brief presentation regarding use of blood products

2. BLOOD COMPONENT TRANSFUSION
DR TANVEER ALAM
PAEDS ONCOLOGY
SKMCH & RC

3.  What is history of transfusion?
 What are Blood components ?
 How are the blood component separated ?
 What are the Indications for transfusion ?
 What is the dose of administration in paeds?
 What are complications?
 How to minimize the errors?
 What are the SKMCH protocol?

4.  Blood transfused in humans since mid-1600’s
 1828 – First successful transfusion
 1900 – Landsteiner described ABO groups
 1916 – First use of blood storage
 1939 – Levine described the Rh factor
HISTORY OF TRANSFUSIONS

5. BLOOD components
Any therapeutic substance prepared from human blood
WHOLE BLOOD
Unseparated blood collected into an approved container
containing an anticoagulant preservative solution
BLOOD COMPONENT
• RBCs
• platelets
• Plasma
• Cryoprecipitate
• GCSF
• Human albumin 4.5%
DEFINITIONS

8. FIRST
CENTRIFUGATION
Whole Blood
Main Bag
Satellite Bag
1
Satellite Bag
2
RBC’s
Platelet-rich
Plasma
First
Closed System

9. SECOND
CENTRIFUGATION
Platelet-rich
Plasma
RBC’s
Platelet
Concentrate
RBC’s
Plasma
Second

11. Storage
On 4° for up to 35 days
Indications
Massive Blood Loss/Trauma/Exchange Transfusion
Considerations
Donor and recipient must be ABO identical
Dosage
10 to 20 ml /kg
Never add medication to a unit
WHOLE BLOOD TRANSFUSION

12. Storage
4° for up to 42 days, can be frozen
Indications
Many indications ie anemia Hb < 7, hypoxia, etc.
dosage
Dose 10 to 15ml/kg Usually transfuse over 2-4 hours
or
Volume required = required rise in Hb in g/dl x wt in kg x 4
or
3-4 mls/kg of red cells raises Hb by 1g/dl
PRBCS TRANSFUSION

13. Storage
Up to 5 days at 20-24°
Indications
 Lumbar puncture - transfuse prior to LP to bring platelets > 50 x 109/l.
 Major surgery - maintain platelet count > 50 x 109/l (critical sites; brain,
spine, eyes > 100 x 109/l).
 Minor surgery - maintain platelet count at >50 x 109/l
 Line insertion - > 50 x 109/l.
 Line removal - > 50 x 109/l.
 Bone marrow trephine - Usually no need to transfuse - discuss with
operator. In some patients (e.g. aplastics or ITP), platelet transfusion
should be avoided if possible.
 Bone marrow aspirate - no need to transfuse.
PLATELETS TRANSFUSION

15. Dosage of platelets
10-20mls/kg for children
There may be a higher requirement in the following circumstances:
Active haemorrhage
Sepsis
Splenomegaly
Consumptive coagulopathy – e.g. DIC
PLATELETS TRANSFUSION
CONTINUE…

16.  Storage
 FFP--12 months at –18 degrees or colder
 Indications
 Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease,
exchange transfusion, massive transfusion,warfarin overdose, INR > 1.5 TO 2
befor surgery
Dose : 10-20mls/Kg
Considerations
 Plasma should be recipient RBC ABO compatible
 In children, should also be Rh compatible
 Usual dose is 20 cc/kg to raise coagulation factors approx 20%
FFP TRANSFUSION

17.  Rich source of Factor VIII, von Willebrand’s factor and fibrinogen
 Stored at -400C

 Dose of cryoprecipitate
 5 ml/kg
 Cryoprecipitate is available in most ABO groups
 Use within 4h of thawing
 use
 Haemophilia (Factor VIII deficiency)
 Fibrinogen deficiency & dysfibrinogenaemia
 Von Willebrand’s disease
CRYOPRECIPITATE

19.  Rich in protein
 This may be stored for several months in liquid form at 40C
 Suitable for replacement of protein e.g. following severe burns ,liver
disfuntion
HUMAN ALBUMIN 4.5 PER CENT

20. INDICATION & DOSE
In severe neutropenia in myelosuppresive chemotherapy
Initially 5mcg/kg/SC & can increase 5mcg/kg every cycle till anc10,000/mm3
BONE MARROW TRANSPLANT
10mcg/kg/day IV over 4 to 24 hours
IN SEVERE CHRONIC NEUTROPENIA
SITE
Abdomen (not around umbbilicus) ,thighs ,hips ,arm (rotate the site)
Keep refrigerated and do not shake before administration
G-CSF (FILGRASTIM

21. 21
Blood/ Start infusion Complete infusion
blood product
Whole blood/ within 30 min. of within 4 hour
red cells removing pack (less in high
from ambient temperature)
refrigerator
Platelet immediately within 20 min
concentrates
FFP within 30 min within 20 min
Time Limits for Infusion

22. Acute
Late
Infective
COMPLICATIONS OF BLOOD TRANSFUSION

23. ACUTE TRANSFUSION
REACTIONS
 Hemolytic Reactions
 Febrile Reactions
 Allergic Reactions
 Coagulopathy with Massive transfusions
 Bacteremia

25. Urticarial
rash
itch
Layrngeal edema
Bronchospasm
and cutaneous flushing
 Termination of transfusion
 IV crystalloids
 Maintenance of airway
 Oxygen
 Adrenaline
 IV antihistamine
 salbutamol
Signs and symptoms
Management
ALLERGIC AND
ANAPHYLAREACTIONS

26. Chills, fever
Low back pain
Headache
Chest pain
Dyspnea
Cyanosis
Restlessness, anxiety
Hypotension
Red urine
Stop transfusion
O2 supply
urine output monitoring
Treat shock
Volume replacement
Signs/Symptoms Management
HEMOLYTIC REACTION

27. Cough
Chest pain
Dyspnea
Distended neck veins
Frothy sputum
Slow infusion
oxygen
Diuretics
Vasodilators
Signs/Symptoms Management
VOLUME OVERLOAD

28. Causes
Pulmonary microvascular occlusion by microaggregates of platelets,
leucocytes and fibrin
Presentation
Fever, breathlessness, nonproductive cough, hypoxemia
TRANSFUSION RELATED
ACUTE LUNG INJURY

29.  Delayed haemolytic Transfusion reaction
Occurs in patients whose level of antibodies to antigen is so low that it escapes
detection by pretransfusion screen. Following transfusion , the secondary
immune response raises the antibody titre to a level that results in delayed
destruction of transfused cells
Presentation- fever falling Hb, jaundice & haemoglobinuria after 5-10 days
 SENSITIZATION
Development of antibodies to donated white cells & platelets
 GRAFT-VERSUS-HOST DISEASES
Occurs in immunodeficient patients
Immunocompetent patients after tansfusion of blood from a relative
Disease is caused by T-lymphocytes
Prevented by administrating gamma-irradiated cellular components to
immunodeficient patients & blood from relative should be gamma irradiated
LATE COMPLICATIONS

30. Every unit of blood contains 250 mg of iron
Repeated transfusions cause iron overload of monocyte-macrophage system
Becomes significant after 100 units
Involves liver, pancrease, myocardium and the endocrine glands
Treatment
Chelation therapy with desferrioxamine
HAEMOSIDEROSIS

31. Transmission of infective diseases
Serum hepatitis virus
HIV
Bacterial infection-result of faulty storage
Malaria
INFECTIVE COMPLICATIONS

32.  Arrange required blood product as you suspect any need
 If a patient need blood in emergency doctor can request blood bank
 Patient can get blood at exchange basis too
 We take consent for all type of blood transfusion when patient admit on
floor
 Written orders for blood transfusion should be given by Dr
 Repeat the sample after completion of transfusion
 If any reaction occur manage the patient immedietly
 Fill the blood reaction form and send the blood sample for culture and
recross match and remaining blood to the blood bank
 Document the probelum online
HOW DO WE DO IT IN SKMCH
&RC