Blood Blood Components Components Dosage And Dosage And
Their Their AdministrationAdministration
Effective blood transfusion therapy Effective blood transfusion therapy depends on availability of different depends on availability of different blood componentsblood components
Components used separately or in Components used separately or in combination can meet most patients combination can meet most patients transfusion needs and keep the risk transfusion needs and keep the risk of transfusion to minimumof transfusion to minimum
Separation of blood components are Separation of blood components are desirable becausedesirable because
1.1. Separation of blood components allows Separation of blood components allows optimal survival for each componentoptimal survival for each component
2.2. Allows transfusing specific blood Allows transfusing specific blood components according to the need of the components according to the need of the patientpatient
3.3. Allows use of unnecessary component Allows use of unnecessary component which may be contraindicated in a which may be contraindicated in a patientpatient
4. Several patients can be treated 4. Several patients can be treated from one unit of donated bloodfrom one unit of donated blood
5. Use of blood components 5. Use of blood components supplements blood supply and adds supplements blood supply and adds to the blood inventoryto the blood inventory
Whole Blood Processed within
8 hours )
Packed red blood cellsFresh frozen plasma Platelets
Component preparationComponent preparation Principle - Differential Principle - Differential
centrifugationcentrifugation Red cellsRed cells
Packed cellsPacked cells Red cells + additiveRed cells + additive
PlasmaPlasma Bank plasmaBank plasma Fresh frozenFresh frozen Cryo supernateCryo supernate
PlateletsPlatelets Platelet rich Platelet rich
concentrateconcentrate Platelet rich plasmaPlatelet rich plasma
CryoprecipitateCryoprecipitate
Plasma + Platelets
BuffyRBC
Whole blood
DEFINITIONSDEFINITIONS
BLOOD PRODUCTBLOOD PRODUCT = Any therapeutic substance = Any therapeutic substance prepared from human bloodprepared from human blood
WHOLE BLOODWHOLE BLOOD = Unseparated blood collected = Unseparated blood collected into an approved container containing an into an approved container containing an anticoagulant preservative solutionanticoagulant preservative solution
BLOOD COMPONENTBLOOD COMPONENT = 1. A constituent of blood = 1. A constituent of blood , separated from whole blood such as, separated from whole blood such as
• Red cell concentrateRed cell concentrate• PlasmaPlasma• Platelet concentratesPlatelet concentrates2. Plasma or platelets collected by apheresis2. Plasma or platelets collected by apheresis3. Cryoprecipitate prepared from fresh frozen 3. Cryoprecipitate prepared from fresh frozen
plasma plasma
Blood ComponentsBlood Components
THE THE PRBCPRBC StorageStorage - 2 – 6 - 2 – 6 OO C C Unit of issueUnit of issue - 1 donation ( unit or pack )- 1 donation ( unit or pack ) AdministrationAdministration - ABO & Rh compatible- ABO & Rh compatible - Never add medication to a unit- Never add medication to a unit - Complete transfusion within 4 hrs of - Complete transfusion within 4 hrs of
commencementcommencement
1Member
Blood ComponentsBlood Components
2. Red cell2. Red cell concentrate concentrate ( packed ( packed red blood cells )- whole blood red blood cells )- whole blood without plasma. Hct 55 -75 % , without plasma. Hct 55 -75 % , Hb approximately 20 g /100 mlHb approximately 20 g /100 ml
IndicationsTrauma - Acute blood loss with > 20% loss of blood volume
Surgery - Trigger – 10gm% - 8gm% Rate of development of anemia, General condition and type of surger
Radiotherapy
Dosage & Administration
Dosage - 1 unit/10 kg body wtAdult dose is 4-8 units
Administration - Preferably ABO & Rh group specific but not essentialOther groups can be used
PLATELETSPLATELETS
Platelet units can be eitherPlatelet units can be either Random donor unitsRandom donor units Apheresis unitsApheresis units
1 random donor unit contains 55 1 random donor unit contains 55 x10x109 platelets9 platelets
1 apheresis unit contains 240x101 apheresis unit contains 240x1099
Indications Production - Aplasia / Neoplasia
Usage - TTP(thrombotic thrombocytopenic purpura), DIC(disseminated intravascular coagulation)
Destruction – immune thrombocytopenic purpura.Sequestration – Hyper-splenism
Guidelines for Platelet Tx.
Mild - 50,000-1,00,000/µlTx - usually not required
Moderate - 20,000-50,000/µlTx-if symptomatic or has to undergo surgery/trauma
Severe - < 20,000/µlRisk of bleeding - highProphylactic Tx
Indications for platelet Indications for platelet transfusiontransfusion
BLEEDINGBLEEDING due to due to thrombocytopaeniathrombocytopaenia
Due to platelet dysfunctionDue to platelet dysfunction
Prevention of spontaneous bleeding Prevention of spontaneous bleeding with counts < 20,000with counts < 20,000
IMPORTANT IMPORTANT PRECAUTIONSPRECAUTIONS
Stored at 20-24 Degree celcius.Stored at 20-24 Degree celcius. Constantly agitatedConstantly agitated Only last for 5 daysOnly last for 5 days Infused in 30 minsInfused in 30 mins
Fresh Frozen plasmaFresh Frozen plasma
Fresh frozen plasmaFresh frozen plasma – labile & – labile & nonlabile clotting factors, nonlabile clotting factors, albumin and immunoglobulin. albumin and immunoglobulin. Factor VIII ( 8 ) level at least 70 Factor VIII ( 8 ) level at least 70 % of normal fresh plasma level% of normal fresh plasma level
StorageStorage - 20 C for 1 yr, - 65 C for 7 yrs.- 20 C for 1 yr, - 65 C for 7 yrs.- Before use thawed at 37 Before use thawed at 37 oo C C
Fresh frozen plasmaFresh frozen plasma
IndicationsIndications
- Replacement of multiple coagulation - Replacement of multiple coagulation factor deficiencies egfactor deficiencies eg
• Liver diseaseLiver disease• Anticoagulant overdoseAnticoagulant overdose• Depletion of coagulation factors in pts Depletion of coagulation factors in pts
receiving large volume transfusionsreceiving large volume transfusions- DIC (disseminated intravascular DIC (disseminated intravascular
coagulation)coagulation)
FRESHFRESH FROZEN PLASMAFROZEN PLASMA
IndicationIndication Clinically significant deficiency of Clinically significant deficiency of
Factors II, V, X, XI Factors II, V, X, XI Replacement of multiple coagulationReplacement of multiple coagulation
factor deficiencies :-factor deficiencies :- liver disease , warfarin treatment, liver disease , warfarin treatment, dilutional and consumption coagulopathydilutional and consumption coagulopathy
ContraindicationContraindication Volume expansionVolume expansion Immunoglobulin replacementImmunoglobulin replacement
Nutritional Nutritional supportsupport Wound healingWound healing
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FRESH FROZEN PLASMAFRESH FROZEN PLASMAPrecautionPrecaution
Acute allergic reaction are common Acute allergic reaction are common Anaphylactic reaction may occurAnaphylactic reaction may occur Hypovolemia alone is not an indication forHypovolemia alone is not an indication for
useuse
Dosage - Initial dose of 15 - 20 ml / kgDosage - Initial dose of 15 - 20 ml / kgAdministrationAdministration
Must be ABO compatible, Rh not Must be ABO compatible, Rh not requiredrequired Infuse as soon as possible after thawing Infuse as soon as possible after thawing
( within 6 hrs )( within 6 hrs ) using standard blood administration setusing standard blood administration set
30/11/49 MD-3-4920
FFPFFP
Fresh Frozen PlasmaFresh Frozen Plasma
Plasma collected from single donor Plasma collected from single donor units or by apheresis units or by apheresis
Frozen within 8 hours of collectionFrozen within 8 hours of collection
-40-40o o CC
Can last for a yearCan last for a year
Dosage & Administration for FFP
Dosage - 10-15 ml/Kg(Approx 2-3 bags for an adult)
Administration - Thawed at +37o C before transfusionABO compatibleGroup AB plasma can be used for all patient
Do`s and Dont`sDo`s and Dont`sIn Blood and In Blood and
Blood Blood ComponentsComponents
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DO`S•Complete the blood request form•Order blood in advance, if possible•Provide clear information on blood products being requested, number of units requested, reason for transfusion, urgency
Risk Benefit Analysis
benefit > risk
risk > benefit
Hb gm/dl 4 5 6 7 8 9 10 11 12 13 14
why nottransfuse
why transfuse
individual patient factorsdecide transfusion trigger
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Blood/ Start infusion Complete infusionblood product
Whole blood/ within 30 min. of within 4 hourred cells removing pack (less in high from ambient temperature)
refrigerator
Platelet immediately within 20 minconcentrates
FFP within 30 min within 20 min
Time Limits for InfusionTime Limits for Infusion
RECORDING OF RECORDING OF TRANSFUSIONTRANSFUSION
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Consent from patient and/or relativesReason for transfusionSignature of the prescribing clinicianPre-transfusion checks of :
patient’s identity, blood pack, compatibility labelsignature of the person performing the check
Transfusiontype and volume of component, donation number, blood group, time at which transfusion commenced,signature of person administering the transfusion
Any transfusion reactionReturn the transfusion slip to the blood bank