blood component

1. • Based on the concept that patients are best
treated by administration of the specific fraction
of blood that they lack.
• One donated unit can help multiple patients
– Conserves resources
– Optimal method for transfusing large
amounts of a specific component
• Reduces the number of donor exposures to a
patient.

2. PACKED RED CELLS
GRANULOCYTES
PLATELET CONCENTRATE
FRESH FROZEN PLASMA
CRYOPRECIPITATE
COAGULATION FACTOR
CONCENTRATES
PLASMA PROTEIN FRACTION
• ALBUMIN
• GAMMA GLOBULIN
• IVIG

4. Use of whole blood
• Rarely used now a days
• Infrequently used in massive trauma
• Cardiac surgeries
• Post operative bleeding unresponsive to
standard replacement therapy.
• paediatric practice, mostly for neonatal
exchange transfusion or paediatric surgery
(cardiac or craniofacial).

5. COMPLICATIONS OF BLOOD PRODUCT
ADMINISTRATION
• Infectious Risks
• Noninfectious Risks
– Immune-mediated Transfusion Reactions
– Nonimmune-mediated Transfusion Reactions

7. Noninfectious Risks
• The extensive use of more sensitive methods for
screening and controlling the infectious risks of
blood product transfusion,
noninfectious complications have emerged as
the major source of transfusion-related morbidity
and mortality.

9. • British committee for Standards in Hematology
recommended to transfuse PRBC when hemoglobin level is
7-8*gm/dl ,(*in case of acute blood loss)
• American Society of Hematology recommended
transfusion of PRBC when hemoglobin is <7gm/dl in non
bleeding medical & surgical patients.
• National Cancer Centre Network has given
recommendation of transfusion when hemoglobin is 7g/dl.
• American Society of Hematology transfuse platelets only
when platelets are<5000/L among inpatients with no active
bleeding. Patients with temperature ≥38°C or with recent
hemorrhage ,platelets <10000/L can receive platelets.

10. The guidelines also emphasize that the decision
to transfuse should not be based only on
hemoglobin level but should incorporate
individual patient characteristics and symptoms.
Clinical judgment is critical in the decision to
transfuse; therefore, transfusing RBCs above or
below the specified hemoglobin threshold may
be dictated by the clinical context. Similarly, the
decision not to transfuse RBCs to a patient with a
hemoglobin concentration below the
recommended thresholds is also a matter of
clinical judgment.

13. Now let’s see what we
are doing in using blood &
blood products in AAH.

14. Total 148 blood components requisitions from
August 2016-January 2017 from various
departments have been reviewed at blood
bank.

15. Here the blood components requisition
form of AAH

16. 10.81%
1.35%
2.03%
3.38%
10.81%
4.05%
14.86%
2.03%
8.78%
20.95%
8.78%
6.76%
0.68%
3.38%
1.35%
total requisition given By different departments

17. .
50%
0.68%
4.73%
2.70%
1.35%
1.35%
0.68%
0.68%
10.14%
4.05%
2.03%
0.68%
1.35%
3.38%
2.03%
0.68%
4.05%
1.35%
0.68%
0.68%
0.68%
0.68%
0.68%
0.68%
1.35%
2.70%
diagnosis not mentioned
haemorrhoids
various types of fractures
TVD
IDA
CVD
surgical site infection
acute abdomen
pregnancy
dengue
ITP
carcinoma ovary
beta thalassemia
AML
DIC
CML
CKD
MVR
peritonitis
epilepsy & spinal cord injury
drug induced PUD
mesenteric cyst
Intussesseption
anemia of prematurity
carcinoma lung
TTP
Primary diagnosis

18. whole blood
42%
PRBC/RCC
33%
FFP
15%
Platelets
6%
not written
4%
Type of blood component transfusion

19. 2.03% 1.35%
13.51%
37.84%
34.46%
7.43%
0
0.68%
2.03%
0.68%
not known not written A+ve B+ve O+ve AB+ve A-ve B-ve O-ve AB-ve
Blood groups

20. 6.08%
93.92%
Previous transfusion history
mentioned
not mentioned93.92%

21. 5.41%
14.86%
22.30%
15.54%
4.73%
6.08%
31.08%
<6 g/dl 6.1-8 g/dl 8.1-10 g/dl 10.1-12 g/dl 12.1-14 g/dl >14.1 g/dl HB not
mentioned
Level of hemoglobin/ platelets during transfusion

22. Transfusion at
different level of
Hemoglobin/platelets by
individual departments…..

23. Gynae & Obstetrics
16.13%
9.68%
25.81%
41.94%
3.23% 3.23%
HB not
mentioned
<6 gm/dl 6.1-8gm/dl 8.1-10 gm/dl 10.1-12
gm/dl
12.1-14gm/dl >14gm/dl

24. General Surgery
22.72%
9.09%
22.72%
27.27%
9.09%
9.09%
Hb not
mentioned
<6 gm/dl 6.1-8 gm/dl 8.1-10
gm/dl
10.1-12
gm/dl
12.1-14
gm/dl
>14.1 gm/dl

25. Cardiac Surgery
53.85%
38.46%
7.69%
Hb not
mentioned
<6gm/dl 6.1-8 gm/dl 8.1-10
gm/dl
10.1-12
gm/dl
12.1-14
gm/dl
>14.1 gm/dl

26. Hematology
6.25%
37.50% 37.50%
18.75%
Hb not
mentioned
<6gm/dl 6.1-8 gm/Dl 8.1-10
gm/dl
10.1-12
gm/dl
12.1-14
gm/dl
>14 gm/dl plt <1000/l

27. Medicine
31.25% 31.25%
12.50%
18.75%
6.25%
not
mentioned
<6gm/dl 6.1-8gm/dl 8.1-10gm/dl 10.1-12gm/dl 12.1-14
gm/dl
>14.1 gm/dl

28. Cardiology
33.33% 33.33% 33.33%
0
HB not
mentioned
<6 gm/dl 6.1-8 gm/dl 8.1-10 gm/dl 10.1-12
gm/dl
12.1-14
gm/dl

29. Gastro Enterology
33.33%
16.67%
16.67%
33.33%
0
HB not
mentioned
<6 gm/dl 6.1-8 gm/dl 8.1-10
gm/dl
10.1-12
gm/dl
12.1-14
gm/dl
>14.1 gm/dl

30. Neurology
50% 50%
0
Hb not
mentioned
<6 gm/dl 6.1-8 gm/dl 8.1-10 gm/dl 10.1-12
gm/dl
12.1-14
gm/dl
>14.1 gm/dl

31. Nephrology
40% 40%
20%
0
Hb not
mentioned
<6 gm/dl 6.1-8 gm/dl 8.1-10gm/dl 10.1-12
gm/dl
12.1-14
gm/dl
>14.1 gm/dl

32. Orthopedics
66.67%
33.33%
Hb not
mentioned
<6 gm/dl 6.1-8 gm/dl 8.1-10
gm/dl
10.1-12
gm/dl
12.1-14
gm/dl
>14.1 gm/dl

33. Urology
60%
20% 20%
Hb not
mentioned
<6 gm/dl 6.1-8 gm/dl 8.1-10 gm/dl10.1-12gm/dl12.1-14gm/dl >14.1 gm/dl

34. Paediatrics
53.85%
15.38%
15.38%
7.69% 7.69%
Hb not
mentioned
<6gm/dl 6.1-8 gm/dl 8.1-10gm/dl 10.1-12gm/dl12.1-14gm/dl >14.1 gm/dl

35. GICU
50%
20%
30%
0
HB not
mentioned
<6gm/dl 6.1-8gm/dl 8.1-10gm/dl 10.1-12gm/dl 12.1-14
gm/dl
>14.1gm/dl

36. Emergency
100%
0
HB not
mentioned
<6gm/dl 6.1-8gm/dl 8.1-10gm/dl 10.1-12
gm/dl
12.1-14gm/dl <14.1gm/dl

37. Among the 15 departments only 5
departments left some of their requested
blood products unused.

38. 96% 93% 89% 90%
67%
4% 7.00% 11.00% 10.00%
33.00%
Internal medicine paediatrics gastroenterology hematology emergency
.
unit requested
unit not used

39. • So , in conclusion
requisitions are not adequately fulfilled with
required information.
We are lagging far behind properly following
international guidelines.
• If we follow the proper guidelines ,we can
avoid many unnecessary transfusions &
transfusion related hazards.

41. Reference:
 Miller’s Anaesthesia 8 th Ed
 Clinical Anaesthesia – Barash 7 th Ed
 Redbook- 2005
 Postgraudate topics- Dr Mahadevan, Dr
Anil kumar Ashokan
 Handbook of Transfusion Medicine Dr
Derek Norfolk 5 th Ed
 Blood Science-Principles and Pathology
Andrew Blann & Nessar Ahmed
 ASA guidelines 2005
 BJA- August issue 2014