blood and blood products

1. Blood and blood products
DR.Krishna Priya L

2. SLO
• At the end of session, Phase III Part I students
must be able to list the indications and discuss
the appropriate use of blood and blood
products.
• At the end of session, Phase III Part I students
must be able to recognize the complications
and management of blood and blood products
with 100% accuracy

3. Blood
• Blood is a connective tissue consisting of
plasma and cellular components
• Average human has 5 litres of blood
• It is a transporting fluid that carries oxygen
and vital substances from one part of body to
another

6. Blood transfusion

7. Indications for blood transfusion
• To replace blood volume in acute blood loss
• To improve hemoglobin level
• To replace proteins,coagulation factors
• To replace leucocytes
• To prevent infections in patients with
leucopenia

10. Blood collection
• Blood is collected in a primary bag
that contains anticoagulant-
preservatives
• Satellite bags may also be attached,
depending on what components are needed
• Anticoagulant-preservatives minimize
biochemical changes and increase shelf
life

11. Blood collection
• Blood is screened for infections
• Investigations –HIV,HBSAG,VDRL,HCV

12. Blood collection
• Components of whole blood are
centrifuged:
“light spin” – short time, low RPM (1500 for
10mins)
“heavy spin” – longer spin, high RPM
(5000rpm for 20mins)
• Centrifuge must be at 40C

17. WHOLE BLOOD
• Source of product for all blood components
• 400-500 ml
• Storage temperature :1-6 C
• Indication-to maintain blood volume & O2 carrying
capacity in acute,massive blood loss.
– Actively bleeding pt>20% of body blood volume.

18. PACKED CELL
• Prepared by removing 200-250ml of plasma from a
unit of W.B.
• 200-250 ml
• Do not contain functional platelets or granulocytes
• Have the same O2 carrying capacity with W.B
• Ind:to increase the O2 carrying capacity in anaemic
pt who require an increase in their red cell mass
w/out increase in their blood volume.
• 1 unit: increase Hb level about 1g/dL (10g/L)& Hct
by 3%.

20. PLATELET
• Prepared by cytapheresis/by seperating PRP from a
unit of Whole blood within 8H of collection &
recentrifuge to remove plasma.
• Stored at 20-24C.
• Each unit of plt expected to increase 5000-10000 plt.
Indications:
1. Dilutional thrombocytopenia in massive blood
transfusion
2. Active bleeding due to
thrombocytopenia/thrombocytopathy

21. SINGLE DONOR PLATELET
• Reduction of infectious complications;
• Reduction of transfusion reactions;
• Ease of leukodepletion;
• Reduction in transfusion frequency;
• Prevention of alloimmunization;
• Treatment of alloimmunized recipients;
• Enhancement of platelet quality;

23. FRESH FROZEN PLASMA
• Prepared by removing plasma from W.B within 8H
of collection.
• Stored at –18C or below.
• Contains all labile & stable clotting factors.
• 200-225ml
• Each unit of FFP increase the level of each clotting
fx by 2-3% in adults.
• Therapeutic dose : 10-15ml/kg.

24. FRESH FROZEN PLASMA
• Indications:
1. As a replacement for isolated coagulation
factor deficiency.
2. The reversal of warfarin treatment.
3. In the case of massive blood transfusion.
4. Antithrombin III def.Tx.
5. Correction of coagulopathy a/w liver
disease.

26. CRYOPRECIPITATE
• The cold-insoluble portion of plasma that remains
after FFP has been thawed at 1-6C.
• Contains
1. Factor VIII:C
2. Factor VIII:vWF
3. Factor XIII
4. Fibrinogen
5. About 10-15ml of plasma
• Stored at –18C & below.

27. CRYOPRECIPITATE
• Indications:
1. von Willebrand’s disease
2. Hemophillia A
3. Factor XIII def.
4. Cong./acquired fibrinogen def.

29. GRANULOCYTES
• Prepared by leukoparesis tech.
• Contain of
1. Large number of granulocytes
2. Other leucocytes
3. 20-50ml of RBC
• Ind.
1. Supportive tx for pt with severe neutropenia with
documented sepsis unresponsive to a/biotic tx.
2. Neonatal sepsis.

30. Indications for blood products in
obstetrics and gynaecology
• Anemia in pregnancy-severe anemia when Hb
is less than 7Gm% at any trimester
• Antepartum haemorrhage-placenta previa
• Postpartum haemorrhage
• Massive blood transfusion maybe needed in
case of DIC due to abruptioplacentae,HELLP
syndrome or PPH

31. Indications for blood products in
obstetrics and gynaecology
• Vesicular mole can cause bleeding requiring
blood transfusions
• Ruptured ectopic pregnancy
• Heavy menstrual bleeding
• Carcinoma cervix
• During surgery

32. Monitoring during transfusion
• Before transfusion,confirm the identity of the
patient,check blood group and crossmatch
• Patients observations-Pulse,blood
pressure,temperature-checked at start of
transfusion and every 15-20 minutes
thereafter and at completion

33. Complications of blood transfusion

34. Acute complications
• Transfusion-related acute lung injury -TRALI is a life-threatening form of
acute lung injury that occurs when recipient neutrophils are activated by
the transfused product in an appropriately primed pulmonary vasculature,
due to the transfused product having either anti-HLA or anti-neutrophil
antibodies. Presenting findings include fever, chills, and respiratory
distress
• Therapy is largely supportive and may include intubation and mechanical
ventilation
• Transfusion-associated circulatory overload-TACO is a form of pulmonary
edema due to volume excess or circulatory overload

35. Acute complications
• Acute hemolysis -AHTR is a life-threatening
reaction caused by acute intravascular hemolysis
of transfused red blood cells (RBCs). This may be
due to ABO incompatibility or caused by a
reaction to alleles in other RBC antigen systems.
• Treatment involves aggressive hydration and
diuresis
• Allergic transfusion reactions -Allergic transfusion
reactions are most often associated with itching
and hives. Treat with antihistamines
• Febrile nonhemolytic transfusion reactions

36. Acute complications
• Anaphylaxis -Anaphylactic reactions are severe
allergic reactions that include angioedema,
wheezing, and/or hypotension. Anaphylactic
reactions may occur in IgA-deficient
individuals who produce anti-IgA antibodies
that react with IgA in the transfused product

37. Acute complications
• Sepsis -Transfusion-associated sepsis (or bacterial
infection) is caused by transfusion of a product that
contains a microorganism.
• Initial findings may include fever, chills, and
hypotension.
• Unlike sepsis from an underlying localized infection,
transfusion-associated sepsis may involve a large
intravenous inoculum, which in the case of gram-
negative organisms, could include an infusion of
endotoxin, leading to high fever.
• Treatment includes broad-spectrum antibiotics and
hemodynamic support.

38. Copyrights apply

39. Delayed reaction

40. STEPS TO BE FOLLOWED
1. Discontinue the transfusion.
2. Keep the IV line open with N/saline.
3. Check all labels,forms & pt identification.
4. Report to Blood Bank personnel.
5. Send requested blood samples.