1 / 35

Component preparation

Plasma + Platelets. Whole blood. Buffy. RBC. Component preparation. Principle - Differential centrifugation Red cells Packed cells Red cells + additive Plasma Bank plasma Fresh frozen Cryo supernate Platelets Platelet rich concentrate Platelet rich plasma Cryoprecipitate.

koko
Download Presentation

Component preparation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Plasma + Platelets Whole blood Buffy RBC Component preparation • Principle - Differential centrifugation • Red cells • Packed cells • Red cells + additive • Plasma • Bank plasma • Fresh frozen • Cryo supernate • Platelets • Platelet rich concentrate • Platelet rich plasma • Cryoprecipitate

  2. DEFINITIONS BLOOD PRODUCT = Any therapeutic substance prepared from human blood WHOLE BLOOD = Unseparated blood collected into an approved container containing an anticoagulant preservative solution BLOOD COMPONENT = 1. A constituent of blood , separated from whole blood such as • Red cell concentrate • Plasma • Platelet concentrates 2. Plasma or platelets collected by apheresis 3. Cryoprecipitate prepared from fresh frozen plasma

  3. Blood Components THE PRBC Storage - 2 – 6 O C Unit of issue - 1 donation ( unit or pack ) Administration - ABO & Rh compatible - Never add medication to a unit - Complete transfusion within 4 hrs of commencement Member 1

  4. Dosage & Administration Dosage - 1 unit/10 kg body wt Adult dose is 4-8 units Administration - Preferably ABO & Rh group specific but not essential Other groups can be used

  5. PLATELETS • Platelet units can be either • Random donor units • Apheresis units • 1 random donor unit contains 55 x109 platelets • 1 apheresis unit contains 240x109

  6. Guidelines for Platelet Tx. Mild - 50,000-1,00,000/µl Tx - usually not required Moderate - 20,000-50,000/µl Tx-if symptomatic or has to undergo surgery/trauma Severe - < 20,000/µl Risk of bleeding - high Prophylactic Tx

  7. Indications for platelet transfusion BLEEDING due to thrombocytopaenia Due to platelet dysfunction Prevention of spontaneous bleeding with counts < 20,000

  8. IMPORTANT PRECAUTIONS Stored at 20-24 Degree celcius. Constantly agitated Only last for 5 days Infused in 30 mins

  9. Fresh Frozen plasma • Fresh frozen plasma – labile & nonlabile clotting factors, albumin and immunoglobulin. Factor VIII ( 8 ) level at least 70 % of normal fresh plasma level Storage - 20 C for 1 yr, - 65 C for 7 yrs. • Before use thawed at 37 o C

  10. Fresh frozen plasma Indications - Replacement of multiple coagulation factor deficiencies eg • Liver disease • Anticoagulant overdose • Depletion of coagulation factors in pts receiving large volume transfusions • DIC (disseminated intravascular coagulation)

  11. FRESHFROZEN PLASMA Indication • Clinically significant deficiency of Factors II, V, X, XI • Replacement of multiple coagulation factor deficiencies :- liver disease , warfarin treatment, dilutional and consumption coagulopathy Contraindication • Volume expansion • Immunoglobulin replacement • Nutritional support • Wound healing

  12. FRESH FROZEN PLASMA MD-3-49 Precaution • Acute allergic reaction are common • Anaphylactic reaction may occur • Hypovolemia alone is not an indication for use Dosage - Initial dose of 15 - 20 ml / kg Administration • Must be ABO compatible, Rh not required • Infuse as soon as possible after thawing ( within 6 hrs ) • using standard blood administration set

  13. FFP Fresh Frozen Plasma Plasma collected from single donor units or by apheresis Frozen within 8 hours of collection -40o C Can last for a year

  14. Dosage & Administration for FFP Dosage - 10-15 ml/Kg(Approx 2-3 bags for an adult) Administration - Thawed at +37o C before transfusion ABO compatible Group AB plasma can be used for all patient

  15. Do`s and Dont`sIn Blood and Blood Components

  16. Risk Benefit Analysis risk > benefit benefit > risk Hb gm/dl 4 5 6 7 8 9 10 11 12 13 14 why transfuse why not transfuse individual patient factors decide transfusion trigger

  17. Time Limits for Infusion Blood/ Start infusion Complete infusion blood product Whole blood/ within 30 min. of within 4 hour red cells removing pack (less in high from ambient temperature) refrigerator Platelet immediately within 20 min concentrates FFP within 30 min within 20 min

  18. TRANSFUSION REACTIONS @RBC’s ! • Nonhemolytic 1-5 % transfusions Causes -Physical or chemical destruction of blood: freezing, heating, hemolytic drug -solution added to blood -Bacterial contamination : fever, chills, urticaria • Slow transfusion, diphenhydramine , antipyretic for fever • Hemolytic • Immediate: ABO incompatibility (1/ 12-33,000) with fatality (1/ 500-800,000) Majority are group O patients receiving type A, B or AB blood Complement activation, RBC lysis, free Hb (+ direct Coombs Ab test)

  19. Chills , fever Facial flushing Hypotension Renal failure DIC Chest pain Dyspnea Generalized bleeding Hemoglobinemia Hemoglobinuria Shock Nausea Vomitting Back pain Pain along infusion vein Signs and Symptoms of AHTR

  20. Anesthesia: hypotension, urticaria, abnormal bleeding • Stop infusion, blood and urine to blood bank, coagulation screen (urine/plasma Hb, haptoglobin) • Fluid therapy and osmotic diuresis • Alkalinization of urine (increase solubility of Hb degradation products) • Correct bleeding, Rx. DIC

  21. @WBC’s! • Europe: All products leukodepleted • USA: Initial FDA recommendation now reversed pending objective data (NOT  length of stay for  expense) • Febrile reactions • Recipient Ab reacts with donor Ag, stimulates pyrogens (1-2 % transfusions) • 20 - 30% of platelet transfusions • Slow transfusion, antipyretic, meperidine for shivering

  22. TRALI (Transfusion related acute lung injury) • Donor Ab reacts with recipient Ag (1/ 10,000) • noncardiogenic pulmonary edema • Supportive therapy

  23. Transfusion-related Acute Lung Injury (TRALI) Acute and severe type of transfusion reaction Symptoms and signs • Fever • Hypotension • Tachypnea • Dyspnea • Diffuse pulmonary infiltration on X-rays • Clinical of noncardiogenic pumonary edema

  24. Transfusion-related Acute Lung Injury(TRALI) Therapy and Prevention • Adequate respiratory and hemodynamic supportive treatment • If TRALI is caused by pt. Ab  use LPB • If TRALI is caused by donor Ab no special blood components

  25. Transfusion-associated Graft-versus-HostDisease ( TA-GVHD) • Rare: immunocompromised patients • Suggestion that more common with designated donors • BMT, LBW neonates, Hodgkin's disease, exchange Tx in neonates

  26. Graft-versus-Host Reaction Signs & Symptoms • Onset ~ 3 to 30 days after transfusion • Clinical significant – pancytopenia • Other effects include fever, liver enzyme, copious watery diarrhea, erythematous skin erythroderma and desquamation

  27. @Platelets! Alloimmunization • 50 % of repeated platelet transfusions • Ab-dependent elimination of platelets with lack of response • Use single donor apheresis • Signs & Symptoms • mild  slight fever and Hb • severe  platelet refractoriness with bleeding Post-transfusion purpura • Recipient Ab leads to sudden destruction of platelets 1-2 weeks after transfusion (sudden onset) • Rare complication

  28. INFECTIOUS COMPLICATIONS I. Viral (Hepatitis 88% of per unit viral risk) Hepatitis B • Risk 1/ 200,000 due to HBsAg, antiHBc screening (7-17 % of PTH) • Per unit risk 1/63-66,000 • 0.002% residual HBV remains in ‘negative’ donors (window 2-16 weeks) • Anti-HBc testing retained as surrogate marker for HIV

  29. NANB and Hepatitis C • Risk now 1/ 103,000 (NEJM 96) with 2nd/ 1/ 125,000 with 3rd generation HCV Ab/ HVC RNA tests • Window 4 weeks • 70 % patients become chronic carriers, 10-20 % develop cirrhosis

  30. HIV • Current risk 1/ 450- 660,000 (95) • With current screening (Abs to HIV I, II and p24 Ag), window 6-8 weeks (third generation ELISA tests in Europe) •  sero -ve window to < 16 days

  31. HTLV I, II • Only in cellular components (not FFP, cryo) • Risk 1/ 641,000 (window period unknown) • Screening for antibody I may not pick up II CJD (and variant CJD)

  32. II. Bacterial • Contamination unlikely in products stored for > 72 hours at 1-6 0 C • gram –ve, gram +ve bacteria most frequent – Yersinia enterocolitica Produced endotoxin Platelets stored at room temperature for 5 days, with infection rate of 0.25% III. Protozoal • Trypanosoma cruzi (Chaga’s disease) • Malaria • Toxoplasmosis • Leishmaniasis

  33. Serological Testingfor Infectious markers • HIV – Ag • Anti – HIV • HBsAg • Anti – HCV • Test for syphilis

  34. METABOLIC COMPLICATIONS Citrate toxicity • Citrate (3G/ unit WB) binds Ca2+ /Mg+ • Metabolized liver, mobilization bone stores • Hypocalcemia ONLY if > 1 unit/ 5 min or hepatic dysfunction • Hypotension more likely due to  cardiac output/ perfusion than  calcium (except neonates) • Worse with hypothermia/ hepatic dysfunction

More Related