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TRANSFUSION MEDICINE

TRANSFUSION MEDICINE. DR. AYESHA JUNAID MBBS,MCPS,FCPS. Professor of Pathology Consultant Haematology Incharge Blood Transfusion Services SIH. TRANSFUSION REQUIREMNT. ONLY APPROPRIATE TRANSFUSION Transfusion of safe blood products to treat a condition leading to significant

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TRANSFUSION MEDICINE

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  1. TRANSFUSIONMEDICINE DR. AYESHA JUNAID MBBS,MCPS,FCPS. Professor of Pathology Consultant Haematology Incharge Blood Transfusion Services SIH

  2. TRANSFUSION REQUIREMNT ONLY APPROPRIATE TRANSFUSION Transfusion of safe blood products to treat a condition leading to significant morbidity /mortality that could not be prevented or managed effectively by other means

  3. TRANSFUSIONMEDICINE Blood Transfusion can be fatal if incorrectly administered

  4. TRANSFUSION Haematological malignancies • 15% of all red cell units transfused to haematological diseases are transfused for Malignant disorders • Effect of the disease itself • Myeloablative /myelosuppressive effects of specific treatment

  5. Indications for RCC, Plts,FFP NO UNIVERSAL TRIGGER FOR TRANSFUSION • Clinical judgment • Quality of life indices • Approach to the management and prevention of complications

  6. BLOOD COMPONENTS • Whole blood • Packed red blood cells • Leukodepleted red cells • Washed red blood cells • Platelets concentrates • Single-donor/Random-donor • Irradiated blood products (red blood cells and platelets concentrates) • Leukocyte (granulocyte) concentrates

  7. BLOOD COMPONENTS Plasma components/products • Fresh-frozen plasma (FFP) • Cryoprecipitate • Factor concentrates (VIII, IX) • albumin • Immune globulins

  8. Blood Components

  9. Whole Blood Red Blood cells, Platelets and White Blood Cells all suspended in Plasma constitute Whole Blood.

  10. Whole Blood Unit After centrifugation whole blood separates into the plasma and platelets on top and packed red blood cells on the bottom. A plasma expresser is used to literally squeeze the plasma and platelets off the top and leave only the red blood cells in the original bag.

  11. PLASMA SEPARATION

  12. Blood Components Random donor Platelets Packed Red Blood Cells Plasma Product

  13. RBC Components Packed RBCs(RCC) • Approx. 1/2 the volume of Whole Blood • Same RBC mass therefore same oxygen carrying capacity • Total Volume 250ml • Expiration Date 35-42 days • CPDA 1 - 35 days closed system • AS-1 - 42 days closed system • Open System - 24 hours

  14. RBC Components continued… LEUKOCYTE REDUCED RBC’S • Removal of leukocytes from RBC component to <5.0 X 106 per unit 1. Leukopoor filtration 2. Washing 3. Freezing and Deglycerolization

  15. Leucodepletion • Removal of majority of white cells is leucodepleton. • Purpose :To reduce incidence of febrile illness and alloimmunization after transfusion.

  16. Platelets • Random-donor platelets concentrates(RPC) • Single-donor platelets concentrates (SPC)

  17. They are harvested by cell separators or from individual donor units of blood. Need of transfusion is in patients with thrombocytopenia , active bleeding or platelet dysfunction . For prophylaxis the platelet count should be more than 5-10 x109/ l Platelet transfusion should be avoided in autoimmune thrombocytopenic purpura. PLATELETS CONCERTERATES

  18. Platelet Components: Random Donor Platelets • Prepared from a Whole Blood (WB) component Step 1:Soft (light) Spin (2-3 min at 3200 rpm) to keep the platelets in the plasma. Step 2:Hard (heavy) Spin (5 min at 3600 rpm) to aggregate platelets. Express off all but 55- 65 ml of plasma and let platelets rest and resuspend on counter (room temp) for 1-2 hours before aggitation.

  19. Platelet Components Includes Random donor platelets, Single donor platelets and Pooled Platelets.

  20. Platelet Components Random Donor Platelet • At least 5.5 x 1010 platelets/unit • Single Donor Platelet - Apheresis • At least 3.0 x 1011 platelets/unit • Suspended in 300 ml plasma

  21. SINGLE DONOR PLATELET APHARESIS

  22. Platelet Components Pooled Platelets • Process of pooling Random Donor Platelets into a central bag. Typically done for adult patients. Need a common “Pool” number on the unit. (Remember we are pooling many donors who each have a unique donor number.) • Pool anywhere from two to twenty units. • Expiration changes from 5 days to 4 hours - Need to be sure the floor is ready to transfuse before pooling.

  23. Plasma Components Fresh Frozen Plasma • Plasma expressed from Whole Blood, needs to be frozen within 8 hours (6 hrs for ACD) of collection for CPDA-1 anticoagulant. • Frozen at -18oC: • Frozen at -65oC: • Thawed: • 150-250 ml total volume • Contains all clotting factors

  24. Fresh frozen plasma ( FFP) , is mainly used for replacement of coagulation factors ( when specific concentrates are unavailable ) FFP are also given after massive transfusion , DIC , in liver disease . HUMAN PLASMA PREPARATIONS

  25. TRANSFUSION REQUIREMNT IN LEUKEMIC PATIENTS • Review your decision • Irradiated • Leukodepleted • CMV negative • Single donor Platelets • TO THE CORRECT PATIENT

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