Blood Product Transfusion

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TransfusionofBlood Product
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History

• 1920Sodium citrate anticoagulant(10 days
  storage)
• 1958 Plastic bag of transfusion 1656 Initial
  theory and methods (UK)
• 1665 Dog to dog transfusion
• 1667Animal to human transfusion(20 times)by
  Denys one case expired with anaphylaxis in third
  transfusion
• 1975 Blood banking and blood products

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Major Indication for Blood Product Transfusion

• Restore Blood Volume
• Maintain oxygen carrying capacity
• Maintain hemostasis
• Maintain leukocyte function

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Blood Donors

• Healthy volunteers
• Usually over the age of 17 years
• At least 110 pounds in weight.
• Each donor is initially screened through a
  detailed medical history

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Blood Test

1. Antibodies to HIV-1 and HIV-2 (AIDS),
2. Antibodies to HBc produced during and after
   infection with Hepatitis B Virus
3. Antibodies to HCV produced after infection with
   the Hepatitis C virus
4. Antibodies to HTLV-I/II produced after infection

• 5. Antibodies to HBsAg produced after infection
  with Hepatitis B
• 6. HIV-1 p24, a test for the HIV (AIDS) antigen
• 7. For blood type (ABO) and Rh factor
• 8. Tp, the agent that causes syphilis
• 9. ALT,Coombs,CMV
• 10. NAT

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NAT (Nucleic Acid Testing)

• A new technology that can detect the genetic
  material of Hepatitis C and HIV.

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Packed Cell
Platelet Concentrate
Plasma
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Red Blood Cells

• 40-50 Blood Volume
• Oxygen carrying
• Store till 42 days in 4-8? C
• The most commonly blood product

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Platelets

• Platelets account for a small percentage of whole
  blood volume
• Control bleeding
• Often transfused in multiple doses
• Platelets must be stored at room temperature
• Only a five day shelf life

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Plasma

• A watery substance in which proteins that trigger
  blood clotting mechanisms are suspended.
• Plasma is used as a raw material
• Fractionated into its different protein
  components
• Factor VIII, and other factors
• Plasma can be stored frozen for up to one year

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Contraindication of Blood Product Transfusion

• No Absolute Indication of Blood Product
  Transfusion

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The most important factor for blood transfusion

• Patients clinical condition
• (Not a laboratory results)

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Questions that need to be asked prior to a blood
transfusion?

• 1)Will the patients condition be improved by a
  blood transfusion?
• 2)Do any alternative therapies to blood
  transfusion exist?
• 3)Do the benefit of a blood transfusion outweigh
  the potential risks?

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Criteria for viability of red blood cells on the
final day of storage in particular anticoagulant

• 1)A mean of 75survival 24 hours after
  transfusion
• 2)Less than 4 hemolysis
• 3)Normal survival after 24 hours

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Indication for Packed Cell Transfusion in Ill
Patient who Admitted in ICU

• HCTlt35-40
• In Neonate HCTlt40-45

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Hct( Post transfusion)(BW80Hct-P)(R-Vol.Hct
-C)BW80

• BWBody Weight(Kg)
• Hct-PPretransfusion Hematocrit
• R-Vol.Volume of red cell transfusion
• Hct-CHematocrit of transfused cell

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Whole Blood ( lt10 Days Storage)

• Those undergoing cardiac surgery
• Acute blood loss ( no
  suitable product is present)

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Shelf Life of Red Cell Products

• CPD 21 Days
• CPD-A 35 Days
• Adsol(AS-1) 42 Days
• Nutricel(AS-3) 42 Days
• Optisol(AS-5) 42 Days

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Red Cell Products

• Whole Blood
• Fresh Whole Blood
• Frozen Deglycerolized Packed Cells
• Packed Cells
• Leukoreduction of Red Cells
• Irradiation of Red Cells

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Whole Blood

• Massive Transfusion
• (Cardiac surgery)
• Exchange Transfusion

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Fresh Whole Blood

• Non refrigerated fresh blood administered by
  exchange transfusion within 4-6 hours of drawing
  can deliver a sufficient number of viable
  leukocytes.
• The dose required is 1x10?9 PMN/Kg (1½Blood
  Exchange Transfusion)

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Frozen Deglycerolized Packed Cells

• Antigen matched transfusion
• Neonatal transfusion

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Filtered Red Cells

• Prevention of febrile non hemolytic reaction

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Irradiation of Red Cells

• Neonates
• Immuno-compromised recipients

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Massive Transfusion

• Replacement of more than one blood volume within
  6 hours period

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Causes of Massive Transfusion

• Neonatal exchange transfusion
• Cardiac surgery
• Trauma
• Liver transplantation

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Complications of Massive Transfusion

• Citrate toxicity
• Alkalosis
• Hypokalemia
• Coagulopathy

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Indication for Packed Cell Transfusion in Ill
Patient who Admitted in ICU

• HCTlt35-40
• In Neonate HCTlt40-45

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Criteria of Platelet Transfusion

• Platelet countlt5,000-10,000/?L
• Minor or Major surgerylt30,000-60,000/?L
• Brain or Ophtalmic Surgerylt50,000?L
• Massive Transfusionlt30,000/?L

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Platelet Transfusion Dose

• One unit platelet will increase the platelet by
  10,000/?L for each square meter of body surface

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Corrected Count Increment(CCI)

• 1 Hour CCIlt7,500 1)Alloimmunization
• 
  2)Autoimmunization
• 3)Blood
  Banking
• 24 Hour CCIlt4,500 1)Sepsis
• 2)Fever
• 3)DIC

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General Principles of Plasma Protein Transfusion
Therapy

• Accurate diagnosis
• In vivo volume distribution of plasma
• Half life of the infused protein
• Concentration of the coagulation factor in
  product

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Dose of Coagulation Factors Requirement
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