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Importance of blood and blood components

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    Importance of blood and blood components Importance of blood and blood components Presentation Transcript

    • Importance of
      Blood
      And
      Blood Component
      Therapy
      By
      Dr Rashmi Sood
      Consultant Transfusion Medicine
      delhi heart & lung institute
      New Delhi.
    • Use of Blood and Blood Components
      as a Medicine
      has come
      a long way!!!!
    • AIMOF Todays Programme
      1) To create awareness of the vital role of
      blood transfusion
      in
      saving lives
      and
      improving the health
      of millions of people each year.
    • AIMOF Todays Programme
      2) To motivate more people to become REGULAR REPEAT VOLUNTARY DONORS
      so that no one suffers for the want of blood.
    • THEME
      MORE BLOOD
      MORE LIFE
    • NEED FOR BLOOD
      • In Delhi, need is about 4 lakh units of blood every year and collection is 3.75 lakh units.
      • Majority of it comes from replacement donors.
      • Voluntary donation is about 27 percent as compared to 45 percent at the national level.
    • How much Blood do we have?
      On average, an adult has about
      five to six liters
      of blood in their circulation.
      The total blood volume is based on body mass.
      Formula is
      70 X Body Weight for MALES.
      66 X Body Weight for FEMALES.
    • Blood in a person
      E .g. A male of body weight 75 Kg has 75 x 70 =
      5250ml or 5.25 litres of blood.
    • Why screen before Blood Donation????
      For the safety of both
      the donor
      and
      the potential recipient .
    • Who can Donate Blood?
      Age :Between 18 to 60 years of Age.
      Weight : At least 45 Kg.
      Hemoglobin: 12.5gm%.
      Frequency of Donations: Minimum interval between donations is 3 months.
      Health: In good health and feeling well.
      Screening: At the time of donation a number of questions are asked to determine donor eligibility.
    • 1.Voluntary-non remunerated.
      2.Replacement or relative.
      3.Professional or commercial.
      62 countries in the world
      have entire collection
      Of blood by
      voluntary
      blood
      donation.
      In India approx. 50% is by Voluntary Blood Donation
    • Screening criteria
      Medical history
      Preliminary health check
    • Temporary Deferral
    • Permanent deferral
    • Tale of the red fluid called
      blood !!!!
    • The Three Formed Elements
    • What is BLOOD?
      The fluid circulating throughout the body.
      • Carrier of carbon dioxide and oxygen to and from the lungs.
      • Carries nourishment to the tissues.
      • And Takes away waste products to Kidneys.
    • Components of Blood
      The blood circulating is referred to as ‘Whole Blood’.
      Whole Blood is made up of several different components each with specific applications .
      WHOLE BLOOD IS just a RAW MATERIAL
    • Red cells, white cells and platelets suspended in plasma as seen under MICROSCOPE
    • WHOLE BLOOD
      VERSUS
      COMPONENTS
    • Presently only 30-35 percent blood is being used as separate components .
    • It should increase
      to
      70-75 percent
      each component is given
      When specifically needed
      Rationalizing the use of blood
      and
      preventing unnecessary wastage.
    • Imagine the outcome without the availability of these drugs!!!!
    • What are Red Cells?
      • Constitute the majority of cells in the blood. Approximately a quarter of the cells in the human body are red blood cells.
      • WHY RED IN COLOUR?
      • These cells' cytoplasm is rich in hemoglobin, an iron-containing biomolecule that can bind oxygen and is responsible for the blood's red color.
      • FUNCTION:Travel throughout the body, deliver oxygen to tissues and remove carbon dioxide to the lungs.
      • This role of the red cells (transporting oxygen) is essential to prevent damage to organs.
    • Where are Packed Red Cells used ?
      • Ask the parents of a thallesemic child.
      • Ask the family members of a kidney
      failure patient.
      • Ask the patients of severe anaemia (Whole Blood Increases Chances of Circulatory Overload).
      • Ask the patients of Haemolytic Anaemia.
    • Packed Red Cells
      • Ask the patients undergoing Cancer treatment(Hypoplastic and Aplastic
      Anaemia).
      • Ask the patients undergoing
      Cardiac surgery .
      • Ask the patients undergoing Knee replacement.
      • Ask the patients of Road accidents .
    • Packed Red Cells
    • Packed Red Blood Cells Contraindications!!
      LRBC should not be used:
      1) When anemia can be corrected with specific medications, e.g., iron, B12, folic acid, erythropoietin, etc
      2) For volume replacement.
    • What are Platelets?
      Platelets are colorless,irregularly shaped bodies found in blood.
    • Platelet Functions
      The primary role of
      platelets is to prevent
      bleeding in injured
      blood vessel walls by
      forming an
      aggregate at
      the site of injury.
    • Platelet Functions
      Platelets can also
      participate in blood
      coagulation,
      inflammation
      and wound healing.
    • Why platelets ? Can’t just fresh blood do the job ?
      • Ask a cancer Physician.
      • Ask a Physician treating patients with bleeding due to severely decreased production or abnormal function of platelets , as in
      • Leukaemia
      • Hypoplastic Anaemia
      • Chemotherapy
      • Bone marrow transplantation
      • Marrow Infiltration eg. Carcinoma , Leukaemia
      • Drug induced or Radiation induced hypoplasia
    • Platelets
      • Ask a Physician treating bleeding patients with platelet consumption or dilutional thrombocytopenia eg.Massive Transfusion with stored blood.
    • Platelets
      • Can be given prophylactically to patients with rapidly falling or low platelet counts, less than 10 x 109/L (10,000/mL), secondary to cancer or chemotherapy.
      • Useful in selected cases of postoperative bleeding with platelet count less than 50 x 109/L (50,000/mL).
      • Viral disease associated with Thrombocytopenia eg.Dengue.
    • Platelets
      • Useful in functional platelet abnormalities.
    • PlateletsContraindications :
      • If bleeding is unrelated to decreased numbers or abnormal platelet function.
      • In patients with consumption of endogenous and exogenous platelets, such as in Thrombotic Thrombocytopenia Purpura (TTP) or Idiopathic Thrombocytopenia Purpura (ITP), unless the patient has a life threatening hemorrhage.
    • Platelets-Preparation:
      Platelets are prepared from whole blood.
      Platelets may also be obtained by apheresis.
      Platelets are suspended in a small amount of the original plasma.
    • Platelet Incubator and Agitator
      Need to be stored with constant agitation.
    • What are White Cells?
      • White blood cells travel throughout the body and protect against bacteria and viruses.
      • There are different types of white blood cells (granulocytes, macrophages and lymphocytes).
      • The lymphocytes help with immune defense.
      • White blood cells can also carry some viruses and bacteria.
    • Who uses White cells ?
      • Easily obtained by Granulocytapheresis.
      • Ask an intensive care physician who is struggling to save a neutropaenic patient refractory to all antibiotics.
    • What is Plasma?
      • Plasma is a protein-salt solution that acts as a transportation medium for the other blood components.
      • The red cells, white cells, and platelets are suspended in the plasma.
      • Plasma is a straw colored clear liquid that is 90% water.
    • Plasma-Functions
      • Plasma helps with clotting, fighting infection, maintaining blood pressure and immunity. In addition, it contains minerals (e.g., sodium and potassium).
    • Plasma-Preparation
      • Fresh frozen plasma is separated from whole blood and frozen within 8 hours of collection (approx. 250 mL).
      • It can also be obtained from by apheresis (approx. 500 mL).
    • Can’t one just use fresh blood?
      • Ask a physician involved in the care of a cirrhotic patient
      • Ask a Transfusion specialist wishing to do an exchange on a young TTP patient
    • Fresh Frozen Plasma (FFP)Function:
      • Fresh frozen plasma contains the clotting factors that are necessary for hemostasis.
      • Plasma also has volume expansion and oncotic properties.
      • Fresh frozen plasma contains a normal concentration of fibrinogen and the labile coagulation factors VIII and V.
    • Fresh Frozen Plasma Indications :
      1.In bleeding patients with multiple
      coagulation factor deficiencies
      secondary to liver disease,DIC and massive
      blood transfusion.
      2.Patients on anticogulant
      drugs like Warfarin sodium
      and Dicumarol are deficient in
    • Indications
      functional Vit.K dependent coagulation factors II,VII,IX
      and X.If these patients are bleeding or need emergency surgery.
      3.FFP is used in antithrombin deficiency,inherited or acquired after oral contraceptive use or in patients with liver disease.
    • Indications
      4.FFP is used in infants with secondary immunodeficiency associated with severe protein losing enteropathy .
      5.FFP is used in patients who have to undergo emergency bypass surgey and are on anticoagulants.
      6.FFP is indicated for massive transfusion (replacement of the patient’s blood volume in < 24 hours) with a demonstrated deficiency of Factor VIII and V, otherwise frozen plasma is adequate.
    • Indications
      7.Fresh frozen plasma is indicated in exchange transfusion in neonates.
    • Cryoprecipitate (Cryo):
      • Cryo is prepared from fresh frozen plasma.
      • A source of coagulation factors :
      • Factor VIII : In acquired deficiency eg DIC , massive transfusion and congenital deficiency as in Hemophilia A.
      • Factor V, Factor XIII.
      • Von Willebrand Factor in Von-Willebrands disease.
      • Fibrinogen and fibronectin are present in Cryo.
      • Cryo can be used to make fibrin glue.
    • Cryoprecipitate (Cryo)
    • What is an Apheresis Donation?
      Apheresis means to selectively collect
      a blood component
      (red cells,
      platelets,
      white cells
      or plasma)
    • Platelets Plasma
    • Principle of APHERESIS Donation
      A specific blood component
      is selected
      and
      separated
      by the machine
      (most commonly platelets or plasma)
    • Advantages :
      • The components that are not required are returned to the donor.
      • Relatively large amounts of the single component can be selectively collected.
    • PLASMA EXCHANGE &RED CELL exchange
      1) Therapeutic Plasma exchange
      indicated in Myasthenia crisis , Guillain Barre Syndrome, Thrombotic thrombocytopaenic purpura, Haemolytic uraemic syndrome etc.
      2) Red cell exchange for falciparum malaria,sickle cell anaemia.
    • Irradiated blood components
      • Prevents Transfusion Associated Graft vs. Host Disease.
      • Irradiation for:
      – Units from blood relatives
      – Allo/Auto Hematopoietic Progenitor Cell Transplant Recipients
      – Intrauterine transfusion
      – Neonates undergoing exchange transfusion
      – Hodgkin’s Disease
      – Cellular immune deficiency disorders
      – Solid Organ Transplants
    • FRACTIONATED PLASMA PRODUCTS 
      INCLUDE :
      1) ALBUMIN
      HUMAN SERUM ALBUMIN
      2) PLASMA PROTEIN FRACTION
      3) IMMUNOGLOBULINS
      IMMUNE SERUM GLOBULIN
      SPECIFIC Igs (HYPER IMMUNE)
      4) COAGULATION PROTEINS
      F VIII,IX, VII
      ACTVATED F IX COMPLEX/ F VIII
      5) PROTEASE INHIBITORS
      AT III, CI ESTERASE INHIBITOR
    • RECOMBINANT BLOOD PRODUCTS:
      1)Recombinant factor VIII e.g. Recombinate
      2)Recombinant factor IX e.g. Benefix
      3) Recombinant factor VII (Novoseven)
      4) vWF, ATIII
      5) Alpha1 protease inhibitor
      6) Hb vaccines
      7) R Hb
      8) Haemopoietic growth factors
      EPO,G-CSF, GM-CSF,TPO,ILs,TNF
    • THANK
      YOU…….