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RATIONAL BLOOD USE..
     ...and its components.
TOPIC

• Historical   interest

• Blood   process

• Blood   product

• Indication

• Special   consideration

• Complication
HISTORICAL INTEREST
THE FIRST BLOOD
TRANSFUSION 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.
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.
TRANSFUSION ATTEMPTS
• In
   1667 Jean-Baptiste Denys, French
 physician, performed transfusion with
 sheep's and calf's blood.

• In
   1818 James Blundell, successfully
 performed transfusion for postpartum
 hemorrhage, using patient's husband's blood.

• In1905 George Washington Crile, co-
 founder of Cleveland Clinic, was the first
 surgeon who used direct blood transfusion
 in surgery.
BLOOD GROUPING
• In
   1901, Karl Landsteiner discovered human blood groups.
 Blood transfusion had become a lot safer since then.
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 Bogdanov's death Soviet established the world's first
    blood bank in 1930s by Sergei Sergeevich Yudin at Nikolay
    Sklifosovskiy Institute.
BLOOD PROCESSING
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.
Rational use of blood component
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
IRRADIATION


      • Inactivate   donor’s T-cells

      • Reduced      GVHD risk

      • Reduce   shelf life to 28 days

        • Increased K+    leak
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 platelets and
labile factors
•May indicated in neonatal
blood exchange
PACKED RED
BLOOD CELL
•Volume ~300 ml
•Hct ~75%
•Contain red cells, white
cells, small of plasma
•Stored at 2-6°c
•10ml/kg raise Hct ~10%
PACKED RED
BLOOD CELL
•Volume ~300 ml
•Hct ~75%
•Contain red cells, white
cells, small of plasma
•Stored at 2-6°c                   yte
                                 oc !
                            Le uk d!
•10ml/kg raise Hct ~10%           ce
                             re du
PACKED RED
BLOOD CELL
•Volume ~300 ml
•Hct ~75%
•Contain red cells, white
cells, small of plasma
•Stored at 2-6°c                   yte
                                 oc !
                            Le uk d!
•10ml/kg raise Hct ~10%           ce
                             re du
PLATELET
CONCENTRATE
•Volume ~50 ml
• Contain platelet 5.5 x 1010
RBC 0.5 ml and white cells
•Stored at 20-26°c with
continuous rocking shelf
•1 unit/10 kg raise platelet
20,000-50,000 ml/mcL
POOLED
LEUKOCYTE-
POOR PLATELET
•Made of 4 unit of whole
blood
•Contain platelet 3 x 1011 and
RBC 5 ml
•Comparable to Plt. conc. 4-6
units (6 - 8 units for SDP)
POOLED
LEUKOCYTE-
POOR PLATELET
•Made of 4 unit of whole
blood
•Contain platelet 3 x 1011 and          yte
                                      oc !
RBC 5 ml                         Le uk d!
                                     duce
•Comparable to Plt. conc. 4-6     re
units (6 - 8 units for SDP)
POOLED
LEUKOCYTE-
POOR PLATELET
•Made of 4 unit of whole
blood
•Contain platelet 3 x 1011 and          yte
                                      oc !
RBC 5 ml                         Le uk d!
                                     duce
•Comparable to Plt. conc. 4-6     re
units (6 - 8 units for SDP)
FRESH FROZEN
PLASMA
•Volume 250 ml
•Contain all coagulation
factor
•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 raise
fibrinogen 100 mg/dL
•Not require group
matching
INDICATION
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*
PATIENT WHO SHOULD NOT
       BE TRANSFUSED


• Nutritional   anemia

• Autoimmune      hemolytic anemia

• Patient   with high peripheral blast count
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
PLATELET CONTRAINDICATE


• Thrombotic   thrombocytopenic purpura

• Heparin   induced thrombocytopenia

• Disseminated   intravascular coagulation without bleeding*
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
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

• Rh   negative person should receive only Rh negative blood

• Platelets
         have no Rh antigen but contaminated RBC can
 induce antibody
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
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
TRANSFUSION
         COMPATIBILITY

Blood 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
PLATELET REFRACTORINESS

• Corrected   count increment (CCI) < 3,000/mcL

• Corrected   count increment = (Pre - Post) x Body surface area

                                     Transfused platelet
PLATELET REFRACTORINESS
• Immune                       • Non-immune

•      Alloimmunization        •      Infection, fever

•      Autoimmune              •      Hypersplenism

•      Drug-related antibody   •      DIC

•      ABO incompatibility     •      BMT patient

                               •      Ampho B

                               •      etc.
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
TRANSFUSION PRACTICE

• Correct   blood component processing

• Correct   sample taking and labeling

• Correct   crossmatch technique

• Correct   blood component label

• Correct   patient identification
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
COMPLICATION OF BLOOD
    TRANSFUSION
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
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
IMMEDIATE HEMOLYTIC
  TRANSFUSION REACTION
• Chill   • Dark   urine

• Fever   • Shock

• Flank   • DIC
 pain
          • Red   serum
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION

        C5




   C3
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION

         CC5
          5b
           a




   CC3
    3b
     a
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION




                        a
         CC5
          5b




                     C5
   CC3
    3b
               C3a
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION




                             a
         CC5
          5b




                          C5
   CC3
    3b
                    C3a


               anaphylotoxic activity
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION

                   FXII generate bradykinin
                          histamine
                          serotonin




                             a
         CC5
          5b




                          C5
   CC3
    3b
                    C3a


               anaphylotoxic activity
IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION

               c k !   FXII generate bradykinin


 Sho                          histamine
                              serotonin




                                 a
         CC5
          5b




                              C5
   CC3
    3b
                        C3a


                  anaphylotoxic activity
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
DELAYED HEMOLYTIC
    TRANSFUSION REACTION

• Occur     1 wk after transfusion

• Anamnestic     immune response

• Extravascular   hemolysis

• Usually   subtle symptoms

• Antibody    gradually decrease after expose to antigen
BACTERIAL CONTAMINATION

• Platelet
         prone to have
 bacterial overgrowth

        enterocollitca can
• Yersinia
 grow at 6°c etc.

• Antibioticshould be started
 if suspected bacterial
 contamination
ALLERGIC REACTION


• Allergic   to plasma protein of donor

• Can    give antihistamine to relieve symptoms

• In   IgA deficiency patient should avoid plasma product
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
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
TRANSFUSION RELATED
GRAFT-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
Recognize
           T                    T



        Engraft        Reject                Recipient
                                              tissue



    HLA antigen

T     T-cells     Transfusion related GVHD
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
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
PROTOCOL FOR
    COMPLICATION EPISODE
         Check label and patient’s identification

Draw blood from patient       Examine transfusing blood

Centrifuge for serum color           Blood group
       Coomb test            Re-crossmatch with pre- and
       Blood group             post-transfusion samples
       Hemoculture                   Hemoculture
PROTOCOL FOR
COMPLICATION EPISODE
    Identify defect in the system

     No accusing investigation

              Solution

       Prevent future event
FIN

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Rational use of blood component

  • 1. RATIONAL BLOOD USE.. ...and its components.
  • 2. TOPIC • Historical interest • Blood process • Blood product • Indication • Special consideration • Complication
  • 4. THE FIRST BLOOD TRANSFUSION 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. 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. TRANSFUSION ATTEMPTS • In 1667 Jean-Baptiste Denys, French physician, performed transfusion with sheep's and calf's blood. • In 1818 James Blundell, successfully performed transfusion for postpartum hemorrhage, using patient's husband's blood. • In1905 George Washington Crile, co- founder of Cleveland Clinic, was the first surgeon who used direct blood transfusion in surgery.
  • 7. BLOOD GROUPING • In 1901, Karl Landsteiner discovered human blood groups. Blood transfusion had become a lot safer since then.
  • 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 Bogdanov's death Soviet established the world's first blood bank in 1930s by Sergei Sergeevich Yudin at Nikolay Sklifosovskiy Institute.
  • 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.
  • 12. 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
  • 13. IRRADIATION • Inactivate donor’s T-cells • Reduced GVHD risk • Reduce shelf life to 28 days • Increased K+ leak
  • 14. SINGLE DONOR PRODUCT • Reduce donor exposure • Single HLA antigen
  • 16. WHOLE BLOOD •Volume 350 or 450 ml •Contain red cell, white cells, platelets, and plasma •Stored at 2-6°c •No functional platelets and labile factors •May indicated in neonatal blood exchange
  • 17. PACKED RED BLOOD CELL •Volume ~300 ml •Hct ~75% •Contain red cells, white cells, small of plasma •Stored at 2-6°c •10ml/kg raise Hct ~10%
  • 18. PACKED RED BLOOD CELL •Volume ~300 ml •Hct ~75% •Contain red cells, white cells, small of plasma •Stored at 2-6°c yte oc ! Le uk d! •10ml/kg raise Hct ~10% ce re du
  • 19. PACKED RED BLOOD CELL •Volume ~300 ml •Hct ~75% •Contain red cells, white cells, small of plasma •Stored at 2-6°c yte oc ! Le uk d! •10ml/kg raise Hct ~10% ce re du
  • 20. PLATELET CONCENTRATE •Volume ~50 ml • Contain platelet 5.5 x 1010 RBC 0.5 ml and white cells •Stored at 20-26°c with continuous rocking shelf •1 unit/10 kg raise platelet 20,000-50,000 ml/mcL
  • 21. POOLED LEUKOCYTE- POOR PLATELET •Made of 4 unit of whole blood •Contain platelet 3 x 1011 and RBC 5 ml •Comparable to Plt. conc. 4-6 units (6 - 8 units for SDP)
  • 22. POOLED LEUKOCYTE- POOR PLATELET •Made of 4 unit of whole blood •Contain platelet 3 x 1011 and yte oc ! RBC 5 ml Le uk d! duce •Comparable to Plt. conc. 4-6 re units (6 - 8 units for SDP)
  • 23. POOLED LEUKOCYTE- POOR PLATELET •Made of 4 unit of whole blood •Contain platelet 3 x 1011 and yte oc ! RBC 5 ml Le uk d! duce •Comparable to Plt. conc. 4-6 re units (6 - 8 units for SDP)
  • 24. FRESH FROZEN PLASMA •Volume 250 ml •Contain all coagulation factor •10-15 ml/kg raise factor ~25% •Stored at -18°c
  • 25. CRYOPRECIPITATE •Volume 15 ml •Contain factor VIII, XIII, von Willebrand factor, fibrinogen •1-2 units/ 10 kg raise fibrinogen 100 mg/dL •Not require group matching
  • 27. 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*
  • 28. PATIENT WHO SHOULD NOT BE TRANSFUSED • Nutritional anemia • Autoimmune hemolytic anemia • Patient with high peripheral blast count
  • 29. 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
  • 30. PLATELET CONTRAINDICATE • Thrombotic thrombocytopenic purpura • Heparin induced thrombocytopenia • Disseminated intravascular coagulation without bleeding*
  • 31. 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
  • 32. CRYOPRECIPITATE • Use for replacing factor VIII, factor XIII, von Willebrand factor, fibrinogen
  • 34. SPACIAL CONSIDERATION • Rh negative patient • Mismatch transfusion • Platelet refractoriness • Massive transfusion
  • 35. 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
  • 36. 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
  • 37. 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
  • 38. TRANSFUSION COMPATIBILITY Blood 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
  • 39. PLATELET REFRACTORINESS • Corrected count increment (CCI) < 3,000/mcL • Corrected count increment = (Pre - Post) x Body surface area Transfused platelet
  • 40. PLATELET REFRACTORINESS • Immune • Non-immune •    Alloimmunization •    Infection, fever •    Autoimmune •    Hypersplenism •    Drug-related antibody •    DIC •    ABO incompatibility •    BMT patient •    Ampho B •    etc.
  • 41. 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
  • 42. TRANSFUSION PRACTICE • Correct blood component processing • Correct sample taking and labeling • Correct crossmatch technique • Correct blood component label • Correct patient identification
  • 43. 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
  • 44. COMPLICATION OF BLOOD TRANSFUSION
  • 45. 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
  • 46. 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
  • 47. IMMEDIATE HEMOLYTIC TRANSFUSION REACTION • Chill • Dark urine • Fever • Shock • Flank • DIC pain • Red serum
  • 54. IMMEDIATE HEMOLYTIC TRANSFUSION REACTION a CC5 5b C5 CC3 3b C3a anaphylotoxic activity
  • 55. IMMEDIATE HEMOLYTIC TRANSFUSION REACTION FXII generate bradykinin histamine serotonin a CC5 5b C5 CC3 3b C3a anaphylotoxic activity
  • 56. IMMEDIATE HEMOLYTIC TRANSFUSION REACTION c k ! FXII generate bradykinin Sho histamine serotonin a CC5 5b C5 CC3 3b C3a anaphylotoxic activity
  • 57. 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
  • 58. DELAYED HEMOLYTIC TRANSFUSION REACTION • Occur 1 wk after transfusion • Anamnestic immune response • Extravascular hemolysis • Usually subtle symptoms • Antibody gradually decrease after expose to antigen
  • 59. BACTERIAL CONTAMINATION • Platelet prone to have bacterial overgrowth enterocollitca can • Yersinia grow at 6°c etc. • Antibioticshould be started if suspected bacterial contamination
  • 60. ALLERGIC REACTION • Allergic to plasma protein of donor • Can give antihistamine to relieve symptoms • In IgA deficiency patient should avoid plasma product
  • 61. 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
  • 62. 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
  • 63. TRANSFUSION RELATED GRAFT-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
  • 64. Recognize T T Engraft Reject Recipient tissue HLA antigen T T-cells Transfusion related GVHD
  • 65. 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
  • 66. 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
  • 67. PROTOCOL FOR COMPLICATION EPISODE Check label and patient’s identification Draw blood from patient Examine transfusing blood Centrifuge for serum color Blood group Coomb test Re-crossmatch with pre- and Blood group post-transfusion samples Hemoculture Hemoculture
  • 68. PROTOCOL FOR COMPLICATION EPISODE Identify defect in the system No accusing investigation Solution Prevent future event
  • 69. FIN

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