1. (وقل اعملوا فسيري الله عملكم ورسوله والمؤمنون)
بسم الله الرحمن الرحيم
(وقل اعملوا فسيري الله عملكم ورسوله والمؤمنون)
صدق الله العظيم

2. BLOOD COMPONENT THERAPY
Dr. Samy Marouf

3. BLOOD COMPONENT THERAPY
It is the transfusion of specific blood components required by the patient.
Principles
Use blood products only when it is essential.
Replace only the deficient component, if possible.
Identify the cause and if possible, treat it.
Use alternative , IV fluids

4. Blood components WB
PLT
PRBC
FFP

5. Optimal additive solution
Platelets
rich
plasma
Platelets
concentrate
2nd centrifugation
Whole
blood
1stcentrifugation
FFP for
clinical use
Red
Cell
concentrate
Fresh plasma
FFP for
fractionation
Optimal additive solution
Cryoprecipitate
Red cells in
OAS

6. Blood COMPONENTS AVAILABLE FROM THE BLOOD BANK
Whole blood
Packed RBCs
Random donor Platelets
Single donor platelets (Apheresis)
Fresh Frozen Plasma (FFP)
Cryoprecipitate 3

7. Whole Blood 450 ml of whole blood with 63 ml of anticoagulant
need for oxygen carrying capacity and volume replacement
no viable platelets or WBC
decreased labile coagulation factors (Factor V and VIII)
Not available since it is not efficient utilization of blood

8. Whole Blood Expected gain 1 gm /dl active bleeding >30%
Neonatal exchange transfusion

9. Packed Red Blood Cells (PRBCs)
ml of RBCs and 50 ml of plasma
Hematocrit 55-70% depending on anticoagulant
shelf life 35 to 42 days depending on the anticoagulant
treatment of symptomatic anemia where oxygen carrying capacity is needed

10. Packed Red Blood Cells (PRBCs)
Indications :
1- Acute blood loss (100% blood volume = 5 Liters of blood)
a – Amount of Loss:
i - > 15% with severe cardiac or Respiratory disease.
ii – 15 – 30% with preexisting Anemia , or continuous blood loss.
iii- > 30% blood loss.

11. b- Hb: i- < 7 gm/ dl.
ii - < 8 gm/dl in elderly with cardiovascular or Resp. disease.
3- Preoperative Transfusion :
a- Treat cause of anemia.
b- Avoid cause of bleeding .
c- Follow Maximum Surgical blood usage list.
4- Chronic Anemia:
b- Erythropoietion therapy.

12. d – sickle cell disease : i – if Hb < 7 gm/ dl.
c – B- Thalassemia: Hb. Maintained > 9.5 gm/ dl.
d – sickle cell disease :
i – if Hb < 7 gm/ dl.
ii – if Hb < 10 gm/ dl. In cases with:
- Cerebro vascular accid. or at high risk.
- Acute chest or abdominal syndrome.
- pre operative for major surgery.
- pregnancy .
- priapism.
Dose : 10 ml/kg

13. Indication for Platelet Transfusion
Decrease platelet production (Bone marrow failure)
Therapeutic:for patient who are bleeding associated with BMF caused by either disease, therapy or irradiation.
Prophylactic: >10x 109/L to decrease morbidity in patients with thrombocytopenia due to B.M.F.

14. Indications for prophylactic Platelets transfusion
major bleed, major surgery >100,000
minor bleed, minor procedure >50,000
prevent spontaneous bleed > 10,000

15. Pooled Platelets
are prepared from the platelet portion of 6 whole blood units plus 300 ml of plasma (potential for 6 infectious disease exposures) expires after 5 days
6 X 5 X 10 E10 = 3.0 x 10 E 11 platelets
6 x 5000 rise /RD plt = 30,000
transfuse the patient with platelets from many donors to see which platelets will raise the platelet count

16. Plateletpheresis donated by a single donor
3.0 x 10 E11 platelets plus 300 ml of plasma, expires after 5 days
raises the platelet count 30,000
used for all platelet transfusions until less than 10,000 platelet increase

17. Low Post-transfusion Increment to Platelets
Definition : it is failure to obtain satisfactory response to platelet transfusion of unselected platelet components.

18. Low Post-transfusion Increment to Platelets
1 hour post (platelet recovery) poor
platelet alloantibodies
platelet autoantibodies
hepatosplenomegaly
24 hour post (platelet survival) poor
infection bleeding
DIC fever

19. Administration of Platelet Concentrate:
ABO compatible platelet are preferred but not necessary.
Platelet concentrate should be transfused as soon as possible after reaching the ward with standard blood transfusion sets with 170 mm filters.
The transfusion should normally be completed within 30 minutes.
Observation during platelet transfusion should include pulse& temperature before& after transfusion.

20. Fresh Frozen Plasma (FFP)
ml of plasma frozen at -18C within 8 hours of collection
no platelets are present
contains all coagulation factors
an unconcentrated source of fibrinogen
use Cryo to correct a low fibrinogen level
needs min lead time to thaw prior to use

21. FFP Continued Definite indication:
Replacement of single or multiple factor deficiencies
Immediate reversal of warfarin effect
Vitamin K deficiency
Acute disseminated intravascular coagulation
Thrombotic thrombocytopenic purpura
not used if non bleeding or for volume replacement
indicated when PT/PTT are >17/55 sec

22. Cryoprecipitate (Cryo)
a white precipitate that forms when FFP at -18C is thawed to 4C
volume is 10 to 15 ml
adult dose is 10 to 20 pooled units
30 minutes is needed for thawing and pooling

23. Cryoprecipitate continued
Cryoprecipitate can be used for the replacement of all of the following:
vWF vWD
Factor VIII Hemoplilia A
Factor XIII Factor XIII def
Fibrinogen dec. fibrinogen *
head injury, massive bleed, trauma,

24. GRANULOCYTE CONCENTRATES
Prepared by cytopheresis
Donor prepared by administering cortisol (releases marginating pool) and hydroxyethyl starch (facilitates RBC/WBC separation)
1 X 1010 WBCs in 200 to 600 mL plasma
Storage at RT for 24 hours
ABO/Rh compatible; HLA compatible

25. Criteria for use
< 500 WBC/mm3
-active infection (as evidenced by fever) not responding to antibiotics
*myeloid hypoplasia with reasonable chance for survival
*Limited usage; usually for neonates with sepsis (immature WBCs)

26. Leukocyte Reduced blood component

27. Leukocyte Reduced RBCs
RBCs with 99.99% of WBCs removed by leukocyte reduction filter
prevents repeated nonhemolytic febrile transfusion reactions
reduces immunosuppression of recipient by donor WBC
All cellular components are leukoreduced now

28. Leukocyte Reduced RBCs continued
decreases post-operative surgical infections due to reduced immunosuppression
prevents or delays HLA alloimmunization
identical to CMV seronegative blood
does not prevent graft versus host disease, only gamma irradiation prevents graft versus host disease

29. Indications for Leukocyte Reduced RBC continued
after second nonhemolytic febrile transfusion reaction
newly diagnosed leukemics
long term multiple transfused patients
sickle cell disease
aplastic anemia
thalassemia

30. Irradiated blood component

31. (Gamma) Irradiated RBCs
RBCs and platelets are exposed to gamma irradiation at 2500 rads for 4.5 minutes
this inactivates the T lymphocytes in the donor unit and prevents graft versus host disease in an immunocompromised recipient

32. Indications for Gamma Irradiated
bone marrow transplant recipients
congenital immunodeficiency syndromes
intrauterine transfusions
transfusions from all blood relatives
Hodgkin’s disease
WBC products (to neutropenic patient)
(never Stem Cells)

33. Massive Transfusion

34. Massive Transfusion
Definition : transfusion of a volume of blood equal to the patient total blood volume in less than 24 hours
Problem of massive transfusion : thrombocytopenia , coagulation factor depletion , O2 affinity changes , hypocalecaemia , hyperkalemia , acid base disturbance , hypothermia
Managemant: (saline, Ringer,albumin HES)

35. Massive Transfusion Give blood products as a ratio
1 dose : 1 dose : 1 dose : 1 dose
5 RBC : FFP : 6 RD PLT : 10 Cryo
________________ (1 PPH) _________
Hgb(10gm)
PT PTT(<1.5 N)
Plt Ct (50000/ul))
Fib(>100mg%)

36. AUTOLOGOUS TRANSFUSION

37. AUTOLOGOUS TRANSFUSION
Definition : It is the use of patient own blood. Autologous transfusion is alternative to allogenic transfusion in elective surgery (T& C) ,3 types (predeposite transfusion ,acute normovolaemic hemodilution , intraoperative blood salavage
Advantages: no risk of viral infection ,all immunological reaction ,decrease post-operative infection ,tumor recurrence

38. AUTOLOGOUS TRANSFUSION
Disadvantages: 50% discarded , not used for other patients , volume overload, bacterial contamination, clerical errors
Exclusion criteria : unconfirmed date ,poor venous access, infection , anemia , hemodynaemic instability

39. AUTOLOGOUS TRANSFUSION
Blood donation schedule:
safety
Donor and pre-transfusion test
Storage

40. Blood warmers

41. Blood warmers
Hypothermia is defined as the core body temperature below 35 C.
Possible side effects of hypothermia are cardiac arrhythmia homeostasis abnormalities from impaired platelet function and slowed enzymatic reactions in the coagulation cascade vasoconstriction , dehydration , lack of oxygen to tissues increased red cell release of potassium and (with blood component transfusion) citrate toxicity. The metabolism of drugs is also impaired.

42. Advantages of blood warning devices: The primary advantage of using blood warming devices during massive transfusion is to prevent the complications caused by hypothermia thus improving survival rates and patient outcomes including decreased length of hospitalization. Hypothermia impairs immune function may promote surgical-wound infection and delay wound healing. Disadvantages and complication:
1-Risk of hemolysis. 2-Risk of sepsis. 3-Decreased infusion rate. 5-Expense.

43. Indication for use:
• Massive transfusions (1 unit /10 minutes). • Trauma situations in which core-re-warming measures are indicated. • Administration rate >50 ml/minute for 30 minutes or more (adults). • Administration rate >15 ml/kg/hour (children). • Exchange transfusion of a newborn.

44. Warning:
• • Do not warm blood components by placing on or near a radiator heater patient-warming blanket or in a conventional microwave oven or plasma thawer. • Do not allow the unit to sit at ambient room temperature for prolonged periods to warm up. • Do not place blood components under running hot tap water or in an unmonitored or improvised warm water bath. • Do not return blood components that have been warmed to inventory

45. Non infectious COMPLICATION OF BLOOD TRANSFUSION

46. Transfusion Reaction

47. Acute Hemolytic Transfusion Reaction
a clerical error (wrong specimen, wrong patient)
1 in 6,000 to 25,000 transfusions
back pain, chest pain, fever, red urine, oliguria, shock, DIC, death in 1 in 4
stop the transfusion

48. Administration
Identity check

49. Work up of An AHTR start normal saline treat patient symptomatically
send blood bag and tubing to culture
send red top and purple top tubes
urine specimen for hemoglobinuria
DAT is positive

50. Non Hemolytic Febrile Transfusion Reaction
NHFTR (1:100)
Recipient has WBC antibodies to Donor WBCs contained within RBCs and Plateletpheresis products
DAT is negative
rise in temperature by 2F or 1C
other causes for fever are eliminated
blood that is hanging can be restarted ??

51. Allergic (Urticarial) Transfusion Reaction
Recipient has antibodies to the Donor’s plasma proteins (1 in 1000)
offending protein is not identified
urticaria, itching, flushing, wheezing
this is the only transfusion reaction where the blood that is hanging can be restarted after treatment with Benadryl
if symptoms continue then STOP

52. Anaphlyactic Transfusion Reaction
anaphylactic reaction (1 in 150,000)
1 in people never made IgA
occurs when exposed to normal blood products which contain IgA
bronchospasm, vomiting and diarrhea and vascular collapse
treat with Epinepherine, Solu-Medrol,

53. Circulatory Overload marginal cardiovascular status
given blood components too rapidly
develops acute shortness of breath, heart failure, edema (1: 10,000)
systolic BP increases 50 mm
infuse slowly, not to exceed 4 hours
split the unit of RBC and give half

54. Transfusion Related Acute Leukocyte Lung Injury
TRALI reaction (1:10,000)
Donor plasma contains WBC antibodies that when transfused to the recipient cause agglutination of recipient’s WBC in the pulmonary capillary beds
Chest X ray looks like ARDS
Donor removed from donating blood

55. Blood Used on Emergency Basis

56. Blood Used on Emergency Basis
for a patient that is bleeding out
and the blood type is unknown
group O, Rh negative, uncrossmatched
recipient may have an unexpected antibody
after 5 min use ABO and Rh type specific blood

57. Sepsis from Bacterial Comtamination
Platelets:
skin contaminants most common cause
plateletpheresis 1 in 5000
pooled platelets 1 in 1000
RBC:
Sepsis from RBC due to Yersinia, Enterics or Gram Positive 1 in 3,000,000

58. Knowing is not enough; we must apply. Willing is not enough; we must do."