08/03/14
بسم ا الرحمن الرحيم
1
BLOOD TRANSFUSION COURSE AIMS OF THE COURSE • To acquaint you with products currently or potentially available from your Blood Bank • To give you broad guidelines for administering each product and its indications. • To define “type-and-screen” procedure in comparison with cross match. • To show the weak basis for ordering and giving whole blood. • To outline major blood transfusion hazards and reactions and to encourage reporting them for investigation
08/03/14
2
BLOOD TRANSFUSION COURSE-Lecture 1
BLOOD PRODUCTS AVAILABLE FROM HOPSITAL BLOOD BANK Dr. Akram Al-Hilali 2009
2
DONATED BLOOD UNIT
08/03/14
08/03/14
33
WHY DO WE FRACTIONATE DONATED BLOOD? ECONOMIC
In order to use each component to transfuse an individual patient, as indicated by his/her clinical condition 08/03/14 08/03/14
TECHNICAL Because each component needs different storage conditions, like temperature, and keeps for a different period under those conditions 44
Thaw Whole Blood Unit
Transfuse
FFP
Infuse Plasma Cryoprecipitate
Precipitate by excess cold
Extract
Centrifuge
Cryop Plasma Platelets
P.R.P.
Transfuse
Thaw & Infuse
Freeze
WBC RBC
Extract
Freeze
Coag Factor Concentrates Plasma
Centrifuge
Platelets WBC PRBC
Freeze
Plasma
Plasma
Platelets
Platelets
WBC (Buffy Coat)
Transfuse
Frozen RBC
Thaw, wash & transfuse
08/03/14
08/03/14
Transfuse
Transfuse
Coagulation-Poor Plasma Preserve
Reconstitute & Infuse
PPF
Infuse
Infuse
55
SINGLE BLOOD BAG
08/03/14
08/03/14
66
DOUBLE BAG
08/03/14
08/03/14
77
TRIPLE BAG
08/03/14
08/03/14
88
QUADRUPLE BAG
08/03/14
08/03/14
99
1.WHOLE BLOOD UNIT* Volume: ~500 ml. Storage in BB: 2-6o C…35 days or 42 days, depending on additive. Contents: RBC, WBC, Platelets & Plasma Time for preparation: 2hours • longer in routine, shorter in emergency. Compatibility: ABO & Rh. Other groups in some cases Indication: ?Acute blood loss. Transfusion time: < 4hrs. 08/03/14
08/03/14
10 10
2.PACKED RED CELL UNIT (PRBC) Volume:~ 300 ml. Storage:2-6 o C…35 days or 42 days, depending on additive. Contents: RBCs, WBC, Platelets and Plasma (reduced) Preparation Time: 2 hours. • Longer in routine, shorter in emergency Compatibility: ABO & Rh. Other groups in some conditions. Indications: Blood loss, surgery, anaemia. Transfusion Time: < 4 hours. 08/03/14
08/03/14
11 11
3.FRESH FROZEN PLASMA UNIT (FFP) Volume: 150-250 ml. Separated within 8 hours of donation. Storage: -30 o Câ&#x20AC;Śone year Contents: Coagulation Factors (all) â&#x20AC;˘ Other Plasma Proteins,Water, minerals. Preparation Time: 20 minutes (thawing). Compatibility: ABO only. Indications: coagulation factor deficiency. Infusion Time: 10-20 minutes- fast is better 08/03/14
08/03/14
12 12
4.Platelet Concentrate Unit Volume: 40-60 ml. Storage: 22-25 o C… 5 days. • Continuous mixing by rotation or rocking. Contents: Platelets, • some leukocytes, plasma. Preparation time: 10 minutes (for pooling) Compatibility: ABO (desirable) Indications: Thrombocytopenia. • Platelets function defects. Transfusion: 2-5 ml/ min. 08/03/14
13
Platelet concentrate Unit
08/03/14
14
5.CRYOPRECIPITATE UNIT (CP) Volume: 15-25 ml. Storage: -30 o C…one year. Contents: Coagulation factors VIII,XIII and Fibrinogen. Preparation Time: 15 minutes (thawing) Compatibility: Not needed Indications: Deficiency of VIII,XIII or DIC Infusion: 3-5 ml/ min 08/03/14
08/03/14
15 15
CROSSMATHING VSRSUS
TYPE AND SCREEN PROCEDURE
08/03/14
16
WHEN BLOOD IS NEEDED FOR A PATIENT The usual action is to order crossmatching of blood units. Number depends on condition. Some or all of the units may not used. Some orders are clearly not indicated. Blood is being ordered in some cases “to be on the safe side” The alternative is “Type-and screen” or “Group & save” 08/03/14
17
CROSSMATCHING STEPS Blood grouping and Rh typing for patient. Units of the same group are selected for crossmatching. Procedure takes at least one hour. Various reagents are used. Unit is crossmatched the day before surgery for cold cases. Unit is reserved for 2-3 days after surgery, if not used intraoperatively. 08/03/14
18
TYPE-AND-SCREEN STEPS Blood grouping and Rh typing for patient. Patientâ&#x20AC;&#x2122;s serum is checked with red cells of known groups (most of the known groups are contained in the red cells used). If serum contains antibodies against any of the blood group antigens on these red cells there will be positive reaction. Procedure takes one hour. If result is negative then any unit that has the same blood group as patient is considered compatible with his/her blood. 08/03/14
19
TYPE-AND-SCREEN Action by Clinical Side Order type-and-screen at least a day prior to surgery/delivery. Donâ&#x20AC;&#x2122;t mention number of units. Enter diagnosis and type of surgery. Enter date of surgery Make sure a blood specimen is taken (like x-match 08/03/14
20
ACTION AT BLOOD BANK Order and specimen are received. Blood group and Rh are done as usual Antibody screen is done. â&#x20AC;˘ Screen negative: just make sure there are at least 2 units of the same group in stock. If not, order more from BDC. â&#x20AC;˘ Screen positive: crossmatch 2 units for the patient and keep in reserve. 08/03/14
21
INTRA-OPERATIVE No undue bleeding: No action. Blood has not been reserved for patient (except in the rare event of positive screen). Unexpected bleeding: • Start fluids, as usual • Call Blood Bank to request a defined number of units. • Give an idea of level of urgency. 08/03/14
22
BLOOD BANK RESPONSE Dire emergency: “Please send someone to collect the blood immediately”. Hand the blood while checking very short x-match on the units given out. Emergency: “You can collect the blood in 20 minutes”. Short crossmatch is performed during this period. For patients who had proven to be antibody screen +ve the 2 units crossmatched can be given immediately, whatever the level of emergency, because they are ready 08/03/14
23
WHEN TO ORDER TYPE-ANDSCREEN INDICATIONS FOR CROSSMATCH AND TYPE-AND-SCREEN OPERATION PROCEDURE Probability of Transfusion need is >30%
Probability is 20-30%
Probability is less than 20%
Crossmatch blood. Number of units depends on procedure
Order typeand-screen
No action
08/03/14
24
ADVANTAGES OF T&S Blood is NOT reserved for patient. All blood stock is thus available to crossmatch for any other patient. Reserved blood in X-match is unusable for 3 days and loses this part of its shelf life. If reservation recurs for the same unit it may expire without being used for anybody 08/03/14
25
DISADVANTAGES OF UNNECESSARY CROSSMATCHING Procedure is more time and reagent consuming, particularly that usually more than one unit are ordered. Blood unit leaves the Blood Bank, where it is stored at optimal conditions in purpose-made fridges. Blood goes outside the fridge and may be kept for a long time at room temperature. Fridges other than those in Blood Bank are not the best controlled. 08/03/14
26
WHY UNNECESSARY CROSSMATCHING ORDERS? Lack of clear departmental guidelines on indications of crossmatching in various procedures. Most orders are done by the resident, who is not experienced and may fear blame by senior staff if no blood is ready at operation. Failure of the Blood Bank to supply blood in a timely and efficient manner, when ordered after type-and-screen is performed. 08/03/14
27
BOTH SIDES SHOULD TAKE FULL RESPONSIBILITY TO ENSURE THAT BLOOD , IS NOT WASTED , ON ONE HAND , AND GIVEN PROMPTLY IF NEEDED ON THE OTHER
08/03/14
28
INTERNATIONAL STANDARD It is accepted that some of the blood ordered to be cross matched will not be used and will be returned to blood bank. Accepted cross matched to transfused number of units (CTR) is 2.0 or less. It is not right to give blood unnecessarily, simply to reduce the ratio. 08/03/14
29