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Blood components
Collection of blood About 450ml-500ml blood collected- antecubital
vein Collected in bags pre-filled with anticoagulant ACD & CPD shelf life 21 days(citrate chelates
calcium, phosphate and dextrose provide energy)
CPD-A 35 days(adenine is an added component, increased production of ATPs for longer shelf life)
Donors tested for Hep B, Hep C, HIV I & II Syphilis
Some for CMV additional typing such as HLA
Apheresis
Blood components are collected selectively from the whole blood donations and remaining blood is returned to the circulation of donor
Advantage is that more than one doses of plateletes or red cells can be collected from one donor per donation
Preservation and Storage Whole Blood is processed into its basic
components by centrifugation Whole Blood (Primary collection pack)--
centrifugation – Manual OR Automated extraction of components (Satellite Pack)
Platelet - Whole blood Processed on the same day of collection or stored overnight at 22'c
Plasma - processed on the came day or stored at 22'c upto 24 hrs
PRBC – stored at 4'c for 48 to 72 hrs
Preservation of RBCs:
1)Additive solutions
2)Frozen RBCs
Additive solutions:
Whole Blood in primary bag containing CPD-- Plasma is removed into another empty satellite bag-- additive solution added to red cells for improved viability
Three types of additive solutions are available AS-1 AS-3 AS-5
Red cells can be stored for 6 weeks at 2-6 'c
Frozen RBCs Red cells less than 6 days old frozen rapidly
after adding cryo preservative agent containing glycerols
Glycerol maintains liquid phase, prevents hypertonicity & damage due to freezing
Frozen red cells can be stored for 10 yrs For use thawed and deglycerolised Once thawed should be used within 24hrs RBCs are frozen in autologous transfusion and
storage of rare blood group
Special RBC preparations:
1)Leucocytes depleted RBCs
2)Gamma irradiated RBCs
3)Washed RBCs
4)CMV negative RBCs
Leucocyte depletion:
Concentration of leucocytes less than 5x10*6 per RBC unit by using special filters
Helps in preventing-
1)non hemolytic febrile transfusion reactions,
2)transmission of CMV EBV ,
3)transfusion related GVHD and
4)transfusion related acute lung injury (TRALI)
Gamma radiation:
To inactivate donor T-cells
Used to prevent GVHD in immunossupressed patients, very small babies, in large volume transfusion and during intrauterine transfusion or when donor is related
Small babies – weight bellow 1.2kg, preferable for any transfusion till 4 months of age
Irradiation reduces shelf life of RBCs to 28days, causes hyperkalemia
Used with in 4hrs in neonates
Washed RBCs
Used to remove plasma and reduce potassium Used in intrauterine transfusion, exchange transfusion, large volume transfusion, patients with immunoglobuline A deficiency
CMV reduced RBCs:
CMV reduced RBCs
Formed By leucocyte reduction or using CMV negative donors
Indicated in neonates and immunocompromised
Guidelines for transfusion of PRBC
Term Neonate
Condition Hb in gm/dl
Severe pulmonary disease <13
Moderate pulmonary disease <10
Severe cardiac disease <13
Major surgery <10
Symptomatic anemia <8
Children and Adolescents
Acute loss of >25% of circulating blood volume Hemoglobin <8gm/dl in perioperative period Hb <8 and symptomatic chronic anemia Hb <8 and marrow failure Hb <13 and severe cardiopulmonary disease
How much to give
Volume of PRBC
=blood volume(ml/kg) x (desired- actual hematocrit) / hematocrit of transfused RBC
5-15ml/kg of PRBC @5ml/kg/hr Should not ideally exceed 4 hrs due increased
risk of bacterial contamination Large volume transfusions->20ml/kg Exchange transfusion-160ml/kg replaces 87%
of blood
Side Effects of RBC Transfusion
1) Infectious
2) Non-infectious
a) Acute– Immunological
– Non immunological
b) delayed
Infections Viral infections- HIV, HBV, HCV, CMV
risk of post transfusion hep B/C is 10% in adults
causes are low viremia, undetected mutant strains
Bacterial infections- traponema etc in case of asympomatic bacteremia in donor
specially platelets as are stored room temp. Parasites- Plasmodium, Trypanosomes others Prions- Cruetzfold desease-incubation period of
approx 6.5years
Non- infectious cause-Acute
Immune mediated hemolysis:
Antibodies present in patient's plasma react with RBC antigen present in donor blood.
Eg. ABO, Rh, other minor group incompatibility
Infants less than 4 months do not produce isoagglutinins eg anti A, anti B
But hemolysis can occur due to materal antibodies
Should be screened for maternal antibodies if non O RBCs are to be given
Immune mediated hemolysis:
Signs and symptoms:
Fever,
Pain at infusion site,
Palpitations, giddiness,
Tachycardia,
Red urine
hypotension
Treatment:
Stop infusion
Hydrate the child- 10-20ml/kg
Frusemide
Treat hypotension with pressors if needed
Infusion of compatible RBCs
Transfusion related acute lung injury (TRALI)
Due to interaction of antibodies present in donor plasma with patients histocompatibility(HLA) antigens.
Cause non-cadiogenic pulmonary edema
Associated with transfusion of whole blood, packed cells, platelets, FFP, IVIG, cryo.
Signs and symptoms:
Mostly within the initial 6 hrs of transfusion Dyspnea Cough Fever Tachycardia Hypo/hypertension
Diagnosis: high degree of suspicion
Presence of donor serum antibodies cross reacting against the recipient
self limiting condition
Treatment is mainly supportive
Care of ABC
Febrile non-hemolytic transfusion reactions:
Due to cytokines released from leucocytes in donor unit
Increase in body temperature less than 2 degree
Less frequent if product is leucoreduced
Allergic reactions:
Due to preformed IgE antibodies in patients plasma against an allergen(protein) in donors plasma.
Mild form- hives and wheezing
Severe-anaphylaxis-rare
Treatment- antihistamines, bronchodilators, corticosteroids
RBCs and platelets can be washed
Acute non-immune reactions:
1)Fluid overload- in case of larger volume transfusion. >10-20ml/kg
Transfusion in chronically anemic pts
2)Hyperkalemia- potassium levels increase in stored blood.
Seen in large vol tx.
PRBC is to be washed and reconstituted in FFP before exchange transfusion
3)Hypoglycemia- blood stored in CPD has high glucose content. Initial hyperglycemia—stimulation of insulin
production ---hypoglycemia after 2-6 hrs.
4)Acid-base problems
5)Hypocalcemia, hypomagnesemia due to binding to citrate
6)Hypothermia- when cool blood is used
Delayed complications:
1)Alloimmunisation:
Uncommon before 4 months of age
Caused by transfusion of blood products with mismatched highly immunogenic antigens eg Rh
2)Transfusion associated graft versus host disease(TA-GVHD)
TA-GVHDLymphocytes from donor mount response against
the recipient's cells
Host is not able to mount response against donor
lymphocytes cause they are immunocompromised
premature babies, congenital immunodeficiencies, donation in relation, immunosuppressive drugs
Signs and symptoms:
Acute GVHD:
Develops from 2-5weeks of transfusion
Erythematous maculopapular rash, persistent anorexia, vomiting, diarrhoea
Increased liver enzymes, bilirubin
Chronic GVHD: persists or develops >3 months post transfusion
Prevented by leucocyte reduction and irradiation
Platelets
RDP: whole blood is subjected to centrifugation SDP: collected by method of plateletpheresis
PLT collected fm single donor, repeated 4-6 times.
3x10*11 platelets v/s 0.5x10*10 Stored for 5 days at 22+/-2 C with agitation Washed platelets decreased anaphylaxis but
shelf life only 24hrs
Indications of Plt transfusion in non-immune thrombocytopenia in
newborn
1) Plt count less than 30,000/cu mm: transfuse all
2) Plt count 30,000-50,000/cu mm: transfuse if
a)sick or bleeding newborn
b)newborn less than 1000gm or less than 1 week
c)previous major bleeding tendency(IVH grade3-4)
d)newborns wit concurrent coagulopathy
e)requiring surgery or exchange transfusion
3)Plt count 50,000-99,000/cu mm: transfuse if actively bleeding
Transfusion of Plt:
Immune- mediated: ITP
Platelets indicated only in severe form (<10000) of thrombocytopenia or bleeding along wit IVIG infusion.
NAIT: high risk of ICH
<50000 plt: IVIG to all
<50000 plt and bleeding: antigen negative plt in addition to IVIG
Dose: 5ml/kg should raise count by 30,000/cu mm
Recommended: 1 unit of platelet per 10 kg body weight
Granulocytes:
Indications: severe sepsis, funfal inf not responding to
antibiotics, Severe neutropenia or dysfunctional neutrophils
Dosing: 10-15ml/kg may need to be repeated every 12-24 hours
Granulocytes should be used within 24hours of collection
FFP:
CONTAINS: 1unit/ml of each coagulation factor Plasma proteins and antibodies
Indications: coagulopathies DIC Vit K def bleeding Inherited deficiencies of coagulation factors
Should not be used for increasing proteins or antibodies as safer, more effective options avbl
S/E as compared with PRBC transfusion
Dose: 10-20ml/kg repeated every 8-12 hrs
S/E:
Hyperkalemia will not occur
TRALI more likely
Acute hemolytic reactions less likely
Citrate induced hypocalcemia can occur
Cryoprecipitate:
Contains:
80-100 U of factor viii in 10-25 ml of plasma
300mg fibrinogen
Varying amount of factor xiii
Von Willebrand factor
Indications:
Congenital factor viii deficiency
Congenital factor ix deficiency
Afibrinogenemia and dysfibrogenemia
Von Willebrand disease
Dose: 5ml/kg