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TRANSFUSION OF BLOOD & TRANSFUSION OF BLOOD & BLOOD COMPONENTSBLOOD COMPONENTS

Dr. Gamini JayaweeraDr. Gamini Jayaweera

TRANSFUSION OF BLOOD & TRANSFUSION OF BLOOD & BLOOD BLOOD COMPONENTSCOMPONENTS• Cellular ComponentsCellular Components

• Plasma ComponentsPlasma Components

Transfusion Of Blood & Blood Transfusion Of Blood & Blood ComponentsComponents

Cellular ComponentsCellular Components• Red Cell Concentrates ( RCC / PC ) Red Cell Concentrates ( RCC / PC )

• RCC with Additive solutionsRCC with Additive solutions

• Leuco reduced / Depleted Red CellsLeuco reduced / Depleted Red Cells

• Washed Red CellsWashed Red Cells

• Irradiated RBC / WBC / PLIrradiated RBC / WBC / PL

• De-Glycerolized Red CellsDe-Glycerolized Red Cells– ( Frozen )( Frozen )

• Platelet ConcentratesPlatelet Concentrates

• Granulocyte Concentrates ( Buffy Coat )Granulocyte Concentrates ( Buffy Coat )

TRANSFUSION OF BLOOD & TRANSFUSION OF BLOOD & BLOOD BLOOD

COMPONENTSCOMPONENTS

Plasma ComponentsPlasma Components

• Fresh Frozen PlasmaFresh Frozen Plasma

• Plasma / Cryo Poor PlasmaPlasma / Cryo Poor Plasma

• CryoprecipitateCryoprecipitate

• Whole BloodWhole Blood

• Fresh Whole BloodFresh Whole Blood Least importantLeast important

Whole BloodWhole Blood

ContentsContents

• Total Volume Aprox. 510 ml (450 ml of Total Volume Aprox. 510 ml (450 ml of blood in 63 ml of anticoagulant)blood in 63 ml of anticoagulant)

• Hb 12g/ dlHb 12g/ dl• Hct 35 – 45 %Hct 35 – 45 %• No functional PL / WBC / Labile No functional PL / WBC / Labile

clotting factors ( V , VIII )clotting factors ( V , VIII )• Store 2Store 2oo – 6 – 6oo c c

Whole BloodWhole Blood

IndicationsIndications

• RBC replacement in acute blood loss RBC replacement in acute blood loss with hypovolaemiawith hypovolaemia

• Exchange TransfusionExchange Transfusion

• When RCC not availableWhen RCC not available

Red Cell ConcentratesRed Cell Concentrates

ContentsContents• Volume 200 – 275 mlVolume 200 – 275 ml

• Hct 60 – 75%Hct 60 – 75%

• Hb 20 g /100mlHb 20 g /100ml

• Plasma 30%Plasma 30%

• Shelf Life 35 DaysShelf Life 35 Days

No PlateletsNo PlateletsNo Functional No Functional LeucocytesLeucocytesNo Clotting FactorsNo Clotting Factors


• ? Oxygen Carrying Capacity? Oxygen Carrying Capacity

• ? 23 DPG Level? 23 DPG Level

• ? K? K++ Leak Leak


IndicationsIndications• Increase the red cell massIncrease the red cell mass

• Symptomatic AnaemiaSymptomatic Anaemia

• Replace the blood loss in Replace the blood loss in haemorrhage (use with crystalloids haemorrhage (use with crystalloids or colloid solution )or colloid solution )

• Patients with Patients with – Liver FailureLiver Failure– Renal FailureRenal Failure– Heart FailureHeart Failure

Red Cell ConcentratesRed Cell Concentrates Transfusion DoseTransfusion Dose

• 1 Unit of RCC Increase Hb by 1g/dl or Hct 1 Unit of RCC Increase Hb by 1g/dl or Hct by 3% in 60 kg patientby 3% in 60 kg patient

• Increment is more in smaller patientsIncrement is more in smaller patients

• When to repeat the Hb after transfusion?When to repeat the Hb after transfusion?• Failure achieve expected increment ?Failure achieve expected increment ?

– Red Cell AntibodiesRed Cell Antibodies– Continued blood loss (External / Internal) Continued blood loss (External / Internal)

Red Cell ConcentratesRed Cell Concentrates Rate Of TransfusionRate Of Transfusion• Rate of transfusion depend on the clinical Rate of transfusion depend on the clinical

situationsituation– As fast as patient can tolerate to Very slow As fast as patient can tolerate to Very slow

transfusiontransfusion– Slow Transfusion must be completed in 4 Slow Transfusion must be completed in 4

hours?hours?•HaemolysisHaemolysis•Bacterial proliferationBacterial proliferation

• Divided dose transfusionDivided dose transfusion• Applying Pressure Applying Pressure

– HaemolysisHaemolysis– Air EmbolismAir Embolism– Rupture of VeinsRupture of Veins

Applying Pressure to increase transfusion Applying Pressure to increase transfusion raterate

1. To Transfuse blood at a faster 1. To Transfuse blood at a faster rate than gravityrate than gravity

2. apply pressure evenly2. apply pressure evenly on the blood packon the blood pack

3. Large bore needles and larger3. Large bore needles and larger cannulas are used if pressure is cannulas are used if pressure is appliedapplied

4. There is a risk of 4. There is a risk of HaemolysisHaemolysis if if Blood has high Haematocrit or Blood has high Haematocrit or

blood transfused through a smallblood transfused through a small needles/canula or bloodneedles/canula or blood

pressurized through clotted filterpressurized through clotted filter

5. Risk of vessel rupture 5. Risk of vessel rupture


Transfusion ConsiderationsTransfusion Considerations• Must be ABO Identical or CompatibleMust be ABO Identical or Compatible• Cross-match Cross-match • Clerical checksClerical checks• Pre transfusion assessmentPre transfusion assessment• Past transfusion records/ complicationsPast transfusion records/ complications• ConsentConsent• Post transfusion observation & follow Post transfusion observation & follow

up up • Recording of transfusion reactionsRecording of transfusion reactions

Red Cells In Additive Red Cells In Additive SolutionsSolutions

ContentsContents

• 150 – 200 ml of RBC with minimal 150 – 200 ml of RBC with minimal plasmaplasma

• 100 ml SAG-M 100 ml SAG-M (saline ,adenine ,glucose ,mannitol)(saline ,adenine ,glucose ,mannitol)

• Hb 15g/dl, Hct 50 – 70%Hb 15g/dl, Hct 50 – 70%

• 42 days shelf life42 days shelf life

• Not recommended for neonatesNot recommended for neonates

Leucocyte (poor) depleted Red Leucocyte (poor) depleted Red CellsCells

ContentsContents

• < 5*10< 5*1066 Leucocytes/ Pack Leucocytes/ Pack

• Prepared by filtrationPrepared by filtration

• Contains mainly Red Cells, NO Contains mainly Red Cells, NO PlateletsPlatelets



• Patients with FNHTRPatients with FNHTR

• Prevent HLA ImmunizationPrevent HLA Immunization

• Reduce the risk of transmission of Reduce the risk of transmission of intra cellular viruses – CMV , EBintra cellular viruses – CMV , EB– Transfusion to Immune compromised Transfusion to Immune compromised

patientspatients– Premature BabiesPremature Babies


• Buffy coat removed RBCs has less Buffy coat removed RBCs has less WBCsWBCs

• Washed Red Cells has less WBCsWashed Red Cells has less WBCs

• Will not prevent GVHDWill not prevent GVHD– Blood must be Irradiated Blood must be Irradiated

Washed Red CellsWashed Red Cells

• Wash the blood pack with Normal Wash the blood pack with Normal SalineSaline

• Removes Removes – > 80% of WBC> 80% of WBC– > 99% of Plasma> 99% of Plasma– > 99% of Platelets> 99% of Platelets

• Red cells suspended in SalineRed cells suspended in Saline

Washed Red CellsWashed Red Cells


• Repeated Allergic ReactionsRepeated Allergic Reactions

• IgA deficiency/ Allergic reactionsIgA deficiency/ Allergic reactions

• PNHPNH

• Patients with T activated red cellsPatients with T activated red cells• Patients with FNHTR (Patients with FNHTR (as an alternative to as an alternative to

filtered blood)filtered blood)

Irradiated Blood / Platelets / Buffy Irradiated Blood / Platelets / Buffy coatscoats

• Expose the unit to high energy Expose the unit to high energy gamma irradiationgamma irradiation

• Source Cesium 137 Source Cesium 137

• Expose the unit to 25 – 30 GyExpose the unit to 25 – 30 Gy

• Kill T lymphocytesKill T lymphocytes

• Prevent GVHDPrevent GVHD

IrradiatedIrradiated Blood / Platelets / Buffy Blood / Platelets / Buffy coatscoats


• Transfusion of cellular products to immune Transfusion of cellular products to immune compromised patientscompromised patients

• BM transplantBM transplant

• Paediatric applicationsPaediatric applications

• Intra uterine transfusionsIntra uterine transfusions

• Exchange transfusionsExchange transfusions

• Transfusions from first and second degree Transfusions from first and second degree relativesrelatives

• All HLA matched transfusionsAll HLA matched transfusions

• All granulocyte transfusionsAll granulocyte transfusions

De-Glycerolized Red De-Glycerolized Red CellsCells

(Frozen Red Cells)(Frozen Red Cells)

• Use glycerol as cryo-protectantUse glycerol as cryo-protectant

• Store in liquid or vapor phase Store in liquid or vapor phase NitrogenNitrogen

• Temperature below – 190Temperature below – 19000 c c

• Shelf life over 15 yearsShelf life over 15 years

• Mainly used for rare blood typesMainly used for rare blood types– e.g. Bombay e.g. Bombay oo

Platelet Platelet ConcentrateConcentrate

ContentsContents

• Random Donor PLRandom Donor PL– 55* 1055* 109 9 PL / Pack PL / Pack– <1.2*10<1.2*109 9 RBCs RBCs– <0.12*10<0.12*1099 WBCs WBCs

• Vol 50- 70 mlVol 50- 70 ml

• Storage 20 – 22 c, with agitation , 3-5 daysStorage 20 – 22 c, with agitation , 3-5 days

Platelet ConcentratePlatelet Concentrate


• Treatment of bleeding due to Treatment of bleeding due to – ThrombocytopeniaThrombocytopenia– ThrombasthaeniaThrombasthaenia

• Prevention of bleeding due to bone Prevention of bleeding due to bone marrow failuremarrow failure


ContraindicationsContraindications

• ITP except in life threatening conditionITP except in life threatening condition• TTPTTP• Untreated DICUntreated DIC

Platelet ConcentratePlatelet ConcentrateFailure to respond to Platelet Failure to respond to Platelet

TransfusionTransfusion• Continued bleeding (Dilution)Continued bleeding (Dilution)• Peripheral consumptionPeripheral consumption• Impaired BM productionImpaired BM production• Fever Fever • SepticaemiaSepticaemia• HypersplenismHypersplenism• HLA AbHLA Ab• Platelet specific AbPlatelet specific Ab• DIC DIC


DoseDose

• One unit (RDP) / 10 kg body wtOne unit (RDP) / 10 kg body wt

OROR

• One unit of SDP ( 240*10One unit of SDP ( 240*1099 PL ) PL )


ComplicationsComplications• Infection risk as same as whole bloodInfection risk as same as whole blood

• FNHTRFNHTR

• Allergic reactionAllergic reaction

• HLA sensitizationHLA sensitization

• Circulatory overloadCirculatory overload


Single Donor Platelets (SDP)Single Donor Platelets (SDP)

(Apheresis PL)(Apheresis PL)

• Vol 150 – 300 mlVol 150 – 300 ml

• 150 – 500 * 10150 – 500 * 1099 PL/ Pack PL/ Pack

Fresh Frozen PlasmaFresh Frozen PlasmaContentsContents

• Separated from fresh whole blood within 6hrs Separated from fresh whole blood within 6hrs of collection and stored at or below - 30 Cof collection and stored at or below - 30 C

• Contains all the clotting factors, Albumin& Contains all the clotting factors, Albumin& Globulins.Globulins.

• Labile factors (F V & F VII ) up to 70% of Labile factors (F V & F VII ) up to 70% of normal level.normal level.

• Volume 150 – 200 ml.Volume 150 – 200 ml.

• Methylene blue/ UV treated FFP – Low risk of Methylene blue/ UV treated FFP – Low risk of infection.infection.

• Store below – 25 c for 1 yearStore below – 25 c for 1 year

• Once thawed transfuse as soon as possible or Once thawed transfuse as soon as possible or max. 4 hrsmax. 4 hrs

Fresh Frozen PlasmaFresh Frozen PlasmaIndicationsIndications

• Clotting factor deficiencies when the specific Clotting factor deficiencies when the specific factor concentrates are not available.factor concentrates are not available.

• Multiple factor deficienciesMultiple factor deficiencies– Liver diseaseLiver disease– Wafarin over doseWafarin over dose– Dilutional coagulopathyDilutional coagulopathy

• DICDIC• TTPTTP• Hereditary angioneurotic oedemaHereditary angioneurotic oedema• Colenesteras deficiency.Colenesteras deficiency.• Neonatal haemorrhage.Neonatal haemorrhage.• Protein C deficiencyProtein C deficiency

Fresh Frozen PlasmaFresh Frozen Plasma

• ABO compatibilityABO compatibility

• No cross matchingNo cross matching

• Use a standard 170mic blood Use a standard 170mic blood administration setadministration set

• Adverse effectsAdverse effects– Allergic reactionsAllergic reactions– Volume overloadVolume overload– InfectionInfection

CryoprecipitateCryoprecipitate

CharacteristicsCharacteristics

• Prepared from FFPPrepared from FFP• Supplied as singe units or pooled unitsSupplied as singe units or pooled units• Contains Contains

– Factor VIIIFactor VIII– VwfVwf– FibrinogenFibrinogen– Factor XIIIFactor XIII– FibronectinFibronectin



• Haemophilia AHaemophilia A• vWF deficiencyvWF deficiency• FXIII deficiencyFXIII deficiency• Fibrinogen deficiencyFibrinogen deficiency• DICDIC


• ABO compatibility preferred in paediatric ABO compatibility preferred in paediatric patientspatients

• No cross matchingNo cross matching

• Use a standard 170mic blood administration Use a standard 170mic blood administration setset

• Adverse effectsAdverse effects– Allergic reactionsAllergic reactions– Transfusion Transmitted InfectionTransfusion Transmitted Infection

BLOOD TYPE COMPATIBILITYBLOOD TYPE COMPATIBILITY Blood Blood type of type of PatientPatient

Compatible Donor Blood / Plasma / Compatible Donor Blood / Plasma / FFPFFP

Red Cell Red Cell ConcentratesConcentrates

Whole Whole BloodBlood

Plasma/Plasma/FFPFFP

O PosO Pos O +, O -O +, O - O +, O -O +, O - O, A , B, O, A , B, AB plasmaAB plasmaO NegO Neg O -O - O -O -

A posA pos A +, A -, O +, O -A +, A -, O +, O - A +, A - A +, A - A or AB A or AB plasmaplasmaA NegA Neg A-, O -A-, O - A - A -

B PosB Pos B +, B -, O +, O -B +, B -, O +, O - B +, B -B +, B - B or AB B or AB plasmaplasmaB NegB Neg B -, O -B -, O - B -B -

AB PosAB Pos AB +, AB -, A +, AB +, AB -, A +, A - , B + B -, O A - , B + B -, O +, O -+, O -

AB +, AB -AB +, AB - AB plasma AB plasma onlyonly

AB NegAB Neg AB -, A -, B -, O -AB -, A -, B -, O - AB -AB -

Thank YouThank You

1. Has a visual & audible temperature alarm

2. Heating by dry heat

3. Flow rate of 150 ml/min

Microaggregate filters are used when large volumes of stored blood is transfused

Pall SQ40 after 1 unit of SAG-M prepared blood

Pall SQ40 after 1 unit of SAG-M prepared blood

Pall SQ40 after 2 units of SAG-M prepared blood

Pall SQ40 after 2 units of SAG-M prepared blood