Component & Effective Use of Blood
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Transcript of Component & Effective Use of Blood
8/3/2019 Component & Effective Use of Blood
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Component preparation,Component preparation,
storage and effective use of storage and effective use of blood productsblood products
©©noleata@iium/bms/07noleata@iium/bms/07--0808
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BLOODCOLLECTION
APHERESIS
WHOLE BLOOD
TRANSPORT & STORAGE OFSCREENED
BLOOD COMPONENTS
STORAGE ofBLOOD COMPONENTS
(SCREENED AND UNSCREENED)
SEPARATION OFBLOOD COMPONENTS
SCREENING
& TESTING
INDICATIONS FOR TRANSFUSION
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Definition:Definition:
• Blood products: any theraeutic
substance prepared from humanblood.
• Whole blood: Unseparated bloodcollected into an approved container
containing an anticoagulant-preservative solution.
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Blood componentsBlood components
1. A constituent of blood separated fromwhole blood, Red cell concentrate Red cell suspension Plasma
Platelet concentrates
2. Plasma or platelets collected by apheresis
3. Cryoprecipitate, prepared from freshfrozen plasma rich in FVIII and
fibrinogen.
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Plasma derivatives
• Human plasma proteins preparedunder pharmaceutical manufacturingconditions:
– Albumin – Coagulation factor concentrates;
FVIII,FIX, FVII concentrates.
– Immunoglobulin.
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HTAA
Blood Bank
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Dr, please savemy girlfriend,
you can take my
blood, anything..
You are tooyoung to donate
and to have agirlfriend..
Historical note:1665
The first recorded successful lood transfusion occurs in England
(dogs to dogs)
Richard Lower, performed the firstsuccessful animal transfusion in 1665,
when he transferred blood from the carotid
artery of one dog to the jugular vein ofanother.
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Historical Note:1667Historical Note:1667
• In November 1667, Lower
transfused Mr. Arthur Coga, "amildly melancholy insane man,"with the blood of a lamb. Mr.Coga, described his experience to
the Royal Society of Medicine andstated that he was much better."cracked a little in his head.“
• Denis’ fourth attempt endedfatally, he was charged withmurder
I ’ v e
t o l d
y o u,
i t ’ s n o
t s a f
e
t o t
a k e m
y
b l o o d
.. s e e
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Historical Note
• For the next 150 years, there was littleinterest in transfusion.
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Historical Note:1818
•• JAMES BLUNDELL 1818JAMES BLUNDELL 1818
– interest in transfusionwas revived by James
Blundell in 1818, it wason the basis of replacement of lostblood in puerperal
hemorrhage and afterseries of experiments.
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Historical Note:1818
• Blundell failed in hisfirst four desperate
attempts to savewomen on the pointof death frompostpartal
hemorrhage, but
• he succeeded in fiveof the next six
attempts…….
• Patient’sselection……early
stage of PPH.
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Blood Components
Separation
GOALS:
1. To maintain viability & function of relevant constituent.2. To prevent physical changes detrimental to constituent.3. Minimize bacterial proliferation.
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d BLOOD PRODUCTS
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• Adenosine Energy.
• Glucose Dextrose.
• Citrate
Anticoagulant.
• Concentration ofanticoagulant and
other derivativeshave been modifiedthrough times
optimum value.• Closedsystem…tubingmethods.
• Sterile low risk ofcontamination.
modern BLOOD PRODUCTS :in plastic bag
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BEGIN:
END:
Wholeblood
PackedRBC
Plateletrichplasma
Plateletrichplasma
PackedRBC
PackedRBC
plasma
platelets
platelets
plasmaPackedRBC
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Preparation Of Packed
Rbc
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Blood is collected as whole blood.
Blood destined for component preparation is drawn into bags with integrallyattached transfer container (closed system)
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Light centrifugation:
for separation of packedRBC & Platelet Rich Plasma(PRP )
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PRP
Sediment:Packed RBC-70-80%plasmaremoved
SEPARATOR STAND: allows PRP to flow into one of thetransfer bag
Platelet Rich
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PackedRBC
stored as
unscreenedblood
Platelet RichPlasma
use forpreparation
of FFP
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Preparation Of FFP & Platelet
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SEPARATOR STAND: express platelet-poor-plasma into the 3rd
attached transfer bag
Plasma placeat
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at< -180C within 6
hours after
donation to getFFP (stored asunscreened
blood)
Platelet stored as
unscreened
blood onagitator
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FFP Packed RBCplatelets
a single donation of whole blood has supplied three separate components(packed red blood cells, platelets, fresh frozen plasma) that can potentially
benefit three different patients.
CRYOPRECIPITATE:
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Melt FFP between 1-6oC Cold insoluble portion of plasma remaining is called cryoprecipitate
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Platelet collection using
apheresis system yield
higher concentration of
platelets.
1 bag = Equivalent to 4- 6 donors (units)
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RECORDS & LABELS
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STORAGE OF BLOODSTORAGE OF BLOODCOMPONENTS andCOMPONENTS and
SPECIFIC INDICATIONS OFSPECIFIC INDICATIONS OFBLOOD COMPONENTSBLOOD COMPONENTS
HISTORICAL NOTES: EARLY 1900HISTORICAL NOTES: EARLY 1900
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TILL 1950sTILL 1950s – – blood storage in bottleblood storage in bottle
Back then
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Back then …
1950Still usingbottle
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Inventors:
Carl Walter and W.P. Murphy, Jr.
I’m using thenew plasticbag..COOL!
Whole Blood (CPD-Adenine-1)
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( )
A 450 ml wholeA 450 ml whole
blood donationblood donation
containscontains:
510 total volumes
450 ml donor blood.
63 ml anti-coagulantpreservative solution
Hb ~ 12 g/ml
Hct -35%-45%
No functionalplatelets
No labile coagulationfactors (V and VIII)
StorageStorage:
+2oC
_ +6o C in
approved bloodbank refrigerator,fitted with atemperature chart
and alarm.TransfusionTransfusion
should be startedshould be started
within 30 minuteswithin 30 minutes
after removal frafter removal frrefrigerator.refrigerator.
Whole Blood (CPD-Adenine-1)
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Whole Blood (CPD-Adenine-1)
Indications:Indications:
Red cell
replacement in acuteblood loss withhypovolaemia
Exchangetransfusion
Patients needingred cell transfusionwhere red cellconcentrates are notavailable
Contraindications:Contraindications:
Risk of volume
overload in ptswith:
Chronic anaemia
Incipient cardiacfailure
ADMINISTRATION:ADMINISTRATION:
Must be ABO and RhD compatible.
Never add medication to a unit of blood.
Complete transfusion within 4 hours ofcommencement.
Red Cell Concentrate(Red Cell Concentrate(‘‘packed Redpacked Red
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150-200ml red cells.
Hb ~ 20g/100 ml
Hct ~ 55% - 75%
Storage:
+2oC- 6o C
Indications:
Replacement of red
cells in anaemicpatients.
Use with crystalloid
replacement orcolloid solution inacute blood loss
150-200ml red cells.
Hb ~ 20g/100 ml
Hct ~ 55% - 75%
Storage:Storage:
+2oC-
6o C
Indications:Indications:
Replacement of red
cells in anaemicpatients.
Use with crystalloidreplacement orcolloid solution inacute blood loss
Administration:Same as whole blood.
Administration:Same as whole blood.
CellsCells’’,, ‘‘PlasmaPlasma--reduced Bloodreduced Blood’’))
Red Cell SuspensionRed Cell Suspension
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150-200ml red cellswith minimal
residual plasma towhich NS,adenine,glucose,mannitolsolution(SAG-M)
has been addded.Hb ~ 15g/100 ml
Hct ~ 50% - 70%
150-200ml red cellswith minimalresidual plasma to
which NS,adenine,glucose,mannitolsolution(SAG-M)has been addded.
Hb ~ 15g/100 ml
Hct ~ 50% - 70%
Indications:
Replacement of red
cells in anaemicpatients.
Use with crystalloid
replacement orcolloid solution inacute blood loss
Indications:Indications:
Replacement of red
cells in anaemicpatients.
Use with crystalloidreplacement orcolloid solution inacute blood loss
Storage:
+2oC- 6o C
Storage:Storage:+2oC- 6o C
Contraindications:Not advised forexchange transfusionin neonates
Contraindications:Contraindications:
Not advised forexchange transfusionin neonates
(CPD(CPD--SAGM)SAGM)
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Standard Blood Bank refrigerator should be fittedwith a temperature chart and alarm.
Storage for SCREENEDSCREENED blood
components
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components
should be separated from theUNSCREENED.UNSCREENED.
Platelet concentratePlatelet concentrate Infection riskInfection risk
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Platelet concentratePlatelet concentrate
CONTENTSCONTENTS::
•Single donor unit
(prepared fromwhole blood in avolume of 50-60 mlof plasma contain at
least•55×109 platelets)•< 1.2 x 10 9 redcells
•< 0.12 x 10
9
leucocytes.
• 150-500 x 109
platelets (from
apheresis.
Infection riskInfection risk
•Same as whole
blood but for adultdose involvesbtween 5 – 6 donorexposures.
•Bacterialcontamination: 1%of pooled units.
STORAGE:STORAGE:Up to 5 DAYS at
20°C – 24°C(with
agitation).
Longer storageincreases the riskof bact proliferationand septicaemia inthe recipient.
INDICATIONS:
Treatment of bleeding due to:
INDICATIONS:INDICATIONS:
Treatment of bleeding due to:
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Treatment of bleeding due to:
•Thrombocytopenia•Platelet function defects.
•Prevention of bleeding d2
thrombocytopenia
CONTRAINDICATIONS:Not for prophylaxis of bleeding,
unless known to have significantpre-operative platelet deficiency.Not indicated in:•ITP
•TTP•Untreated DIC•Thrombocytopenia ass withsepticaemia, until treatment has
commenced or in cases ofhypersplenism.
Treatment of bleeding due to:
•Thrombocytopenia
•Platelet function defects.
•Prevention of bleeding d2thrombocytopenia
CONTRAINDICATIONSCONTRAINDICATIONS:Not for prophylaxis of bleeding,
unless known to have significantpre-operative platelet deficiency.Not indicated in:•ITP
•TTP•Untreated DIC•Thrombocytopenia ass withsepticaemia, until treatment has
commenced or in cases ofhypersplenism.
Platelet concentratePlatelet concentrate
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Platelet concentratePlatelet concentrate
DOSAGE
I unit of plt conc/10 kgBW in a 60-70 kg adult,
4-6 single donor unitscontaining 240 x 10 9 pltsshould raise the plt countby 20-40 x 10 9 /L
Increment will be less ifthere is:
SplenomegalyDIC
Septicaemia
DOSAGEDOSAGE
I unit of plt conc/10 kgBW in a 60-70 kg adult,
4-6 single donor unitscontaining 240 x 10 9 pltsshould raise the plt countby 20-40 x 10 9 /L
Increment will be less ifthere is:
Splenomegaly
DIC
Septicaemia
ADMINISTRATION
ADMINISTRATIONADMINISTRATION
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After pooling, plt conc
should be infused ASAP.MUST NOT BEREFRIGERATED beforeinfusion – reduces plt fx.
Should be infusedthough a fresh standardblood administration set.Should be infused over a
period of about 30minutes.Do not give plt concprepared fr RhD positive
donors to an Rh D negativefemale with child bearingpotential.Give plt that are ABO
compatible wheneverpossible.
After pooling, plt conc
should be infused ASAP.MUST NOT BEREFRIGERATED beforeinfusion – reduces plt fx.
Should be infusedthough a fresh standardblood administration set.Should be infused over a
period of about 30minutes.Do not give plt concprepared fr RhD positive
donors to an Rh D negativefemale with child bearingpotential.Give plt that are ABO
compatible wheneverpossible.
Fresh Frozen Plasma
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Contains normalplasma levels ofstable clotting factors,
albumin and Ig.
Fc VIII level at least70% of normal fresh
plasma level.
UNIT OF ISSUE:Usual volume of packis 200-300 ml.
Contains normalplasma levels ofstable clotting factors,
albumin and Ig.
Fc VIII level at least70% of normal fresh
plasma level.
UNIT OF ISSUE:UNIT OF ISSUE:Usual volume of pack
is 200-300 ml.
Fresh Frozen P lasmaFresh Frozen Plasma
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INDICATIONS:
Replacement ofmultipe coagulation
factor def•Liver dise
•Warfarin overdose
•DIC
•TTP
•Depletion of
coagulation factorsin pts receiving largevolume transfusion.
INDICATIONS:INDICATIONS:
Replacement ofmultipe coagulationfactor def
•Liver dise
•Warfarin overdose
•DIC•TTP
•Depletion ofcoagulation factors
in pts receiving largevolume transfusion.
DOSAGE:
Initial dose: 15ml/kg
DOSAGE:DOSAGE:
Initial dose: 15Initial dose: 15
ml/kgml/kg
Fresh Frozen P lasmaFresh Frozen Plasma
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STORAGE:At -25°C or colder up to 1year.
Before use, should bethawed in the blood bank in
water between 30 - 37°C.
Higher temperatures will
destroy clotting factors andproteins.
STORAGE:STORAGE:
At -25°C or colder up to 1year.
Before use, should bethawed in the blood bank inwater between 30 - 37°C.
Higher temperatures will
destroy clotting factors andproteins.
Fresh Frozen P lasmaFresh Frozen Plasma
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ADMINITSTRATION:
ABO compatible to avoid
risk of haemolysis in
recipient.No compatibil ity testing
required.
Infuse using standard
blood administration set as
soon as possible after
thawing.
Labile coagulation factors
rapidly degrade, use within 6
hours of thawing.
ADMINITSTRATION:ADMINITSTRATION:
ABO compatible to avoid
risk of haemolysis in
recipient.
No compatibil ity testing
required.
Infuse using standardblood administration set as
soon as possible after
thawing.
Labile coagulation factors
rapidly degrade, use within 6
hours of thawing.
CryoprecipitateCryoprecipitate
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Fac VIII:80-100iu/pack
Fibrinogen:150-300 mg/pack
UNIT OF ISSUE:UNIT OF ISSUE:
Usu supplied as asingle donor pack orpack of 6 or moresingle donor units.
-involves at least 6donor exposures.
y p py p p
CryoprecipitateCryoprecipitate
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STORAGE:AT -25oC or colderfor up to 1 year.
y p py p p
CryoprecipitateCryoprecipitate
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INDICATIONS:
Alternative for Fc VIII conc in the tx of inherited
def (Haemop A, fc XIII, VWD)
As a source of fibrinogen in acquired
coagulopathies eg DIVC
INDICATIONS:INDICATIONS:
Alternative for Fc VIII conc in the tx of inherited
def (Haemop A, fc XIII, VWD) As a source of fibrinogen in acquired
coagulopathies eg DIVC
y p py p p
CryoprecipitateCryoprecipitate
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Administration:
•If possible: use ABOcompatible.
•No compatibility
testing required.
•After thawing infuseas soon as possible .
•Must be infusedwithin 6 hours ofthawing
Administration:Administration:
•If possible: use ABOcompatible.
•No compatibility
testing required.
•After thawing infuseas soon as possible .
•Must be infusedwithin 6 hours ofthawing
y p p
Effective use of blood productsBlood bankBlood bank
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Blood bank Blood bank
•Proper collection, separationand storage of blood
components.
•Correct legal identification
procedure:•Donor
•Blood
group
ect
•Quality assurance in everysteps.
•Proper screening procedure
•Pre-donation.
•Post-donation.•Appropriate release of blood
and its products
Clear indication.
Proper handling of units.Documentatations.
PatientsPatients ’ ’ sitesite
•Indications must be clear.
•Check on documentations and
avoid mishandling of units.
•Correct transportation system and
storage prior transfusion.
•Timing of transfusion.
•Corret use of drif set and branulas.
•Patient’s monitoring during and
after transfusion.
•Good Ward-blood bank
communication.
•Blood transfusion reaction.
•Any queries…
•Ect
Think of your intention to
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transfuse……• Sensible..
• Clear indication/s.
• No other alternatives.
• is the most appropriate therapy?
• Can the risk be avoided?
• Is the patient fully informed?
• Hazard of components therapy?• What is the time frame for decision-making
process?
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.