Blood and Blood Product Transfusion

8/9/2019 Blood and Blood Product Transfusion

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Blood and BloodBlood and Blood

Product TransfusionProduct TransfusionKyi Than OoKyi Than Oo

FRCS (Glasg)FRCS (Glasg)Associate ProfessorAssociate Professor


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Types of blood transfusionTypes of blood transfusion

Heterologous (Different species)Heterologous (Different species)

Homologous (Same species)Homologous (Same species)

Autologous (Same person)Autologous (Same person)


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Composition of bloodComposition of blood

Red Blood cells + PlasmaRed Blood cells + Plasma

Plasma containsPlasma contains

--white blood cells,white blood cells,--platelets, fibrinogen,platelets, fibrinogen,

--all the clotting factors,all the clotting factors,

--proteins like albumin.proteins like albumin.


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Blood products available..Blood products available..

Whole bloodWhole blood

Packed cells ( RBCs)Packed cells ( RBCs)

Platelet concentratePlatelet concentrate Fresh frozen plasmaFresh frozen plasma

CryoprecipitateCryoprecipitate

Factor VIII, factor IX concentrates, fibrinogenFactor VIII, factor IX concentrates, fibrinogen

OthersOthers-- Granulocytes, washed RBCS,Granulocytes, washed RBCS,leukoreduced RBCs, SAGleukoreduced RBCs, SAG--M blood, humanM blood, humanalbuminalbumin


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Plasma fractionsPlasma fractionsBlood componentsBlood componentsWholeWhole

bloodblood

CryopreciCryopreci

pitatepitate

FreshFresh

FrozrnFrozrnPlasmaPlasma

plateletsplateletsPackedPacked

red cellsred cells

FreshFresh

oldold

Clotting factorClotting factor

concentratesconcentrates

ImmunoglobulinImmunoglobulin

preparationspreparationsSaline albuminSaline albumin

solutionsolution

SaltSalt--poorpoor

albuminalbumin

whenwhenfibrinogenfibrinogenlevel is lesslevel is less

than 80than 80--100mg/dl100mg/dl

Initially a tx for VWInitially a tx for VWDz, HemophiliaDz, Hemophilia

Now a source ofNow a source offibrinogen in obstetricfibrinogen in obstetricemergenciesemergencies

when PT &when PT &

PTT arePTT arehigher thanhigher than

1.5 times1.5 timescontrolcontrollevelslevels

All clotting factors;All clotting factors;

no plateletsno platelets

Can supplementCan supplement

RBCs when wholeRBCs when whole

blood not availableblood not available

for exchangefor exchange

transfusiontransfusion

when platelet.when platelet.count lesscount lessthanthan50000/cmm50000/cmm

or whenor whenmassive bloodmassive bloodloss orloss orreplacementreplacementhas occurredhas occurred

--WashedWashed

RBCsRBCsPts with allergicPts with allergicreactions toreactions to

plasma proteinsplasma proteins

--LeukoLeuko--

poorpoor

RBCsRBCsPts with febrile,Pts with febrile,nonnon--hemolytichemolyticreactions toreactions to

plasma WBCsplasma WBCs

assiveassive

aemorrhagaemorrhag

ajor liverajor liver

aumaauma

leedingleeding

ssociatedssociated

ith liverith liver

iseaseisease

Clotting disordersClotting disorders

HaemophiliaHaemophilia

Liver diseaseLiver disease

dose: 1dose: 1-- 1.51.5--2 packs/2 packs/10 kg10 kg

(8(8--1010

packs)packs)

normalnormal

dose: 12dose: 12 --

15ml/ kg15ml/ kg

(4(4--5packs)5packs)

PlateletPlateletconcentratesconcentrates

(1(1pack/10kg)pack/10kg)

dose : 6unitsdose : 6units


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Why blood transfusion ? (Indication)Why blood transfusion ? (Indication)

SevereSevere blood lossblood loss following traumafollowing trauma or from anyor from anypathology e.g. GI bleedpathology e.g. GI bleed

DuringDuringmajor operativemajor operative procedures e.g. APR ,procedures e.g. APR ,

cardiovascular surgery etc.cardiovascular surgery etc. PostoperativelyPostoperativelyin a patient who has become severelyin a patient who has become severely

anemic.anemic.

FollowingFollowingsevere burnssevere burns (hemolysis)(hemolysis)

PreoperativelyPreoperativelyin pts of chronic anemia who requirein pts of chronic anemia who requireurgent surgery.urgent surgery.

Pts withPts with hemorrhagic diseasehemorrhagic disease e.g.e.g. hemophilia,hemophilia,thrombocytopenia, liver disease etc.thrombocytopenia, liver disease etc.


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Whole bloodWhole blood

Collected from a healthy and fit donorCollected from a healthy and fit donor

410 ml410 ml of blood is collected into a bagof blood is collected into a bag

containing 75 ml of CPDA (anticoagulant)containing 75 ml of CPDA (anticoagulant) Stored at 4Stored at 4CC 22C for up to 3C for up to 3--5 wks5 wks

(CPDA(CPDA 5 wks)5 wks)

UsesUses freshfresh blood is used for resuscitation inblood is used for resuscitation ina pt witha pt with severe acutesevere acute blood lossblood loss


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Changes in stored bloodChanges in stored blood

White blood cellsWhite blood cells are rapidlyare rapidlydestroyeddestroyed..

PlateletsPlatelets are functional only up toare functional only up to 24 hours24 hours

( due to cold temperature).( due to cold temperature). Clotting factorsClotting factorsVIII and V are labile and theirVIII and V are labile and their

levels fall rapidly afterlevels fall rapidly after 7 days7 days..

2,3 DPG level is decreased2,3 DPG level is decreased causing reducedcausing reducedoxygen release into tissues.oxygen release into tissues.

HigherHigher temptemp can lead to transmission ofcan lead to transmission ofinfections.infections.


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Plasma fractionsPlasma fractionsBlood componentsBlood components

CryoprecCryoprec

ipitateipitate

FreshFresh

FrozrnFrozrn

PlasmaPlasma

plateletsplateletsPacked red cellsPacked red cells

Clotting factorClotting factor

concentratesconcentrates

ImmunoglobuliImmunoglobulin preparationsn preparations

Saline albuminSaline albuminsolutionsolution

SaltSalt--poorpoor

albuminalbumin

whenwhenfibrinogenfibrinogen

level islevel isless thanless than

8080--

100mg/dl100mg/dlInitially a tx for VWInitially a tx for VWDz, HemophiliaDz, Hemophilia

Now a source ofNow a source offibrinogen infibrinogen inobstetricobstetricemergenciesemergencies

when PT &when PT &

PTT arePTT arehigher thanhigher than

1.5 times1.5 times

controlcontrollevelslevels

All clotting factors;All clotting factors;

no plateletsno platelets

Can supplementCan supplement

RBCs when wholeRBCs when whole

blood not availableblood not available

for exchangefor exchange

transfusiontransfusion

when platelet.when platelet.count lesscount lessthanthan50000/cmm50000/cmm

or whenor when

massive bloodmassive bloodloss orloss orreplacementreplacementhas occurredhas occurred

--Washed RBCsWashed RBCsPts with allergic reactions to plasmaPts with allergic reactions to plasma

proteinsproteins

--LeukoLeuko--poorpoor

RBCsRBCsPts with febrile, nonPts with febrile, non--hemolytichemolytic

reactions to plasma WBCsreactions to plasma WBCs

Clotting disordersClotting disorders

HaemophiliaHaemophiliaLiver diseaseLiver disease

dose: 1dose: 1--

1.51.5 --22packs/ 10packs/ 10kgkg

(8(8--1010packs)packs)

normalnormal

dose: 12dose: 12 --15ml/ kg15ml/ kg

(4(4--5packs)5packs)

PlateletPlatelet

concentratesconcentrates(1(1

pack/10kg)pack/10kg)

dose : 6unitsdose : 6units


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Packed red cellsPacked red cells

Obtained by centrifuging whole blood at 2000Obtained by centrifuging whole blood at 2000--2300 g for 152300 g for 15--20 minutes and then removing the20 minutes and then removing theplasma.plasma.

Contains aboutContains about 180 cc of RBCs + 30 cc of180 cc of RBCs + 30 cc ofplasmaplasma.( Total volume.( Total volume 200200--250 cc).250 cc).

HematocritHematocrit about 70about 70--80 %80 %

Solutions like ASSolutions like AS--1, AS1, AS--5, optisol etc is added5, optisol etc is added

No viable WBCsNo viable WBCs, platelets or clotting factors., platelets or clotting factors.

UsesUses-- chronic anemia, elderly, children, derangedchronic anemia, elderly, children, derangedcardiaccardiac function.function.


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Red blood cellsRed blood cells


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Other RBC products..Other RBC products..

Washed red blood cellsWashed red blood cells PC are washed withPC are washed withsaline to remove the plasma and proteins;saline to remove the plasma and proteins;reduces transfusion reactions.reduces transfusion reactions.

LeukocyteLeukocyte--reduced red blood cellsreduced red blood cells-- WBCs areWBCs areremoved using filters; reduces incidence of nonremoved using filters; reduces incidence of non--hemolytic febrile reactions.hemolytic febrile reactions.

Pediatric/ divided RBC unitsPediatric/ divided RBC units-- smaller units aresmaller units areprepared, each containing 45prepared, each containing 45--50 cc of RBCs and50 cc of RBCs and15 cc of plasma.15 cc of plasma.


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Complications of bloodComplications of blood

transfusiontransfusionTransfusion reactionsTransfusion reactions incompatibility,incompatibility, allergicallergic

reactions, simple pyrexial reactions, sensitization toreactions, simple pyrexial reactions, sensitization toleucocytes and platelets, immunologicalleucocytes and platelets, immunologicalsensitization.sensitization.

InfectionsInfections-- HIV, hepatitis,HIV, hepatitis, bacterial infections,bacterial infections,malaria.malaria.

CongestiveCongestive cardiaccardiac failurefailure

ThrombophlebitisThrombophlebitisAir embolismAir embolism

Coagulation failureCoagulation failure Disseminated intravascular coagulationDisseminated intravascular coagulation (DIC)(DIC)


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Complications of blood transfusionComplications of blood transfusion

Metabolic complicationsMetabolic complicationsHyperkalaemiaHyperkalaemia

Citrate toxicity & hypocalcaemiaCitrate toxicity & hypocalcaemia

Release of vasoactive peptidesRelease of vasoactive peptides

HaemosiderosisHaemosiderosis

(After repeated transfusion in patients with(After repeated transfusion in patients withhaematological diseases)haematological diseases)

ImmunologicalImmunological

Reduction of immunityReduction of immunity


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Volume expandersVolume expandersWhen a patient has lost a lot of body fluids but does not needWhen a patient has lost a lot of body fluids but does not need

red blood cells or other specific blood components,red blood cells or other specific blood components,volume expanders may be given to prevent or treat shockvolume expanders may be given to prevent or treat shock

caused by fluid losscaused by fluid loss..O

therO

therThe most commonThe most commonColloidsColloidsCrystalloidsCrystalloids

solutions that contain largesolutions that contain large

molecular weight that do notmolecular weight that do not

readily cross capillary wallsreadily cross capillary walls

solutions that containsolutions that containsodiumsodium

purifiedpurifiedproteinprotein

fractionsfractions

dextransdextranshydroxyethydroxyethyl starchhyl starch

(HES),(HES),

albuminalbuminlactatedlactatedRingersRingers

normalnormalsalinesaline


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Blood and Blood Product Transfusion