BLOOD COMPONENT TRANSFUSION

DR TANVEER ALAM

PAEDS ONCOLOGY

SKMCH & RC

What is history of transfusion? What are Blood components ? How are the blood component separated ? What are the Indications for transfusion ? What is the dose of administration in paeds? What are complications? How to minimize the errors? What are the SKMCH protocol?

Blood transfused in humans since mid-1600’s 1828 – First successful transfusion 1900 – Landsteiner described ABO groups 1916 – First use of blood storage 1939 – Levine described the Rh factor

HISTORY OF TRANSFUSIONS

BLOOD components Any therapeutic substance prepared from human bloodWHOLE BLOOD Unseparated blood collected into an approved container

containing an anticoagulant preservative solutionBLOOD COMPONENT • RBCs• platelets• Plasma• Cryoprecipitate• GCSF• Human albumin 4.5%

DEFINITIONS

FIRST CENTRIFUGATION

Whole Blood Main Bag

Satellite Bag 1

Satellite Bag 2

RBC’sPlatelet-rich Plasma

First

Closed System

SECOND CENTRIFUGATION

Platelet-rich Plasma

RBC’s PlateletConcentrate

RBC’s

Plasma

Second

StorageOn 4° for up to 35 days

Indications Massive Blood Loss/Trauma/Exchange TransfusionConsiderations Donor and recipient must be ABO identical

Dosage10 to 20 ml /kg

Never add medication to a unit

WHOLE BLOOD TRANSFUSION

Storage4° for up to 42 days, can be frozenIndicationsMany indications ie anemia Hb < 7, hypoxia, etc.dosageDose 10 to 15ml/kg Usually transfuse over 2-4 hours orVolume required = required rise in Hb in g/dl x wt in kg x 4 or3-4 mls/kg of red cells raises Hb by 1g/dl

PRBCS TRANSFUSION

StorageUp to 5 days at 20-24°

Indications Lumbar puncture - transfuse prior to LP to bring platelets > 50 x

109/l. Major surgery - maintain platelet count > 50 x 109/l (critical sites;

brain, spine, eyes > 100 x 109/l). Minor surgery - maintain platelet count at >50 x 109/l Line insertion - > 50 x 109/l. Line removal - > 50 x 109/l. Bone marrow trephine - Usually no need to transfuse - discuss

with operator. In some patients (e.g. aplastics or ITP), platelet transfusion should be avoided if possible.

Bone marrow aspirate - no need to transfuse.

PLATELETS TRANSFUSION

Dosage of platelets 10-20mls/kg for children There may be a higher requirement in the following circumstances: Active haemorrhage Sepsis Splenomegaly Consumptive coagulopathy – e.g. DIC

PLATELETS TRANSFUSION CONTINUE…

Storage FFP--12 months at –18 degrees or colder Indications Coagulation Factor deficiency, fibrinogen replacement, DIC,

liver disease, exchange transfusion, massive transfusion,warfarin overdose, INR > 1.5 TO 2 befor surgery

Dose : 10-20mls/Kg

Considerations Plasma should be recipient RBC ABO compatible In children, should also be Rh compatible Usual dose is 20 cc/kg to raise coagulation factors approx 20%

FFP TRANSFUSION

Rich source of Factor VIII, von Willebrand’s factor and fibrinogen Stored at -400C Dose of cryoprecipitate 5 ml/kg Cryoprecipitate is available in most ABO groups Use within 4h of thawing use Haemophilia (Factor VIII deficiency) Fibrinogen deficiency & dysfibrinogenaemia Von Willebrand’s disease

CRYOPRECIPITATE

Rich in protein This may be stored for several months in liquid form at 40C Suitable for replacement of protein e.g. following severe burns ,liver

disfuntion

HUMAN ALBUMIN 4.5 PER CENT

INDICATION & DOSEIn severe neutropenia in myelosuppresive chemotherapyInitially 5mcg/kg/SC & can increase 5mcg/kg every cycle till anc10,000/mm3 BONE MARROW TRANSPLANT10mcg/kg/day IV over 4 to 24 hoursIN SEVERE CHRONIC NEUTROPENIASITEAbdomen (not around umbbilicus) ,thighs ,hips ,arm (rotate the site)Keep refrigerated and do not shake before administration

G-CSF (FILGRASTIM

21

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 Infusion

AcuteLate

Infective

COMPLICATIONS OF BLOOD TRANSFUSION

ACUTE TRANSFUSION REACTIONS

Hemolytic Reactions Febrile Reactions Allergic Reactions Coagulopathy with Massive transfusions Bacteremia

Urticarial rash itch

Layrngeal edemaBronchospasm

and cutaneous flushing

Termination of transfusion IV crystalloids Maintenance of airway Oxygen Adrenaline IV antihistamine salbutamol

Signs and symptoms Management

ALLERGIC AND ANAPHYLAREACTIONS

Chills, feverLow back pain

HeadacheChest painDyspneaCyanosis

Restlessness, anxiety Hypotension

Red urine

Stop transfusionO2 supply

urine output monitoringTreat shock

Volume replacement

Signs/Symptoms Management

HEMOLYTIC REACTION

CoughChest painDyspnea

Distended neck veinsFrothy sputum

Slow infusionoxygen

DiureticsVasodilators

Signs/Symptoms Management

VOLUME OVERLOAD

CausesPulmonary microvascular occlusion by microaggregates of platelets, leucocytes and fibrinPresentation

Fever, breathlessness, nonproductive cough, hypoxemia

TRANSFUSION RELATED ACUTE LUNG INJURY

Delayed haemolytic Transfusion reactionOccurs in patients whose level of antibodies to antigen is so low that it escapes detection by pretransfusion screen. Following transfusion , the secondary immune response raises the antibody titre to a level that results in delayed destruction of transfused cellsPresentation- fever falling Hb, jaundice & haemoglobinuria after 5-10 days SENSITIZATION Development of antibodies to donated white cells & platelets GRAFT-VERSUS-HOST DISEASESOccurs in immunodeficient patientsImmunocompetent patients after tansfusion of blood from a relative Disease is caused by T-lymphocytesPrevented by administrating gamma-irradiated cellular components to immunodeficient patients & blood from relative should be gamma irradiated

LATE COMPLICATIONS

Every unit of blood contains 250 mg of ironRepeated transfusions cause iron overload of monocyte-macrophage systemBecomes significant after 100 unitsInvolves liver, pancrease, myocardium and the endocrine glands

TreatmentChelation therapy with desferrioxamine

HAEMOSIDEROSIS

Transmission of infective diseasesSerum hepatitis virus

HIV Bacterial infection-result of faulty storage

Malaria

INFECTIVE COMPLICATIONS

Arrange required blood product as you suspect any need If a patient need blood in emergency doctor can request blood bank Patient can get blood at exchange basis too We take consent for all type of blood transfusion when patient

admit on floor Written orders for blood transfusion should be given by Dr Repeat the sample after completion of transfusion If any reaction occur manage the patient immedietly Fill the blood reaction form and send the blood sample for culture

and recross match and remaining blood to the blood bank Document the probelum online

HOW DO WE DO IT IN SKMCH &RC