Download - Blood & blood products
Blood & Blood Products
S.LaxinyMedical StudentFHCSEUSL
Blood-Whole Blood
Fresh Whole Blood
Blood Products
Cellular Components-Red Cell Concentrates
Platelet Concentrates
Granulocyte Concentrate
Plasma Components-Fresh Frozen plasma
Cryoprecipitate
Cryopoor plasma
Stored plasma
Plasma Derivatives-Albumin
Immunoglobulin
Coagulation Factors
Transfusion practice in Paediatrics
For transfusion purpose,there are two groups of children
1.Neonates and infants <4 months
2.Infants >4 months and children
Neonates and infants <4 months-
No demonstrable amount of anti-A & anti-B
In infants >4 months & children-
Blood grouping
Antibody screening
Cross matching
Blood volume
Premature baby 100ml/kg
Full term baby 85ml/kg
Infant 72ml/kg
Children 76ml/kg
Adults 80ml/kg
Hemoglobin concentration in children
Age Hb concentration g/dl
Cord blood +16.5
Day 1 +18.0
1 month +14.0
3 months +11.0
6months-6 years +12.0
7-13 years +13.0
Amount to be transfused must br carefully calculated,
Whole Blood (WB)
Whole Blood (WB)
• Whole blood=Donor blood + Anticoagulant• 1 Unit-450ml• Anticoagulant (CPDA-1)-63ml• No functional platelets• No labile coagulation factors• WB is used for component preparation.• Hct-45%• Stored at 2-60c • Shelf life-35 days
Whole Blood
Mandatory screening tests
• HBsAg• Anti-HCV• Anti-HIV 1 & 2• VDRL/ TPPA• Malarial Parasite
Fresh Whole Blood
Packed Red Cells
Light spin, 22oC(within 8 hrs)
Platelet Rich Plasma
Platelet Concentrate Fresh Plasma
Store at 22oC Freeze(FFP)
Heavy spin,22oC
Preparation of blood components from whole Blood
Whole Blood
Indications
• Acute blood loss with hypovolaemia• Exchange transfusion-severe anaemia at birth
severe hyperbilirubinaemia• Massive transfusion• Cardiovascular bypass surgery
Whole BloodRisk of volume overload : Chronic anaemia Cardiac failure
Dose of blood transfusion-20ml/kg
Increase Hb by 1 g/dl
Rate of Blood Transfusion-3ml/kg/hr
Transfusion considerations-ABO compatible
Cross match compatible
Start transfusion slowly
Whole Blood
Potential Adverse Effectso Reactions-Haemolytic
Febrile
Allergic
Anaphylactico Infectious diseaseso Sepsiso Circulatory overloado TA-GVHDo TRALI
Fresh Blood
Blood < 5 days
Source of coagulation factors, platelets
& WBC
Blood <5days for Exchange transfusion in
newborns-to prevent hyperkalemia
& to supply red cells with adequate
content of 2,3-DPG.
Blood Products
Red Cell Concentrates
Platelet Concentrates
Granulocyte Concentrate
Fresh Frozen plasma
Cryoprecipitate
Cryopoor plasma
Stored plasma
Albumin
Immunoglobulin
Coagulation Factors
Plasma Derivatives
Plasma Components
Cellular Components
Blood
Red Cell Concentrates
Red Cell Concentrates Also called Packed Red Cells Platelets and plasma are removed I Unit- 200- 250ml Hct-65-75% Shelf life-35 days Stored at 2-40c Preferable to transfuse immediately
Red Cell Concentrates
Indications
Anaemia
Thalassemia
Sickle cell disease
Guidelines for Paediatric red cell transfusions
Anaemia
Infants within first 4 months of life
• Hb< 13.0 g/dL and severe pulmonary disease • Hb < 10.0 g/dL and moderate pulmonary disease • Hb < 13.0 g/dL and severe cardiac disease • Hb < 10.0 g/dL and major surgery • Hb < 8.0 g/dL and symptomatic anemia • Acute blood loss >10% of total blood volume.
Guidelines for Paediatric red cell transfusions
Infants >4 months & children
• Acute loss > 25% circulating blood volume • Hb < 8.0 g/dL in perioperative period • Hb < 13.0 g/dL and severe cardiopulmonary
disease • Hb < 8.0 g/dL and marrow failure • Hb < 8.0 g/dL and symptomatic chronic anemia
Red Cell Concentrates
Autoimmune hemolytic anaemia
• RCC to prevent coronary insufficiency,
congestive heart failure, cardiac
decompensation or neurological impairment.
• Transfusion may stimulate autoantibody
production complicating subsequent
transfusion.
Red Cell Concentrates
Thalassemia
• Periodic regular blood transfusions
• Every 3 or 4 weeks
• Rate 2-3 hours/unit
• Pre transfusion Hb level -9-10g/dl
• Post transfusion Hb should not rise >14g/dl
Red Cell Concentrates
Thalassemia
• Annual blood consumption=total blood transfused over 12 months/patien’s weight in middle of the year.
• If blood consumption is >200ml/kg BW
spleenectomy should be
considered
Sickle cell disease
Indications for simple top up transfusion
• Severe anaemia
• Splenic or hepatic sequestration
• Aplastic crisis
Indications in surgery
• Organ transplantation
• Eye,major abdominal surgery
Don’t raise >10g/dl=raise viscosity
Red Cell Concentrates
Dose of blood transfusion-10ml/kg
cardiac failure-3-5ml/kg
Increase Hb by 1 g/dl
Rate of Blood Transfusion -3ml/kg/hr
Adverse effects :Same as Whole blood
Leucoreduced Red Blood Cells
Most plasma & 70-80% WBC(buffy coat)
removed &100ml of AS added.
Indication
Symptomatic anaemia
Suitable for patients requiring repeated
transfusions.
Prevent febrile non haemolytic reactions.
Leucoreduced Red Blood Cells
• WBC : <5 108 /L
• Hct : 50–60 %
• Volume : 350 ml
• Shelf life : 42 days
• Stored at 2- 60c
Dose of blood transfusion-10ml/kg
Rate of Blood Transfusion -3ml/kg/hr
Increase Hb by 1 g/dl
Transfusion considerations-ABO identical
Crossmatch compatible
Adverse effects :Same as Whole blood except
febrile reactions
.
•
Leucodepleted Red Blood Cells
Same as leucoreduced RBC But WBC <5106 / L Hct : 50–60 % Volume : 350 ml Shelf life : 42 days Stored at 2- 60c
Indications: Symptomatic anaemia Prevent febrile non haemolytic reactions. Suitable for patients requiring repeated transfusions.
Washed Red Blood Cells
• RBC washed with 1-2 L Normal Saline• RBC : 20% reduced• Plasma 90% reduced• WBC : 90% reduced
• WBC count: <5 108 /L
• Prevent febrile non hemolytic reactions.• Washing eliminates antibodies & other
plasma constituents• Indications: Symptomatic anemia• Transfuse within 6 hours
Washed Red Blood Cells
Indications
Multitransfused patients with
recurrent febrile reactions Urticarial reactions Anaphylactic reactions IgA deficiency with IgA antibodies Paroxysmal nocturnul hemoglobinuria Patients with T activated cells by infections
who require transfusion
ABO group selection for RBC Transfusion
Recipient ABOGroup
Component ABO Group
1st Choice 2nd Choice 3rd Choice 4thChoice
A A O None None
B B O None None
AB AB A B O
O O None None None
Oh (Bombay Group)
Oh None None None
Platelets Concentrate
Types of Platelets
o Recovered platelets(Random donor platelets)o Apheresis platelets(single donor platelets)
Platelets Concentrate
Random donor platelets
o Made from a unit of whole blood.
Prepared by 2 methodso Platelet rich plasmao Buffy coat removal
o I unit :50109 plateletso Volume: 50 ml
Platelets Concentrate
Single donor platelets
o Made from single donor
o Apheresed using cell separator machine
o 1 unit SDP: 300109 = 6 units RDP
o Volume of 1 unit SDP: 200-350 ml
Platelets Concentrate
o Stored at 200c-240co Shelf life: 5days
o Once issued should be transfused as soon
as possible
Useso Prophylactico Therapeutic
Platelets Concentrate
Guidelines for Pediatric Platelet Transfusions
INFANTS WITHIN FIRST 4 MONTHS OF LIFE
PLTs < 100 × 109/L and bleeding
PLTs < 50 × 109/L and invasive procedure
PLTs < 20 × 109/L and clinical stable
PLTs < 100 × 109/L and clinically unstable
PLTs at any count, but with PLT dysfunction
plus bleeding or invasive procedure
Platelets Concentrate
CHILDREN AND ADOLESCENTS
PLTs < 50 × 109/L and bleeding
PLTs < 50 × 109/L and invasive procedure
PLTs < 20 × 109/L and marrow failure with hemorrhagic risk factors
PLTs < 10 × 109/L and marrow failure without hemorrhagic risk factors
PLTs at any count, but with PLT
dysfunction plus bleeding or invasive procedure
Platelets Concentrate
Contraindications
o TTP(Thrombotic Thrombocytopenic Purpura)o HIT(Heparin Induced Thrombocytopenia)
o Should be ABO compatible
ABO group selection for Platelet Transfusion
Recipient ABO
Component ABO
1st Choice 2nd Choice 3rd Choice 4thChoice
A A AB B O
B B AB A O
AB AB A B O
O O A B AB
Granulocytes
1. Granulocyte concentrate
2. Buffy coat
Granulocyte concentrate
Prepared by apheresis 1 unit Contain 1 1010 Granulocytes Volume: 200-300 ml 1 or more units daily
Granulocytes
Buffy Coat
Layer between red cells & plasma I unit: 1-2 109
Volume: 50 ml Stored at 220c-240c Shelf life -1 day Should be ABO & Rh specific Should be irradiated to prevent GVHD Dose-10 units/day Should be administered within 12 hours.
Granulocytes
Indications• Severe neutropenia (<0.5 109/L) with
severe infections
Contraindications• Bone marrow failure• sepsis • PUO
Irradiated blood products
• Inactivate T-Lymphocytes• Prevent GVHD• Shelf life-28 days
Indications• Bone marrow/ stem cell transplant• Intrauterine transfusions• Congenital immunodeficiency syndrome• Premature newborn• Neonatal exchange transfusion-give within
24 hours.
Blood warming
• Warming is not necessary for routine transfusions.
• Warming of blood increase red cell metabolism & bacterial growth.
• Electric warmer or water bath is used to warm blood
Indication• Exchange transfusion in neonates• Presence of cold agglutinins• Rapid infusion through CVP lines
Blood Donation EmblemBlood Donation Emblem
Plasma components
Fresh Frozen plasma
Cryoprecipitate
Cryopoor plasma
Stored plasma
Fresh frozen plasma
Fresh frozen plasma
Contains• All coagulation factors
• Plasma proteins
Indications• Single clotting factor deficiency• Multiple clotting factors deficiencies-DIC
• Massive transfusions,
• Warfarine overdose
• Haemorrhagic disease of neonates
• TTP
Not recommened• Plasma volume expansion
FFP
DOSAGE• 12-15ml/kg (1unit – 200-250ml)• Must be ABO compatible• Storage temperature: <-300c• Thawed in blood bank at 370c
Thaw at 4oC & heavy spin
Fresh Frozen Plasma
Cryoprecipitate
-Refrozen within 1 hr
-Store at < - 18oC
Cryoremoved Plasma
Freeze -80oC immediately
Stored at < -18oC
Cryoprecipitate (CRYO)
I unit Contains• FVIII, FXIII, vWF,
• Fibrinogen
• I unit =15 ml• Stored at -300c
Cryoprecipitate (CRYO)
Indications• Hemophilia A• Von Willebrand’s disease• FX111 or fibrinogen deficiency
Dose• Depend on desired Factor level
• ABO compatibility
• Rate 10-15ml/min
• Transfuse immediately
Cryopoor Plasma / Cryosupernatant
Contains• Stable clotting factors• No factor 8 & fibrinogen
Indication• Replacment in plasma exchange for TTP
Stored plasma
Anticoagulant factors containing preservative solution
Contain stable clotting factorsNo labile coagulation factorsVolume: 200-250 mlShelf life-1 year
IndicationPlasma protien deficiency
ABO group selection for Plasma/FFP Transfusion
Recipient ABO
Component ABO
1st Choice 2nd Choice 3rd Choice 4thChoice
A A AB None None
B B AB None None
AB AB None None None
O O AB A B
World Blood Donor Day-June 14th
Plasma derivatives
• Factor VIII• Factor IX• Factor VIII- vWF concentrates
1. Factor VIII
Indication-
Hemophilia A
Loading dose,maintenance dose
Loading dose = desired factor VIII level –
patient’s baseline level Body weight(kg)/2
Plasma derivatives
2.Factor IX
Indication-
Hemophilia B
Loading dose + maintenance dose
Loading dose=desired factor IX level –
patient’s baseline level Body weight(kg)
Plasma derivatives
3.Factor VIII- vWF concentrates
• Indications-
• Type IIB & severe type III Von Willebrand’s disease
• Mild disease-FFP
• Moderate disease-cryoprecipitate
Plasma derivatives
Albumin
2 preparations• Human albumin solution4.5%(plasma
protein fraction)• Human albumin solution20%(salt poor
albumin)
Indications• Nephrotic syndrome• Liver disease with fluid
overload
Plasma derivatives
Immunoglobulin
Normal immunoglobulin• Prepared from normal plasma
Indications• Hypogammaglobulinaemia• Infections• Immune thrombocytopenic purpura
Specific immunoglobulins• Obtained from donors with high titres of
antibodies• Eg- anti-D, anti-hepatitis B& anti-varicella
zoster
Adverse reactions of Blood Transfusion
Classification –acute
delayed
Causes Incorrect blood component transfusion Error in collection Error in storage Error in administration of blood, Mistakes in compatibility testing, Laboratory errors
Acute Transfusion Reactions
Acute adverse reactions-<24hrs
2 types
1.Immunologic
2.Non immuologic
Immunologic Adverse reactionsHaemolytic transfusion reaction
Febrile non-hemolytic transfusion reaction
Allergic
Anaphylaxis
Transfusion related acute lungs injury (TRALI)
Acute reactions
Non immuologic acute reactions
Marked fever with shock Atypical reaction with hypotension Congestive heart failure Air embolism Hypocalcaemia Hypothermia Hypokalemia and hyperkalemia Thrombophlebitis
Delayed adverse reaction
• >24hrs
2 types
1)Immunologic reactions
2)Non immuologic reactions
Immunologic reactions• Alloimmunization to RBC,WBC,platelets,
Plasma protein&HLA• Haemolytic reactions• TA-GVHD• Post transfusion purpura
Delayed adverse reaction
Non immuologic reactions
• Iron overload• Transfusion transmitted diseases
Acute Haemolytic transfusion reaction
Etiology-ABO incompatibility
Clinical features
Symptoms
Chills
Chest pain
Back pain
Nausea, vomiting
Flushing, sweating
Pain at infusion site
Abdominal discomfort
Restlessness
Acute Haemolytic transfusion reactionSigns
Fever with rigors
Tachycardia
Dyspnoea
Tachypnoea
Pallor
Hypotension
Hemoglobinuria
Anuria / Oliguria
Cyanosis
Shock & DIC
Acute Haemolytic transfusion reaction
Lab evidence
DAT positive Indirect bilirubin increased Hemoglobinemia Hemoglobinuria
Acute Haemolytic transfusion reaction
Management Stop transfusion immediately Maintain IV access with crystalloid Maintain BP,pulse Ventilation & oxygenation IV diuretics-mannitol IV
frusemide IV bolus Send blood samples to blood bank-5ml of
plain blood & 2ml of EDTA blood FBC and blood picture Urine sample for hemoglobinuria
Acute Haemolytic transfusion reaction
If intravascular hemolysis is confirmed
• Monitor renal status• Monitor coagulation status• If hb is markedly reduced ,compatible red
cell transfusion may be required to combat hypoxemia.
• Treat DIC if it occurs
Delayed Haemolytic transfusion reaction
• 3-7 days after the transfusion• Most common in multiparous women &
mulitple transfusions.
Etiology-immunologic response to donor red
cell antigen
Delayed Haemolytic transfusion reaction
Clinical features• Fever • Jaundice• Dark coloured urine
Lab evidence• Absence of anticipated Hb or HCT• Indirect hyperbilirubinemia• DAT positive
Delayed Haemolytic transfusion reaction
Diagnosis
Presence of alloantibodies in post transfusion
sample
Treatment• Rarely necessary• Observe urine output• Transfuse of blood that lacks the
responsible antigen.• Issue medical card to these patients.
Febrile Non Haemolytic Transfusion Reaction
Etiology- Antileucocyte antibodies against donor leucocytes& cytokines from donor leucocytes
Clinical features• 1-2 hours later• Fever ,chills&rigors• Flushing• Tachycardia
Febrile Non Haemolytic Transfusion Reaction
Management
• Stop transfusion• Restart slowly• Treat with oral paracetamol• saline washed or leucoreduced cells
Transfusion tranmissible infections
Viral infections
• Hepatitis A, B, C• HTLV-1 & HTLV-2• HIV-1 & HIV-2• CMV• EBV• West Nile Virus
Prion-eg.new variant CJD
Transfusion tranmissible infections
Protozoal infections
• Trypanosoma cruzi (Chaga’s disease) • Malaria• Toxoplasmosis• Leishmaniasis
• Use HBV vaccine,prophylactic anti malarial in regularly transfused patients
Transfusion tranmissible infections
Bacterial contamination• Rare condition• Cause death• Most frequent – Yersinia enterocolitica
Causes Inappropriate storage conditios Improper blood warming Keeping blood in domestic refrigerators Delay in initiating blood transfusion Transfusion over > than 4 hours stored at room temperature-platelets Addition of any medication to blood bag.
Transfusion tranmissible infections
Bacterial contamination
Clnical featureso Fever 40 0 C o Hypotensiono Collapse shocko Abdominal cramps,nausea,vomitingo DICo Hemoglobinuriao Intravascular hemolysiso Renal failure
Transfusion tranmissible infections
Bacterial contamination
Clinical features• Fever 40 0 C with rigor immediately
after transfusion• Hypotension,collapse ,Shock• Abdominal cramps,nausea,vomiting• DIC,haemoglobinuria,renal failure
Transfusion tranmissible infections
Bacterial contamination
Management
• Stop transfusion• Inspect blood bag for signs of bacterial
overgrowth.• Send sample for smear +culture• Treat the infection
Transfusion associated graft versus host disease
Etiology- engrafment of transfused functional
lymphocytes
Mortality>90-99%
10-12 day after transfusion
Clinical features• Jaundice & elevated
liver enzyme• Erythroderma• Diarrhoea• Pancytopenia
Skin manifestation of GVHD Generalized swelling, erythroderma and bullous formation
Transfuion associated graft versus host disease
Investigations
• Skin biopsy• HLA typing
Patients at risk
• All newborn & premature babies• Leukemia• All immunocompromised patients
Transfusion-Related Acute Lung Injury (TRALI)
Etiologyo Antibodies to leucocytes or complemento Within 4 hours
Clinical featureso Marked respiratory distresso Hypoxiao Hypotensiono Fevero Bilateral pulmonary infiltrateso Normal CVP
Transfusion-Related Acute Lung Injury (TRALI)
a b
(a)Bilateral patchy alveolar infiltrate in TRAL (b) Complete resolution
TRALI
Treatment
• High dose steroids -methyl prednisolone 1g IV bolus
• Ventilator support/ Oxygenation
Prevention
• Avoid use of plasma from multiparous females
• Use washed RBC• Use leucocyte filters
Post transfusion purpura
Etiology• Antiplatelet antibodies• 5-10 days after infusion
Clinical features• Acute severe thrombocytopenia in a
multiparous female or multiply transfused person
Post transfusion purpura
• Self limited recovery in 21 days
Treatment• IV immunoglobulin 2g/kg over 2-5 days• If not available-steroids or plasma
exchange
Prevention• Use leucodepleted components
Allergic urticarial reaction
Etiology• Antibodies to plasma protein
Clinical features• Itching• Urticaria• Rash• Flushing• Wheezing
Allergic urticarial reaction
Treatment
• Transfusion can be continued• IV chlorpheniramine 10mg
Prevention
• If there is previous allergic reaction-give prophylaxis
• Use saline washed red cells
Anaphylactic reactions
Etiology- antibodies to IgA in transfused
blood• Occurs after infusion of few mls of blood
in IgA deficient patient
Clinical features• Tachycardia• Abdominal cramps• Diarrhoea• Loss of consciousness• Hypothermia,hypotension,shock• Absence of fever differentiates it from
other reactions.
Anaphylactic reactions
Treatment
• Stop transfusion• Start IV crystalloids• Give oxygen• Give chlorpheniramine 10mg slowly IV• Hydrocortisone 100-200 mg IV• Salbutamol nebulizer• If anaphylactic shock-give adrenaline
1:1000 solution 0.5ml IM• Send sample for IgA level• Use saline washed red cells
Iron overload
• Due to life long monthly transfusions
• In β thalassemia major
It results
• Cardiac failure
• Cardiomyopathy
• Liver cirrhosis
• Diabetes
• Delayed growth & sexual maturation
• Hyperpigmentation of skin
Guidelines for Clinical transfusion practices
• Record the reason for transfusion• Get the consent form signed by the patient.• Select the blood product & quantity to be transfused.• Fill the blood request form• Send 5ml recipient’s blood sample with the form.• Blood bank laboratory performs antibody screen &
compatibility test.• Check patient’s details with cross
match report from blood bank.• start administration of blood
within ½ hour of issue from blood bank.
Guidelines for Clinical transfusion practices
• Record date & time of beginning &
termination of blood transfusion.• Use 23G needle to transfusion.• Check for air bubbles in transfusion line.• Hands should be washed.• Chamber half fill.• Monitor patient’s pulse,BP& temperature
prior to initiation & during blood transfusion.
Guidelines for Clinical transfusion practices
• Observe the patient throughout transfusion.
• The first 30 minutes are crucial.• Monitor patients condition at the end of
blood transfusion.• Return transfusion record
form to the blood bank.• Observe the patient for 1 hour. • Monitor the post transfusion effects.• Dispose the blood bag with other
biohazard waste in the ward.
Don’ts for Blood Transfusion• Don’t use blood without mandatory screening
test.• Don’t delay initiation of blood transfusion.• Don’t warm blood without proper monitoring.• Don’t transfuse 1 unit over more than 4 hours.• Don’t use 1 transfusion set for >4 hours or >2
units of blood.• Don’t leave patients unmonitored.• Don’t add any medication to blood bags.• Don’t forget to return unused blood to the blood
bank for safe disposal.• Don’t store platelets in a refrigerator.
Thank You