Transfusion of Blood Product

History: 1920:Sodium citrate anticoagulant(10 days storage) 1958: Plastic bag of transfusion 1656: Initial theory and methods (UK) 1665: Dog to dog transfusion 1667:Animal to human transfusion(20 times)by Denys ;one case expired with anaphylaxis in third transfusion 1975: Blood banking and blood products

Major Indication for Blood Product Transfusion: Restore Blood Volume Maintain oxygen carrying capacity Maintain hemostasis Maintain leukocyte function

Blood Donors: Healthy volunteers Healthy volunteers 17 years Usually over the age of 17 years 110 pounds At least 110 pounds in weight. detailed medical history Each donor is initially screened through a detailed medical history

Blood Test: 1. Antibodies to HIV-1 and HIV-2 (AIDS), 2. Antibodies to HBc produced during and after infection with Hepatitis B Virus 3. Antibodies to HCV produced after infection with the Hepatitis C virus 4. Antibodies to HTLV-I/II produced after infection 5. Antibodies to HBsAg produced after infection with Hepatitis B 6. HIV-1 p24, a test for the HIV (AIDS) antigen 7. For blood type (ABO) and Rh factor 8. Tp, the agent that causes syphilis 9. ALT,Coombs,CMV 10. NAT

NAT (Nucleic Acid Testing): A new technology that can detect the genetic material of Hepatitis C and HIV.

Packed CellPlatelet ConcentratePlasma

Red Blood Cells: 40-50% Blood Volume Oxygen carrying Store till 42 days in 4-8  C The most commonly blood product

Platelets: Platelets account for a small percentage of whole blood volume Control bleeding multiple doses Often transfused in multiple doses stored at room temperature Platelets must be stored at room temperature five day Only a five day shelf life

Plasma: A watery substance A watery substance in which proteins that trigger blood clotting mechanisms are suspended. raw material Plasma is used as a raw material “ Fractionated ” “ Fractionated ” into its different protein components Factor VIII, and other factors up to one year Plasma can be stored frozen for up to one year

Contraindication of Blood Product Transfusion No Absolute Indication of Blood Product Transfusion

The most important factor for blood transfusion: Patient’s clinical condition (Not a laboratory results)

Questions that need to be asked prior to a blood transfusion? patient’s condition 1)Will the patient’s condition be improved by a blood transfusion? alternative therapies 2)Do any alternative therapies to blood transfusion exist? benefit 3)Do the benefit of a blood transfusion outweigh the potential risks?

Criteria for viability of red blood cells on the final day of storage in particular anticoagulant: 1)A mean of 75%survival 24 hours after transfusion 2)Less than 4% hemolysis 3)Normal survival after 24 hours

Indication for Packed Cell Transfusion in Ill Patient who Admitted in ICU: HCT<35-40% In Neonate HCT<40-45%

Hct( Post transfusion) = (BW*80*Hct-P)+(R-Vol.*Hct-C) BW*80 BW=Body Weight(Kg) Hct-P=Pretransfusion Hematocrit R-Vol.=Volume of red cell transfusion Hct-C=Hematocrit of transfused cell

Whole Blood ( <10 Days Storage): Whole Blood ( <10 Days Storage): cardiac surgery Those undergoing cardiac surgery Acute blood loss Acute blood loss ( no suitable product is present)

Shelf Life of Red Cell Products: CPD: 21 Days CPD-A: 35 Days Adsol(AS-1): 42 Days Nutricel(AS-3): 42 Days Optisol(AS-5): 42 Days

Red Cell Products: Whole Blood Fresh Whole Blood Frozen Deglycerolized Packed Cells Packed Cells Leukoreduction of Red Cells Irradiation of Red Cells

Whole Blood: Massive Transfusion (Cardiac surgery) Exchange Transfusion

Fresh Whole Blood: Non refrigerated fresh blood administered by exchange transfusion within 4-6 hours of drawing can deliver a sufficient number of viable leukocytes. The dose required is 1x10  9 PMN/Kg (1½Blood Exchange Transfusion)

Frozen Deglycerolized Packed Cells Antigen matched transfusion Neonatal transfusion

Filtered Red Cells: Prevention of febrile non hemolytic reaction

Irradiation of Red Cells: Neonates Immuno-compromised recipients

Massive Transfusion: Replacement of more than one blood volume within 6 hours period

Causes of Massive Transfusion: Neonatal exchange transfusion Cardiac surgery Trauma Liver transplantation

Complications of Massive Transfusion: Citrate toxicity Alkalosis Hypokalemia Coagulopathy

Indication for Packed Cell Transfusion in Ill Patient who Admitted in ICU: HCT<35-40% In Neonate HCT<40-45%

Criteria of Platelet Transfusion: Platelet count<5,000-10,000/  L Minor or Major surgery< 30,000-60,000/  L Brain or Ophtalmic Surgery<50,000  L Massive Transfusion<30,000/  L

Platelet Transfusion Dose: One unit platelet will increase the platelet by 10,000/  L for each square meter of body surface

Corrected Count Increment (CCI): 1 Hour CCI<7,500 1 Hour CCI<7,500 1)Alloimmunization 2)Autoimmunization 3)Blood Banking 24 Hour CCI<4, Hour CCI<4,500 1)Sepsis 2)Fever 3)DIC

General Principles of Plasma Protein Transfusion Therapy: Accurate diagnosis In vivo volume distribution of plasma Half life of the infused protein Concentration of the coagulation factor in product

Dose of Coagulation Factors Requirement: