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Blood and BloodBlood and Blood
Product TransfusionProduct TransfusionKyi Than OoKyi Than Oo
FRCS (Glasg)FRCS (Glasg)Associate ProfessorAssociate Professor
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Types of blood transfusionTypes of blood transfusion
Heterologous (Different species)Heterologous (Different species)
Homologous (Same species)Homologous (Same species)
Autologous (Same person)Autologous (Same person)
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Composition of bloodComposition of blood
Red Blood cells + PlasmaRed Blood cells + Plasma
Plasma containsPlasma contains
--white blood cells,white blood cells,--platelets, fibrinogen,platelets, fibrinogen,
--all the clotting factors,all the clotting factors,
--proteins like albumin.proteins like albumin.
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Blood products available..Blood products available..
Whole bloodWhole blood
Packed cells ( RBCs)Packed cells ( RBCs)
Platelet concentratePlatelet concentrate Fresh frozen plasmaFresh frozen plasma
CryoprecipitateCryoprecipitate
Factor VIII, factor IX concentrates, fibrinogenFactor VIII, factor IX concentrates, fibrinogen
OthersOthers-- Granulocytes, washed RBCS,Granulocytes, washed RBCS,leukoreduced RBCs, SAGleukoreduced RBCs, SAG--M blood, humanM blood, humanalbuminalbumin
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Plasma fractionsPlasma fractionsBlood componentsBlood componentsWholeWhole
bloodblood
CryopreciCryopreci
pitatepitate
FreshFresh
FrozrnFrozrnPlasmaPlasma
plateletsplateletsPackedPacked
red cellsred cells
FreshFresh
oldold
Clotting factorClotting factor
concentratesconcentrates
ImmunoglobulinImmunoglobulin
preparationspreparationsSaline albuminSaline albumin
solutionsolution
SaltSalt--poorpoor
albuminalbumin
whenwhenfibrinogenfibrinogenlevel is lesslevel is less
than 80than 80--100mg/dl100mg/dl
Initially a tx for VWInitially a tx for VWDz, HemophiliaDz, Hemophilia
Now a source ofNow a source offibrinogen in obstetricfibrinogen in obstetricemergenciesemergencies
when PT &when PT &
PTT arePTT arehigher thanhigher than
1.5 times1.5 timescontrolcontrollevelslevels
All clotting factors;All clotting factors;
no plateletsno platelets
Can supplementCan supplement
RBCs when wholeRBCs when whole
blood not availableblood not available
for exchangefor exchange
transfusiontransfusion
when platelet.when platelet.count lesscount lessthanthan50000/cmm50000/cmm
or whenor whenmassive bloodmassive bloodloss orloss orreplacementreplacementhas occurredhas occurred
--WashedWashed
RBCsRBCsPts with allergicPts with allergicreactions toreactions to
plasma proteinsplasma proteins
--LeukoLeuko--
poorpoor
RBCsRBCsPts with febrile,Pts with febrile,nonnon--hemolytichemolyticreactions toreactions to
plasma WBCsplasma WBCs
assiveassive
aemorrhagaemorrhag
ajor liverajor liver
aumaauma
leedingleeding
ssociatedssociated
ith liverith liver
iseaseisease
Clotting disordersClotting disorders
HaemophiliaHaemophilia
Liver diseaseLiver disease
dose: 1dose: 1-- 1.51.5--2 packs/2 packs/10 kg10 kg
(8(8--1010
packs)packs)
normalnormal
dose: 12dose: 12 --
15ml/ kg15ml/ kg
(4(4--5packs)5packs)
PlateletPlateletconcentratesconcentrates
(1(1pack/10kg)pack/10kg)
dose : 6unitsdose : 6units
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Why blood transfusion ? (Indication)Why blood transfusion ? (Indication)
SevereSevere blood lossblood loss following traumafollowing trauma or from anyor from anypathology e.g. GI bleedpathology e.g. GI bleed
DuringDuringmajor operativemajor operative procedures e.g. APR ,procedures e.g. APR ,
cardiovascular surgery etc.cardiovascular surgery etc. PostoperativelyPostoperativelyin a patient who has become severelyin a patient who has become severely
anemic.anemic.
FollowingFollowingsevere burnssevere burns (hemolysis)(hemolysis)
PreoperativelyPreoperativelyin pts of chronic anemia who requirein pts of chronic anemia who requireurgent surgery.urgent surgery.
Pts withPts with hemorrhagic diseasehemorrhagic disease e.g.e.g. hemophilia,hemophilia,thrombocytopenia, liver disease etc.thrombocytopenia, liver disease etc.
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Whole bloodWhole blood
Collected from a healthy and fit donorCollected from a healthy and fit donor
410 ml410 ml of blood is collected into a bagof blood is collected into a bag
containing 75 ml of CPDA (anticoagulant)containing 75 ml of CPDA (anticoagulant) Stored at 4Stored at 4CC 22C for up to 3C for up to 3--5 wks5 wks
(CPDA(CPDA 5 wks)5 wks)
UsesUses freshfresh blood is used for resuscitation inblood is used for resuscitation ina pt witha pt with severe acutesevere acute blood lossblood loss
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Changes in stored bloodChanges in stored blood
White blood cellsWhite blood cells are rapidlyare rapidlydestroyeddestroyed..
PlateletsPlatelets are functional only up toare functional only up to 24 hours24 hours
( due to cold temperature).( due to cold temperature). Clotting factorsClotting factorsVIII and V are labile and theirVIII and V are labile and their
levels fall rapidly afterlevels fall rapidly after 7 days7 days..
2,3 DPG level is decreased2,3 DPG level is decreased causing reducedcausing reducedoxygen release into tissues.oxygen release into tissues.
HigherHigher temptemp can lead to transmission ofcan lead to transmission ofinfections.infections.
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Plasma fractionsPlasma fractionsBlood componentsBlood components
CryoprecCryoprec
ipitateipitate
FreshFresh
FrozrnFrozrn
PlasmaPlasma
plateletsplateletsPacked red cellsPacked red cells
Clotting factorClotting factor
concentratesconcentrates
ImmunoglobuliImmunoglobulin preparationsn preparations
Saline albuminSaline albuminsolutionsolution
SaltSalt--poorpoor
albuminalbumin
whenwhenfibrinogenfibrinogen
level islevel isless thanless than
8080--
100mg/dl100mg/dlInitially a tx for VWInitially a tx for VWDz, HemophiliaDz, Hemophilia
Now a source ofNow a source offibrinogen infibrinogen inobstetricobstetricemergenciesemergencies
when PT &when PT &
PTT arePTT arehigher thanhigher than
1.5 times1.5 times
controlcontrollevelslevels
All clotting factors;All clotting factors;
no plateletsno platelets
Can supplementCan supplement
RBCs when wholeRBCs when whole
blood not availableblood not available
for exchangefor exchange
transfusiontransfusion
when platelet.when platelet.count lesscount lessthanthan50000/cmm50000/cmm
or whenor when
massive bloodmassive bloodloss orloss orreplacementreplacementhas occurredhas occurred
--Washed RBCsWashed RBCsPts with allergic reactions to plasmaPts with allergic reactions to plasma
proteinsproteins
--LeukoLeuko--poorpoor
RBCsRBCsPts with febrile, nonPts with febrile, non--hemolytichemolytic
reactions to plasma WBCsreactions to plasma WBCs
Clotting disordersClotting disorders
HaemophiliaHaemophiliaLiver diseaseLiver disease
dose: 1dose: 1--
1.51.5 --22packs/ 10packs/ 10kgkg
(8(8--1010packs)packs)
normalnormal
dose: 12dose: 12 --15ml/ kg15ml/ kg
(4(4--5packs)5packs)
PlateletPlatelet
concentratesconcentrates(1(1
pack/10kg)pack/10kg)
dose : 6unitsdose : 6units
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Packed red cellsPacked red cells
Obtained by centrifuging whole blood at 2000Obtained by centrifuging whole blood at 2000--2300 g for 152300 g for 15--20 minutes and then removing the20 minutes and then removing theplasma.plasma.
Contains aboutContains about 180 cc of RBCs + 30 cc of180 cc of RBCs + 30 cc ofplasmaplasma.( Total volume.( Total volume 200200--250 cc).250 cc).
HematocritHematocrit about 70about 70--80 %80 %
Solutions like ASSolutions like AS--1, AS1, AS--5, optisol etc is added5, optisol etc is added
No viable WBCsNo viable WBCs, platelets or clotting factors., platelets or clotting factors.
UsesUses-- chronic anemia, elderly, children, derangedchronic anemia, elderly, children, derangedcardiaccardiac function.function.
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Red blood cellsRed blood cells
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Other RBC products..Other RBC products..
Washed red blood cellsWashed red blood cells PC are washed withPC are washed withsaline to remove the plasma and proteins;saline to remove the plasma and proteins;reduces transfusion reactions.reduces transfusion reactions.
LeukocyteLeukocyte--reduced red blood cellsreduced red blood cells-- WBCs areWBCs areremoved using filters; reduces incidence of nonremoved using filters; reduces incidence of non--hemolytic febrile reactions.hemolytic febrile reactions.
Pediatric/ divided RBC unitsPediatric/ divided RBC units-- smaller units aresmaller units areprepared, each containing 45prepared, each containing 45--50 cc of RBCs and50 cc of RBCs and15 cc of plasma.15 cc of plasma.
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Complications of bloodComplications of blood
transfusiontransfusionTransfusion reactionsTransfusion reactions incompatibility,incompatibility, allergicallergic
reactions, simple pyrexial reactions, sensitization toreactions, simple pyrexial reactions, sensitization toleucocytes and platelets, immunologicalleucocytes and platelets, immunologicalsensitization.sensitization.
InfectionsInfections-- HIV, hepatitis,HIV, hepatitis, bacterial infections,bacterial infections,malaria.malaria.
CongestiveCongestive cardiaccardiac failurefailure
ThrombophlebitisThrombophlebitisAir embolismAir embolism
Coagulation failureCoagulation failure Disseminated intravascular coagulationDisseminated intravascular coagulation (DIC)(DIC)
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Complications of blood transfusionComplications of blood transfusion
Metabolic complicationsMetabolic complicationsHyperkalaemiaHyperkalaemia
Citrate toxicity & hypocalcaemiaCitrate toxicity & hypocalcaemia
Release of vasoactive peptidesRelease of vasoactive peptides
HaemosiderosisHaemosiderosis
(After repeated transfusion in patients with(After repeated transfusion in patients withhaematological diseases)haematological diseases)
ImmunologicalImmunological
Reduction of immunityReduction of immunity
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Volume expandersVolume expandersWhen a patient has lost a lot of body fluids but does not needWhen a patient has lost a lot of body fluids but does not need
red blood cells or other specific blood components,red blood cells or other specific blood components,volume expanders may be given to prevent or treat shockvolume expanders may be given to prevent or treat shock
caused by fluid losscaused by fluid loss..O
therO
therThe most commonThe most commonColloidsColloidsCrystalloidsCrystalloids
solutions that contain largesolutions that contain large
molecular weight that do notmolecular weight that do not
readily cross capillary wallsreadily cross capillary walls
solutions that containsolutions that containsodiumsodium
purifiedpurifiedproteinprotein
fractionsfractions
dextransdextranshydroxyethydroxyethyl starchhyl starch
(HES),(HES),
albuminalbuminlactatedlactatedRingersRingers
normalnormalsalinesaline
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Thank YouThank You