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Special Blood Products

Special Blood Products. Laura Cooling MD, MS Associate Medical Director Transfusion Medicine. Over-ordering: Platelets account for 61% of all components wasted. Surgery accounts for 60% of all platelets wasted 51.5% Cardiac 3.82% Transplant 4.54% Other. Cryo 18.7%. Platelets 61%.

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Special Blood Products

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  1. Special Blood Products Laura Cooling MD, MS Associate Medical Director Transfusion Medicine

  2. Over-ordering: Platelets accountfor 61% of all components wasted Surgery accounts for 60% of all platelets wasted 51.5% Cardiac 3.82% Transplant 4.54% Other Cryo 18.7% Platelets 61%

  3. Most Blood collected, stored in Adsol • Fraction is collected in CPD and CPDA • concern for mannitol in neonates Massive Transfusion in Neonates • Extracorporeal Membrane Oxygenation • Exchange Transfusion • Cardiovascular Surgery Adsol RBC are acceptable for routine, small transfusions in neonates

  4. Platelets: Specialty Products • Single donor apheresis platelets • Crossmatched platelets • HLA-matched platelets Pathology consult and evaluation • Patients with suspected alloimmune platelet refractoriness

  5. Irradiated Blood Products • Prevent transfusion-associated GVHD. • Engraftment donor lymphocytes • Mortality >80-90% • Cellular components only (RBC, platelets) Symptoms: • Fever • Skin eruptions • Diarrhea • Elevated LFT • Pancytopenia

  6. RELATED OR HLA-MATCHED DONOR HLA: A1, A1, B8, B8 PATIENT HLA: A1, A2, B7, B8 Patient Compatible A1, B8 Donor Incompatible A2, B7

  7. INDICATIONS • Intrauterine transfusion/exchange transfusion • Premature neonates • (<1200-1500gm and < 4 month age) • Congenital immunodeficiencies • Bone marrow transplant recipients • Hematologic malignancy • Solidtumor malignancy requiring high dose, multiagent chemotherapy • HLA-matched platelets • Directed donations from relatives ORGAN TRANSPLANTS DO NOT REQUIRE IRRADIATION

  8. Adverse Effects of Irradiation • Increased rigidity, less deformability • Contributes storage lesion (RBC) • Increased K+ leak • Decrease ATP, pH • “accelerated aging” Give irradiated components only to those patients at risk

  9. CMV-safe • Prevent TA-CMV in at-risk patients • Transmitted by lymphocytes • cellular components only (RBC, platelets) • Prevented by leukodepletion (CMV-safe) Indications: (CMV-safe) • Intrauterine transfusion • Premature infants/exchange transfusion • Bone marrow transplant • Solid organ transplant CMV-seronegative (U of M): CMV-negative BMT recipient of a CMV-negative donor

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