Blood ComponentsBlood Components Dosage And Their Dosage And Their

AdministrationAdministration

Fadi KhaizaranFadi KhaizaranDallaa General HospitalDallaa General Hospital

LD/BB Chief TechniciansLD/BB Chief TechniciansNov 2012Nov 2012

History of Transfusions

Blood transfused in humans since mid-1600’s 1828 – First successful transfusion 1900 – Landsteiner described ABO groups 1916 – First use of blood storage 1939 – Levine described the Rh factor

Transfusion Overview

Integral part of medical treatment Most often used in Hematology/Oncology, but

other specialties as well (surgery, ICU, etc) Objectives

Blood components Indications for transfusion Safe delivery Complications

Blood Components

Prepared from Whole blood collection or apheresis Whole blood is separated by differential centrifugation

Red Blood Cells (RBC’s) Platelets Plasma

Cryoprecipitate Others

Others include Plasma proteins—IVIg, Coagulation Factors, albumin, Anti-D, Growth Factors, Colloid volume expanders

Apheresis may also used to collect blood components

Differential CentrifugationFirst Centrifugation

Whole Blood Main Bag

Satellite Bag 1

Satellite Bag 2

RBC’sPlatelet-rich Plasma

First

Closed System

Differential CentrifugationSecond Centrifugation

Platelet-rich Plasma

RBC’s PlateletConcentrate

RBC’s

Plasma

Second

Whole Blood

Storage 4° for up to 35 days

Indications Massive Blood Loss/Trauma/Exchange Transfusion

Considerations Use filter as platelets and coagulation factors will not be

active after 3-5 days Donor and recipient must be ABO identical

RBC Concentrate

Storage 4° for up to 42 days, can be frozen

Indications Many indications—ie anemia, hypoxia, etc.

Considerations Recipient must not have antibodies to donor RBC’s

(note: patients can develop antibodies over time) Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl) Usually transfuse over 2-4 hours (slower for chronic

anemia

Platelets

Storage Up to 5 days at 20-24°

Indications Thrombocytopenia, Plt <15,000 Bleeding and Plt <50,000 Invasive procedure and Plt <50,000

Considerations Contain Leukocytes and cytokines 1 unit/10 kg of body weight increases Plt count by 50,000 Donor and Recipient must be ABO identical

Plasma and FFP

Contents—Coagulation Factors (1 unit/ml) Storage

FFP--12 months at –18 degrees or colder Indications

Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease, exchange transfusion, massive transfusion

Considerations Plasma should be recipient RBC ABO compatible In children, should also be Rh compatible Account for time to thaw Usual dose is 20 cc/kg to raise coagulation factors approx 20%

Cryoprecipitate

Description Precipitate formed/collected when FFP is thawed at 4°

Storage After collection, refrozen and stored up to 1 year at -18°

Indication Fibrinogen deficiency or dysfibrinogenemia vonWillebrands Disease Factor VIII or XIII deficiency DIC (not used alone)

Considerations ABO compatible preferred (but not limiting) Usual dose is 1 unit/5-10 kg of recipient body weight

Granulocyte Transfusions

Prepared at the time for immediate transfusion (no storage available)

Indications – severe neutropenia assoc with infection that has failed antibiotic therapy, and recovery of BM is expected

Donor is given G-CSF and steroids or Hetastarch Complications

Severe allergic reactions Can irradiate granulocytes for GVHD prevention

Leukocyte Reduction Filters

Used for prevention of transfusion reactions Filter used with RBC’s, Platelets, FFP,

Cryoprecipitate Other plasma proteins (albumin, colloid

expanders, factors, etc.) do not need filters—NEVER use filters with stem cell/bone marrow infusions

May reduce RBC’s by 5-10% Does not prevent Graft Verses Host Disease

(GVHD)

RBC TransfusionsPreparations

Type Typing of RBC’s for ABO and Rh are determined for

both donor and recipient

Screen Screen RBC’s for atypical antibodies Approx 1-2% of patients have antibodies

Crossmatch Donor cells and recipient serum are mixed and

evaluated for agglutination

RBC TransfusionsAdministration

Dose Usual dose of 10 cc/kg infused over 2-4 hours Maximum dose 15-20 cc/kg can be given to hemodynamically

stable patient Procedure

May need Premedication (Tylenol and/or Benadryl) Filter use—routinely leukodepleted Monitoring—VS q 15 minutes, clinical status Do NOT mix with medications

Complications Rapid infusion may result in Pulmonary edema Transfusion Reaction

Platelet TransfusionsPreparations

ABO antigens are present on platelets ABO compatible platelets are ideal This is not limiting if Platelets indicated and type specific

not available

Rh antigens are not present on platelets Note: a few RBC’s in Platelet unit may sensitize the Rh-

patient

Platelet TransfusionsAdministration

Dose May be given as single units or as apheresis units Usual dose is approx 4 units/m2—in children using 1-2

apheresis units is ideal 1 apheresis unit contains 6-8 Plt units (packs) from a

single donor Procedure

Should be administered over 20-40 minutes Filter use Premedicate if hx of Transfusion Reaction

Complications—Transfusion Reaction

18

Blood/ Start infusion Complete infusionblood product

Whole blood/ within 30 min. of within 4 hourred cells removing pack (less in high from ambient temperature)

refrigerator

Platelet immediately within 20 minconcentrates

FFP within 30 min within 20 min

Time Limits for InfusionTime Limits for Infusion

Is the product clearly prescribed? Are any drugs required before or during

transfusion? i.e. antibiotics Is the rate of transfusion appropriate? Does the patients condition require medical

review prior to transfusion

All patients having a blood transfusion MUST have a NAMEBAND containing all of their required details

1st checkers

Registered Nurse/ Midwife, Doctor

2nd Checkers

Any of the above &

Qualified Theatre Practitioner

or qualified nurse

Base line observations – Temperature, pulse and blood pressure

Further observations (as above) at 15 minutes

A set of observations at the end of transfusion

More frequently if the patient is unwell, unobservable, unconscious or a child.

Ensure the venflon is secure, patent and there are no signs of inflammation

Give the patient the call bell Patients should remain in a clinical area for

the duration of the TransfusionReview the patients fluid balance and

medication.

LEAKSDISCOLOURATIONCLUMPING

EXPIRY DATE

If there is ANY discrepancy - DO NOT transfuse

Pre-administration Procedure

Step 3: Undertake visual inspection

Step 1: Check the blood component has been prescribedStep 2: Undertake baseline observations

Be extra vigilant when checking the identity of the unconscious / compromised patient

Step 1: Ask the patient to tell you their:

Full Name + Date of Birth

Check this information against the patient’s ID wristband

Step 2: Check the patient’s

– First name– Surname– Date of birth

– Hospital number

on the compatibility/traceability label against the patient’s ID wristband

Administration Procedure

Any discrepancies DO NOT TRANSFUSE !

Administration ProcedureStep 3: Check the compatibility/traceability label with the blood bag label

SURNAME

FIRST NAME(s)

HOSPITAL NUMBER

D.O.B.BLOOD GROUP(Patient and Unit)

DONOR NUMBER

EXPIRY DATE

Special Requirements

Blood Component Bedside Check Procedure

 

Stop the Transfusion and seek Medical Input and inform the Transfusion Laboratory staff

Check the Blood component matches the patient details

Replace the unit and giving set with Normal Saline 0.9%

Send the discontinued unit with giving set attached back to transfusion capped off at the end with a white venflon cap – and any previous transfused bags sealed with the blue plugs all in biohazard bags

Documentation (complete the checklist)

Complete a Trust Incident form