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Blood HO Training Module
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Rational Use of Blood Rational Use of Blood and Blood Productsand Blood Products
Blood - specialized bodily fluid delivers nutrients/oxygen to cellstransports waste products away
Medical terms related to blood often begin with haemo- or haemato (from the Ancient Greek word αἷμα (haima) for "blood").Considered a specialized form of connective tissue, given its origin in the bones Presence of potential molecular fibers in the form of fibrinogen.
BloodBlood
In vertebrates, it is composed of blood cells (RBC, WBC, Platelets) suspended in a liquid called blood plasma. Plasma, which comprises 55% of blood fluid, is mostly water (90% by volume)Contains
dissolved proteinsglucosemineral ionshormonescarbon dioxide (main medium for excretion
BloodBlood
a - erythrocytesb - neutrophilc - eosinophil
d - lymphocyte
Types of Blood ProductsWhole BloodPacked CellsWhite CellsPlateletsFresh Frozen PlasmaCryoprecipitateOther Components
Whole BloodWhole BloodContentsContents
RBC’sRBC’sWBC’sWBC’sPlateletsPlateletsPlasmaPlasmaClotting factors depending on storage Clotting factors depending on storage timetime
Whole BloodAll around the world, most countries have stopped giving whole Blood to the patients for the following reasons:
More likely carrier of diseasesFrequency of serious shortages of blood, it is considered imprudent to use whole Blood
Most patients require only one particular component.
Better patient management by giving only the necessary component
Utilizing normal Blood storage techniques, Blood products have a greater shelf life than whole Blood;Blood filtration and other techniques help to make Blood saferBlood products can often be infused regardless of ABO Blood group.
Packed CellsPacked CellsObtained by spinning down whole bloodObtained by spinning down whole bloodContentsContents
RBC’sRBC’s20% Plasma20% Plasma
IndicationsIndicationsReplace Hb and OReplace Hb and O22 carrying capacity with carrying capacity with less volume usually for Hb<7gless volume usually for Hb<7gSevere anemia, blood loss, CHFSevere anemia, blood loss, CHF
Packed Cells
Preferred choice for correcting Anemia and even correcting acute blood lossLeuco-depleted packed cells are becoming common to reduce risk of complications - Infective risk for CJD and also immune complications
PlateletsPlateletsContentsContents
PlateletsPlateletsWBC’sWBC’sPlasmaPlasma
IndicationsIndicationsLow platelet counts <20,000 but if Low platelet counts <20,000 but if patient bleeding, can transfuse at higher patient bleeding, can transfuse at higher valuesvalues
PlateletsPlatelets - essential for the coagulation of BloodPlatelets - stored at room temperature. Heat or cold storage will render platelets inactive. Require continuous gentle agitation.Can be stored at the Blood center for up to five days. When received for transfusion, both pooled and apheresis platelets will expire in less than four hours.
Effect of Platelet Product and Patient Weight on Platelet Increment
Patient weight (in kg) 20 45 70 90
Single whole Blood platelet concentrate
17,600 8,800 5,900 4,400
Standard apheresis of four pooled whole Blood
platelets
70,400 35,200 23,500 17,600
Large apheresis or six pooled
whole Blood platelets
105,600 52,800 35,200 26,400
GranulocytesGranulocytesContentsContents
WBC’sWBC’s20% Plasma20% Plasma
IndicationsIndicationsLife-threatening decreases in WBC countLife-threatening decreases in WBC countNot Practiced in MalaysiaNot Practiced in Malaysia
Fresh Frozen PlasmaFresh Frozen PlasmaContentsContents
Complete profile of Clotting factorsComplete profile of Clotting factorsFibrinogenFibrinogenProthrombinProthrombinAlbuminAlbuminGlobulinsGlobulins
Fresh Frozen PlasmaFresh Frozen PlasmaIndicationsIndications
Clotting factor deficiencyClotting factor deficiency1 ml of FFP per Kg pt weight will 1 ml of FFP per Kg pt weight will increase clotting factors by around 1%increase clotting factors by around 1%
DIVCDIVCVolume expansion - superceded by other Volume expansion - superceded by other colloids eg gelatin/starchcolloids eg gelatin/starch
CryoprecipitateCryoprecipitateContentsContents
Factors VIII and XIII, FibrinogenFactors VIII and XIII, FibrinogenIndicationsIndications
Hemophilia AHemophilia AFibrinogen deficiencyFibrinogen deficiencyFactor XIII deficiencyFactor XIII deficiency
CryoprecipitateCryoprecipitateContentsContents
Factors VIII and XIII, FibrinogenFactors VIII and XIII, FibrinogenIndicationsIndications
Hemophilia AHemophilia AFibrinogen deficiencyFibrinogen deficiencyFactor XIII deficiencyFactor XIII deficiencyDIVCDIVC
Other FactorsOther Factors
Factors II, VII, IX, and XFactors II, VII, IX, and XIndicationsIndications
Hemophilia BHemophilia BLiver diseaseLiver diseaseBleeding tendenciesBleeding tendencies
BLOOD COMPONENT CONTENTS VOLUME SHELF LIFE**Red cells (AS-1) RBC w/ appx. 25 mL of plasma; 100 mL
of saline; additive solution (adenine, mannitol). Hct 60%
340 mL 42 days 4o C
Platelet concentrate Platelets; includes some WBC; 50 mL of plasma, a few RBC (Hct less than .005)
50 mL 5 days 20o C
Platelet apheretic Platelets; includes some WBC; 300 mL of plasma; a few RBC
300 mL 5 days 200 C
Fresh frozen plasma Plasma proteins, all coagulation factors, complement
225 mL 1 year 18o C
Cryoprecipitate 150 mg of fibrinogen, at least 80 units of factor VIII, von Willebrand factor, factor XIII, fibronectin
15 mL 1 year 18o C
Blood TransfusionBlood TransfusionBlood must be typed prior to administration Blood must be typed prior to administration ABO AntigensABO Antigens
A Antigen A Antigen Type AType AB Antigens B Antigens Type BType BA and B Antigens A and B Antigens Type ABType ABNo Antigens No Antigens Type OType O
Blood TransfusionsBlood TransfusionsPlasma Antibodies Agglutinate (Clump) Plasma Antibodies Agglutinate (Clump) Cells of other Types Cells of other Types Type A = B Antibodies Type A = B Antibodies
(Clumps B or AB)(Clumps B or AB)Type B = A AntibodiesType B = A Antibodies
(Clumps A or AB)(Clumps A or AB)
Blood TransfusionsBlood Transfusions
Type AB = No AntibodiesType AB = No Antibodies(Clumps Nothing)(Clumps Nothing)
Type O = A and B AntibodiesType O = A and B Antibodies(Clumps everything except O)(Clumps everything except O)
Blood TransfusionsBlood Transfusions
O Negative = Universal DonorO Negative = Universal DonorAB Positive = Universal RecipientAB Positive = Universal Recipient
Blood TransfusionsBlood TransfusionsRh FactorRh Factor
85% of Population85% of PopulationRh PositiveRh Positive
15% of Population15% of PopulationRh NegativeRh Negative
Rh Negative patients produce Rh Rh Negative patients produce Rh antibodies only if exposed to Rh Positive antibodies only if exposed to Rh Positive bloodblood
Blood TransfusionsBlood Transfusions
Erythroblastosis FetalisErythroblastosis FetalisRh Negative mother exposed to Rh Rh Negative mother exposed to Rh Positive fetal blood during deliveryPositive fetal blood during deliveryMother produces Rh AntibodiesMother produces Rh AntibodiesAntibodies cross placenta during Antibodies cross placenta during subsequent pregnancysubsequent pregnancyFetal blood hemolysesFetal blood hemolyses
Blood TransfusionsBlood Transfusions
Erythroblastosis FetalisErythroblastosis FetalisPrevented by administration of Rhogam Prevented by administration of Rhogam to motherto mother
Transfusion Transfusion ComplicationsComplications
FeverFeverMost common reactionMost common reactionDonor WBC incompatibilitiesDonor WBC incompatibilitiesManagement : Management :
Stop transfusion if severeStop transfusion if severeAntipyretics if mildAntipyretics if mild
Allergic ReactionsAllergic ReactionsSigns/SymptomsSigns/Symptoms
ItchingItching
UrticariaUrticaria
ChillsChills
FeverFever
Facial edemaFacial edema
WheezingWheezing
Anaphylactic shockAnaphylactic shock
Allergic ReactionsAllergic ReactionsManagementManagement
OxygenOxygenIV fluidsIV fluidsEpinephrineEpinephrineAntihistaminesAntihistamines
Hemolytic ReactionHemolytic ReactionChills, feverChills, fever
Low back painLow back pain
HeadacheHeadache
Chest painChest pain
DyspneaDyspnea
CyanosisCyanosis
Restlessness, anxiety Restlessness, anxiety
HypotensionHypotension
Red urineRed urine
Hemolytic ReactionHemolytic ReactionManagementManagement
Stop transfusionStop transfusionTreat shockTreat shockVolume replacementVolume replacementMannitolMannitolSend blood from patient and bag to blood Send blood from patient and bag to blood bank for checkingbank for checking
Volume OverloadVolume OverloadSigns/SymptomsSigns/Symptoms
CoughCough
Chest painChest pain
DyspneaDyspnea
Distended neck veinsDistended neck veins
Coarse crepsCoarse creps
Frothy sputumFrothy sputum
Volume OverloadVolume Overload
ManagementManagementSlow infusionSlow infusionDiureticsDiureticsVasodilatorsVasodilators
Massive Transfusion Massive Transfusion ComplicationsComplications
Coagulation DisturbancesCoagulation DisturbancesPlatelet/Clotting factor deteriorationPlatelet/Clotting factor deterioration
Citrate IntoxicationCitrate IntoxicationHypocalcemiaHypocalcemiaMetabolic AlkalosisMetabolic Alkalosis
HyperkalemiaHyperkalemiaRBC’s Lyse/Release KRBC’s Lyse/Release K++
Transfusion Transfusion ComplicationsComplications
Acid/Base ImbalancesAcid/Base ImbalancesBanked blood gradually acidifiesBanked blood gradually acidifies
Poor tissue OxygenationPoor tissue OxygenationLoss of 2,3 DPGLoss of 2,3 DPG
Transfusion Transfusion ComplicationsComplications
HypothermiaHypothermiaInadequate warming during transfusionInadequate warming during transfusion
Viral HepatitisViral HepatitisRisk rises with each unitRisk rises with each unit
Blood Blood TransfusionTransfusion
IV catheter 18g or largerIV catheter 18g or largerNo fluid other than salineNo fluid other than saline
DD55W lyses RBC’sW lyses RBC’s
RL contains calcium/triggers clottingRL contains calcium/triggers clottingTwoTwo persons confirm ABO/Rh persons confirm ABO/RhBlood filter in administration setBlood filter in administration set
Blood Blood TransfusionTransfusion
Infusion pumpsInfusion pumpsExcessive pressure can cause hemolysisExcessive pressure can cause hemolysis
Rewarming above 38Rewarming above 3800C can cause C can cause hemolysishemolysisNeverNever add medications directly add medications directly
Blood and Products
Blood should be used responsibly and carefullyAppropriately used can save livesOver transfusion and wrong use is a waste of resources and put patients at risk of complicationsAlways consult if unsure of indication