Transcript Whole Blood - yeditepetip4

BLOOD COMPONENTS
TRANSFUSION INDICATIONS
Dr. Meral SÖNMEZOĞLU
Yeditepe University Hospital
Transfusion Center
BLOOD DONATION
Differential Centrifugation
First Centrifugation
Closed System
Whole Blood
Main Bag
Satellite Bag
1
First
RBC’s
Platelet-rich
Plasma
Satellite Bag
2
Differential Centrifugation
Second Centrifugation
RBC’s
Platelet-rich
Plasma
Second
RBC’s
Platelet
Concentrate
Plasma
Whole Blood

Whole Blood (WB) is blood taken from a
suitable donor using a sterile and
pyrogen free anticoagulant and
container.
 W B is a source material for component
preparation, which is its major use.
 WB for transfusion is used without
further processing.
 WB for transfusion should not contain
irregular antibodies of clinical
significance.
Whole Blood

Storage


Indications


4° for up to 35 days
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

Red Cells is obtained by removal of a
major part of the plasma from WB.
 Red Cells also contains the greater part of
the whole blood leucocytes (about 2.5 to
3.0 × 109 cells) and a varying content of
platelets depending on the method of
centrifugation.

For the preparation, plasma is removed from
Whole Blood after centrifugation
RBC Concentrate

Storage


Indications


4° for up to 42 days, can be frozen
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
Function of RBCs
Oxygen Transport
 Delivery of oxygen from lungs to tissues
Oxygen transport is dependent on
 Hematocrit
 Cardiac output
 Oxygen extraction
Normovolemic Anemia
As hematocrit falls
 Blood viscosity decreases
 Cardiac output increases (Stroke volume,
 pulse)
 Delivery of O2 
 O2 extraction 
 Consumption of O2 remains constant
Limits of Compensation
At very low hemoglobin levels
(approximately 4 g/dL)
 O2 delivery does not meet demand
 Anerobic metabolism  lactic acidosis 
cardiac arrest
Indications for RBC transfusions
1940s
 Recommended that surgery patients have a
hemoglobin of 8 to 10 g/dL
 Led to a general rule of hemoglobin > 10 g/dL of
surgery patients
1980s
 Development of invasive monitoring techniques
lead to a better understanding of oxygen
delivery and consumption
 Lower hemoglobin levels could be tolerated
Hemoglobin and Hematocrit
Levels in Healthy Adults
Hemoglobin
(g/dL)
Mean -2SD
Female 14.0 12.0
Male
15.5 13.5
Hematocrit
(%)
Mean -2SD
41
36
47
41
Hematology: Basic Principles and Practice. Elsevier 2005
Transfusion Trigger:
Multicenter, Randomized Control Study
of ICU Patients
Transfusion
Hb
Strategy
Trigger
Conservative 7.0 g/dL
Liberal
Maintenance
Level
7.0 to 9.0 g/dL
10.0 g/dL 10.0 to 12.0 g/dL
Herbert PC et al. N Engl J Med. 1999;340: 409-417
Transfusion Trigger:
Multicenter, Randomized Control Study of ICU
Patients
30-day mortality
P
Restrictive
18.7%
0.11
Liberal
23.3%
Restrictive
Liberal
Restrictive
Liberal
Less acutely ill
30-day mortality
8.7%
16.1%
Cardiac disease patient
30-day mortality
20.5%
22.9%
P
0.03
P
0.69
Herbert PC et al. N Engl J Med. 1999;340: 409-417
Restrictive vs Liberal Transfusion in
Other Conditions
No difference
Pediatric ICU patients
 7.0 g/dL vs 9.5 g/dL
 Lacroix J, et al. N Engl J Med. 2007:356;1609-1619
Moderate to severe head injury
 7.0 g/dL vs 10.0 g/dL
 McIntyre LA et al. Neutrocrit Care 2006;5:4-9
Possible difference
Cardiovascular disease
 7.0 g/dL vs 10.0 g/dL
 Liberal transfusions may be better in patients with
acute myocardial infarction and unstable angina
 Hebert PC et al. Crit Care Med. 2001;29:227-234.
Platelets

Storage


Indications




Up to 5 days at 20-24°
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
Platelets
Plasma and FFP

For the preparation, plasma is removed from Whole
Blood after centrifugation

It must contain, on average, not less than 70 IU Factor
VIII per 100 ml and at least similar quantities of the other
labile coagulation factors and naturally occurring
inhibitors.
Plasma and FFP


Contents—Coagulation Factors (1 unit/ml)
Storage


Indications


FFP—36 months at –35 degrees or colder
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


Storage


After collection, refrozen and stored up to 1 year at -18°
Indication





Precipitate formed/collected when FFP is thawed at 4°
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 Transfusions
Preparations

Type


Screen



Typing of RBC’s for ABO and Rh are determined for
both donor and recipient
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 Transfusions
Administration

Dose



Procedure




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Usual dose of 10 cc/kg infused over 2-4 hours
Maximum dose 15-20 cc/kg can be given to hemodynamically
stable patient
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 Transfusions
Preparations

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 Transfusions
Administration

Dose




Procedure




May be given as single units or as apheresis units
Usual dose is approx 4 units/m2—in children using 12 apheresis units is ideal
1 apheresis unit contains 6-8 Plt units (packs) from a
single donor
Should be administered over 20-40 minutes
Filter use
Premedicate if hx of Transfusion Reaction
Complications—Transfusion Reaction
Serological Testing
3



tests:
ABO/Rh
Antibody detection/identification
Crossmatch
ABO/Rh Typing
 In
the ABO typing, the forward and reverse
MUST match
 In the Rh typing, the control must be
negative
 Both of these will indicate what type of
blood should be given
Blood Grouping using gel
cards
Antibody screen and/or ID

The antibody screen will detect the presence of
any unexpected antibodies in patient serum
 If antibodies are detected, identification should
be performed using panel cells (with an
autocontrol)
 IS
 37° (LISS)
 AHG
 If an antibody is present, units negative for the
antigen must be given (remember the
calculation?)
 Proceed to the crossmatch…
Crossmatching
 Purpose:




Prevent transfusion reactions
Increase in vivo survival of red cells
Double checks for ABO errors
Another method of detecting antibodies
Crossmatch
 Two


types of crossmatches
Major – routinely performed in labs
Minor – not required (by AABB since 1976)
Major vs Minor Crossmatch



Why is the minor
crossmatch
unnecessary?
Donated units are
tested for
antibodies
Most blood is
transfused as
packed cells,
having little
antibodies
Crossmatch
No agglutination ~ compatible
Agglutination ~ incompatible
Donor RBCs
(washed)
Patient serum
Conclusions
 Although
RBCs are much safer than 20
years ago, transfusion practices have
become more restrictive
 The transfusion threshold at most
institutions is a hemoglobin of 7 to 8 g/dL
for most patients
 Higher thresholds are used for specific
patients
TRANSFUSION REACTIONS
Transfusion Reactions are…
Adverse reactions
associated with the
transfusion of blood and its
components
Transfusion reactions
 Non-threatening
to fatal
 Hemolytic or non-hemolytic – may or may
not cause RBC destruction
 Acute to delayed


Acute – rapid onset
Delayed – days to weeks
 Reactions
may involve antigen-antibody
interactions
 May involve infectious agents
Transfusion Fatalities Reported to
the FDA (FY 2004 to 2006)
TRALI
Other (Non ABO Hemolytic Reactions)
Bacterial Contamination
ABO Hemolytic
Uncertain
Total
Number
and %
86 (39%)
67 (31%)
20 (9%)
15 (7%)
31 (14%)
219
Disease Transmission
 Hepatitis
 HIV
 HTLV
 Cytomegalovirus
 Malaria
 Babesiosis
 Syphilis
Infectious Risk of Transfusion
Klein HG et al. Transfusion 2007;47:2338-2347
SHOT 2011
Serious Hazards of Transfusion (SHOT) Steering Group.
The 2011 Annual SHOT Report (2012)
1996-2011 SHOT (n=9925)
SHOT 2011
Serious Hazards of Transfusion (SHOT) Steering Group.
The 2011 Annual SHOT Report (2012)
Enfeksiyon Riski (Türkiye)
, 1.014.516 (56.4%) bağış Türk
Kızılay’ı tarafından toplandı.
 2005 de 20%.
 42% si ilk kez bağışçı olmayandan
 Serolojik test pozitifliği 2010;
 Sifiliz: 0,10%
 HIV : 0,17%
 HCV: 0,25%
 HBsAg:0,93%
 2010’da
Enfeksiyon Riski HBsAg (Türkiye)
Blood Collection Number in TRC
1200000
1000000
Number
800000
600000
400000
200000
0
2004
2005
2006
2007
2008
2009
2010
TRANSFÜZYON
Evliliğe benzer
 İyi
düşünmeden yapılmamalıdır
 Gerekmedikçe yapılmamalıdır
 Gereğinden fazla yapılmamalıdır
 En güvenlisi hiç yapılmamalıdır