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7/27/2019 DIC Blood Component Therapy
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DIC & Blood component therapy
Gp Capt G S Sandhu
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DIC
DIC is a syndrome characterized by diffuse activationof the coagulation system leading to intravascular fibrindeposition.
Thromboplastins
endothelial cell activation - Activation of coagulation
Massive activation of coagulation - depletion ofcoagulation factors and platelets
(consumptive coagulopathy)
- hemorrhagic complications.
Microvascular fibrin thrombi - impair tissue circulationmulti-organ dysfunction
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Obstetric aetiology
Abruptio placentae Severe pre-eclampsia
Severe Sepsis
Amniotic fluid embolism
Prolonged IUFD Molar pregnancy
Placenta accreta
Intra-amniotic hypertonic saline
Acute Fatty Liver of pregnancy
Transfusion reactions
Large feto-maternal haemmorrhage
Severe trauma
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Patho-physiology of DIC
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Coagulation & Fibrinolytic Systems
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Severity of DIC
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Management principles
Assess derangement of function
Control hemorrhage
Replace blood loss, coagulation factors and
platelets as indicated
Supportive management to correct multi-
organ dysfunction
Treat underlying cause
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Massive blood loss
Loss of one blood volume within a 24 hr
period
50% blood volume loss within 3 hrs
Rate of blood loss 150 ml /min
Massive transfusion 10 units in 24 hrs or
> 50 ml / kg / hr in adults
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Blood product
Any therapeutic substance prepared from
human blood
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Blood component
A constituent of blood separated from
whole blood
Where resources are available use of blood
components allows optimal utilization of
donated blood
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Apheresis
It is a sterile process by which a specificcomponent is mechanically separated and
collected while components not required arere-infused back to the donor
Platelet pheresis : Collection of donorplatelets by apheresis
Plasma pheresis : Collection of donorplasma by apheresis
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Whole blood
Qty 450 ml donor blood + 63 ml anticoagulant
Anticoagulant preservative solution CPD, CPD-
A(Citrate, Phosphate, Dextrose, Adenine) or ACD Storage time 21 days (ACD, CPD) / 35 days
(CPD-A)
Start transfusion within 30 mins of issue
Complete transfusion within 4 hrs of starting
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Effects of storage of blood
pH
plasma K+
RBC content of 2, 3 DPG leading to
reduced release of oxygen at tissue level
Loss of platelets within 48 hrs of donation
in Factor VIII to 10 20% of normal
within 48 hrs of donation
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Indications of whole blood
transfusion RBC replacement in acute blood loss with
hypovolemia
Exchange transfusions
When RBC concentrates are not available
(Use of whole blood may sometimes be the
safest and most sustainable way of meeting
urgent transfusion requirements)
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Advantages : Whole blood
transfusion Simple inexpensive collection packs
No special processing
For patients with haemorrhage, supplies
RBC, volume and stable coagulation factors
(Factors IX and VII)
Disadvantage : Higher volume load
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RBC concentrate (Packed RBC)
Quantity 220340 ml (Generally 250 ml).
Contains 150200ml RBC
Prepared by gravity separation /centrifugation of whole blood
RBC concentrate also contains WBC
Storage time 21 days (ACD, CPD) / 35 days
(CPD-A)
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Indications of RBC concentrates
Replacement of RBC in anaemic patients
Along with crystalloids in acute blood loss
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Disadvantages of RBC concentrates
viscosity. Haematocrit 55 75%
WBC are cause of febrile non-haemolytic
reactions
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RBC suspension
150200 ml RBC + 110 ml Normal saline,
Adenine, Glucose and Mannitol solution
(SAG-M) as a Red cell nutrient medium. Less viscosity as compared to RBC
concentrates
Better flow rates during transfusion
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Indications of blood transfusion in
Obstetrics Replacement of acute blood loss
Pregnancy < 36 weeks
Hb 5.0 gm% or lessHb 5 to 7 gm%
Established or incipient cardiac failure or clinicalevidence of hypoxia
Pre-existing cardiac disorder Serious infection i.e. pneumonia
Malaria
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Indications of blood transfusion in
Obstetrics Pregnancy > 36 weeks
Hb 6.0 gm% or less
Hb 6 to 8 gm%
Established or incipient cardiac failure or clinical
evidence of hypoxia
Pre-existing cardiac disorder
Serious infection i.e. pneumonia
Malaria
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Fresh Frozen plasma
Volume 200300 ml (Generally 250 ml) Separated from whole blood and frozen at -250 C within
6 to 8 hrs of collection in order to preserve labile
coagulation factors (Factors V and VIII)
Supplies 150 mg fibrinogen / unit + other coagulation
factors
Can be stored for 1 yr
At - 250 C, Factor VIII levels maintained at 70% ofnormal fresh plasma levels
At 2 to 60 C labile clotting factor activity will decline to
1020% within 48 hrs
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Fresh Frozen Plasma : Indications
Replacement of multiple coagulation factor
deficiencies
DIC
Liver disease
Warfarin overdose
Dilutional coagulopathy (large volumetransfusions)
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Fresh Frozen Plasma
Not recommended as replacement fluid Expensive
Risk of transfusion transmitted infections
No benefit over use of crystalloids / colloids
Dose : Initial dose 15 ml / kg body wt
One unit FFP raises Plasma fibrinogen by 25 mg%
Must be thawed between 30 - 370 C before use
Should be used within 6 hrs of initiating thawing Infuse within 20 minutes
If not used immediately, store between 2 to 60 C for
maximum 24 hrs
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Cryoprecipitate
Prepared from FFP by collecting precipitateformed during controlled thawing and re-suspending it in 10 to 20 ml plasma
Rich in Fibrinogen(150300mg/ pack), FactorVIII (80100 IU / pack), von Willebrand factor,Fibronectin, Factor XIII
Storage at - 25
0
C for 1 yr Should be infused within 6 hrs of thawing
Infuse over 20 minutes
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Cryoprecipitate
Indications
Von Willebrands disease
Factor VIII deficiency (Haemophilia A)
DIC (as a source of Fibrinogen)
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Platelet concentrate
(Prepared from whole blood donation)
Single donor unit
Prepared from one donation
Contain 55 x 109 platelets
Pooled donor unit Prepared from 4 to 6 donor units pooled into one pack
Contains 240 x 109 platelets
Volume 5060 ml Storage at 200 to 240 C (with agitation) for up to 5 days
Bacterial contamination (with consequent risk of
septicaemia in recipient) occurs in 1% of pooled units
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Platelet concentrate
(Collected by Plateletpheresis) Platelet content 150500 x 109 platelets
Storage at 200 to 240 C (with agitation) for
up to 24 hrs
ABO compatibility important to prevent
haemolysis of recipient RBC
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Platelet concentrate Indications
Thrombocytopenia (< 50,000 / cu mm in a bleeding / surgical patient) Platelet function defects
Dosage
1 unit platelet concentrate / 10 kg body wt
A unit of random (pooled) donor platelets increases platelet count
by 5000 to 8000 / cu mm.
Infuse within 4 hrs of issue to reduce risk of bacterial contamination
Do not refrigerate
Infuse within 20 minutes of starting
Rh negative recipients should not receive platelet concentrates fromRh positive donors
ABO compatible platelet concentrates to be infused wheneverpossible