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Blood Component Therapy Slide 1 Blood Component Therapy Slide 2 Blood Component Therapy Slide 3 Blood Component Therapy Slide 4 Blood Component Therapy Slide 5 Blood Component Therapy Slide 6 Blood Component Therapy Slide 7 Blood Component Therapy Slide 8 Blood Component Therapy Slide 9 Blood Component Therapy Slide 10 Blood Component Therapy Slide 11 Blood Component Therapy Slide 12 Blood Component Therapy Slide 13 Blood Component Therapy Slide 14 Blood Component Therapy Slide 15 Blood Component Therapy Slide 16 Blood Component Therapy Slide 17 Blood Component Therapy Slide 18 Blood Component Therapy Slide 19 Blood Component Therapy Slide 20 Blood Component Therapy Slide 21 Blood Component Therapy Slide 22 Blood Component Therapy Slide 23 Blood Component Therapy Slide 24 Blood Component Therapy Slide 25 Blood Component Therapy Slide 26 Blood Component Therapy Slide 27 Blood Component Therapy Slide 28 Blood Component Therapy Slide 29 Blood Component Therapy Slide 30 Blood Component Therapy Slide 31 Blood Component Therapy Slide 32 Blood Component Therapy Slide 33 Blood Component Therapy Slide 34 Blood Component Therapy Slide 35 Blood Component Therapy Slide 36
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A number of groups have issued clinical practice guidelines for blood component therapy in an effort to improve transfusion practices, minimize the incidence of adverse transfusion reactions, and decrease costs. This slideshow by Dr Somnath Longani, Consultant, Midland Healthcare & Research Center Lucknow explains about the Blood Component Therapy in detail.

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Blood Component Therapy

  1. 1. Blood Component Therapy Dr. Somnath Longani MBBS,MD
  2. 2. Historical Time Line • 1628 English physician William Harvey discovers the circulation of blood • 1665 first recorded blood transfusion dog from other dog • 1667 was transfusing blood of animal to human • 1901- Karl Landsteiner’s discovery of ABO grouping and foundation for scientific transfusion practices • 1920’s - Development of anti-coagulation solutions to store donated blood • 1950’s - Disposable plastic systems for collection and aseptic separation of blood components
  3. 3. Blood Components Role of Whole Blood ???
  4. 4. REPLACING BLOOD LOSS Blood loss should be replace with crystalloid or colloid • Risk Of Adverse Reactions • Use Screened Blood • Avoid Blood Transfusions as much as possible
  5. 5. CRITERIA OF BLOOD TRANSFUSION • Hemoglobin concentration below 7 with symptom • <7gm/dl pt with ventillator • <10gm/dl CAD, Pulmonary disease • <9gm/dl old age pt • Acute blood loss>25% of blood volume
  6. 6. BLOOD VOLUME Neonate  Premature 95ml/kg  Full term 85ml/kg Infant 80ml/kg Adult  Men 75ml/kg  Women 65ml/kg
  7. 7. BLOOD GROUPS • Human red cell membrane contain 300 different antigenic system • Blood transfusion only ABO and Rh system • Other red cell antigen systems include Lewis p Kidd kell Duffy • These antigens rarely cause serious hemolytic reaction
  8. 8. COMPATIBILITY TEST • Indirect coombs test test use for blood transfusion • Serum of pt mix with red blood cell and finally anti human globulin added • Agglutination occur indirect coombs test is positive • Require 45 min
  9. 9. • CROSS MATCH • Donor red cell mix with recipient serum • Emergency transfusion
  10. 10. • Packed RBC – Anticoagulant – CPDA / CPD – Volume – 350ml – Shelf life – 35 days – HCT – 60-80% PRBC transfusion
  11. 11. • Alternative AS-1(ADSOL) AS-3(Nutrice) it extend shelf life to 6weeks • Hypertonic glycerol solution for up to 10 years • Red cell normally stored at 1-6 c
  12. 12. Administration of PRBC • Cross matching • Patient identification • Catheter size – >22G – Separate line • Use Filter
  13. 13. Administration of PRBC • Method – Universal precautions • Volume – Depends on indication – 10-15ml/kg  Hb by 1-2gm/dl • Infusion time – 4hr • Monitor
  14. 14. Platelet Transfusion Types • Isolation from a unit of donated blood (RDP) (50-60ml) • Apheresis from a donor (SDP) (150-300ml) • 1 SDP ~ 4-6 RDP
  15. 15. Platelet Transfusion • Indications – <50000/mm3 and bleeding – <50000/mm3 and invasive procedure – <10000-20000/mm3 • Storage : Room temperature (20-24c) • Shelf life: 5 days
  16. 16. FRESH FROZEN PLASMA • Plasma Frozen At –18 to -300 C within 8 hrs • Shelf life – 1yr • Stable Clotting Factors as well as Factor VIII • 35 - 50 ml • ABO matching
  17. 17. FFP- INDICATIONS Indications • Hereditary clotting factor deficiencies • Von Willebrand disease • Acquired coagulation defects – severe liver disease – DIC – Severe Vitamin K deficiency bleeding • On Warfarin therapy • Dose – 10-15ml/kg • Goal to achieve 30% of normal coagulation factor
  18. 18. CRYOPRECIPITATE • Cryoprecipitate is prepared by thawing FFP between 1ºC and 6ºC and recovering precipitate – Factor VIII 80 – 100 IU /Bag, – Fibrinogen 150 –300 mg/pack
  19. 19. INDICATIONS • Von Willebrand Disease • Hemophilia A • Factor XIII deficiency • DIC • Dys & Hypofibrinogenemia • One Unit per 7 – 10 Kg. BW
  20. 20. Granulocyte Transfusion • Prepared by leukophresis • Neutropenic pt with bacterial infection not responding to antibiotic • Very short life span • Daily transfusion of 1010 granulocyte • G-CSF GM-CSF
  21. 21. Complications of Blood Transfusion
  22. 22. Types • Infection • Transfusion reactions • Circulatory overload • Metabolic • Iron overload
  23. 23. Infection • Viral infection Hep B,Hep C, HIV,CMV,Parvo virus • Parasitic infection Malaria, Toxoplasmosis,Chagas disease • Bacterial infection Gram + Staphalococcus,Gram – Yersenia and Citrobacter
  24. 24. Transfusion reactions 1. Acute Hemolytic reaction Awake patients- Chills,fever,nausea, chest and flank pain Anaesthetised patient Hypotension,tachycardia, haemoglobinurea ,oozing blood from surgical site
  25. 25. Management • Stop transfusion • Recheck • Put urinary catheter • Osmotic diuresis
  26. 26. 2. Delayed haemolytic reaction Extravascula hemolysis  2-20 days after transfusion  Generally mild  Symptoms:Malaise,Jaundice,Fever
  27. 27. Transfusion reactions 2. Febrile reaction – Related to the presence of cytokines produced by donor leukocytes Due to platelet or white cell Manage by Leukoreduction transfusion 3. Allergic reaction – Vary in severity from mild hi wheels and itching to fatal anaphylaxis – More common with plasma and platelet transfusions
  28. 28. Anaphylactic reaction • Rare1:150000 transfusion • Typically in IgA deficient pt • Receive IgA containing blood • Treatment-epinephrine fluids ,corticosteroid • Transfuse IgA free blood
  29. 29. Transfusion Associated Lung Injury (TRALI) • With in 6 hours of transfusion • Incidence 1:5000 transfusion • Acute hypoxia and non cardiogenic pulmonary edema • Especially platelet and FFP • Alveolar capillary membrane damage Manegment-
  30. 30. GRAFT Vs HOST Disease • Immunocompromised patient • Contain lymphocytes against compromised host • Use-leukocyte filter, irradiation
  31. 31. Massive Blood Transfusion • Transfuse one to two time the pt blood volume or 10 to 20 unit • Coagulopathy • Citrate toxicity • Hypothermia • Serum potasium concentration
  32. 32. Autologous Transfusion • Patient undergoing elective surgical procedure • High probability of blood transfusion • Collection usually started 4-5 weeks prior • Allowed to donate until 11gm/dl • Minimum 72 hrs required plasma volume return to normal • 3 or 4 unit collected
  33. 33. Blood Salvage Reinfusion • Uses in cardiac, major vascular,orthopedic surgery • Blood aspirated and collected in reservoir • Mix with heparin • Red cell washed concentrated to remove debris • Hematocrit concentration 50-60% • Contraindication septic contamination ,malignancy
  34. 34. If possible always avoid a transfusion…… Risk of infections/ reactions Transfusion may prove fatal (TRALI)
  35. 35. If transfusion is must… Use appropriate blood component not just blood
  36. 36. THANK YOU
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A number of groups have issued clinical practice guidelines for blood component therapy in an effort to improve transfusion practices, minimize the incidence of adverse transfusion reactions, and decrease costs. This slideshow by Dr Somnath Longani, Consultant, Midland Healthcare & Research Center Lucknow explains about the Blood Component Therapy in detail.

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