module 1: the journey of blood: donation to distribution transfusion training workshop kkm 2012
TRANSCRIPT
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Module 1: The Journey of Blood: Donation to Distribution
Transfusion Training WorkshopKKM 2012
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The journey
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Donors
Voluntary, non-remunerated
We advocate self-deferral
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Donate
At blood collection centers/blood drives
Donate whole bloodor
Donate platelet only / plasma only
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Transportation
The donated blood is quickly transported to the blood bank
Whole blood is kept at RT before processing
The cold chain is maintained throughout
Blood is labeled as UNSCREENED and quarantined until virology results are obtained
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Testing Screening for infectious diseases:
HBV, HCV, HIV, Syphilis Newly emerging viruses ? Bacteria, parasites, fungi ?
If all the tests are negative the blood is labeled SCREENED
If either one of the tests are positive, the blood is pulled out of stock and discarded
The blood donor will be called back for counseling and further testing
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Different Components
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Blood Components
Prepared from whole blood donation
Blood components derived from plasma Fresh Frozen Plasma (FFP) Cryoprecipitate Cryosupernatant Plasma-derived fractionated products
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Fresh Whole Blood
Efficacy based on the minimal time from donation to administration
“Freshness” is different among collection centers
Fresh WB is defined as <7 days old
It has a haematocrit level of 30 – 40%
Storage: 2 – 6°C (4±2°C)
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Fresh Whole Blood
Constituents Coagulation factors: all present, but rapid
reduction in FV, FVIII (labile factors) Platelets: as WB is cold-stored, platelets do
not circulate; do not arrest bleeding Storage lesions
Most indications for WB are now well managed with blood component therapy
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Packed Red Cells
Prepared by removing most of the plasma from the unit
It has a haematocrit level of 55 – 65%
Storage: 2 – 6°C (4±2°C)
Shelf life: 42 days (max)
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Packed Red Cells
Red cells are the preferred product for patients with symptomatic anaemia
Restore/ improve oxygen-carrying capacity
2,3-diphosphoglycerate (DPG) necessary to allow oxygen release to tissues
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Fresh Frozen Plasma (FFP)
Storage at -20°C
Prepared within 6 hrs of WB collection
ABO compatible and crossmatching not required
Contents : all coagulation factors, no platelet
Use: to replace all coagulation factor deficiencies
Thawed in 37°C water bath in the BB
Administer within 30 min after thawing (activity of labile FV, FVIII is rapidly lost)
Increase factor levels 20 – 30% per dose of 10 – 15 ml/kg BW
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Cryoprecipitate
Prepared from FFP – 10 – 20 ml
Dosage: 1 unit/10 kg
ABO compatible and crossmatching not required
Contents: Fibrinogen, FVIII, FXIII and vWF
Indications: Correction of fibrinogen
deficiency (DIC) Correction of factor XIII
deficiency
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Liver Plasma / Cryosupernatant
Contents : plasma- stable clotting factors, no platelet
Storage temperature : frozen -20oC or colder
Indications: Plasma exchange
eg. in TTP Should not be used
for blood volume expansion or protein replacement
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Platelets
Platelets Random Apheresis
Kept at RT 22 – 24°C and constantly agitated
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Distribution: blood components will be supplied to hospitalsBased on:
Average daily usage: to avoid expiry / wastage Patient load Special circumstances: patient with massive bleeding, natural disaster
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What happens in the blood transfusion unit?
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Pre-transfusion Compatibility Testing Positive recipient
identification: blood request form and blood samples
Clerical check: manual or computerized
Every patient, every time
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Process Blood Sample
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Serological Tests
1. Blood grouping
ABO testing Rh testing
2. Rh negative: additional testing is performed
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Serological Testing
3. Antibody screening to detect presence of
clinically significant unexpected alloantibodies
all positive screening must be investigated regardless of whether transfusion is needed
4. Antibody identification laborious, time-consuming
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Pre-transfusion Compatibility TestingCross-match testing:
Serologic cross-match
Immediate spin/RT LISS 37°C AHG
Estimated 20-25minutes
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Pre-transfusion Compatibility Testing Selection and issuance of suitable
blood/ blood components ABO and Rh type Rare blood: liaise with hospital BB, PDN Specifications: filtered blood, irradiated
blood, exchange transfusion
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Pre-transfusion Compatibility Testing Group, screen and
hold (GSH)1. Positive recipient i/d
2. ABO, Rh grouping
3. Rh negative
4. Antibody screen
5. Antibody identification
Group and cross-match (GXM)
Conversion of GSH (steps 1 – 5)
6. Serologic cross-match Immediate spin/RT LISS 37 AHG
7. Blood issued
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The end