BLOOD TRANSFUSION COURSE- Lecture 2
BLOOD UTILIZATION Dr. Akram Al-Hilali
2009
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WHOLE BLOOD UNIT or PACKED RED CELL UNIT WHICH ONE TO ORDER?
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Whole blood unit
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Thaw Whole Blood Unit
Transfuse
FFP
Infuse Plasma Precipitate by excess cold
Cryoprecipitate Extract
Centrifuge
Cryop P.R.P.
Plasma Platelets
Transfuse
Thaw & Infuse
Freeze
WBC RBC
Extract
Freeze
Coag Factor Concentrates Plasma
Centrifuge
Platelets
Plasma
Platelets
Platelets
WBC (Buffy Coat)
WBC PRBC
Plasma
Freeze
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Frozen RBC
Coagulation-Poor Plasma
Transfuse
Transfuse Thaw, wash & transfuse Transfuse
Preserve Reconstitute & Infuse
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PPF
Infuse
Infuse
WHAT IS IN A WHOLE ?BLOOD UNIT Red cells Leukocytes Platelets Plasma
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WHAT IS IN A PACKED RED ?CELL UNIT Red cells Leukocytes Platelets Plasma
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?NO DIFFERENCE PACKED RBC UNIT
All the red cells 20-70% of leukocytes 10% of platelets Third of the plasma
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WHOLE BLOOD UNIT
All the red cells All the leukocytes All the platelets All the plasma
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ARE THE COMPONENTS ?GOOD ENOUGH
Red cells are stored at 4oC within 2-6
hours of donation. They are good for 5 or 6 weeks, depending on the additive in the bag. This is true for whole blood and packed red cell units. Amount of plasma in the unit does not have an effect on the red cell viability, so long as the nutritive-anticoagulant is present.
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ARE OTHER COMPONENTS ?GOOD ENOUGH
Leukocytes are mostly non-viable
within hours of storage at 4oC. Some lymphocytes are viable for a long time. However, these are harmful to the patient. Even non-viable leukocytes may be harmful to many categories of patients. Hence, we remove leukocytes by leukodepletion filters for such patients. 08/02/14
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ARE THE COMPONENTS ?GOOD ENOUGH
Platelets are viable for a couple
of days at 4oC. Viability is reduced. They also tend to aggregate when settled at 4oC. They are harmful when given aggregated. They make microemboli in the lung. It is no good to give whole blood to treat thrombocytopenia. 08/02/14
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ARE THE COMPONENTS ?GOOD ENOUGH Many coagulation factors in plasma lose their activity in a gradual manner over 2-7 days. The longer stored blood (>one week) can be considered as useless from coagulation point of view. Water, electrolytes and albumin stay good as long as the blood is stored.
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BLOOD FROM THE BLOOD BANK IS ALMOST NEVER GIVEN ON DAY OF DONATION. SAFETY LAB TESTS ARE SO MANY THAT RESULTS WILL HAVE TO WAIT FOR AT LEAST 24 HOURS. WHOLE BLOOD UNIT MEANWHILE STAYS AT4oC 08/02/14
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What are we giving to the ?patient in a whole blood unit
Full red cell complement Dead leukocytes Useless platelets, may be harmful. Water and electrolytes of the plasma. Albumin solution ( total 15 g in a unit) 3 times more citrate than in packed red cells. 3 times more red cell antibodies, if they are present in the plasma
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A UNIT OF WHOLE BLOOD IS ORDERED LOSS
One unit of FFP or liquid plasma+ cryo One unit of platelets More citrate is given to the patient More antibodies are given to the patient (anti-A and anti-B in case of group O blood)
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GAIN Water Electrolytes Albumin
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PLATELET CONCENTRATE Storage temperature. Leukocyte content and bacterial phagocytosis. Febrile Reactions caused by platelet transfusions. “Sterilization” by additives+ UV light 08/02/14
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Platelet bag rotator
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PLATELET PRODUCTS AVAILABLE
Platelet unit derived from one random whole blood donation. “Adult platelet concentrate unit” formed by pooling 5 random units in one bag. Pooled platelets formed by pooling any number of units ordered for a particular patient “Single Donor Aphaeresis” unit taken from one donor by thrombaepheresis procedure. It contains platelets equivalent to 4-7 random units.
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Fresh Frozen Plasma Indications
Best example for multiple factor deficiency is liver cell pathology. Warfarin overdose and correction of warfarin effect in emergency surgery is another condition where FFP is used. DIC is a deficiency state of multiple factors and FFP offers help. However, FVIII and Fibrinogen present in FFP may not match the loss in these two factors in DIC. When more than 2 units of blood are transfused there will be dilutional deficiency of coagulation factors and one FFP unit ought to be given with every 2 subsequent blood units.
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Fresh Frozen Plasma Notes on Usage
Contains no intact cells. Leukodepletion for the immune compromised and neonates is not mandatory, though preferable by some . No need to irradiate in the immune deficient patients, because even if there are cells in it they would be damaged by freezing and thawing. Communicable diseases are transferable by FFP. Malaria is probably not transferred. In plasma exchange procedures at least a third of volume removed has to be replaced by FFP.
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Fresh Frozen Plasma Notes on Usage
It should transfused within 4 hours if not kept in the fridge after thawing. It should be used within 6 hours if kept in fridge after thawing. It can be used within 24 hours, if kept in fridge, but with reduced effectiveness. It should not be re-frozen. If transfusion time passes return to BB to be used as liquid plasma.
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Fresh Frozen Plasma Notes on Usage
Dose depends on extent of correction intended and whether there is ongoing consumption. A modest dose is 10 ml/kg The effect of FFP decreases quickly due to short half life, particularly of FVII. One should not be surprised if PT/INR correct by FF and returns to high level after 6-8 hours. So dose needs to be repeated. Give at the rate of 10-20 ml/minute. Very fast rate is essential in severe bleeding disorders.
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Fresh Frozen Plasma Notes on Usage
It has to be ABO compatible with patient’s red cells. It can be ordered any time before actual usage in order that BB makes sure of availability. However, specify time it actually needs to be collected. BB will only thaw at that time. If to be used for invasive procedure give it immediately before starting the procedure and part of it can continue infusion while the procedure is going on. Do not order more than 2 units at a time
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Fresh Frozen Plasma-24 Plasma separated from whole blood after 8 hours but in less than 24 hours after donation. A little inferior to FFP from coagulation point of view. Can be used in plasma exchange, burns and whenever coagulation problem is not serious.
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Liquid Plasma Unit
Volume: 150-200 ml. Obtained from FFP after removal of Cryoprecipitate, after 24 hours of donation or from thawed unused FFP
Storage :2-6 o C….26 days Contents: Albumin, • Other proteins, water and electrolytes. Deficient in coagulation Preparation Time: None. Compatibility: ABO Infusion: 2 ml/ minute or faster. Indications: Albumin deficiency, burns.
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Cryoprecipitate Indications
CP contains only 3 coagulation factors: Fibrinogen, VIII and XIII However, these factors are 4-5 times more concentrated than in FFP. A whole unit contains 70% of the 3 factors in the original blood unit. Can be used in specific conditions only.
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Cryoprecipitate Indications
• DIC and other consumptive coagulopathies like cardiopulmonary bypass. Fibrinogen deficiency as after streptokinase tPA. Hemodilution after multiple unit transfusion Uncontrolled bleeding in liver cirrhosis (together with FFP, at 1:2 ratio)
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Cryoprecipitate Notes on Usage
No blood group specificity involved. Can be pooled before issuing, due to small volume. Can be given individually by syringe. The unit (15 ml) can be given over 2-5 minutes. Request only when patient is ready to take.
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HOW DO WE MAKE UP FOR ?WHOLE BLOOD WITHOUT LOSS
If patient needs red cells only: give Packed Red Cell Unit [PRBC], as in anemia. If patient needs red cells and crystalloids only: give PRBC+ Crystalloids. If patient needs red cells, crystalloids and colloid: give PRBC+ Crystalloids+ Plasma Protein derivative (PPD) or liquid plasma. If patient needs RBC, coagulation factors(with or without crystalloid and colloid) give: PRBC+ FFP If patient needs the above with platelets: give PRBC+ FFP+ Platelet (and may be cryo)
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FINAL NOTES ON UTILIZATION
Always order Packed RBC units: Order FFP and/or Platelet concentrate if and as necessary with the Packed RBC unit, depending on the patient’s condition. A bleeding patient with normal coagulation and platelet count will start needing one FFP and one platelet unit for every 2 Packed RBC units after 3rd unit transfused.
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FRESH WHOLE BLOOD
This refers to blood prepared on day of donation. Donor is pre-tested. Crossmatching is done immediately after donation or prior to donation. This is not an impossible job but is logistically very complicated, especially when donation takes place at another site.
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