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Published byMark Ryan Modified over 8 years ago
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Blood Transfusion Products
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Learning Objectives To identify the products that can be derived from whole blood donations To describe the conditions that can be treated with blood transfusion products To describe the screening process of blood products
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Blood Donation Products
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Whole blood In most circumstances, blood component therapy has replaced the use of whole blood. However, whole blood is still occasionally used for massive transfusion in circumstances in which rapid correction of acidosis, hypothermia and coagulopathy is required. This mainly occurs in military situations for trauma patients who require resuscitation.
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Red Blood Cells RBCs are prepared from whole blood by removal of most of the plasma. They are indicated in both acute haemorrhage and chronic anaemia. Red cell units have a haematocrit of 70% Shelf life of 35 days and 42 days respectively when refrigerated at 1-6°C.
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Platelets Each unit of platelets is prepared from a single whole blood collection by differential centrifugation and contains at least 5.5 x 10 10 platelets in 50 ml of plasma. They are stored at 20-24°C in plastic containers under agitation and have a shelf life of five days. Each unit can raise platelet count by 5-10 x 10 9 /L. Platelets are not usually cross-matched with the recipient, but ABO type-specific platelets should be provided where possible. Platelets are given to patients with thrombocytopenia who are bleeding or those with severe thrombocytopenia.
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Granulocytes These are mainly given to neutropenic cancer patients developing bacterial sepsis unresponsive to conventional antibiotic therapy for at least 24-48 hours.neutropenic Granulocyte preparations can only be stored for 24 hours at 20-24°C. They need to be cross-matched with the recipient's serum because of the large number of red cells they contain Granulocytes are only usually considered for patients with an absolute neutrophil count <0.5 x 10 9 /L and a good chance of marrow recovery
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Fresh Frozen Plasma FFP is produced by centrifugation of one donation of whole blood, and collecting the supernatant liquid. [4]4 The plasma is frozen within eight hours of collection, in order to maintain the activity of factor V and factor VII The main indication for FFP is deficiency of multiple coagulation factors found in liver disease and disseminated intravascular coagulation (DIC) It is also often used for urgent reversal of warfarin anticoagulationwarfarin
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Albumin This is available as 5% or 25% solution for the treatment of hypovolaemia and hypoalbuminaemia. The cost-benefit of albumin in the treatment of hypovolaemia is controversial but it is still used in the management of liver disease and ascites. It is tested for hepatitis C virus (HCV) RNA and virally inactivated, and not considered as a risk factor for viral transmission. Its use has now largely been superseded by non-plasma colloidal solutions
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Immunoglobulins Intravenous (IV) immunoglobulin is used in the treatment of immuno-thrombocytopenia, Guillain-Barré syndrome and autoimmune haemolytic anaemias. RhD immunoglobulin is used to prevent exposure to D-positive red cells causing Rh sensitisation in D-negative patients. This is usually given in pregnancy and immediately after birth to prevent haemolytic disease of the newborn in future babies.
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Factor VIII Also known as human antihaemophilic fraction, this is prepared from human plasma by a suitable fractionation technique and indicated for the treatment and prophylaxis of haemorrhage in haemophilia A. Large or frequently repeated doses in patients with blood groups A, B or AB can lead to intravascular haemolysis, this is less likely to occur with high-potency purified concentrates. Side-effects include allergic reactions, chills and fever. [4]4
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Screening Process
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Prior to donation Donors are typically required to give consent for the process and this requirement means minors cannot donate without permission from a parent or guardian If a potential donor does not meet these criteria, they are 'deferred'. The donor's race or ethnic background is sometimes important since certain blood types, especially rare ones, are more common in certain ethnic groups.
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In 2011, the UK reduced its blanket ban on MSM donors to a narrower restriction which only prevents MSMs from donating blood if they have had sex with other men within the past year. Donors are examined for signs and symptoms of diseases that can be transmitted in a blood transfusion, such as HIV, malaria, and viral hepatitis. Screening may include questions about risk factors for various diseases, such as travel to countries at risk for malaria or variant Creutzfeldt-Jakob Disease (vCJD).
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The donor is also examined and asked specific questions about their medical history to make sure that donating blood is not hazardous to their health. The donor's hematocrit or hemoglobin level is tested to make sure that the loss of blood will not make them anemic, and this check is the most common reason that a donor is ineligible. Pulse, blood pressure, and body temperature are also evaluated
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Post Donation The donor's blood type must be determined if the blood will be used for transfusions The collecting agency usually identifies whether the blood is type A, B, AB, or O and the donor's Rh (D) type and will screen for antibodies to less common antigens. More testing, including a crossmatch, is usually done before a transfusion.
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Most blood is tested for diseases, including some STDs. The tests used are high-sensitivity screening tests and no actual diagnosis is made. The blood is usually discarded if these tests are positive The donor is generally notified of the test result
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Donated blood is tested by many methods, but the core tests recommended by the World Health Organization are these four: Hepatitis B Surface Antigen Antibody to Hepatitis C Antibody to HIV, usually subtypes 1 and 2 Serologic test for Syphilis A variety of other tests for transfusion transmitted infections are often used based on local requirements. Additional testing is expensive.
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Cytomegalovirus is a special case in donor testing in that many donors will test positive for it. The virus is not a hazard to a healthy recipient, but it can harm infants[ and other recipients with weak immune systems.
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