?so long ?

y B raxton Hicks 1869 Sodiu m Phosphate as a nontoxicanticoag u lant.

y Kar l Landsteine r 1901 A BO blood g r. System.

y W or ld W ar II - establishment of blood banks by the

A me r ican Red C ross in 1947.

Clotting was the principle obstacle to overcomeClotting was the principle obstacle to overcome.



Approved Anticoagulant PreservativeApproved Anticoagulant PreservativeSolutionsSolutions

Stor age TimeStor age Time

Name A bb reviation DaysName A bb reviation Daysy A cid citr ate dext rose A CD 21y Citrate-phosphate - dext rose CPD 21y Citrate-phosphate - dext rose-

adenine CPD A -1 35

y Citrate-phosphate - do u bledext rose CP2D 21



Preparation of blood componentsPreparation of blood componentsis possible due tois possible due to

y Mu ltiple plastic packs systems.y Ref r igerated cent r if u ge.y Different specific g ravity of cellu lar components:

R B

C 1.08 -1.09

Platelets - 1.03 1.04

Plasma - 1.02 -1.03



C lassification of Blood Products:C lassification of Blood Products:

y Whole Blood

y components - Cellular -Plasma

y Plasma derivatives



Blood Component

A Constit u ent sepa r ated f r om whole blood, by diffe r ential cent r if u gation

of one donor u

nit or

by aphaeresis.



Cellular componentsCellular components

y Red cell concent r ate.

y Platelet concent rate.

y Gr anu locyte concent rate.



P lasma ComponentsP lasma Components

y F resh f rozen plasma ( FF P)

y Cr yoprecipitate



P lasma DerivativesP lasma Derivatives

y A lbu min 5% & 25%y Plasma P rotein F ractions.y Facto r VIII concent rate.y Imm u noglob u lins.y F ibr inogen.y O the r coagu lation facto r s.



WHOLE BLOODWHOLE BLOOD

Fr esh b lood ( B lood less than 24 h r s old )

y Premat ur e newbo r ns with respi r ato r y dist ress synd rome andseverely dec reased 2,3 DPG levels.

y Patients who a re per sistently hypotensive, poo r ly per f u sed, &acidotic and who need la rge amo u nt of blood.



W hole Blood (CPDA-1)B lood collected into an app r oved containe r containing ananticoag u lant p reser vative solu tion.

Total Vol m- 350 ml. of whole B lood & 49 ml. A nticoag u lant.

Hb app roximately 12 g/ml.Haematoc r it 35% - 45%.

No f u nctional platelets .No labile coag u lation facto r s (V & VII)Shelf live 35 days in (CPD A -1)

Stor age :-B etn + 20c and + 6 0c in app roved blood bank ref r iger ato r,

fitted with a temp.cha r t & alar m.



I ndications :-

Red cell replacement in ac u te blood loss with hypovolaemia.Exchange t r ansf u sion.Pts needing red cell t ransf u sions whe re red cell concent rates

or su spensions a r e not available.

A dminist r ation:Mu st be A BO & Rh-D compatible with the r ecipient.Never add medication to a u nit of blood.Complete t ransf u sion within 4 h r s. of commencement.



Loss of viability of R B CS.

Loss of A TP.

Depletion of 2-3 DPG.

Loss of granu locyte f u nction.

Decrees in p H of blood.

Inc rease in plasma K+ Level.

Decrease in facto r VII level.

For mation of mic roaggregates.

What are the changes which occur inWhat are the changes which occur instored Bloodstored Blood



WHOLE BLOODWHOLE BLOODy Eff ects:

1u

nit of whole blood ( 350ml) - Hb by abo u t 0.75 gm/dl.( 450ml) - Hb by

abou t 1 gm/dl.

In pediat r ic patients, 8ml/kg of W .B . - Hb by abou t 1 gm/dl.



P acked Red Cells

Red Cells in additive solution

Leucocyte P oor red cells

Washed red ± Cells

Frozen red Cells

Irradiated red cells.

Red CellsRed Cells



Red Blood Cells

y Hb < 6 gm/dl in the absence of disease.

y Hb between 8-10 gm/dl with disease.



Red BloodC

ellsRed BloodC

ellsI ndicationsI ndications --y B .M. produ ction - Le u kemia.

- A plastic anemia.y R B C sur vival - Hemolytic anemia.

-Thalassemia

y Excessive B leeding -s ur gical (anticipated blood loss>1000ml)-t rau matic .

y O the r s - A nemia associated with incipient/established ca rdiac failur e.

-F u ll te r m p regnancy with Hb val u e

<7 gm/dl.



RedRed Cell concentrateCell concentrate(P acked red Cell, P lasma reduced blood)

Red Cells from which most of P lasma removedRed Cells from which most of P lasma removed .

250 ml packed red Cells (150 ml red cells + 100 ml P lasma)

Hb appro. 20 g/100 ml (Not less than 4 5 g\unit) Haematoerit 55% -75%Raises Hb by 1 Gm % & heamatocrit by 3 % (Rise detected

after 24 hours.) Storage temp 2-6 0c

Shelf life 3 5 days in C PDA -1

Indications : Replacement of red cells in anemic patients. Acute& massive blood loss (along with crystalloid or colloid)



Red Cell suspensionRed Cell suspension(Red cells in additive solution)

Commonly used additive solution is SA GM (S aline, adenine, glucose &Commonly used additive solution is SA GM (S aline, adenine, glucose &mannitolmannitol) )

150 -200 ml red cells with minimal residual plasma. Hb approx. 15gm/ 100 ml

Haematocrit 50% - 70% .

Advantage of this methodMax amount of plasma removed for preparation of plasma

components.Red cells with improved viability obtained, shelf life

increases from 3 5 to 4 2 days. Flow of infusion is improved due to reduction in viscosity.

Contraindicated for exchange transfusion in neonate.



LeucocyteLeucocyte ± ± poor depleted redpoor depleted red cellscells A red Cell suspension or containing less than 5*106 white cells/bag, prepared by filtration

through a leucocytes depleting filter.

Hb & haematocnt depend on whethe r the p rodu ct is whole blood,red cell concent r ate o r red cell s u spension.Leu cocyte depletion significantly r edu ces the r isk of t ransmission

of CMV.Indications:

To avoid sensitization to HL A antigen in patients with seve reaplastic anaemia who a r e likely to r eceive allogenic bone ma rr ow

transplant.Patients who have expe r ienced two o r mo re previou s febr ile

reactions to red cell t ransf u sion.To redu ce the r isk of t ransmission of CMV.



W ashed red cellsW ashed red cellsPacked red cells can be washed with normal saline to remove

plasma proteins, white cells & platelets.

Use of such red cells is restricted for Ig A ± deficient individualswho have developed anti Ig A antibodies.



Fr z

Fr z r r llllRed ce lls c e st r ed fr zen t 10 ea rs.

To r even t aemo l sis of r ed ce lls du ring fr ee zing t aw ing , a cr op r ote ctive agen t s uc a s gl ce r ol is added .

onor r ed ce lls wit r a r e lood gr oup s c an e st or ed fr ozen .

Red cells can be sto red f rozen fo r f ur the r au tologo u s tr ansf u sion if blood g rou p is rare.B efore tr ansf u sion red cells a r e thawed & glyce r ol removed

gradu ally.

Su ch red cells a re vir tu ally f ree f rom le u cocytes, platelets & plasma& thu s thei r u se is associated with lowe r r isk of non- haemolytictransf u sion reactions.



Irr i tIrr i t llllTr an sf usion of gamma irr ad ia ted r ed ce lls is i nd ica ted f or

pr even tion of gr a ft Vs ost disea s e in s usc ep ti le ind ividua ls like Immunode ficien t ,

atien ts r e ce iving lood fr om first deg r ee r e la tive s.L mpho c te s fr om dono r lood r ea ct aga inst t he tiss ue s of the

r e cipien t .

amma irr ad ia tion (25Gamma irr ad ia tion (25 -- 00 GyGy ) inh i its r ep lica tion of dono r ) inh i its r ep lica tion of dono r lympho cyte s.lympho cyte s.



Advantages of transfusion of redAdvantages of transfusion of redcells over Wh ole bloodcells over Wh ole blood

y Redu ce r isk of circu lato r y over load.

y Less sever ity & incidence of alle r gic reactions.

y A BO antibodies a re r edu ced.

y Removed plasma can be u sed fo r pr epa r ing FF P &Cr yoprecipitate



PlateletsPlatelets

Tw o Methods :y Differential cent r if u gation of a u nit of whole blood.

( Platelet concent rate )y Plateletphe r esis



StorageStorage

y U p to 72 ho ur s at 20 240c with constant agitation.

y Max. pe r iod of sto rage is 3 to 5 days.

y Mu st not be ref r iger ated as this will redu ce platelet

f u nction.



Platelet concentratePlatelet concentrateI ndications I ndications

y Platelet co u nt <5000 / µl regardless of clinical condition.

y Platelet co u nt 5000 -10000/ µl- if the r e is inc reased r isk of

bleedingy Platelet co u nt 10,000 -20,000/ µl- if th rombocytopenicbleeding.

y PC <20,000/ µl- if dec reased p rodu ction chemothe rapy. Riskof bleeding p rophylactically.

y < 50,000/ µl- if dest ru ction (DIC)y <50,000/ µl- if Platelet dil u tion (massive T/ F )y < 70-80,000/ µl- majo r sur ger y



Platelet concentratePlatelet concentrateyy Dosage :Dosage :1u nit /10kg body weight (The u su al dose is 4- 6 u nits)

or

1.50u nits/10kg body weight in cases of Inc reased dest ru ctionof platelets.

y Single dono r u nit in a vol u me of 50-60 ml of plasma sho u ldcontain

a) A

t least 55 A

t least 55 ××101099

plateletsplateletsb) < 1.2< 1.2 ××101099 red cellsred cellsc) < 0.12< 0.12 ××101099 leu cocytes.leu cocytes.

y Pooled u nit sho u ld contain at least 240240 ××101099 platelets.platelets.



Platelet concentratey A BO compatibility between dono r & recipient is of

mino r impo r tance in platelet t ransf u sion.

y Rh (D) negative female patient of child bea r ing agesho u ld be given platelets f rom Rh (D) negative dono r.



Platelet concentratePlatelet concentrate

y e ff ect - (by the clinical resu lts & platelet co u nt obtained 1 h r late r )each u nit of P.C. will raise platelet co u nt app roximately by

y A du lts : ( 5000 -10000/ µl.) in 70 kg weight.

y Child : (20000/ µl ) in 18 kg body weight.

y Infants : (75000-100000/ µl ).



Platelet concentratePlatelet concentrate

y Risk associated with platelet t r ansf u sion :

- A

lloimmu

nisation.

-Platelet ref r acto r y state (less than 20 % of the expectedinc rease).

-Infections.

-Graft ver su s host disease



Plateletp heresis

y A por tion of dono r s platelet and some plasma isremoved with the retur n of dono r s R B Cs, WB Cs andremaining plasma.

y A rou tine p r oced ur e takes 1 to 1.5 hour s.

y The p rodu ct is p repa red in closed system and can besto r ed fo r 5 days.



Relative merits of Relative merits of plateletp heresisplateletp heresisand random donor plateletand random donor platelet

PlateletpheresisPlateletpheresis Random donor plateletRandom donor platelet

Average > 3x10 Average > 3x10 1111 plateletsplateletsPlasma volume 200 mlPlasma volume 200 mlLeucocytes < 5.5 x 10Leucocytes < 5.5 x 1066

obviate the need of filtrationobviate the need of filtrationRed cellsRed cells-- tracestraces

pHpH-- 6.0 or more6.0 or moreExposes a patient to one donorExposes a patient to one donor

Less exposure to infectionsLess exposure to infections

5.5 x105.5 x101010 plateletsplatelets5050--60 ml60 ml101088 in each unit, filtration isin each unit, filtration is

requiredrequiredMoreMore

pHpH-- 6.0 or more.6.0 or more.Exposes a patient to multipleExposes a patient to multiple

donors.donors.More exposure to infectionsMore exposure to infections



F res h frozen plasmaF res h frozen plasma

I ndications :I ndications :y Congenital o r acqu ir ed coag u lation facto r deficiency

with - A ctive bleedingLiver disease, DIC, Coag u lopathy in massive

tr ansf u sion.y

Deficiency of factors II, VII, IX & X.y W ar far ine ove r dose r ever sal.

y Th r ombotic th r ombocytopenic p ur pur a.



F res h frozen plasmaDosage Dosage 15ml/kg of body weight (thawed at 30 -37 0 C)

Compatibility test- is not necessa r y.

Rh positive plasma sho u ld not be given to Rh negative women in the r ep r odu ctive age g r ou p.

Eff ectEff ectB y A PTT , PT & fibr inogen assay.



Difference Between Ap heresis FF P

And Wh ole-blood Derived FF P AFF P AFF P WBD WBD--FF PFF P

T otal volume T otal volume 540 ml540 ml 200 ml200 ml

solute lasmasolute lasma 486 ml486 ml 160 ml160 ml

nticoagulantnticoagulantCPD/CPD 1CPD/CPD 1

4% sodium citrate4% sodium citrate 3% sodium citrate3% sodium citrate

nticoagulant/ lasmanticoagulant/ lasma 1:101:10 1:51:5

Citrate/100ml lasmaCitrate/100ml lasma 0.4 g 0.4 g 0.6 g 0.6 g

GlucoseGlucose 100mg/dl100mg/dl 400400--715 mg/dl715 mg/dl

Cryo reci itateCryo reci itate MoreMore LessLess

Residual latelet &Residual latelet &

WBCs WBCs

Less than WBDLess than WBD--

FFPFFP



C ryoprecipitateC ryoprecipitate

y Prepa red by slowly thawing 1 u nit of FF P at 4-6 0 c & thenresu spending it in 10-20 ml plasma.

y The u nit is then ref rozen -25 0 c or coole r & can be sto red fo r 1 year at this temp.

yy Contains Contains facto r VIII 80 100 iu /packF ibr inogen 150 300 mg/pack.Facto r XIII & fibronectine.



Cryoprecipitate

Cryoprecipitate

(factorVIII, fibrinogen , Von- W illebrands factor, F ibronectin & factor XIII)

Indications :y Haemophilia A

y Von W illebr ands disease.y Congenital o r acqu ired fib r inogen deficiency.y A

cqu

ired facto

rVIII deficiency.y Facto r XIII deficiency.

y Sour ce of fibr in glu e u sed as topical haemostatic agent.



P lasma DerivativesP lasma DerivativesHu man A lb u min sol u tions :Hu man A lb u min sol u tions :

y

A lbu min p repa red by cold ethanol f r actionation of pooledplasma.

y A vailable as 5%,20%,25% solu tions.

y A lbu min sol u tions a r e heat t reated at 60 0 c for 10 hour s.



Factor VIII

Concentrate

Factor VIII

Concentrate

y F VIII concent rate p repa red by f ractionation f rom la rge pools of donated plasma.

y Treated with heat o r chemicals to dest roy lipid enveloped vi ru ses.

y Stored at 2 to 6 0 c.

y Vials f reeze d r ied p rotein labelled with content, u su ally abo u t250 iu of F VIII / vial.



Factor IX

Concentrate

Factor IX

Concentrate

y B oth plasma de r ived & recombinant F IX concent rate a reavailable fo r treatement of Haemophilia B .( Chr istmasdisease ).

y U nit of iss u e : Vials of f r eeze d r ied p rotein labelled withcontent, u su ally abo u t 350 600 iu of Facto r IX.



Prot h rombinProt h rombin C omplex C oncentrateC omplex C oncentrate(PCC )(PCC )

y Contains F II , IX , X & sometimes also F VII.

y Immediate co rr ection of p rolonged PT.

y Cont raindicated in patients with live r disease & th r ombotictendancy.



M ust before transfusion

y Disposable ste r ile t r ansf u sion sets.y 170 to 200 micron filte r s.y B y physician o r qu alified n ur sey B lood g rou ping.y Cross matching & compatability testing.y Inspection of blood / blood p rodu ct bag.



Th ankTh ankyouyou

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