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7/30/2019 3. Transfusion Medicine
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TransfusionMedicine
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Lecture Overview
Background
Blood collection
Blood component manufacture
Pre-transfusion testing
Transfusion administration Transfusion reaction
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Background
Multidisciplinary specialty:
Blood donation
Blood component preparation
Blood cell serology
Blood transfusion therapy
Transfusion medicine (operationally):
Blood Center
Transfusion services Hospital Blood Bank
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Transfusion
Donor
Blood/blood
component
Recipient
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Blood Collection
Donor criteria established to protect donor &
recipient.
Collection in a manner to minimize the risk ofbacterial infection.
The rate of blood flow must be sufficient enough
to prevent blood clot during phlebotomy. Volume of blood withdrawn
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Phlebotomy :
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Requirements of Allogeneic Donor Qualification
Category Criteria
Age > 17 years
Blood Pressure < 180 mmHg systolic; < 100 mmHg diastolic
Pulse 50-100/min, w.o pathologic irregularities
Temperature < 37oC
Hemoglobin > 12.5 g/dL
General medical history Free of major organ disease, cancer, abnormal bleeding
tendency
Pregnancy Defer for 6 months
Recipient of blood transf/tissuetransplant
Defer for 12 months
Vaccination ?
Infectious disease ?
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DONOR
Registration
Selection :
Might the procedure be harmful to the
donor ? Might the donors blood be a risk to the
recipient ?
Medical History/limited physicalexamination (miniphysical)performed on the day of donation.
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Donor reaction :
Informed consent
Risks of procedure :
Vasovagal reaction
Hematoma
Tests to be performed on the donors
blood
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Blood
Proper
identification
Removed Processing
/test
Storage
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Blood Component Manufacture
1. RBC
2. Plasma3. Cryoprecipitated AHF
4. Platelet Concentrate
5. Leukocyte Component6. Leukocyte-Reduced Blood Component
Whole blood donation component
Special component; Pathogen reduction
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Preparation of blood components
Prepared from whole blood
using large refrigerated centrifuges
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Whole Blood
PRC Plasma
FFP
Cryoprecipitate
WRC
PRCPRP
PC
Blood components
Blood derivates
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RBC
Removal of plasma by centrifugation
Anticoagulant: CPDA-1 (+dextrose
& adenine to preserve RBC ATP
level)
Store up 35 days at 1-6 C
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Biochemical changes during liquid
storage
pH drops
2,3-DPG decrease
Plasma potassium rises
Plasma sodium decrease
Plasma hemoglobin increase
Greatest concern during massive &
neonatal transfusion
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Plasma
In liquid state storedin 1-6 C loss labile clotfactor (FV & F VIII)
Frozen for extended
preservation -18oCFresh Frozen Plasma
(FFP) thawed at 37 C
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Cryoprecipitated AHF
Cold insoluble portion of plasma
remaining after FFP thawed at
refrigerator temperature.
Contain:
Approx 50% of FVIII (80 IU)
20-40% fibrinogen
Von Willebrand factor
F XIII
Treatment for Hemophilia
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Platelet Concentrate
Contain at least 5.5 X 10.10
platelet/unit (produced by
apheresis 3 X 10.11)
Store at room temp (20-24 C)agitation up to 5 days
Contain:
Small amount of red cell
30-50 ml plasma
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Leukocyte Component
Granulocyte:
Prepared by apheresis
Store at room temp 24 hrs.
Better given soon after collected
Mononuclear cells:
Apheresis
Source of hematopoietic progenitor
cells (HPCs) for autologous/allergenic
transplantation.
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Leukocyte-Reduced Blood Component
Leukocyte in PRC/PC cause
adverse effects (febrile nonhemolytic
transfusion reaction, immunization to
leukocyte antigens)
Universal leukocyte reduction:
< 5 X 10.6/unit RBC
< 8.3 X 10.5/unit WB
Filtration
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Pre transfusion testing :
General consideration
Antibody screen
Crossmatch
Selection of units
Interpretation of compatibility testing
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Blood Processing Tests
ABO and Rh typing
Antibody testing (red cell antibodies)*
Transfusion-Transmitted Diseases :
HIV
Hepatitis B (HBsAg)
Hepatitis C (HCV)
Syphillis (VDRL)
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Transfusion reactions
Non hemolyticTransfusion reactions
Hemolytic Transfusion reactions
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Non hemolyticTransfusion reactions
Febrile non hemolytic t.r
Allergic reaction
Anaphylactic reaction
Bacterial contamination
Circulatory overload
Transfusion-Related Lung Injury
Post Transfusion Purpura
Hemosiderosis
Graft-versus-Host disease
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HemolyticTransfusion reactions
Acute non immune hemolytic t.r
Acute immune hemolysis t.r
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Alternatives to blood transfusion
Hemopoietic Growth Factors &
Cytokines :
Erythropoietin, interleukin
Substituted for RBC and platelet:
RBC : perfluorocarbons, polymerized
hemoglobin solution
Platelet : HLA-stripped platelet, liquidCold stored platelet
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Hemapheresis
Process of removing normal or
abnormal blood constituents from
circulating blood.
Divided into :
Cytapheresis (removal of the cellular
component)
Plasmapheresis (removal of the plasmafraction)
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Hemapheresis
machine
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Donor/patient complications common
to all hemapheresis procedures :
Citrate reactions
Allergic, anaphylactoid, anaphylactic
reactions
Angiotensin Converting Enzyme inhibitors Hypovolemia and vasovagal reactions
Hydroxyethyl starch and coagulopathy
Air Embolus
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Blood Banking
Tissue Banking
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Tissue Bank & Progenitor Cells
The products of tissue bank :
Extend life
Improve the quality of life
Clinical applications of allogeneic
tissue and the types of tissue
available grown exponentially in
the last 2 decade.
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Sources of Tissue
Living donors : Individuals who donate for their own use
(autologous HPCs)
Directed donors for a given individual (sperm
donation) Altruistically for unknown recipients (surgical
discard bone or sperm donation)
Cadaveric donors :
- bone, skin, cardiac valves, eye tissue- obtained several24 hours after death (if the
body refrigerated)
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Tissue Bank Activities :
Donor screening :To ensure the quality of the tisuue
obtained (bacterial,viral,genetic disease)
Cryopreservation :To extend the usable storage period of
the material being frozen by reducingthe metabolic demand of the cells at the
lower temperatures without any loss ofviability due to either the freezing orthawing procedures.
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Tissue Bank :
Skin tissue
Musculoskeletal tissue
Cardiac valves
Cornea
Reproductive tissue
Hematopoietic Progenitor Cell (HPC)
Bone marrow Peripheral blood progenitor cells
Umbilical cord blood
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WHO : Blood is R E D
R
E
D
are
expensive
angerous