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WHERE DO OUR BLOOD AND BLOOD PRODUCTS COME FROM?

WHERE DO OUR BLOOD AND BLOOD PRODUCTS COME FROM?. Australian Red Cross Blood Service collects >900,000 units of whole blood from volunteer donors every year Only2.5% of Aussies are blood donors!!!

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WHERE DO OUR BLOOD AND BLOOD PRODUCTS COME FROM?

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  1. WHERE DO OUR BLOOD AND BLOOD PRODUCTS COME FROM? • Australian Red Cross Blood Service collects >900,000 units of whole blood from volunteer donors every year • Only2.5% of Aussies are blood donors!!! • Australia is self sufficient in blood and blood products with the exception of some manufactured plasma products – IVIgG, Rh anti D, some Factor 8 and Factor 9 products

  2. What happens to a blood donation? • Processed or ‘fractionated’ into - 1 unit of concentrated (packed) red cells (PC) 1 unit of fresh frozen plasma (FFP) 1 (of a pool of 4) units of platelets (1 unit of pooled platelets is from 4 donors) • A special process is used to leucoreduce red cells and platelets which reduces febrile nonhaemolytic reactions to transfusion

  3. How much do we use in HNEAHS? • Every year ~ 23,000 units of red cells 3,500 units pooled platelets 3,500 units fresh frozen plasma 210 paediatric ‘quad’ packs 4,500 bottles Albumex 4 2,300 bottles Intragam 3gm 4,500 bottles Intragam 12gm 4,000 vials Rh anti D Ig

  4. What does it cost? • The cost of products alone is ~ $7million • 1 unit PC - $242 • 1 unit pooled platelets - $430 • 1 unit FFP - $50 • 1 bottle Albumex 4 - $80 • 1 bottle Intrgam 3gm - $250 • 1 bottle Intragam 12gm - $1015 • 1 vial Rh anti D - $115

  5. Every donation undergoes extensive testing • ABO and Rh D typing • Extended blood group typing of some units to provide compatible blood for patients with red cell antibodies stimulated by pregnancy or previous transfusion • Plasma is tested for antibodies against red cell antigens

  6. Transfusion transmitted disease testing • Syphilis • HIV 1 and 2 • Hepatitis B • Hepatitis C • HTLV 1 and 2 • CMV – not all donations (60% donors +ve)

  7. Diseases screened by donor questionnaire (no test available) • Malaria – can be transmitted in red cells only – exclusion for 1 year after travel to endemic areas (test coming) • Creuztfeldt-Jakob disease (CJD) – causes ‘mad cow ‘ disease – never reported in Australia - 4 possible cases world wide – donors excluded who have spent 6 months in the UK between 1 Jan 1980 and 31 Dec 1996 or had a transfusion in UK • Dengue fever – sporadic - far Nth Qld • West Nile virus – sporadic - USA

  8. Indication for transfusion • Red cells are the oxygen transport system of the body - essential for life - the only indication for red cell transfusion is to supply oxygen to vital organs - causes of reduced oxygen transport blood loss bone marrow failure – chemotherapy - haematological malignancy - comorbidities can increase the need for red cells - lung disease cardiac disease

  9. A normal red cell has a life span of ~ 120 days • A unit of packed cells has an expiry of 42 days after collection – this is calculated so that 75% of transfused red cells are viable at the time of expiry of the unit • Normal Hb – adult female 115 – 165 g/L adult male 130 - 180 g/L

  10. Platelets – normal function is to initiatethe clotting process • 150 – 400 x 10~9/L • Normal life span 9 days / expiry 5 days after collection • For prevention of surgical bleeding need platelet count > 80 x 10~9/L • Haemato-oncology patients with bone marrow failure – stable , not bleeding, not febrile – prophylactic transfusion if platelet count <10 x 10~9/L • Aspirin and NSAID’s interfere with normal function – cease 7 days preop

  11. Decision to transfuse • In all cases transfusion must be a balance of the benefits versus the risks • Transfusion is never completely risk free

  12. Hb Thresholds Risk > Benefit Benefit > Risk 40 50 60 70 80 90 100 110 120 130 140 Additional factors in compromise of oxygen transport Reversible in short-term Within this region individual patient factors determine transfusion threshold Haemoglobin g/L Why Transfuse? Why not Transfuse? UNLIKELY LIKELY MAYBE

  13. Clinical Responsibilities Transfusion Reaction • Notify Medical Officer (MET/ Medical Response call) • Patients observations to be attended • All clerical and identity checks to be repeated • Provide supportive therapy. • Change giving set – keep line open with N/ Saline as ordered. Contact Blood bank/ Pathology immediately • Return used pack • Send patient blood/ urine specimens with form as directed by your Laboratory

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