TRANSFUSION MEDICINE MBBS,MCPS,FCPS. Professor of Pathology DR. AYESHA JUNAID MBBS,MCPS,FCPS. Professor of Pathology Consultant Haematology Incharge Blood Transfusion Services SIH

TRANSFUSION REQUIREMNT ONLY APPROPRIATE TRANSFUSION Transfusion of safe blood products to treat a condition leading to significant morbidity /mortality that could not be prevented or managed effectively by other means

TRANSFUSION MEDICINE Blood Transfusion can be fatal if incorrectly administered

TRANSFUSION Haematological malignancies 15% of all red cell units transfused to haematological diseases are transfused for Malignant disorders Effect of the disease itself Myeloablative /myelosuppressive effects of specific treatment

Indications for RCC, Plts,FFP NO UNIVERSAL TRIGGER FOR TRANSFUSION Clinical judgment Quality of life indices Approach to the management and prevention of complications

BLOOD COMPONENTS Whole blood Packed red blood cells Leukodepleted red cells Washed red blood cells Platelets concentrates Single-donor/Random-donor Irradiated blood products (red blood cells and platelets concentrates) Leukocyte (granulocyte) concentrates

BLOOD COMPONENTS Plasma components/products Fresh-frozen plasma (FFP) Cryoprecipitate Factor concentrates (VIII, IX) albumin Immune globulins

Blood Components

Whole Blood Red Blood cells, Platelets and White Blood Cells all suspended in Plasma constitute Whole Blood.

Whole Blood Unit After centrifugation whole blood separates into the plasma and platelets on top and packed red blood cells on the bottom. A plasma expresser is used to literally squeeze the plasma and platelets off the top and leave only the red blood cells in the original bag.

PLASMA SEPARATION

Blood Components Random donor Platelets Packed Red Blood Cells Plasma Product

RBC Components Packed RBCs(RCC) Approx. 1/2 the volume of Whole Blood Same RBC mass therefore same oxygen carrying capacity Total Volume 250ml Expiration Date 35-42 days CPDA 1 - 35 days closed system AS-1 - 42 days closed system Open System - 24 hours

RBC Components continued… LEUKOCYTE REDUCED RBC’S Removal of leukocytes from RBC component to <5.0 X 106 per unit 1. Leukopoor filtration 2. Washing 3. Freezing and Deglycerolization

Leucodepletion Removal of majority of white cells is leucodepleton. Purpose : To reduce incidence of febrile illness and alloimmunization after transfusion.

Platelets Random-donor platelets concentrates (RPC) Single-donor platelets concentrates (SPC)

PLATELETS CONCERTERATES They are harvested by cell separators or from individual donor units of blood. Need of transfusion is in patients with thrombocytopenia , active bleeding or platelet dysfunction . For prophylaxis the platelet count should be more than 5-10 x109/ l Platelet transfusion should be avoided in autoimmune thrombocytopenic purpura.

Platelet Components: Random Donor Platelets Prepared from a Whole Blood (WB) component Step 1: Soft (light) Spin (2-3 min at 3200 rpm) to keep the platelets in the plasma. Step 2: Hard (heavy) Spin (5 min at 3600 rpm) to aggregate platelets. Express off all but 55- 65 ml of plasma and let platelets rest and resuspend on counter (room temp) for 1-2 hours before aggitation.

Platelet Components Includes Random donor platelets, Single donor platelets and Pooled Platelets.

Platelet Components Random Donor Platelet At least 5.5 x 1010 platelets/unit Single Donor Platelet - Apheresis At least 3.0 x 1011 platelets/unit Suspended in 300 ml plasma

SINGLE DONOR PLATELET APHARESIS

Platelet Components Pooled Platelets Process of pooling Random Donor Platelets into a central bag. Typically done for adult patients. Need a common “Pool” number on the unit. (Remember we are pooling many donors who each have a unique donor number.) Pool anywhere from two to twenty units. Expiration changes from 5 days to 4 hours - Need to be sure the floor is ready to transfuse before pooling.

Plasma Components Fresh Frozen Plasma Plasma expressed from Whole Blood, needs to be frozen within 8 hours (6 hrs for ACD) of collection for CPDA-1 anticoagulant. Frozen at -18oC: Frozen at -65oC: Thawed: 150-250 ml total volume Contains all clotting factors

HUMAN PLASMA PREPARATIONS Fresh frozen plasma ( FFP) , is mainly used for replacement of coagulation factors ( when specific concentrates are unavailable ) FFP are also given after massive transfusion , DIC , in liver disease .

TRANSFUSION REQUIREMNT IN LEUKEMIC PATIENTS Review your decision Irradiated Leukodepleted CMV negative Single donor Platelets TO THE CORRECT PATIENT