TRANSFUSION OF BLOOD & BLOOD COMPONENTS

Dr. Gamini Jayaweera

TRANSFUSION OF BLOOD & BLOOD COMPONENTS

Cellular Components

Plasma Components

Transfusion Of Blood & Blood Components Cellular Components

Red Cell Concentrates ( RCC / PC ) RCC with Additive solutions Leuco reduced / Depleted Red Cells Washed Red Cells Irradiated RBC / WBC / PL De-Glycerolized Red Cells
( Frozen )

Platelet Concentrates Granulocyte Concentrates ( Buffy Coat )

TRANSFUSION OF BLOOD & BLOOD COMPONENTS Plasma Components

Fresh Frozen Plasma Plasma / Cryo Poor Plasma Cryoprecipitate

 Whole Blood
Fresh Whole Blood
Least important

Whole Blood
Contents

Total Volume Aprox. 510 ml (450 ml of

blood in 63 ml of anticoagulant) Hb 12g/ dl Hct 35 45 % No functional PL / WBC / Labile clotting factors ( V , VIII ) Store 2o 6o c

Whole Blood
Indications

RBC replacement in acute blood loss with

hypovolaemia Exchange Transfusion When RCC not available

Red Cell Concentrates

Contents

Volume 200 275 ml Hct 60 75% Hb 20 g /100ml Plasma 30% Shelf Life 35 Days
No Platelets No Functional Leucocytes No Clotting Factors

Red Cell Concentrates

? Oxygen Carrying Capacity
? 23 DPG Level ? K+ Leak

Red Cell Concentrates

Indications

Increase the red cell mass Symptomatic Anaemia Replace the blood loss in haemorrhage
Liver Failure Renal Failure Heart Failure

(use with crystalloids or colloid solution ) Patients with

Red Cell Concentrates

Transfusion Dose

1 Unit of RCC Increase Hb by 1g/dl or Hct by

3% in 60 kg patient

Increment is more in smaller patients

When to repeat the Hb after transfusion? Failure achieve expected increment ?
Red Cell Antibodies Continued blood loss (External / Internal)

Red Cell Concentrates

Rate Of Transfusion Rate of transfusion depend on the clinical situation As fast as patient can tolerate to Very slow transfusion Slow Transfusion must be completed in 4 hours? Haemolysis Bacterial proliferation Divided dose transfusion Applying Pressure Haemolysis Air Embolism Rupture of Veins

Applying Pressure to increase transfusion rate

1. To Transfuse blood at a faster rate than gravity 2. apply pressure evenly on the blood pack 3. Large bore needles and larger cannulas are used if pressure is applied 4. There is a risk of Haemolysis if Blood has high Haematocrit or blood transfused through a small needles/canula or blood pressurized through clotted filter 5. Risk of vessel rupture

Red Cell Concentrates

Transfusion Considerations Must be ABO Identical or Compatible Cross-match Clerical checks Pre transfusion assessment Past transfusion records/ complications Consent Post transfusion observation & follow up Recording of transfusion reactions

Red Cells In Additive Solutions

Contents 150 200 ml of RBC with minimal plasma 100 ml SAG-M (saline ,adenine ,glucose ,mannitol) Hb 15g/dl, Hct 50 70% 42 days shelf life Not recommended for neonates

Leucocyte (poor) depleted Red Cells

Contents

< 5*106 Leucocytes/ Pack Prepared by filtration Contains mainly Red Cells, NO Platelets

Leucocyte (poor) depleted Red Cells

Indications

Patients with FNHTR Prevent HLA Immunization Reduce the risk of transmission of intra
cellular viruses CMV , EB
Transfusion to Immune compromised patients Premature Babies

Leucocyte (poor) depleted Red Cells

Buffy coat removed RBCs has less WBCs Washed Red Cells has less WBCs Will not prevent GVHD
Blood must be Irradiated

Washed Red Cells

Wash the blood pack with Normal Saline Removes
> 80% of WBC > 99% of Plasma > 99% of Platelets

Red cells suspended in Saline

Washed Red Cells

Indications

Repeated Allergic Reactions IgA deficiency/ Allergic reactions PNH Patients with T activated red cells Patients with FNHTR (as an alternative to filtered
blood)

Irradiated Blood / Platelets / Buffy coats

Expose the unit to high energy gamma

irradiation Source Cesium 137 Expose the unit to 25 30 Gy Kill T lymphocytes Prevent GVHD

Irradiated Blood / Platelets / Buffy coats

Indications Transfusion of cellular products to immune compromised patients BM transplant Paediatric applications Intra uterine transfusions Exchange transfusions Transfusions from first and second degree relatives All HLA matched transfusions All granulocyte transfusions

De-Glycerolized Red Cells

(Frozen Red Cells)

Use glycerol as cryo-protectant Store in liquid or vapor phase Nitrogen Temperature below 1900 c Shelf life over 15 years Mainly used for rare blood types
e.g. Bombay

Platelet Concentrate
Contents
Random Donor PL
55* 109 PL / Pack <1.2*109 RBCs <0.12*109 WBCs

Vol

50- 70 ml

Storage 20 22 c, with agitation , 3-5 days

Platelet Concentrate
Indications

Treatment of bleeding due to

Thrombocytopenia Thrombasthaenia

Prevention of bleeding due to bone

marrow failure

Platelet Concentrate
Contraindications

ITP except in life threatening condition TTP Untreated DIC

Platelet Concentrate
Failure to respond to Platelet Transfusion Continued bleeding (Dilution) Peripheral consumption Impaired BM production Fever Septicaemia Hypersplenism HLA Ab Platelet specific Ab DIC

Platelet Concentrate
Dose One unit (RDP) / 10 kg body wt
OR

One unit of SDP ( 240*109 PL )

Platelet Concentrate
Complications

Infection risk as same as whole blood FNHTR Allergic reaction HLA sensitization Circulatory overload

Platelet Concentrate
Single Donor Platelets (SDP) (Apheresis PL) Vol 150 300 ml 150 500 * 109 PL/ Pack

Fresh Frozen Plasma

Contents Separated from fresh whole blood within 6hrs of collection and stored at or below - 30 C Contains all the clotting factors, Albumin& Globulins. Labile factors (F V & F VII ) up to 70% of normal level. Volume 150 200 ml. Methylene blue/ UV treated FFP Low risk of infection. Store below 25 c for 1 year Once thawed transfuse as soon as possible or max. 4 hrs

Fresh Frozen Plasma

Indications Clotting factor deficiencies when the specific factor concentrates are not available. Multiple factor deficiencies
Liver disease Wafarin over dose Dilutional coagulopathy

DIC TTP Hereditary angioneurotic oedema Colenesteras deficiency. Neonatal haemorrhage. Protein C deficiency

Fresh Frozen Plasma

ABO compatibility No cross matching Use a standard 170mic blood
administration set Adverse effects
Allergic reactions Volume overload Infection

Cryoprecipitate
Characteristics
Prepared from FFP Supplied as singe units or pooled units Contains
Factor VIII Vwf Fibrinogen Factor XIII Fibronectin

Cryoprecipitate
Indications

Haemophilia A vWF deficiency FXIII deficiency Fibrinogen deficiency DIC

Cryoprecipitate
ABO compatibility preferred in paediatric

patients No cross matching Use a standard 170mic blood administration set Adverse effects
Allergic reactions Transfusion Transmitted Infection

BLOOD TYPE COMPATIBILITY

Blood type of Patient O Pos O Neg A pos A Neg Compatible Donor Blood / Plasma / FFP Red Cell Concentrates O +, O OA +, A -, O +, O A-, O Whole Blood O +, O OA +, A APlasma/FFP O, A , B, AB plasma A or AB plasma

B Pos
B Neg AB Pos

B +, B -, O +, O B -, O -

B +, B B-

B or AB plasma
AB plasma only

AB Neg

AB +, AB -, A +, A AB +, AB - , B + B -, O +, O AB -, A -, B -, O AB -

Thank You

1. Has a visual & audible temperature alarm

2. Heating by dry heat 3. Flow rate of 150 ml/min

Microaggregate filters are used when large volumes of stored blood is transfused

Pall SQ40 after 1 unit of SAG-M prepared blood

Pall SQ40 after 2 units of SAG-M prepared blood