TRANSFUSION OF BLOOD

&
BLOOD PRODUCTS
BLOOD PRODUCTS

* Blood components
- Celular
- Non Celular

* Plasma fraction (derivates)

 BLOOD COMPONENTS
CELULAR
• WHOLE BLOOD
• PACKED RED BLOOD CELL
• PLATELETS
• GRANULOCYTES PHERESIS

NON CELULAR
• FRESH FROZEN PLASMA (FFP)
• CRYOPRECIPITATE
 PLASMA FRACTION
• HUMAN ALBUMIN

• IMMUNOGLOBULIN PREPARATION (90% Ig G)

• FC VIII & FC IX
Kuliah:
Fokus transfusi pada keadaan ;
- Anemia
- Trombositopenia
- Hipokoagulasi
INDICATION
 NEW YORK STATE
COUNCIL ON HUMAN BLOOD AND
TRANSFUSION SERVICES
GUIDELINES FOR TRANSFUSION
OF RED BLOOD CELLS - ADULTS
 I. ACUTE BLOOD LOSS (SURGERY, TRAUMA OR BLEEDING)

A. Blood Volume Loss Of:

1. 15 - 30 percent  crystalloids or colloids, not RBCs

2. 30 - 40 percent  requires rapid volume replacement, RBC
transfusion is probably necessary;
3. >40 percent  is life-threatening and volume replacement,
including RBC transfusion, is required.
 Hb Concentration
Hb >10 g/dL transfusion is rarely indicated.

Hb 6-10 g/dL indications for transfusion should

be based on the patient’s risk of
inadequate oxygenation from ongoing
bleeding and/or high-risk factors.

Hb < 6 g/dL transfusion is almost always indicated.

 A. The cause of the anemia should be established.

B. Anemia secondary to aplasia or bone marrow

suppression. In patients with no symptoms of anemia

1. Hb 6-7 g/dL may be sufficient

2. evidence of cardiovascular, pulmonary or cvd may

need to be transfused with a Hb of > 7 g/dL.
 Criteria for Transfusion
University of North Carolina
Hospitals
Chapel Hill, NC
(Adults)
 General Criteria for Transfusion of Red Blood Cells:
1. Hgb < 7 g/dl in an asymptomatic patient.

2. Hgb < 10 g/dl in cases of increased risk of ischemia - pulmonary disease,

coronary artery disease, cerebral vascular disease, etc.

3. Acute Blood Loss Resulting In:

a. estimated or anticipated blood loss > 15% of total blood volume
b. diastolic blood pressure < 60 mm Hg
c. systolic blood pressure decrease > 30 mm Hg
d. oliguria/anuria

4. Symptomatic anemia resulting in:

a. tachycardia (> 100 beats/minute)
b. mental status changes
c. electrocardiographic signs of cardiac ischemia

d. angina .dyspnea, light headedness or dizziness with mild exertion

 Special red cell preparations and indications:

1. Whole Blood ( 250 cc )

Whole blood is unavailable since oxygen carrying capacity plus
volume repletion can be obtained from red cells plus colloid or
crystalloid replacement. Storage of whole blood precludes the
production of components, and thus, the most effective use of
donated blood.

2. PRC ( 150 – 300 cc )

3. PRC Washed ( 180 cc )

 to prevent rx immunologic
 General Criteria for Transfusion of Platelets (Adults):
1. Recent (within 24 hours of request) platelet count <10 X 109/L
(for prophylaxis in stable, non febrile , or < 20 X 109/L for
prophylaxis with fever (in last 24 hours) or instability.

2. Recent (within 24 hours of request) platelet count < 50 X

109/L involving: documented hemorrhage or rapidly falling
platelet count planned invasive or surgical procedure

3. Documented platelet dysfunction (e.g. prolonged bleeding

time > 1.5 X the upper limit of normal, platelet function tests,
drug-induced, or history) with:
petechiae, purpura, bleeding, invasive or surgical procedure

4. Neurosurgical patients with platelet < 100.000/mm3

 General criteria for the transfusion of FFP:

* For the treatment or prophylaxis of multiple or

specific coagulation factor deficiencies (PT and/or PTT >
the upper limits of normal and/or documented specific
coagulation factor deficiency).

* FFP is also indicated in those patients with a

suspected coagulation deficiency (PT/PTT pending) who
are bleeding or at risk of bleeding from an invasive
procedure.
 Acceptable indications for the transfusion of FFP
* Congenital deficiencies of: or Acquired deficiencies
related to:
- anti-thrombin III , Warfarin therapy
- factors II, V, VII, IX, X, XI, Vitamin K deff
* Massive transfusion
* Disseminated intravascular coagulation
 Faktor Koagulasi Konsentrasi Waktu-paruh (jam)

Fibrinogen 2 – 4.5 mg/mL 100 - 150

Protrombin (faktor II) ~ 1 unit/mL 50 - 80
Faktor V ~ 1 unit/mL 12 - 24
Faktor VII ~ 1 unit/mL 6
Faktor VIII ~ 1 unit/mL 12
Faktor IX ~ 1 unit/mL 24
Faktor X ~ 1 unit/mL 30 - 60
Faktor XI ~ 1 unit/mL 40 - 80
Faktor XIII ~ 1 unit/mL 150 - 300
Faktor von Willebrand’s ~ 1 unit/mL 24
Kusuma et al. Hospital Physician 2009: 35 – 40
 Dose
Author Year Laboratory Criteria
(mL/kg)
Japanese Ministry of Health and 1999 PT/PTT > 1.5 times normal; factor 8 – 12
Welfare level <30%
North Ireland Clinical Resources 2001 PT/PTT > 1.5 times normal 12 – 15
Efficiency Support Team
Australia National Health and 2001 Abnormal coagulation 5 – 20
Medical Research Council
American Red CrossTabel 7. Guidelines
2002 PT/PTTFresh
transfusi > 1.5Frozen
times normal
Plasma Non
given
South African National Blood 2003 Distubed coagulation 15 – 20
Service
British Committee for Standar in 2004 Multiple factor deficences 10 – 15
Haematology
New York State Courcil on 2004 PT/PTT > 1.5 times normal 10 - 20
Human Blood and Transfusion
services
Holland et al. Am J Clin Pathol 2006;126:133-139
General criteria for the transfusion of cryoprecipitate:

* For the treatment or prevention of bleeding associated with certain

known or suspected clotting factor Fc VIII, IX, XIII, VWf, fibrinogen
deficiencies (an elevated bleeding time or fibrinogen < 150 mg/dl

* 2. Bleeding associated with renal failure or certain platelet

dysfunctional disorders may also benefit from cryoprecipitate.
 Faktor Waktu-paruh
Jumlah/Unit
Koagulasi (jam)
Fibrinogen 150 – 250 mg 100 - 150

Faktor VIII 80 – 150 unit 12

Faktor von Willbrand 100 – 150 unit 24

Faktor XIII 50 – 75 unit 150 - 300

Kusuma et al. Hospital Physician 2009: 35 – 40