Principles of Blood Transfusion & Applications

Principles of Blood component/ Pr oduct replacement

Principle

1 Identify cause of deficiency

2 Replace only deficiency compone nt

3 Blood product should be as safe as posible

Blood compone nts & plasma derivatives

Whole blood is collected into plastic bag (contain anti-coagulant, preservative)

Citrate Bind plasma Ca2+

Prevent activation of coagulation cascade

Phosphate Maintain red cell 2,3-DPG

Dextrose Substrates for metabolic processes of cellular component

Blood component = a product separated from a single unit of whole blood

Plasma derivative = blood product separated from large volume of pooled plasma

Blood compone nts Blood pr oducts

Not 100% safe – HIV window period Manufactured, Safer, No

microorganisms

Red cell conce ntrates Coagulation factor concentrates

• Factor VIII (8) concentrates

(Hemophilia A)

• Factor IX (9) concentrate

(Hemophilia B)

Platelet concentrates

Fresh frozen plasma

Cryoprecipitate Albumin

Cryosupernatant Immunoglobulin

Preparation of blood components from whole blood

Screen 4

HIV

Hepatitis B,C

Syphilis

Malaria/ Parasite (not compulsory)

Blood loss – signs, symptoms, indications for transfusion

Volume Lost Clinical signs Preparation of choice

mL Total Blood

Volume

500 10% None No transfusion or crystalloid solution

1000 20% Tachycardia Crystalloid solution or colloid or RBC if

necessary

1500 30% BP ↓ Crystalloid solution + Colloid + RBC or

blood if available

2000 40% Shock Crystalloid solution + Colloid + RBC or

blood if available

Patient & Donor RBC - selection by ABO, Rh type

Patient Donor

A A,O

B B,O

AB A, B, AB, O

O O

Rh +ve Rh +ve, Rh –ve

Rh –ve Rh -ve

Patient & Donor Plasma - selection by ABO

Recipient Donor

O O, A, B, AB

A A, AB

B B, AB

AB AB

Pretransfusion Tests – for RBC transfusion

From patient From donor Cross-matching

ABO, Rh ABO, Rh GXM

Antibody screening GSH

Antibody identification

Ordering Blood

Plasma Derivatives (Blood products)

Human albumin solutions 5%, 20%, 25% Indication

• Replacement fluid in therapeutic plasma exchange

• Diuretic-resistant oedema treatment (in hypoproteinaemic patient –

nephrotic syndrome)

• Volume replacement

• Burns

• Hypoalbuminaemia

Coagulation Factors

Factor VIII concentrate

Factor IX concentrate

Prothrombin concentrate (PCC)

Immunogloblin

Intramuscular use

(IM)

Anti-RhD

Immunoglobulin

(Anti-D RhIG)

IV use

Specific antibodies to

infectious agents

• Hepatitis B

• Rabies

• Tetanus

Prevention HDN in

RhD negative mothers

ITP/ other immune

disorders

Immune de ficiency

state

Immune de ficiency state

Hypogammaglobulinaemia

HIV-related disease

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Whole Blood

1 unit = 450 ml + 63 ml anticoagulant

Storage – 2-6 °C

Life span – 35 days

Changes occur during storage

1. Red cells

a. Lose ATP

b. Lose 2,3-DPG

2. White cells

a. Granulocyte – lost phagocytic, bactericidal properties (after 4-6h

collection)

b. Do not lose antigenic properties

i. Capable of sensitizing recipient

ii. Cause non-hae molytic febrile transfusion reaction

3. Platelets

a. Lose haemostatic function (within 48h)

4. Coagulation factors

a. Factor V & Factor VIII lose coagulant activity (50%) (within 48-

72h storage)

5. Biochemi cal changes

a. ↑ K+

b. ↑ H+

6. Microaggregates

a. Aggregates of aged platelets, leucocytes, fibrin strands formed

b. Cause transfusion related lung injury (TRALI)

Indication

Exchange transfusion in infants for haemolytic disease of new born

Acute hypovolemia (haemorrhagic shock)/ Blood loss >30%

Massive transfusion

Red cell concentrate (Packed cell)

Prepare by removing 200ml of plasma from Whole Blood after centrifugation

Storage – 2-6 °C

Half life – 35 days

Increment – 1-1.5gm/dl per unit

Types

Red cell concentrate Leukocyte

reduced red cell

γ irradiated

red cell

Washed red

blood cells

Symptomatic

anaemia

Prevent non-

haemolytic

febrile

transfusion

reaction (due to

antibodies to

white cells &

platelets in

recipients

exposed to

previous

transfusion,

pregnancies)

Prevent TA-

GVHD (bone

marrow

transplant,

immune

compromised,

neonate)

Severe allergic

reaction

following

transfusion

Iron, Folate, B12

deficiency anaemia

(rare, except in

elderly patients with

Angina, CCF)

Hypoproliferative

anaemia

• Malignancy

• Chemotherapy

/ radiotherapy

• Aplastic

anaemia, MDS,

myelofibrosis

Hypersensitive

to plasma

Haemolytic anaemia

(rare, except

anaemia poorly

tolerated & Hb <

7g/dL)

Prevent

sensitization

(marrow

transplantation)

Paroxysmal

nocturnal

haemo-

globinuria

Not indicated in

• Undiagnosed/

asymptomatic

anaemia

• Anaemia

responsive to

haematinic

• For volume

expansion

• Post operative

Hb > 8g/dL

↓ Transmission

of disease

(cytomegalovirus

, cJD)

Platelet concentrate (from whole blood)

Content

Volume – 50-60 ml

Platelet – 55x10�

Leukocytes – 0.05 x10� /L

RBC contamination – 0.02 x10� /L

Storage - <5 days (22°C, continous agitation)

Dose – 4-6 units in adult OR 1 unit/10 kg body weight

Increment – 5-10 x10� per unit platelet

Plateletpheresis Volume – 150-300 ml

Platelet – 300 x10� (6 single donations)

No RBC contamination

Minimal WBC contamination

1 unit = 1 therapeutic dose

Role of platelet - 1° homeostasis

Normal platelet count – 140-450 x10�/L

Indication

Treatment of bleeding (thrombocytopenia/ abnormal platelet function)

Prophylactic platelet transfusion (based on platelet count)

< 100 x��� /L <50 x��� /L < 10 x��� /L

Undergoing major

surgery

Newborn state Prophylactic use with

minor bleeding/ stable

patients

Plasma coagulation

abnormality

Surgery within previous

48h

Fever/ Severe infection

Minor surgical

procedure/ invasive

procedure

Not indicated

Idiopathic thrombocytopenia purpura (unless life threatening bleeding)

Thrombotic thrombocytopenic purpura

Fresh Frozen Plasma (FFP)

Prepare within 6h of collection

Freeze at -30°C for 1 year

Properties

Volume – 200 ml

Prior to use, FFP is thawed in water bath

Thawed plasma should be used < 2h

Contains all coagulation factors

Factor VIII

Sodium

Potassium

Glucose

Citrate

Indications

Replacement of single coagulation factor deficiency

(when specifi c factor concentrates not available)(Factors II, VII, X, XI, XIII)

Vitamin K deficiency with bleeding episodes (haemorrhagic disease of newborn)

Acute disseminated intravascular coagulation

Thrombotic thrombocytopenic purpura (at least 3L/ day)

Microvascular bleeding (following massive blood transfusion)

Not indicated in

Volume expander/ nutritional supplement

Albumin supplementation

Hypogammaglobulinaemia correction

Haemophilia, vWD, congenital procoagulant, anticoagulant factor deficiency

(virally inactivated, recombinant factor conce ntrates are preferred)

Bleeding only, Prolonged PT only, Prolonged APTT only

Cryoprecipitate

Obtained from 1 single donation of fresh plasma

Rapid freezing within 6h of collection

Subsequent thawing at 4-8 °C

Removal of cryosupernatant

Properties

Volume – 20 ml

Contain

• Factor VIII

• Fibrinogen

• Factor XIII

• vWF

Storage -30°C (1 year)

Administration – need to be thawed in water bath & used within 2h

Involves preparation of fibrin glue

Indications

Von Willebrand’s disease

Hypofibrinogenemia

DIC

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