Rational Use of Blood Components

8/18/2019 Rational Use of Blood Components

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Rational Use of Blood

ComponentsDr. M. Mohandoss

Assistant Professor

Transfusion Medicine,

Malabar Cancer Centre, Thalaserry


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Component Therapy

1. ptimal preser!ation of in !itro function of blood

". #$cient utili%ation of blood donations

"1&'(&1) MA*ABAR CA+C#R C#+TR#


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Methods of Component Preparation

hole Blood Apheresis

Platelet RichPlasmaMethod

Bu-y CoatMethod

ManualMethod

Automation



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Platelet Rich Plasma (PRP) method

Whole blood

Soft spin within

(1800 rpm 6 hrs x 9 min at 22oC)

Red cells Platelet rich plasma (PRP)

Hard spin(3000 rpm

x 7 min at 22oC)

Plasma Platelet Conc.

(RDP)

PRP

RBC

PRP

PCFFP



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PRP Method

• Manual plasma expresser



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Bufy Coat method

Whole blood

Hard spin within

(3000 rpm 6 hrs x 9 min at 22oC)

Red cells Bufy coat plasma

Soft spin(1800 rpm x 7 min at 22oC)

Platelet Conc. WBC with ew RBC

Plasma

RBC



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Benets of Bu-y coat method

• Platelet yield impro!ed a lot

• Reduced BCs in product

• RBC contamination drasticallydecreased



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Blood Component #/tractor

0ensors

0ealers

0ensor

0ealer

Press



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Principle of Apheresis



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SDP Vs RDP•Decreased chances of TTI and alloimmunization

• ↓ number of donor support required

• Lesser Donor reactions

• Ensures adequate dose

• ABO matched platelet support

• Consistent and standardized yield

RDP RDPRDPRDPRDP RDP

SDP

= 1 adult dose3x 1011/ unit)

! 1 adult dose(4 x 1010/unit)

% %%%%


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0tora3e


CMP+#+T0 0TRA6# T#MP#RATUR#

Pac7ed red blood cells 4PRBC5 8" to 9:C

Platelets 4P*T05 8"" to 8";:C underconstant a3itation


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Answer 4 Qs before transfusion

• hy to transfuse ?

• benet @ ris7

• patients symptoms s lab le!els

• prophylactic s therapeutic

•

hat to transfuse ?• hole blood &'• components & fractions 4


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Case 1

A patient 4;)yr Male5 admitted folloin3 roadtra$c accident

0uspected to ha!e blunt abdominal in2ury and

internal bleedin30hifted to T EbFG3

hich component ould you li7e to transfuse?

1. hole blood

". Pac7ed Red Blood Cells

(.


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hole blood in TruesenseE.


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hole blood is notholeH

• After ";hrs of stora3e B essentially

becomes red cells suspended in a proteinsolution

•

Chan3es in PlateletsB stored at ;:C I platelets rapidly lose!iability

After G hrs I in !i!o sur!i!al reduced to " days

• 6ranulocytes J Monocytes I function reducedithin Ghrs and disinte3rates ithin ";hrs

• Microa33re3ates increase in number

•


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hy hole blood is notrational?

Maximie blood resource

hole blood one patient

component therapy four patients

Pac7ed red cells thalassemiaPlasma li!er disease & burns

Platelets thrombocytopenia

Cryoprecipitate hemophilia

Decrease cost o manaement

e/cept for the cost of ba3, other e/pensesremain same


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hy hole blood is notrational?Better patient manaement

concentrated dose of reLuired component

a!oid circulatory o!erload

minimi%es reactions


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hy hole blood is notrational?#/ample 1F ReLuirement of platelets to raise

count from "' to )','''&ul

fresh hole blood ) units 1)' ml

random platelets ) units ")' mlapheresis platelets 1 unit "'' ml

#/ample "F ReLuirement of fKKK to stop bleed inhemophilic patient

fresh hole blood "' units,''' mlcryoprecipitate "' units;'' ml


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Modern transfusion therapyEE.means component therapy

• ptimal preser!ation of in !itro function ofblood

• More e-ecti!e treatment by specicreplacement of deciency

• #$cient utili%ation of blood donations

• "he proper use o blood re*uires+,

Nnoled3e of pathophysiolo3y of conditionbein3 treated

Kdentication of the specic deciency neededby the patient

Choice of appropriate component for therapy


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Case "

A ; year old boy ith thalassemia is onhypertransfusion therapy.

0ince last ( months patient 3ets fe!er and chillsfolloin3 transfusion

Did not 3et any benet ith premedicationE

hich component ill you recommend for transfusion?

Krrradiated PRBC

*eu7oltered PRBC

Minor phenotype matched cells

Blood from his family member


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storage time

passenger leukocytes

Cytokine generation in stored

PC

Circulatin cyto#ine

-&"R

Threshold

Exceeded

/0 , 12

/0 3 4

/0 3 5

"&-, 6

R7&"89

":-,2

:R',6

Tr ansfused Leukocytes

Cytokine production in

vivo


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*eu7o=depleted BloodComponents

7d;erse 8fects due to 0eu#ocytes

•


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Kndications for *eu7oreducedblood

• Recommended•


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Clinical Kndications


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Case (

• (" years & Male, fe!er since 9 days

• Den3ue


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Thrombocytopenia

Virus induced BMsuppression

Increased

Consumption

latelet !ysfunction

"#idenced by t$e absence of A! releaseand impaired aggregation

Immune MediatedClearance

% Auto Ab

% Cross%reactingantibodies


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SDP

RDP

1 dose

ABO / Rh, HLA / HPA matching possible

Monitoring of dose feasible

Fewer donor exposures

Decreased incidence o ! ! "

↓ Rate of alloimmunization

COST

Apheresis Deri!ed Platelet Concentrates


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Case ;

• )" years & Male

• Nnon case of cirrhosis

• Patient as posted for endoscopy

• *aboratory aluesbF Q.)3&d*,

PTF"' sec

K+RF 1.9• Transfused " units of


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???....

as


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Definite indications for the use of FFP .ingle factor deficiency w$ere specific factor conc is not

a#ailable Immediate re#ersal of warfarin effect

Acute !IC TT

Conditional use of FFP in the presence of bleeding &

disturbed coagulation

Massi#e transfusion Li#er disease wit$ acti#e bleeding

No ustifications for the use of FFP /ypo#olemia 0utritional support Treatment of immunodeficiency states

BCSH guidelines for use of FFP


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Case !

atient continues to bleed*

Visceral in1uries noted *

/emostasis not ac$ie#ed*

2se of Combination of

Components


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< = PRBC

!"

#


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Massi!e Transfusion Protocol

To standardi%e blood product support durin3the early chaotic phase of

resuscitationE.

Allo early administration of bloodcomponents, especially


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Cryoprecipitate

Composition

!ol 1'="' ml

f KKK 9) = G' KU&unit

!


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CryoprecipitateE.

Ma2or Kndicationsypobrino3enemia


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Current Transfusion Practice

Rate of Knappropriate transfusions

RBCF 19 = )).(

PlateletsF 1( = ;G.


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Problems of Knappropriate Use

• ealth ris7 associated ith transfusion

• Cost of mana3ement

• Unnecessary pressure on the supply of blood

0T Report

"'1"

''()*

+T% '()*

,T%

-('*

+llo

.*

T+C/

> 4)? were pat$ological reactio

w$ic$ may not pre#entable


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Ris7 s Benets of Transfusion

0enefit 1 %isk %isk 1 0enefit

/b 6g;dL7 4 ) @ 9 :( :: :3 :

&$y not transfuse &$y transfuse

e#ersiblein s$ort term

Additional factors in comproof o,ygen transport

Indi#idual patient

factors determine


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0ummary

Transfusion is a li#e tissue transplantation

Transfusion s$ould not be dictated by lab #alues

alone but s$ould also be based on t$e patientDsclinical status

!etermine t$e trigger and dose to be

administered


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Gie blood !"en it is reall#ne$essar#

Gie t"e %atient onl# !"at isneeded

"han# you

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Rational Use of Blood Components