1. Blood Transfusion: It is best to AVOID it Dr. Syed Muhammad Irfan
MBBS, FCPS (PK), FACP (USA)
Professor and Head
Department of Hematology & Transfusion Medicine
Liaquat National Hospital, Karachi 1

2. Why we transfuse To restore or maintain Blood Volume
Improve Oxygen carrying capacity
Achieve Hemostasis
Leukocytes in neutropenic patients

3. Can We do without blood Highly ethical and Professional
Issues pertinent to PK ? Shortage
To avoid Adverse blood reactions
Cost saving
Personal / Religious concerns

4. Avoiding blood & using Alternative
Indication and judicious use . . .
Alternative Products:
- Hematinic drugs
- Growth Factors
- Hemostatic Agents
- Crystalloids, Colloids
- Autologus Transfusion
Therapeutic Practices
Management Policies
Miscellaneous

5. If Transfusion is unavoidable
Blood is life saving but
is life threatening also.
Only when necessary
Specific & safe product,
Lowest effective dose & frequency
Diagnose and treat the cause

6. What to Transfuse Cellular Products: Red Cells Platelets Granulocytes:
Plasma products
FFP
Cryoprecipitate (CP)
Other Products

8. Red Cell Concentrate (RCC or PRC)
Universal Hb threshold ? ? Clinical
decisions are best
Ch anemias are well compensated;
Identify and treat the cause
Trigger in Acute Loss ?
No functional plts and granulocytes
Volume is about 200 cc
1 unit increases Hb: 1 gm / dl (HCT 3 % )
Use G canula

9. “Group O” PRC are universal donors
How much, how frequent, How to give
Transfuse as soon as you receive: 2-4 hr
Perioperative period: > 8 gm/dl.
We have no MSBOS (C/T ratio)
Can use leukocyte filters / washed NS
irradiated RC in special situations
Autologus transfusion in some cases

10. Practical transfusion 2006
When to transfuse PRC ?
stable patients
bleeding patients
< 4g/dl:
transfuse
4-7g/dl:
Tx usually necessary
7-10g/dl:
usually not necessary
> 10 g/dl:
Tx rarely required
Blood loss < 15% :
Fluids only; no blood
Blood Loss 15-30%
consider Tx
30-40% :
Tx usually necessary
> 40%:
tx indicated
Practical transfusion 2006

11. Washed Red Cells

12. Leukocyte Reduction Filters (maintains closed system)
Final unit must have less than 5 x 106 WBCs

13. Platelets Treat Patient – Not counts
Clinical status is main determinant
- Serious bleeds < 5000
- Uncomplicated: 10,000-20,000 is safe
- Complicated: 30, ,000
- Epidural & Massive transf > 50,000 ?
- Most surgeries: 80, ,000
- Neuro and retinal surg > 100,000
No Rh antigen. +ive can be given to –ive
Survival is < 24 hrs

14. Platelets Generally not indicated if no bleeding . . ITP,
Septicemia, DIC
Drug induced Thrombocytopenia
Hypersplenism
TTP
HIT and HITT
Routine cross match is not require, but if contains more than 2ml of red cells.
D typing is not require, less than 0.5 ml of red cells transfused carry small risk of immunization.

15. Random Donor Must give in right dose: 1 unit / 10 kg
Mixed groups can be given
Volume / unit: ml
Increment: 5000 – 10,000/bag
Not widely available in PK
Less RBC and Leukocytes contamination
5.5x1010 per unit (55x109)
ABO compatible preferably n=(P0-P1)x BSA/ CI=(P1-P0)x BSA/n

16. Single Donor Increase 30,000 – 60,000 (equals 6-8 RDP) Advantages:
Less donors
No volume overload
Lesser disease transmission
Less Plt Alloimmunization
Volume: 250 ml
Cost is the main concern
3x1011 per unit (300x109)

17. Fresh Frozen Plasma Has all coagulation factors and AT-III
Usual dose: 1 bag / 10 kg
ABO compatible & without regard to Rh
Volume / unit is about 200 cc
Not indicated as
Plasma expander in routine cases
Nutritional / Power source
Immunoglobin source

18. Fresh frozen plasma: indication
Deficiency: VIII, Fibrinogen, vWbD etc
Prolonged PT/APTT in surgical patients
Prolonged PT/APTT in bleeding patients
Masive transfusion
Reversal of warfarrin toxicity
Replacement of protein C/S/ATIII
Plasma exchange in TTP,
BCSH guidelines 2004

19. Cryoprecipitate Cryosupernatant By-product of FFP
Volume not a problem: just cc
Group specific or mixed (without Rh type)
Specifically used for factor VIII, I, XIII,
VII deficiency and vWD.
Topical hemostatic agent: Fibrin glue
Cryosupernatant
Volume about 180 cc
Mainly contain Factor II, VII, IX, and X
BCSH guidelines 2004

20. Whole Blood 450 +/- 50 ml Rarely used and minimally available
No sufficient labile coagulation factor
Restore blood volume & red cell mass
Indications :
- Exchange transfusion
Acute massive loss:
Contraindications
Volume replacement
correction of anemia in normovolumics

21. Irradiated products WHY ? To Prevent TA-GVHD (Graft vs. Host Disease)
TA-GVHD carries 90 % mortality
WHOM ?
Family donors
Immunocompromised recipients
HLA matched SCT donors
I/U transfusion

22. More Special blood products CMV negative HbS negative Antigen negative
Deglycerolysed red cells
Autologus blood 22

23. Summarising . . . . Best to avoid transfusion
If indicated; go for specific component
- It is Ethical
- Less transfusion Reactions
- Reduced cost
- More availability
Always consider alternatives

24. References: AABB (USA) Ludman Blood Transfusion
ABC of Blood Transfusion (UK) 24