Blood Blood Components Components Dosage And Dosage And

Their Their AdministrationAdministration

Effective blood transfusion therapy Effective blood transfusion therapy depends on availability of different depends on availability of different blood componentsblood components

Components used separately or in Components used separately or in combination can meet most patients combination can meet most patients transfusion needs and keep the risk transfusion needs and keep the risk of transfusion to minimumof transfusion to minimum

Separation of blood components are Separation of blood components are desirable becausedesirable because

1.1. Separation of blood components allows Separation of blood components allows optimal survival for each componentoptimal survival for each component

2.2. Allows transfusing specific blood Allows transfusing specific blood components according to the need of the components according to the need of the patientpatient

3.3. Allows use of unnecessary component Allows use of unnecessary component which may be contraindicated in a which may be contraindicated in a patientpatient

4. Several patients can be treated 4. Several patients can be treated from one unit of donated bloodfrom one unit of donated blood

5. Use of blood components 5. Use of blood components supplements blood supply and adds supplements blood supply and adds to the blood inventoryto the blood inventory

Whole Blood Processed within

8 hours )

Packed red blood cellsFresh frozen plasma Platelets

Component preparationComponent preparation Principle - Differential Principle - Differential

centrifugationcentrifugation Red cellsRed cells

Packed cellsPacked cells Red cells + additiveRed cells + additive

PlasmaPlasma Bank plasmaBank plasma Fresh frozenFresh frozen Cryo supernateCryo supernate

PlateletsPlatelets Platelet rich Platelet rich

concentrateconcentrate Platelet rich plasmaPlatelet rich plasma

CryoprecipitateCryoprecipitate

Plasma + Platelets

BuffyRBC

Whole blood

DEFINITIONSDEFINITIONS

BLOOD PRODUCTBLOOD PRODUCT = Any therapeutic substance = Any therapeutic substance prepared from human bloodprepared from human blood

WHOLE BLOODWHOLE BLOOD = Unseparated blood collected = Unseparated blood collected into an approved container containing an into an approved container containing an anticoagulant preservative solutionanticoagulant preservative solution

BLOOD COMPONENTBLOOD COMPONENT = 1. A constituent of blood = 1. A constituent of blood , separated from whole blood such as, separated from whole blood such as

• Red cell concentrateRed cell concentrate• PlasmaPlasma• Platelet concentratesPlatelet concentrates2. Plasma or platelets collected by apheresis2. Plasma or platelets collected by apheresis3. Cryoprecipitate prepared from fresh frozen 3. Cryoprecipitate prepared from fresh frozen

plasma plasma

Blood ComponentsBlood Components

THE THE PRBCPRBC StorageStorage - 2 – 6 - 2 – 6 OO C C Unit of issueUnit of issue - 1 donation ( unit or pack )- 1 donation ( unit or pack ) AdministrationAdministration - ABO & Rh compatible- ABO & Rh compatible - Never add medication to a unit- Never add medication to a unit - Complete transfusion within 4 hrs of - Complete transfusion within 4 hrs of

commencementcommencement

1Member

Blood ComponentsBlood Components

2. Red cell2. Red cell concentrate concentrate ( packed ( packed red blood cells )- whole blood red blood cells )- whole blood without plasma. Hct 55 -75 % , without plasma. Hct 55 -75 % , Hb approximately 20 g /100 mlHb approximately 20 g /100 ml

IndicationsTrauma - Acute blood loss with > 20% loss of blood volume

Surgery - Trigger – 10gm% - 8gm% Rate of development of anemia, General condition and type of surger

Radiotherapy

Dosage & Administration

Dosage - 1 unit/10 kg body wtAdult dose is 4-8 units

Administration - Preferably ABO & Rh group specific but not essentialOther groups can be used

PLATELETSPLATELETS

Platelet units can be eitherPlatelet units can be either Random donor unitsRandom donor units Apheresis unitsApheresis units

1 random donor unit contains 55 1 random donor unit contains 55 x10x109 platelets9 platelets

1 apheresis unit contains 240x101 apheresis unit contains 240x1099

Indications Production - Aplasia / Neoplasia

Usage - TTP(thrombotic thrombocytopenic purpura), DIC(disseminated intravascular coagulation)

Destruction – immune thrombocytopenic purpura.Sequestration – Hyper-splenism

Guidelines for Platelet Tx.

Mild - 50,000-1,00,000/µlTx - usually not required

Moderate - 20,000-50,000/µlTx-if symptomatic or has to undergo surgery/trauma

Severe - < 20,000/µlRisk of bleeding - highProphylactic Tx

Indications for platelet Indications for platelet transfusiontransfusion

BLEEDINGBLEEDING due to due to thrombocytopaeniathrombocytopaenia

Due to platelet dysfunctionDue to platelet dysfunction

Prevention of spontaneous bleeding Prevention of spontaneous bleeding with counts < 20,000with counts < 20,000

IMPORTANT IMPORTANT PRECAUTIONSPRECAUTIONS

Stored at 20-24 Degree celcius.Stored at 20-24 Degree celcius. Constantly agitatedConstantly agitated Only last for 5 daysOnly last for 5 days Infused in 30 minsInfused in 30 mins

Fresh Frozen plasmaFresh Frozen plasma

Fresh frozen plasmaFresh frozen plasma – labile & – labile & nonlabile clotting factors, nonlabile clotting factors, albumin and immunoglobulin. albumin and immunoglobulin. Factor VIII ( 8 ) level at least 70 Factor VIII ( 8 ) level at least 70 % of normal fresh plasma level% of normal fresh plasma level

StorageStorage - 20 C for 1 yr, - 65 C for 7 yrs.- 20 C for 1 yr, - 65 C for 7 yrs.- Before use thawed at 37 Before use thawed at 37 oo C C

Fresh frozen plasmaFresh frozen plasma

IndicationsIndications

- Replacement of multiple coagulation - Replacement of multiple coagulation factor deficiencies egfactor deficiencies eg

• Liver diseaseLiver disease• Anticoagulant overdoseAnticoagulant overdose• Depletion of coagulation factors in pts Depletion of coagulation factors in pts

receiving large volume transfusionsreceiving large volume transfusions- DIC (disseminated intravascular DIC (disseminated intravascular

coagulation)coagulation)

FRESHFRESH FROZEN PLASMAFROZEN PLASMA

IndicationIndication Clinically significant deficiency of Clinically significant deficiency of

Factors II, V, X, XI Factors II, V, X, XI Replacement of multiple coagulationReplacement of multiple coagulation

factor deficiencies :-factor deficiencies :- liver disease , warfarin treatment, liver disease , warfarin treatment, dilutional and consumption coagulopathydilutional and consumption coagulopathy

ContraindicationContraindication Volume expansionVolume expansion Immunoglobulin replacementImmunoglobulin replacement

Nutritional Nutritional supportsupport Wound healingWound healing

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FRESH FROZEN PLASMAFRESH FROZEN PLASMAPrecautionPrecaution

Acute allergic reaction are common Acute allergic reaction are common Anaphylactic reaction may occurAnaphylactic reaction may occur Hypovolemia alone is not an indication forHypovolemia alone is not an indication for

useuse

Dosage - Initial dose of 15 - 20 ml / kgDosage - Initial dose of 15 - 20 ml / kgAdministrationAdministration

Must be ABO compatible, Rh not Must be ABO compatible, Rh not requiredrequired Infuse as soon as possible after thawing Infuse as soon as possible after thawing

( within 6 hrs )( within 6 hrs ) using standard blood administration setusing standard blood administration set

30/11/49 MD-3-4920

FFPFFP

Fresh Frozen PlasmaFresh Frozen Plasma

Plasma collected from single donor Plasma collected from single donor units or by apheresis units or by apheresis

Frozen within 8 hours of collectionFrozen within 8 hours of collection

-40-40o o CC

Can last for a yearCan last for a year

Dosage & Administration for FFP

Dosage - 10-15 ml/Kg(Approx 2-3 bags for an adult)

Administration - Thawed at +37o C before transfusionABO compatibleGroup AB plasma can be used for all patient

Do`s and Dont`sDo`s and Dont`sIn Blood and In Blood and

Blood Blood ComponentsComponents

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DO`S•Complete the blood request form•Order blood in advance, if possible•Provide clear information on blood products being requested, number of units requested, reason for transfusion, urgency

Risk Benefit Analysis

benefit > risk

risk > benefit

Hb gm/dl 4 5 6 7 8 9 10 11 12 13 14

why nottransfuse

why transfuse

individual patient factorsdecide transfusion trigger

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Blood/ Start infusion Complete infusionblood product

Whole blood/ within 30 min. of within 4 hourred cells removing pack (less in high from ambient temperature)

refrigerator

Platelet immediately within 20 minconcentrates

FFP within 30 min within 20 min

Time Limits for InfusionTime Limits for Infusion

RECORDING OF RECORDING OF TRANSFUSIONTRANSFUSION

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Consent from patient and/or relativesReason for transfusionSignature of the prescribing clinicianPre-transfusion checks of :

patient’s identity, blood pack, compatibility labelsignature of the person performing the check

Transfusiontype and volume of component, donation number, blood group, time at which transfusion commenced,signature of person administering the transfusion

Any transfusion reactionReturn the transfusion slip to the blood bank