Health

1. Blood component therapy
• Blood components include whole blood itself, packed red blood cells, fresh
frozen plasma, cryoprecipitate, platelets and granulocyte components.
Because of hazards of transfusion, the need for it should be specific.
• Transfusion of all blood components must be done through a filter
designed to remove clots and aggregates. The initial administration of
blood should be very slow as a life threatening reactions may occur.
Transfusion should be completed within four hours and prior to expiration
of the blood product.

2. Hazards of transfusion: two types:
A- Acute transfusion reaction: acute haemolytic transfusion reaction,
transfusion related acute lung injury, non- haemolytic febrile transfusion
reactions, coagulopathy from massive transfusion, bacterial
contamination, hypervolemia and hypocalcaemia.
B- Adverse reactions with delayed consequences: transfusion related
alloimmunization of RBC, WBC and platelets, post-transfusion purpura,
transfusion associated graft VS host disease and transfusion transmitted
infections.

3. Testing of donated blood:
Blood is typed including ABO and RH type. Testing is also
performed for Human Immunodeficiency Virus, hepatitis C
virus, human T-Cell lymphotropic virus, hepatitis B core
antigen, hepatitis B surface antigen and syphilis.

4. Whole blood:
1-Description: 513 ml (450 ml WB &63 ml CPDA ;citrate-
phosphate-dextrose-adenine) unit of WB has haematocrit of
0.3-0.4 and shelf life of 35 days. Within 24 hours of collection;
platelets, granulocytes and plasma clotting factor ν and factor
νш are dysfunctional.
2-Indications:
• Exchange transfusion (not more than 5-7 days old).
• After cardiopulmonary bypass.
• Extracorporeal membrane oxygenation.
• Massive transfusion.

5. Packed RBC:
1-Description: 200 ml unite of PRBC has haematocrit about 0.6 and
shelf life of 42 days when stored just above freezing.
2-Indications:
• Acute blood loss > 15-20% blood volume.
• HB<8gm% with severe infections, severe pulmonary disease,
uncorrectable pre-operative anaemia or emergency surgery.
• HB<7gm% with chronic transfusion dependent states as
hemoglobinopathies other than thalassemia major.
• Patient on ventilator support with HB <10gm% on minimal settings or
with HB<11 gm% on significant settings.

6. 3-Dosage:
• The following equation should be used to calculate
transfusion volumes:
• Weight (kg) x increment in Hb (g/dL) x 3/(haematocrit level
of PRBC )

7. Fresh frozen plasma:
1-Description:
• Atypical unit of plasma (160-250ml) is prepared from WB by
separation following centrifugation.
• Labile clotting factors ν and νш are not stable in stored plasma at
1-6oc. Plasma frozen within 8 hours of donation contains at least
0.7unites/ml of factor νш.
2-Indications:
• Inherited clotting factor deficiency (unknown, multiple factors and
if single factor but factor concentrate is not available).
• Haemorrhagic disease of newborn.
• DIC with clinical bleeding.

8. • Liver disease with coagulopathy and bleeding.
• Dilutional coagulopathy after massive transfusion
• Plasma exchange in TTP/HUS.
3-Dosage: The maximum tolerated dose is 10-15 ml/kg/12
hours (This dose increases the clotting factors by 20%
immediately after transfusion).

9. Platelet concentrates (PC):
1-Description:
Each unite contains 5.5×1010 platelets, about 50 ml plasma, 0.5 ml RBC and
varying number of leucocytes so in small children or recurrent PC
transfusions, try to use ABO matched PC. PC are stored for up to 5 days at
20-24oc with continuous gentle agitation.
2-Indications:
• Prophylactic (without bleeding):
a-<5-10,000/cumm in non-sick child.
b-<20,000/cumm in sick child.
c-Before surgery
ɪ. bone marrow aspiration/biopsy can be done without platelet support.
ɪɪ. Lumber puncture <30,000/cumm
ɪɪɪ. Surgery at critical site as CNS <100,000
ɪν. Other surgeries <50,000/cumm

10. • Chronic stable thrombocytopenia only in presence of
mucosal bleeding
• Platelet dysfunction only in presence of significant mucosal
bleeding
• ITP in mucosal bleeding
3-dosage:
PC unit/10 KG can be expected to raise the platelet level by
50×109/L.

11. Cryoprecipitate:
1-Description:
It’s prepared when FFP is thawed at 4oc. precipitate is then re-frozen
within 1 hour in 10-15 ml of donor plasma and stored at 18oc for
about 1 year. It contains 80-100 unites of factor νɪɪɪ , 100-250 mg of
fibrinogen, 40-60 mg of fibronectin, 40-70% of vWF and 30% of factor
xɪɪɪ.
2-Indications:
• Haemophilia A
• Low fibrinogen level as in DIC
• Von willebrand’s disease
• Factor xɪɪɪ deficiency
3-Dosage:
about 1 unite for 5-10 kg

12.  Some measures to reduce adverse transfusion
side effects:
• Washed red cells
• Irradiated red cells
• Filtered red cells

13. THANKS