RATIONAL BLOOD USE..     ...and its components.
TOPIC• Historical   interest• Blood   process• Blood   product• Indication• Special   consideration• Complication
HISTORICAL INTEREST
THE FIRST BLOODTRANSFUSION ATTEMPT   • In1492 "the harrowing story was told that, at    the suggestion of a Jewish physici...
BLOOD AND CIRCULATION•   In 1628 William Harvey    published De Motu Cordis (On    the Motion of the Heart and    Blood) r...
TRANSFUSION ATTEMPTS• In   1667 Jean-Baptiste Denys, French physician, performed transfusion with sheeps and calfs blood.•...
BLOOD GROUPING• In   1901, Karl Landsteiner discovered human blood groups. Blood transfusion had become a lot safer since ...
DEVELOPMENT OF BLOOD      BANKING•   Anticoagulant was discovered in 1910, making the way to    blood banking.•   First st...
BLOOD PROCESSING
HOW IS DONATED BLOOD        PROCESSED?• Blood   and blood components come from potential donors.• Wholeblood was used in fi...
LEUKOCYTE REDUCTION• WBC   less than 5 x 106/unit*• Reduced   febrile reaction risk          yte                          ...
IRRADIATION      • Inactivate   donor’s T-cells      • Reduced      GVHD risk      • Reduce   shelf life to 28 days       ...
SINGLE DONOR PRODUCT          • Reduce    donor exposure          • Single   HLA antigen
BLOOD PRODUCT
WHOLE BLOOD•Volume 350 or 450 ml•Contain red cell, white cells,platelets, and plasma•Stored at 2-6°c•No functional platele...
PACKED REDBLOOD CELL•Volume ~300 ml•Hct ~75%•Contain red cells, whitecells, small of plasma•Stored at 2-6°c•10ml/kg raise ...
PACKED REDBLOOD CELL•Volume ~300 ml•Hct ~75%•Contain red cells, whitecells, small of plasma•Stored at 2-6°c               ...
PACKED REDBLOOD CELL•Volume ~300 ml•Hct ~75%•Contain red cells, whitecells, small of plasma•Stored at 2-6°c               ...
PLATELETCONCENTRATE•Volume ~50 ml• Contain platelet 5.5 x 1010RBC 0.5 ml and white cells•Stored at 20-26°c withcontinuous ...
POOLEDLEUKOCYTE-POOR PLATELET•Made of 4 unit of wholeblood•Contain platelet 3 x 1011 andRBC 5 ml•Comparable to Plt. conc. ...
POOLEDLEUKOCYTE-POOR PLATELET•Made of 4 unit of wholeblood•Contain platelet 3 x 1011 and          yte                     ...
POOLEDLEUKOCYTE-POOR PLATELET•Made of 4 unit of wholeblood•Contain platelet 3 x 1011 and          yte                     ...
FRESH FROZENPLASMA•Volume 250 ml•Contain all coagulationfactor•10-15 ml/kg raise factor~25%•Stored at -18°c
CRYOPRECIPITATE•Volume 15 ml•Contain factor VIII, XIII,von Willebrand factor,fibrinogen•1-2 units/ 10 kg raisefibrinogen 100...
INDICATION
THRESHOLD FOR RBC              TRANSFUSION• Hb    < 7 g/dL in general patient• Hb    < 10 g/dL in patient with ischemic he...
PATIENT WHO SHOULD NOT       BE TRANSFUSED• Nutritional   anemia• Autoimmune      hemolytic anemia• Patient   with high pe...
PLATELET REQUIREMENT• In   bleeding patient: keep platelet > 50,000 - 80,000/mcL• Bleeding   in vital organ: keep platelet...
PLATELET CONTRAINDICATE• Thrombotic   thrombocytopenic purpura• Heparin   induced thrombocytopenia• Disseminated   intrava...
FRESH FROZEN PLASMA• Ingeneral each milliliter of plasma count as 100% factor  activity       100% +      0%     =    50% ...
CRYOPRECIPITATE• Use for replacing factor VIII, factor XIII, von Willebrand factor, fibrinogen
SPACIAL CONSIDERATION
SPACIAL CONSIDERATION• Rh   negative patient• Mismatch     transfusion• Platelet   refractoriness• Massive    transfusion
RH NEGATIVE• Rh   negative is determined by absence of D antigen• Antibody    occur 4 - 8 wks after expose to D antigen• R...
PLATELET TRANSFUSION IN         RH NEGATIVE• Check if patient already have Rh antibody• Give anti-D IgG before or within 7...
MISMATCH TRANSFUSION• Transfuse          packed red cell without foreign antigen to avoid major mismatch reaction• Transfu...
TRANSFUSION         COMPATIBILITYBlood group Compatible    Compatible     A         RBC              A, O         Plt. & F...
PLATELET REFRACTORINESS• Corrected   count increment (CCI) < 3,000/mcL• Corrected   count increment = (Pre - Post) x Body ...
PLATELET REFRACTORINESS• Immune                       • Non-immune•      Alloimmunization        •      Infection, fever• ...
MASSIVE TRANSFUSION• 1 Total   blood volume within 24 hr.• Keep   platelet > 50,000/mcL• Keep   coagulogram less than 1.5 ...
TRANSFUSION PRACTICE• Correct   blood component processing• Correct   sample taking and labeling• Correct   crossmatch tec...
TRANSFUSION PRACTICE• Check   if bags are in good condition • No   leakage • No   fibrin clot• Recordvital sign at before, ...
COMPLICATION OF BLOOD    TRANSFUSION
COMPLICATION OF BLOOD      TRANSFUSION• Immediate  hemolytic        • Febrilenonhemolytic transfusion reaction          tr...
IMMEDIATE HEMOLYTIC    TRANSFUSION REACTION• ABO     incompatibility is the most common cause• Can   be fatal even 30 ml o...
IMMEDIATE HEMOLYTIC  TRANSFUSION REACTION• Chill   • Dark   urine• Fever   • Shock• Flank   • DIC pain          • Red   se...
IMMEDIATE HEMOLYTICTRANSFUSION REACTION
IMMEDIATE HEMOLYTICTRANSFUSION REACTION
IMMEDIATE HEMOLYTICTRANSFUSION REACTION
IMMEDIATE HEMOLYTICTRANSFUSION REACTION        C5   C3
IMMEDIATE HEMOLYTICTRANSFUSION REACTION         CC5          5b           a   CC3    3b     a
IMMEDIATE HEMOLYTICTRANSFUSION REACTION                        a         CC5          5b                     C5   CC3    3...
IMMEDIATE HEMOLYTICTRANSFUSION REACTION                             a         CC5          5b                          C5 ...
IMMEDIATE HEMOLYTICTRANSFUSION REACTION                   FXII generate bradykinin                          histamine     ...
IMMEDIATE HEMOLYTICTRANSFUSION REACTION               c k !   FXII generate bradykinin Sho                          histam...
IMMEDIATE HEMOLYTIC       TRANSFUSION REACTION• IV   fluid maintain urine output 100 ml/hr  • Furosemide     or mannitol if...
DELAYED HEMOLYTIC    TRANSFUSION REACTION• Occur     1 wk after transfusion• Anamnestic     immune response• Extravascular...
BACTERIAL CONTAMINATION• Platelet         prone to have bacterial overgrowth        enterocollitca can• Yersinia grow at 6...
ALLERGIC REACTION• Allergic   to plasma protein of donor• Can    give antihistamine to relieve symptoms• In   IgA deficienc...
FEBRILE NONHEMOLYTIC    TRANSFUSION REACTION• Fever• Caused    by alloantibody to HLA antigen on Plt. or WBC• No   specific...
TRANSFUSION RELATED      ACUTE LUNG INJURY• TRALI• Causeby alloantibody from donor to WBC of recipient• Occur within 6 hou...
TRANSFUSION RELATEDGRAFT-VERSUS-HOST DISEASE• Cause    by engraftment of donor T-cells• Damage     to epithelium and bone ...
Recognize           T                    T        Engraft        Reject                Recipient                          ...
PATIENT IN RISK OF GVHD      FROM TRANSFUSION• Bone   marrow transplant patient• Intrauterine   transfusion• Hx   of fludar...
PROTOCOL FOR    COMPLICATION EPISODE Chill, fever, rash, flank pain, chest tightness,vital sign change, alteration of consc...
PROTOCOL FOR    COMPLICATION EPISODE         Check label and patient’s identificationDraw blood from patient       Examine ...
PROTOCOL FORCOMPLICATION EPISODE    Identify defect in the system     No accusing investigation              Solution     ...
FIN
Rational use of blood component
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Rational use of blood component

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Review general usage of blood components and basic transfusion medicine.

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  • Transcript of "Rational use of blood component"

    1. 1. RATIONAL BLOOD USE.. ...and its components.
    2. 2. TOPIC• Historical interest• Blood process• Blood product• Indication• Special consideration• Complication
    3. 3. HISTORICAL INTEREST
    4. 4. THE FIRST BLOODTRANSFUSION ATTEMPT • In1492 "the harrowing story was told that, at the suggestion of a Jewish physician, the blood of three boys was infused into the dying pontiff ’s mouth (the concept of circulation and methods for intravenous access did not exist at that time). They were ten years old, and had been promised a ducat each. All three died." Diario della città di Roma di Stefano Infessura scribasenato. 15th cent.
    5. 5. BLOOD AND CIRCULATION• In 1628 William Harvey published De Motu Cordis (On the Motion of the Heart and Blood) revealed the action of the heart pumping blood around the body in a circuit.
    6. 6. TRANSFUSION ATTEMPTS• In 1667 Jean-Baptiste Denys, French physician, performed transfusion with sheeps and calfs blood.• In 1818 James Blundell, successfully performed transfusion for postpartum hemorrhage, using patients husbands blood.• In1905 George Washington Crile, co- founder of Cleveland Clinic, was the first surgeon who used direct blood transfusion in surgery.
    7. 7. BLOOD GROUPING• In 1901, Karl Landsteiner discovered human blood groups. Blood transfusion had become a lot safer since then.
    8. 8. DEVELOPMENT OF BLOOD BANKING• Anticoagulant was discovered in 1910, making the way to blood banking.• First stored blood was successfully transfused in 1916 by Oswald Hope Robertson, an English-born medical scientist, during World War I.• The first academic transfusion institution was found by Alexander Bogdanov in Moscow.• After Bogdanovs death Soviet established the worlds first blood bank in 1930s by Sergei Sergeevich Yudin at Nikolay Sklifosovskiy Institute.
    9. 9. BLOOD PROCESSING
    10. 10. HOW IS DONATED BLOOD PROCESSED?• Blood and blood components come from potential donors.• Wholeblood was used in first era of transfusion but blood components are now wildly used for better efficient management.
    11. 11. LEUKOCYTE REDUCTION• WBC less than 5 x 106/unit*• Reduced febrile reaction risk yte oc ! Le uk d! duce• Reduced CMV transmission re• ReducedHLA- alloimmunization risk
    12. 12. IRRADIATION • Inactivate donor’s T-cells • Reduced GVHD risk • Reduce shelf life to 28 days • Increased K+ leak
    13. 13. SINGLE DONOR PRODUCT • Reduce donor exposure • Single HLA antigen
    14. 14. BLOOD PRODUCT
    15. 15. WHOLE BLOOD•Volume 350 or 450 ml•Contain red cell, white cells,platelets, and plasma•Stored at 2-6°c•No functional platelets andlabile factors•May indicated in neonatalblood exchange
    16. 16. PACKED REDBLOOD CELL•Volume ~300 ml•Hct ~75%•Contain red cells, whitecells, small of plasma•Stored at 2-6°c•10ml/kg raise Hct ~10%
    17. 17. PACKED REDBLOOD CELL•Volume ~300 ml•Hct ~75%•Contain red cells, whitecells, small of plasma•Stored at 2-6°c yte oc ! Le uk d!•10ml/kg raise Hct ~10% ce re du
    18. 18. PACKED REDBLOOD CELL•Volume ~300 ml•Hct ~75%•Contain red cells, whitecells, small of plasma•Stored at 2-6°c yte oc ! Le uk d!•10ml/kg raise Hct ~10% ce re du
    19. 19. PLATELETCONCENTRATE•Volume ~50 ml• Contain platelet 5.5 x 1010RBC 0.5 ml and white cells•Stored at 20-26°c withcontinuous rocking shelf•1 unit/10 kg raise platelet20,000-50,000 ml/mcL
    20. 20. POOLEDLEUKOCYTE-POOR PLATELET•Made of 4 unit of wholeblood•Contain platelet 3 x 1011 andRBC 5 ml•Comparable to Plt. conc. 4-6units (6 - 8 units for SDP)
    21. 21. POOLEDLEUKOCYTE-POOR PLATELET•Made of 4 unit of wholeblood•Contain platelet 3 x 1011 and yte oc !RBC 5 ml Le uk d! duce•Comparable to Plt. conc. 4-6 reunits (6 - 8 units for SDP)
    22. 22. POOLEDLEUKOCYTE-POOR PLATELET•Made of 4 unit of wholeblood•Contain platelet 3 x 1011 and yte oc !RBC 5 ml Le uk d! duce•Comparable to Plt. conc. 4-6 reunits (6 - 8 units for SDP)
    23. 23. FRESH FROZENPLASMA•Volume 250 ml•Contain all coagulationfactor•10-15 ml/kg raise factor~25%•Stored at -18°c
    24. 24. CRYOPRECIPITATE•Volume 15 ml•Contain factor VIII, XIII,von Willebrand factor,fibrinogen•1-2 units/ 10 kg raisefibrinogen 100 mg/dL•Not require groupmatching
    25. 25. INDICATION
    26. 26. THRESHOLD FOR RBC TRANSFUSION• Hb < 7 g/dL in general patient• Hb < 10 g/dL in patient with ischemic heart disease• Hb < 10 g/dL in pre-operative patient or bleeding patient*• In symptomatic or frail patient*
    27. 27. PATIENT WHO SHOULD NOT BE TRANSFUSED• Nutritional anemia• Autoimmune hemolytic anemia• Patient with high peripheral blast count
    28. 28. PLATELET REQUIREMENT• In bleeding patient: keep platelet > 50,000 - 80,000/mcL• Bleeding in vital organ: keep platelet > 100,000/mcL• In chronic thrombocytopenia: keep > 10,000/mcL• In DIC keep platelet > 20,000/mcL• In APL keep platelet > 30,000 - 50,000/mcL
    29. 29. PLATELET CONTRAINDICATE• Thrombotic thrombocytopenic purpura• Heparin induced thrombocytopenia• Disseminated intravascular coagulation without bleeding*
    30. 30. FRESH FROZEN PLASMA• Ingeneral each milliliter of plasma count as 100% factor activity 100% + 0% = 50% Hemostat level = 40%• Ifcoagulogram ≤1.5 times of normal, other causes of abnormal bleeding should be sought
    31. 31. CRYOPRECIPITATE• Use for replacing factor VIII, factor XIII, von Willebrand factor, fibrinogen
    32. 32. SPACIAL CONSIDERATION
    33. 33. SPACIAL CONSIDERATION• Rh negative patient• Mismatch transfusion• Platelet refractoriness• Massive transfusion
    34. 34. RH NEGATIVE• Rh negative is determined by absence of D antigen• Antibody occur 4 - 8 wks after expose to D antigen• Rh negative person should receive only Rh negative blood• Platelets have no Rh antigen but contaminated RBC can induce antibody
    35. 35. PLATELET TRANSFUSION IN RH NEGATIVE• Check if patient already have Rh antibody• Give anti-D IgG before or within 72 hr after platelet transfusion• 100 units can neutralize RBC 5 ml• 300 units can neutralize Plt. conc. 30 units or LPPC 3 units
    36. 36. MISMATCH TRANSFUSION• Transfuse packed red cell without foreign antigen to avoid major mismatch reaction• Transfuse plasma without offending antibody to avoid minor mismatch reaction• Platelet is considered as plasma due to high plasma content • Platelet recovery will be less than expected
    37. 37. TRANSFUSION COMPATIBILITYBlood group Compatible Compatible A RBC A, O Plt. & FFP A, AB B B, O B, AB AB AB, A, B, O AB O O O, A, B, AB
    38. 38. PLATELET REFRACTORINESS• Corrected count increment (CCI) < 3,000/mcL• Corrected count increment = (Pre - Post) x Body surface area Transfused platelet
    39. 39. PLATELET REFRACTORINESS• Immune • Non-immune•    Alloimmunization •    Infection, fever•    Autoimmune •    Hypersplenism•    Drug-related antibody •    DIC•    ABO incompatibility •    BMT patient •    Ampho B •    etc.
    40. 40. MASSIVE TRANSFUSION• 1 Total blood volume within 24 hr.• Keep platelet > 50,000/mcL• Keep coagulogram less than 1.5 times• Not recommend 1:1:1 transfusion protocol
    41. 41. TRANSFUSION PRACTICE• Correct blood component processing• Correct sample taking and labeling• Correct crossmatch technique• Correct blood component label• Correct patient identification
    42. 42. TRANSFUSION PRACTICE• Check if bags are in good condition • No leakage • No fibrin clot• Recordvital sign at before, start, 15 min after, 1 hr after, and 4 hr after transfusion
    43. 43. COMPLICATION OF BLOOD TRANSFUSION
    44. 44. COMPLICATION OF BLOOD TRANSFUSION• Immediate hemolytic • Febrilenonhemolytic transfusion reaction transfusion reaction• Delayed hemolytic • Transfusion-related acute transfusion reaction lung injury• Bacterial contamination • Transfusion-related graft- versus-host disease• Allergic reaction • Post transfusion purpura
    45. 45. IMMEDIATE HEMOLYTIC TRANSFUSION REACTION• ABO incompatibility is the most common cause• Can be fatal even 30 ml of incompatible blood• Intravascular hemolysis• Renal failure• Shock
    46. 46. IMMEDIATE HEMOLYTIC TRANSFUSION REACTION• Chill • Dark urine• Fever • Shock• Flank • DIC pain • Red serum
    47. 47. IMMEDIATE HEMOLYTICTRANSFUSION REACTION
    48. 48. IMMEDIATE HEMOLYTICTRANSFUSION REACTION
    49. 49. IMMEDIATE HEMOLYTICTRANSFUSION REACTION
    50. 50. IMMEDIATE HEMOLYTICTRANSFUSION REACTION C5 C3
    51. 51. IMMEDIATE HEMOLYTICTRANSFUSION REACTION CC5 5b a CC3 3b a
    52. 52. IMMEDIATE HEMOLYTICTRANSFUSION REACTION a CC5 5b C5 CC3 3b C3a
    53. 53. IMMEDIATE HEMOLYTICTRANSFUSION REACTION a CC5 5b C5 CC3 3b C3a anaphylotoxic activity
    54. 54. IMMEDIATE HEMOLYTICTRANSFUSION REACTION FXII generate bradykinin histamine serotonin a CC5 5b C5 CC3 3b C3a anaphylotoxic activity
    55. 55. IMMEDIATE HEMOLYTICTRANSFUSION REACTION c k ! FXII generate bradykinin Sho histamine serotonin a CC5 5b C5 CC3 3b C3a anaphylotoxic activity
    56. 56. IMMEDIATE HEMOLYTIC TRANSFUSION REACTION• IV fluid maintain urine output 100 ml/hr • Furosemide or mannitol if needed• Maintain blood pressure• Check label• Re-crossmatch on pre- and post-transfusion samples• Prevention future event
    57. 57. DELAYED HEMOLYTIC TRANSFUSION REACTION• Occur 1 wk after transfusion• Anamnestic immune response• Extravascular hemolysis• Usually subtle symptoms• Antibody gradually decrease after expose to antigen
    58. 58. BACTERIAL CONTAMINATION• Platelet prone to have bacterial overgrowth enterocollitca can• Yersinia grow at 6°c etc.• Antibioticshould be started if suspected bacterial contamination
    59. 59. ALLERGIC REACTION• Allergic to plasma protein of donor• Can give antihistamine to relieve symptoms• In IgA deficiency patient should avoid plasma product
    60. 60. FEBRILE NONHEMOLYTIC TRANSFUSION REACTION• Fever• Caused by alloantibody to HLA antigen on Plt. or WBC• No specific treatment• Must differentiate from other causes of fever
    61. 61. TRANSFUSION RELATED ACUTE LUNG INJURY• TRALI• Causeby alloantibody from donor to WBC of recipient• Occur within 6 hours after transfusion• Symptoms is the same as ARDS
    62. 62. TRANSFUSION RELATEDGRAFT-VERSUS-HOST DISEASE• Cause by engraftment of donor T-cells• Damage to epithelium and bone marrow• Fatal condition• Prevent with irradiation of blood component with T-cells
    63. 63. Recognize T T Engraft Reject Recipient tissue HLA antigenT T-cells Transfusion related GVHD
    64. 64. PATIENT IN RISK OF GVHD FROM TRANSFUSION• Bone marrow transplant patient• Intrauterine transfusion• Hx of fludarabine use (follicular lymphoma, CLL, AML)• HLA matched transfusion• Transfusion from relatives• Severe congenital immunodeficiency
    65. 65. PROTOCOL FOR COMPLICATION EPISODE Chill, fever, rash, flank pain, chest tightness,vital sign change, alteration of consciousness, dark urine Stop transfusion! Check vital sign, load IV fluid maintain BP and urine output Aware of renal complication
    66. 66. PROTOCOL FOR COMPLICATION EPISODE Check label and patient’s identificationDraw blood from patient Examine transfusing bloodCentrifuge for serum color Blood group Coomb test Re-crossmatch with pre- and Blood group post-transfusion samples Hemoculture Hemoculture
    67. 67. PROTOCOL FORCOMPLICATION EPISODE Identify defect in the system No accusing investigation Solution Prevent future event
    68. 68. FIN
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