ERCIYES TRANSFUZYON TIBBI EGITIM PROGRAMI

1. ERCIYES TRANSFUZYON TIBBI EGITIM PROGRAMI

3. 1. Platelet Products Guideline: Platelets for transfusion can be prepared either by separation of units of platelet concentrates (PCs) from whole blood, which are pooled before administration, or by apheresis from single donors. Comparative studies have shown that the posttransfusion increments, hemostatic benefit, and side effects are similar with either product. Thus, in routine circumstances, they can be used interchangeably. In most centers, pooled PCs are less costly. Single-donor platelets from selected donors are preferred when histocompatible platelet transfusions are needed. Both preparations can be stored for up to 5 days after collection at 20°C to 24°C with good maintenance of platelet viability. Level of Evidence: I Grade of Recommendation: A PCs from Whole Blood. Often referred to as random-donor platelets, PCs are prepared by centrifugation of standard units of whole blood. There are two methods for doing this: (1) the platelet-rich plasma (PRP) method, and 2) the buffy coat (BC) method.4 The PRP method is used in the United States, whereas the BC method is in common use in Europe. In the PRP method, an initial low G force (soft) spin produces PRP, which is separated from the red cells. The PRP is then centrifuged at a higher G force (hard) spin, and most of the platelet-poor plasma is removed.5-8 The residual PCs contain approximately 0.5 to 0.75 x 1011 platelets/unit or approximately 60% to 75% of the platelets from the original unit of whole blood. Because some blood centers now supply units with higher numbers of platelets, clinicians should be aware of the average dose provided by their particular center. One drawback to this method is that the resulting PCs also contain 108 to109 WBCs or approximately 50% or more of the leukocytes from the original unit of whole blood. Platelets are stored at 20°C to 24°C using continuous gentle horizontal agitation in storage bags specifically designed to permit O2 and CO2 exchange to optimize platelet quality.9-14 This combination of storage container, agitation, preservative solution, temperature, and the use of approximately 50 mL of plasma permits satisfactory preservation of platelets for up to 7 days.15,16 However, several instances of bacterial contamination of PCs stored for this period have been reported,17,18 and the storage time from collection to transfusion is now limited to 5 days.19 PCs can also be obtained from 40- to 50-mL BCs collected at the red cell/plasma interface after high-speed centrifugation of 450 mL whole-blood donations.20-22 After gentle resuspension in a satellite bag, the BC is centrifuged at low speed and the platelets collected in the supernatant.21 Alternatively, four to six BCs are pooled, diluted in plasma, and centrifuged at low speed to suspend the platelets in the supernatant, which is then transferred into a large-volume storage bag. Plasma can be replaced with a crystalloid platelet additive solution, thus reducing the amount of plasma that might be infused to plasma-incompatible recipients.22,23 The BC-PCs must be used within 6 hours of preparation if the bags have been entered during pooling. Storage can be extended to 5 days if the whole procedure is performed in closed systems. A number of studies indicate that BC-PCs produce comparable in vivo platelet survival and contain similar numbers of less-activated platelets and fewer white cells compared with PCs prepared with the PRP method.24-26 Most patients require a dose of platelets larger than can be provided by platelets from one unit of whole blood, and several PCs are usually pooled to obtain an appropriate dose for most patients. If the volume of plasma in the final pooled component is too large, as might be the case for some pediatric recipients, some of the plasma can be removed before transfusion. From 15% to 55% of platelets are lost during this additional centrifugation step.27,28 Volume reduction should therefore be limited to patients who require severe volume restriction or situations where ABO incompatible platelets are the only available PC for a neonate or child. Single-Donor Platelets Produced by Apheresis. Although the Food and Drug Administration term for this component is "platelets, apheresis," the component is usually called single-donor platelets. Donors usually undergo two venipunctures. Blood pumped from one vein passes through a blood-cell separator centrifugation system with removal of the platelets or other cellular components and return of the plasma and RBCs to the donor’s other arm. Plateletpheresis usually requires approximately 11/2 to 2 hours and involves processing 4,000 to 5,000 mL of the donor’s blood.29-35 This results in a plateletpheresis product that contains the number of platelets equivalent to six to nine units of PC prepared from whole blood. However, many centers have recently begun to split their apheresis collections into two products so that the dose may actually be more equivalent to four to five units of PC. Clinicians are therefore advised to check on the policies of their local blood supplier so as to best determine the appropriate number of units or apheresis products to transfuse in particular clinical situations. Current standards require that a bag of apheresis platelets must contain at least 3 x 1011 platelets in at least 75% of the products tested.36 Platelets obtained by plateletpheresis are processed, tested, and labeled similar to whole blood. This includes ABO and Rh typing and testing for all required transfusion-transmitted diseases. The plateletpheresis product is stored for up to 5 days at 20°C to 24°C29,37-40 in the same manner as platelets prepared from whole blood. The number of platelets contained in each bag is determined, although this information may not be recorded on the label. Each apheresis product has a volume of approximately 200 mL and contains few red cells, so that red cell crossmatching is not necessary. The WBC content varies, depending on the instrument and technique used for collection, but most plateletpheresis products now contain less than 5 x 106 leukocytes and can be considered to be leukocyte reduced (see below). 1. Platelet Products Guideline: Platelets for transfusion can be prepared either by separation of units of platelet concentrates (PCs) from whole blood, which are pooled before administration, or by apheresis from single donors. Comparative studies have shown that the posttransfusion increments, hemostatic benefit, and side effects are similar with either product. Thus, in routine circumstances, they can be used interchangeably. In most centers, pooled PCs are less costly. Single-donor platelets from selected donors are preferred when histocompatible platelet transfusions are needed. Both preparations can be stored for up to 5 days after collection at 20°C to 24°C with good maintenance of platelet viability. Level of Evidence: I Grade of Recommendation: A PCs from Whole Blood. Often referred to as random-donor platelets, PCs are prepared by centrifugation of standard units of whole blood. There are two methods for doing this: (1) the platelet-rich plasma (PRP) method, and 2) the buffy coat (BC) method.4 The PRP method is used in the United States, whereas the BC method is in common use in Europe. In the PRP method, an initial low G force (soft) spin produces PRP, which is separated from the red cells. The PRP is then centrifuged at a higher G force (hard) spin, and most of the platelet-poor plasma is removed.5-8 The residual PCs contain approximately 0.5 to 0.75 x 1011 platelets/unit or approximately 60% to 75% of the platelets from the original unit of whole blood. Because some blood centers now supply units with higher numbers of platelets, clinicians should be aware of the average dose provided by their particular center. One drawback to this method is that the resulting PCs also contain 108 to109 WBCs or approximately 50% or more of the leukocytes from the original unit of whole blood. Platelets are stored at 20°C to 24°C using continuous gentle horizontal agitation in storage bags specifically designed to permit O2 and CO2 exchange to optimize platelet quality.9-14 This combination of storage container, agitation, preservative solution, temperature, and the use of approximately 50 mL of plasma permits satisfactory preservation of platelets for up to 7 days.15,16 However, several instances of bacterial contamination of PCs stored for this period have been reported,17,18 and the storage time from collection to transfusion is now limited to 5 days.19 PCs can also be obtained from 40- to 50-mL BCs collected at the red cell/plasma interface after high-speed centrifugation of 450 mL whole-blood donations.20-22 After gentle resuspension in a satellite bag, the BC is centrifuged at low speed and the platelets collected in the supernatant.21 Alternatively, four to six BCs are pooled, diluted in plasma, and centrifuged at low speed to suspend the platelets in the supernatant, which is then transferred into a large-volume storage bag. Plasma can be replaced with a crystalloid platelet additive solution, thus reducing the amount of plasma that might be infused to plasma-incompatible recipients.22,23 The BC-PCs must be used within 6 hours of preparation if the bags have been entered during pooling. Storage can be extended to 5 days if the whole procedure is performed in closed systems. A number of studies indicate that BC-PCs produce comparable in vivo platelet survival and contain similar numbers of less-activated platelets and fewer white cells compared with PCs prepared with the PRP method.24-26 Most patients require a dose of platelets larger than can be provided by platelets from one unit of whole blood, and several PCs are usually pooled to obtain an appropriate dose for most patients. If the volume of plasma in the final pooled component is too large, as might be the case for some pediatric recipients, some of the plasma can be removed before transfusion. From 15% to 55% of platelets are lost during this additional centrifugation step.27,28 Volume reduction should therefore be limited to patients who require severe volume restriction or situations where ABO incompatible platelets are the only available PC for a neonate or child. Single-Donor Platelets Produced by Apheresis. Although the Food and Drug Administration term for this component is "platelets, apheresis," the component is usually called single-donor platelets. Donors usually undergo two venipunctures. Blood pumped from one vein passes through a blood-cell separator centrifugation system with removal of the platelets or other cellular components and return of the plasma and RBCs to the donor’s other arm. Plateletpheresis usually requires approximately 11/2 to 2 hours and involves processing 4,000 to 5,000 mL of the donor’s blood.29-35 This results in a plateletpheresis product that contains the number of platelets equivalent to six to nine units of PC prepared from whole blood. However, many centers have recently begun to split their apheresis collections into two products so that the dose may actually be more equivalent to four to five units of PC. Clinicians are therefore advised to check on the policies of their local blood supplier so as to best determine the appropriate number of units or apheresis products to transfuse in particular clinical situations. Current standards require that a bag of apheresis platelets must contain at least 3 x 1011 platelets in at least 75% of the products tested.36 Platelets obtained by plateletpheresis are processed, tested, and labeled similar to whole blood. This includes ABO and Rh typing and testing for all required transfusion-transmitted diseases. The plateletpheresis product is stored for up to 5 days at 20°C to 24°C29,37-40 in the same manner as platelets prepared from whole blood. The number of platelets contained in each bag is determined, although this information may not be recorded on the label. Each apheresis product has a volume of approximately 200 mL and contains few red cells, so that red cell crossmatching is not necessary. The WBC content varies, depending on the instrument and technique used for collection, but most plateletpheresis products now contain less than 5 x 106 leukocytes and can be considered to be leukocyte reduced (see below).

4. Available Platelet Preparations ~450 mL of Whole Blood is collected from a donor into a primary bag, with attached satellite bags. After centrifugation, platelet rich plasma is expressed off the red cells into a satellite bag. A second centrifugation allows for separation of platelets from the plasma. Available Platelet Preparations ~450 mL of Whole Blood is collected from a donor into a primary bag, with attached satellite bags. After centrifugation, platelet rich plasma is expressed off the red cells into a satellite bag. A second centrifugation allows for separation of platelets from the plasma.

5. Transfusion Medicine BulletinOriginally Published: April 1995 Platelet TransfusionsPart 1: Components Available Platelet transfusions have been used increasingly as a therapeutic modality for the past 10 to 15 years. Since 1989, platelets have exceeded red cells and whole blood as the most commonly transfused blood component in the Puget Sound area. This represents an approximate 300 percent increase in platelet transfusions since 1980. Although local platelet usage has leveled off in the past two years, during 1994, 148,367 units of platelets were transfused compared to 109,482 units of red cells. Platelet concentrates are prepared either from donated whole blood or by apheresis technology (Table 1). Both methods use differential centrifugation of whole blood to prepare a concentrate of platelets suspended in the donor’s plasma. Platelet concentrates are nearly free of red cells; the number of white cells varies with the technique used in preparation. In this bulletin, we will compare two components offered by the Puget Sound Blood Program, "apheresis platelets" and "pooled platelets." A bag of apheresis platelets is collected from a single donor with return of the red cells to the donor. Pooled platelets are made by pooling (into one bag prior to transfusion) four to six units of platelets fractionated from whole blood. A unit of whole blood platelets is that amount of platelets prepared from one homologous blood donation. To meet FDA guidelines, 75 percent of whole blood platelets must contain at least 5.5 x 1010 platelets. Whole blood platelets prepared by the Puget Sound Blood Program contain an average of 8.0 x 1010 suspended in approximately 50 ml of donor plasma. To meet FDA guidelines, 75 percent of apheresis platelets obtained from a single donor must contain at least 30 x 1010 platelets. Apheresis platelets prepared by the Blood Program contain an average of 50 x 1010 platelets suspended in 200 to 400 ml of plasma. Thus, a single apheresis platelet collection is approximately equivalent to six units of whole blood platelets. Table 1Whole Blood PlateletsApheresis PlateletsPlateletContent1 platelet concentrate 8.0 x 1010 platelets in 50 ml plasma1 apheresis platelet 50 x 1010 platelets in 200 to 400 ml plasmaWBCContent~108 per unitFrequently (75%) 5 x 106Usual AdultDose4 to 6 units, pooled1 unitABOCompatibilityPreferablePreferable. Volume reduction if donor's plasma incompatible with recipient's red blood cellsUseGeneral use for nonalloimmunized patients General use for nonalloimmunized patients Alloimmunized patients requiring HLA-matched platelets (HLA-typed donors or family members) Advantages Reduced donor exposure Lower WBC content Donor requirements and infectious disease screening for apheresis platelet donation are the same as for whole blood donation, except that recent ingestion of aspirin is not permitted for apheresis donation since the product may be the sole source of platelets for a recipient. Platelets aceylated by aspirin are dysfunctional and require six to eight hours for recovery of normal function following transfusion. Whole blood platelets and apheresis platelets can be stored for up to five days. Viability and efficacy are best maintained by storage of the bags at room temperature (20 to 24° C), with agitation to facilitate gas exchange. Platelet storage is limited to five days because of an increased risk of contaminant bacterial growth at room temperature and because of a progressive decline in platelet viability during storage. As a rule, one unit of whole blood platelets should raise the platelet count by 5 to 10,000 µl in an adult. For transfusion, the usual adult dose is four to six units of pooled whole blood platelets or a single apheresis platelet collection. For pediatric patients, the usual dose is one unit of whole blood platelets per 10 kg body weight. Currently (April 1995), for an equivalent dose of platelets, pooled whole blood platelets ($290 per six units) cost less than apheresis platelets ($375). If available, platelets for transfusion should be ABO identical with the recipient. Since platelet concentrates contain very few red cells, there is no risk of a hemolytic transfusion reaction even if transfused across a major ABO-compatibility barrier (e.g., group A platelets into group O recipient). However, platelets do contain ABO antigens that appear to have a minor, but measurable, role in reducing the platelet increment following platelet transfusion if incompatible with the patient's plasma. In addition, some studies have demonstrated an incidence of both HLA and platelet specific alloantibodies when patients were given ABO incompatible platelets, leading to alloimmune platelet refractoriness (Carr, et al., 1990). If there is a minor ABO incompatibility between donor and recipient (e.g., group O platelets into group A recipient), hemolysis of the recipient's red cells may occur if the donor's ABO isoagglutinin titer is very high. High titers are rarely a problem if the platelet product is a pool representing several donors, but single donor platelets that are ABO-plasma incompatible should be volume reduced prior to transfusion to avoid the possibility of hemolysis. Ideally, transfused platelets should be Rh (D) compatible with the recipient. Although not present on platelets, the Rh (D) antigen is present on Rh (D) positive red cells. Since platelet concentrates contain a few red cells, Rh (D) negative patients must receive from Rh (D) negative donors. Rh (D) positive patients can receive platelets from either Rh (D) positive or Rh (D) negative donors. The efficacy of pooled platelets and apheresis platelets appears to be equivalent in non-alloimmunized patients, who represent the majority of. platelet transfusion recipients. There are several benefits of apheresis platelets, however, compared to pooled platelets. The use of single-donor apheresis platelets reduces the risk of infectious disease transmission because of exposure to fewer donors. In addition, apheresis platelets contain markedly fewer white blood cells compared to pooled platelets. Recent evidence suggests that febrile reactions to platelet transfusions are caused by cytokines (e.g., IL-l, IL-6, and TNF) released from leukocytes during storage (Heddle, et al., 1994). Because they contain fewer leukocytes, apheresis platelets may thus result in fewer febrile transfusion reactions than pooled platelets. Finally, for the treatment of the alloimmunized patient who is refractory to platelet transfusions, apheresis platelets serve as the only source of HLA matched platelets.  References Carr R, Hutton JL, Jenkins JA, Lucas CF and Amphlett NW: Transfusion of ABO-mismatched platelets leads to early platelet refractoriness. Br J Haematol 75:408-413, 1990. Heddle NM, Klama L, Singer J, Richards C, Fedak P, Walker I and Kelton JG: The role of the plasma from platelet concentrates in transfusion reactions. N Engl J Med 331:625-628, 1994. Transfusion Medicine Bulletin Richard B. Counts, MDExecutive Director Thomas H. Price, MDMedical Director Alex Reiner, MDMedical Education Program Director Sherrill J. Slichter, MDResearch and Education Division Director D. Michael Strong, PhDOperations Division Director Arthur R. Thompson, MD, PhDHemophilia & Coagulation Program Director Linda D. YriondoCommunications Manager Transfusion Medicine BulletinOriginally Published: April 1995 Platelet TransfusionsPart 1: Components Available Platelet transfusions have been used increasingly as a therapeutic modality for the past 10 to 15 years. Since 1989, platelets have exceeded red cells and whole blood as the most commonly transfused blood component in the Puget Sound area. This represents an approximate 300 percent increase in platelet transfusions since 1980. Although local platelet usage has leveled off in the past two years, during 1994, 148,367 units of platelets were transfused compared to 109,482 units of red cells. Platelet concentrates are prepared either from donated whole blood or by apheresis technology (Table 1). Both methods use differential centrifugation of whole blood to prepare a concentrate of platelets suspended in the donor’s plasma. Platelet concentrates are nearly free of red cells; the number of white cells varies with the technique used in preparation. In this bulletin, we will compare two components offered by the Puget Sound Blood Program, "apheresis platelets" and "pooled platelets." A bag of apheresis platelets is collected from a single donor with return of the red cells to the donor. Pooled platelets are made by pooling (into one bag prior to transfusion) four to six units of platelets fractionated from whole blood. A unit of whole blood platelets is that amount of platelets prepared from one homologous blood donation. To meet FDA guidelines, 75 percent of whole blood platelets must contain at least 5.5 x 1010 platelets. Whole blood platelets prepared by the Puget Sound Blood Program contain an average of 8.0 x 1010 suspended in approximately 50 ml of donor plasma. To meet FDA guidelines, 75 percent of apheresis platelets obtained from a single donor must contain at least 30 x 1010 platelets. Apheresis platelets prepared by the Blood Program contain an average of 50 x 1010 platelets suspended in 200 to 400 ml of plasma. Thus, a single apheresis platelet collection is approximately equivalent to six units of whole blood platelets. Table 1Whole Blood PlateletsApheresis PlateletsPlateletContent1 platelet concentrate 8.0 x 1010 platelets in 50 ml plasma1 apheresis platelet 50 x 1010 platelets in 200 to 400 ml plasmaWBCContent~108 per unitFrequently (75%) 5 x 106Usual AdultDose4 to 6 units, pooled1 unitABOCompatibilityPreferablePreferable. Volume reduction if donor's plasma incompatible with recipient's red blood cellsUseGeneral use for nonalloimmunized patients General use for nonalloimmunized patients Alloimmunized patients requiring HLA-matched platelets (HLA-typed donors or family members) Advantages Reduced donor exposure Lower WBC content Donor requirements and infectious disease screening for apheresis platelet donation are the same as for whole blood donation, except that recent ingestion of aspirin is not permitted for apheresis donation since the product may be the sole source of platelets for a recipient. Platelets aceylated by aspirin are dysfunctional and require six to eight hours for recovery of normal function following transfusion. Whole blood platelets and apheresis platelets can be stored for up to five days. Viability and efficacy are best maintained by storage of the bags at room temperature (20 to 24° C), with agitation to facilitate gas exchange. Platelet storage is limited to five days because of an increased risk of contaminant bacterial growth at room temperature and because of a progressive decline in platelet viability during storage. As a rule, one unit of whole blood platelets should raise the platelet count by 5 to 10,000 µl in an adult. For transfusion, the usual adult dose is four to six units of pooled whole blood platelets or a single apheresis platelet collection. For pediatric patients, the usual dose is one unit of whole blood platelets per 10 kg body weight. Currently (April 1995), for an equivalent dose of platelets, pooled whole blood platelets ($290 per six units) cost less than apheresis platelets ($375). If available, platelets for transfusion should be ABO identical with the recipient. Since platelet concentrates contain very few red cells, there is no risk of a hemolytic transfusion reaction even if transfused across a major ABO-compatibility barrier (e.g., group A platelets into group O recipient). However, platelets do contain ABO antigens that appear to have a minor, but measurable, role in reducing the platelet increment following platelet transfusion if incompatible with the patient's plasma. In addition, some studies have demonstrated an incidence of both HLA and platelet specific alloantibodies when patients were given ABO incompatible platelets, leading to alloimmune platelet refractoriness (Carr, et al., 1990). If there is a minor ABO incompatibility between donor and recipient (e.g., group O platelets into group A recipient), hemolysis of the recipient's red cells may occur if the donor's ABO isoagglutinin titer is very high. High titers are rarely a problem if the platelet product is a pool representing several donors, but single donor platelets that are ABO-plasma incompatible should be volume reduced prior to transfusion to avoid the possibility of hemolysis. Ideally, transfused platelets should be Rh (D) compatible with the recipient. Although not present on platelets, the Rh (D) antigen is present on Rh (D) positive red cells. Since platelet concentrates contain a few red cells, Rh (D) negative patients must receive from Rh (D) negative donors. Rh (D) positive patients can receive platelets from either Rh (D) positive or Rh (D) negative donors. The efficacy of pooled platelets and apheresis platelets appears to be equivalent in non-alloimmunized patients, who represent the majority of. platelet transfusion recipients. There are several benefits of apheresis platelets, however, compared to pooled platelets. The use of single-donor apheresis platelets reduces the risk of infectious disease transmission because of exposure to fewer donors. In addition, apheresis platelets contain markedly fewer white blood cells compared to pooled platelets. Recent evidence suggests that febrile reactions to platelet transfusions are caused by cytokines (e.g., IL-l, IL-6, and TNF) released from leukocytes during storage (Heddle, et al., 1994). Because they contain fewer leukocytes, apheresis platelets may thus result in fewer febrile transfusion reactions than pooled platelets. Finally, for the treatment of the alloimmunized patient who is refractory to platelet transfusions, apheresis platelets serve as the only source of HLA matched platelets.

14. Taze tam kan= Vericiden alinan tam kanin saklama dolabina girmeden 6-8 saat içinde hastaya verilmesidir. Tam kan: 1-6C’de 35-42 gün saklanir (koruyucu solüsyona bagli olarak). Hacim: 450-500 ml Içerik: RBC: 200 ml Plazma:250 ml WBC (10e9) ve PLT Antikoagülan (63 ml) Endikasyon: Pediatri hastalarda Exchange, açik kalp cerrahi operasyonlari, fazla miktar kanama (total kan volümünün %30 üzeri)

15. Tam Kan Kullanma Orani GELISMIS ÜLKELERDE ORTALAMA %5 TÜRKIYE’DE 1999: %80 2001: %57 EÜTF 2004: % 10

16. Hacim: yaklasik 250 ml (additive solusyonla 300-350 ml) Içerik: Plazma : 50-90 ml RBC: 200 ml; Hematokrit: %70-80 WBC (10e8) ve PLT Antikoagulan 200 mg demir Saklama: 1-6 ºC’de 21-42 gündür. CPD:21 gün CPDA-1:35 gün SAG-M ve ADSOL (AS-1,3,5)’lü Eritrosit Süspansiyonlarinin hematokriti: %55-60 dir, saklama süreleri 42 gündür. ABO ve Rh uyumu gerekir.

18. %0.9 NaCl (serum fizyolojik) %5 Albumin ABO uygun plazma Bunlar disinda hiçbir sivi veya ilaç kan torbasi içerisine konulmamali Kan seti ile ayni setten verilmemeli veya puse edilmemelidir (Ringer laktat, %0.45 saline, antibiyotik, TPN vs).

19. Transfüzyon hizi= 1-2 ml/kg/saat (75-150 ml/saat) 1 ünite verilme süresi yaklasik 1-2 saat Hizli verilmesi gerektigi durumlarda >1ml/kg/10 dk (75 ml/10 dk) veya pediatrik torbalarda verilmelidir. 170 µ’luk lokosit filtreli standart transfüzyon setleri kullanilmalidir.

20. Hastanin Hb bakarak transfüzyon yapilmamali; Transfüzyonu baslatacak bir Hb seviyesi yoktur. Ciddi kardiyopulmoner hastaligi olanlarda Hb 7-10 gr altinda ise transfüzyon yapilabilir. 1ünite Hb=1 gr, Htk=%3 artirir. Endikasyon: Hipoplastik anemiler Aplastik anemiler Kemoterapi sonrasi kemik iliginin baskilanmasi Myelodisplastik sendrom Paroksismal nokturnal hemoglobinüri Immünolojik nedenli olmayan kazanilmis hemolitik anemiler Konjenital hemolitik anemiler (Talasemi ortak hücreli anemi, eritrosit enzim bozukluklari, eritrosit membran bozukluklari) Eritropoietin tedavisine yanit vermeyen anemili KBY hastalari Akut ve kronik hemoraji

23. 1. Trombositopeni: Kanamasi veya pihtilasma bozuklugu yoksa PLT<10.000/mm3 Kanamasi olmayan fakat Pihtilasma bozuklugu olanlarda PLT<20.000/mm3 Kanamasi olan, DIK gelisen, cerrahi bir islem uygulanacak hastalarda PLT<50.000/mm3 Göz veya beyin ameliyati yapilacak hastalarda PLT<100.000/mm3 Masif kan transfüzyonu 2. Trombositopati: Konjenital trombosit fonksiyon bozuklugu Ilaçlar (aspirin, tiklodipin vs) Kardiak by-pass Metabolik bozukluk: böbrek ve karaciger yetmezligi TTP, ITP ve HIT ciddi kanama yoksa kontrendikedir

24. Taze Donmus Plazma Tam kanin 8 saat içinde +2-6°C’de santrifüj edilmesi ile taze plazma elde edilir. Saklama: -18 ºC’de dondurulur ve 1 yil saklanir Volüm: 200-250 ml Transfüzyon öncesi 37ºC’de çözülür ve çözündükten sonra 1-6ºC’de 24 saat saklanabilir (oda isisinda ise 4 saat içinde kullanilmalidir). ABO uyumu aranir. Rh uyumu aranmaz. Isinlama ve filtrasyon rutin olarak önerilmez

25. Taze Donmus Plazma Içerik: Taze plazma içinde koagülasyon faktörleri, globulin ve albümin bulunur. Dogal Antikoagülanlar Canli hücreler içermez Tüm pihtilasma faktörlerini içerir: Bu üründe labil koagülasyon faktörlerinin (FV ve FVIII) aktiviteleri korunmustur. 400 mg fibrinojen 1 IU/ml diger tüm faktörler

26. Kumadin tedavisi altinda iken Kanayan hastalarda: Kumadinin etkisini acil olarak ortadan kaldirmak Kanayan ve K vitamin eksiklgi olanlarda Trombotik Trombositopenik Purpura (TTP) DIK (kanama varsa) Herediter anjiyonörotik ödem (C1-esteraz inhibitör eksikligi) Masif transfüzyon (10-15 ünite RBC/24 saat) Agir karaciger yetmezligi (kanama varsa) Protein C ve Protein S eksikligi Taze Donmus Plazma:Endikasyon

27. Taze Donmus Plazmanin Kullanilmamasi Gereken Durumlar Volüm genisletmek amaciyla Yalnizca uzamis PT/aPTT degerlerini düzeltmek amaciyla Heparin etkisini tersine çevirmek Spesifik faktör konsantrelerinin varliginda (FVIII ve FIX) Nütrisyonel destek amaciyla Kardiyopulmoner bypass sonrasi profilaktik amaçla Protein kaybini yerine koymak amaciyla AT-3 eksikligi durumunda (spesifik konsantresi var) KULLANILMAMALIDIR!

28. Kriyopresipitat TDP 1-6°C’de yavas yavas eritilir Santrifüj ile süpernatan ayristirilarak atilir Kalan peltemsi kisma kriyopresipitat denir Hemen -18°C’de dondurulur, 1 yil saklanir. Kullanim için plazma çözücülerde çözdürülür (37C) ve 6 saat içinde kullanilir (20-24C’de). CRYO üniteleri havuzlanmis ise 4 saat içinde kullanilmalidir.

29. Hacim: 10-15 ml’dir. ABO uyumu gereklidir. Rh uyumu aranmaz. Içerik: FVIII: 80-120 Ü FVIII (>80IU olmalidir) Fibrinojen: 250 mg fibrinojen (>150 mg olmalidir) FXIII: 40-60 IU (TDP’da bulunan F13 içeriginin %20-30) vWF: 80-120 IU (TDP’da bulunan vWF içeriginin % 40-70) Fibronektin içerir.

35. ÖLÜM VEYA CIDDI KOMPLIKASYON SIKLIGI However, the more important cause of death or major complications is from giving the wrong unit of blood to the wrong patient (in red) ; ie. Medical errors. Transfusion transmitted infections are infrequent cause of death or major complication. This data is from UK but similar data exists from North America.However, the more important cause of death or major complications is from giving the wrong unit of blood to the wrong patient (in red) ; ie. Medical errors. Transfusion transmitted infections are infrequent cause of death or major complication. This data is from UK but similar data exists from North America.

36. DIKKAT!!!!! Kayit hatasi ? Ölüm Dogru hasta, dogru etiket Tam-eksiksiz istem formu Verici örneginin dogru etiketlenmesi Dogru etikete sahip kan torbasi Kan ürünü ile beraber mutlaka “cross-match” kagidinin kontrol edilmesi

37. Transfüzyon Yapilirken Dikkat Edilmesi Gereken Hususlar Transfüzyon mutlaka bu konuda bilgili birisi tarafindan yapilmalidir Kan ürünü ile birlikte verilen formda Ünite numarasi Komponentin adi, son kulanma tarihi Alicinin adi-soyadi ve dosya numarasi Alici ve vericinin ABO ve Rh gruplari Karsilastirma sonuçlari bulunmalidir.

38. Kan ürünü kan bankasinda ve kan saklama dolaplarinda muhafaza edilmelidir. Eritrosit veya tam kan herhangi bir nedenle kan bankasi saklama dolabinin disina çikarildiysa: Oda isisinda ise (20-24 0C) 4 saatte, Buzdolabinda ise (1-6 0C) 24 saat içinde tüketilmelidir. Aksi taktirde ürün imha edilmelidir (kontaminasyon riski). Ideal Kan Bankaciliginda Kan Merkezini terk eden kan tekrar Kan Merkezine dönmemelidir. Ürünü kan dolabi disinda saklama

39. Kan ürünleri uygulama kurallari 1- Hasta transfüzyona hazirlanir: a-Ürüne göre IV yol, igne veya kateter çapi uygunlugu b-Izin belgesi c-Hastaya açiklama 2- Kan veya kan ürünü kan bankasindan alinir. Trombosit ve granülosit süspansiyonlari oda isisinda, plazma çözündürüldükten sonra buzdolabinda bekletilmelidir. 3- Kan ürünü torbasi özellikle giris yerlerindeki kaçak, renk, pihti varligi yönünden kontrol edilmelidir. Eritrosit  süspansiyonu koyu-kirmizi, trombosit sari-açik çilek, granulosit koyu-pembe rengindedir.

40. Kan ürünleri uygulama kurallari 4- Ürünün ünit numarasi , son kullanma tarihi kontrol edilmelidir. 5- Tüm kan ürünleri filtre ile uygulanmalidir. 6- Uygulama öncesinde o kan ürününün hastaya ait olup olmadigi tekrar kontrol edilmelidir. 7- Transfüzyona baslamadan önce hastanin nabzi, solunum sayisi, kan basinci ölçülüp kaydedilmeli, 15’ sonra kontrol edilmeli ve transfüzyon bitene kadar 30-60 ‘ bir izlenmelidir.

41. Kan ürünleri uygulama kurallari 8- Kan ürünleri infüzyon hizi ilk 15 ‘ da 0.5 -1ml/dk olmali, hasta yan etkiler yönünden izlenmelidir. Daha sonra eritrosit ve granulosit süspansiyonu 1-2, trombosit 1, plazma 4 saat içinde infuze edilmelidir. 9- Tüm kan ürünleri bakteriel kontaminasyon riski nedeniyle 4 saat içinde uygulanmalidir. 10- Transfüzyonla ilgili tüm bilgiler mutlaka dosyaya kaydedilmelidir.

42. Transfüzyon uygulanan hastanin dosyasinda bulunmasi gereken belge ve bilgiler Izin belgesi Transfüzyon baslangiç ve bitis zamani Verilen kan ürününün tipi ve ünit numarasi Transfüzyon öncesi, süresi ve sonrasi vital bulgular Hastanin toleransi ve gelisen reaksiyonlar Verilen kan miktari