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Blood transfusion.pptx
- 1. USE OF BLOOD AND BLOOD PRODUCTS By DR. BARIBOTE O. S. MBBS 2012 NDU
- 2. outline • Introduction • Historical Perspective • Definitions • Classification of blood transfusion • Blood components/indication • Principles guiding blood transfusion • Effects of Storage of blood • Massive blood transfusion with associated problems • Complications of blood transfusion • Management of pt who do not accept transfusion
- 3. Introduction Blood is a vital physiology fluid and it transfusion is a critical part of day-to- day clinical practice Errors in blood transfusion as well as non availability of blood can lead to serious consequences in terms of morbidity and mortality A major concern is for safe, effective and quality blood to be available when required
- 4. Historical perspective The history of blood transfusion originated from the discovery of blood circulation in 1682 by William Harvey The earliest blood transfusion occurred in 1665 The first human blood transfusion was performed by Dr Philip Syng Physick in 1795 The first transfusion for haemorrhage was performed by James Blundell in London in 1818 First blood bank was established in Leningrad in 1932
- 5. Definition Blood • a special connective tissue that is located in the circulatory system Blood transfusion • life saving procedure which involves the safe transfer of blood and/or its components from a donor to a recipient. Whole blood • A unit collected in a suitable anticoagulant with blood cells and plasma
- 6. Definition contd Fresh blood • Blood transfused within 3hrs of collection • It has all its constituents preserved i.e. platelets, leucocytes, factor V and VIII. Massive blood transfusion • Replacement of one or more of the patient’s total blood volume within 24hr or about 5L in an adult
- 7. Safe blood Donated by a carefully selected, healthy donor Free from infections that could be harmful to the recipient Processed by reliable methods of testing, component production, storage and transportation Transfused only upon need and for the patient’s health and wellbeing Safe blood
- 8. Classification of blood transfusion Autologous • collection and re-infusion of the patient's own blood or blood component Allogenic • collection and transfusion of a compatible blood from a donor
- 9. Autologous transfusion Collection and reinfusion of patient’s own blood Reduce the need for homologous transfusion (HT) and is particularly helpful in emergencies Increasingly practiced because it prevent the transmission of diseases Avoids immunological complications of HT Has the disadvantage of wastages of units in most cases
- 10. •Preoperative autogolous blood donation PABD •Acute Isovolaemic haemodilution AIVH •Intraoperative blood salvage •Postoperative blood salvage Types of Autologous Transfusion
- 11. Elective surgery Collect blood 3-5wk before surgery 1 – 5units can be donated Hb should be over 10g/dl Donations should be 1 -2wks apart and the last should not be within 72hrs of surgery Iron supplement as well as recombinant human erythropoietin can be given to prevent anaemia PABD
- 12. PABD is particularly vital Patient with rare blood groups or multiple blood group antibodies Patient with serious psychiatric risk because of anxiety about exposure to donor blood Patients who refuse to consent to donor blood
- 13. Acute Isovolaemic Haemodilution (AIVH) It involves the donation of blood (1-4 units) immediately before surgery The blood volume is simultaneously replaced with crystalloid or colloid The blood is stored in the OR at room temp and reinfused
- 14. It is often used in cardiac bypass surgery where immediate postop transfusion of fresh whole blood is seen as an advantage The pt’s initial Hb should be >12g/dl and must not get below 9g/dl after haemodilution The pulse, BP, and urine output should be monitored during the collection It has fluid overload, cardiac ischemia and wrong blood into patient errors as possible complications
- 15. Intraoperative cell salvage Blood shed in a cavity during surgery Scoop into a sterile kidney dish or bowl containing anticoagulant Filtered into a bottle through a 4 -6 layers of sterile guage Reinfused using the normal blood giving set The main complication is bleeding as washing removes the clotting proteins
- 16. It is particularly useful Ruptured spleen Penetrating injuries Haemothorax Cardiovascular surgery Orthopaedic operation It should not be used Blood contaminated by bowel content Blood during a tumor resection
- 17. Postoperative blood salvage • knee or hip replacement • correction of scoliosis. PCS is mainly used in orthopaedic procedures, especially after • Filtered • washed in an automated system Blood collected from wound drains and then either reinfusion to the patient.
- 18. Blood components It is a constituent of blood separated from whole blood or plasma Whole blood is now rarely used for transfusion in developed countries Transfusion is tailored to the specific component needed so that the dose can be optimised
- 20. Whole blood • It is 450ml of whole blood in 63ml of anticoagulant • Contains no functional platelets or clotting factors Description • +4 to +6 0C and a shelf life of 35days Stored • To restore blood volume in cases of sudden loss of 25% or more • Patients undergoing exchange transfusion (in SCA patient in crisis) • Patients who continue to bleed after receiving 4 units of packed red blood cells Indicated
- 21. • Chronic anaemia and anaemia in patient in incipient HF Contraindicated • Must be ABO and RhD compatible with the recipient. • Never add medication to a unit of blood. • Complete transfusion within 4 hours of commencement Administration Whole blood contd
- 22. Packed Red Cells • It is sediment gotten when whole blood is centrifuged at 3000rev/min and the plasma removed • It is about 150 – 200ml and raises the Hb by 1g/dl or PCV 3% in a 70kg adult Description: • +4 to +6 0C and a shelf life of 35days Storage • Chronic anaemia • Anaemia in the setting of renal or liver failure to prevent fluid overload Indication
- 23. Transfusion triggers for PRBC For ICU patients and hospitalized hemodynamic patient transfusion should be considered at Hb concentration of 7g/dl or < For patients undergoing orthopedic, cardiac surgeries and those with preexisting cardiovascular disease, transfusion be considered at Hb concentration of 8g/dl or <
- 24. Platelet concentrate • It is the precipitate after platelet rich plasma is centrifuge at 3000rev/min • Platelet rich plasma is the supernatant after whole blood is centrifuged at 1000rev/min Description • +200c and has shelf life of 5 days Storage • 1 unit /10kg and usually raises platelet count by 30 -60 x 109/l Dosage
- 25. PCs contd • Asymptomatic severe thrombocytopenia (platelet count < 10,000/μL) • For bleeding patients with less severe thrombocytopenia (platelet count < 50,000/μL) • For bleeding patients with platelet dysfunction due to antiplatelete drugs but with normal platelet count • For patients receiving massive transfusion that causes dilutional thrombocytopenia Indication • Thrombotic thrombocytopenic purpura (TTP). • Heparin induced thrombocytopenia • Untreated DIC. • Thrombocytopenia associated with septicaemia, or in cases of hypersplenism. Contraindication
- 26. PCs contd • A unit should be infusion over a period not more than 30mins Administration • ABO and Rh compatibility should be ensured compatibility
- 27. Fresh frozen plasma • It is the supernatant after fresh whole blood is centrifuged at 3000rev/min • Rapidly frozen to -250c with a mixture of CO2 and ethyl alcohol within 8hrs of collection • It contains plasma proteins, clotting factors, fribrinolytic and complement systems Description • -250c and shelf life of 36months • It should be converted to liquid between +300c and +370c before transfusion Storage
- 28. FFP contd • Deficiencies of coagulation factors or inhibitors of coagulation for which specific concentrates are not available • Emergency treatment of warfarin overdose and vitamin K deficiency when factor IX complex concentrate is not available • Treatment of thrombotic thrombocytopenic purpura • Treatment of DIC Indication • 15ml/kg • It should be ABO compatible and transfused as soon as possible after thawing Dosage/Administration
- 29. Cryoprecipitate • It is the precipitate when FFP is allowed to thaw at +40c and the supernatant plasma removed • It is rich in factor VIII, XIII, fribrinogen and von willebrand factor Description • -250c and shelf life 12months • Each unit will raise fibrinogen level by 5 -10mg/dL • Dose in an adult is 10units (target is 100mg/dL) Storage/Dosage
- 30. Cryoprecipitate contd • von Willebrand Factor (von Willebrand’s disease). • Factor VIII (haemophilia A). • DIC. • Can be used in isolated Factor XIII deficiency. • Ameliorate platelet dysfunction associated with uraemia. Indications: • ABO compatible product should be used. • After thawing, infuse as soon as possible. • Must be transfused within 6 hours of thawing. Administration:
- 31. Other fractions Human albumin Immunoglobulins Factor concentrates Granulocytes • Factor VIII • Factor IX • Fibrinogen
- 32. Effect of storage of blood Red cells • Abt 1% are lost for every day of storage • Swell lose K to plasma • Decrease of level of 2,3 DPG Leucocytes • Not viable after 24hrs of storage Platelets • Not viable after 24hrs of storage Electrolytes • Hyperkalaemia • Hypernatraemia • Hypocalaemia
- 33. Effect of storage contd Clotting factors • Factor VIII and V declines rapidly and has little activity after 7days • Factor X has no activity after 7days • Factor XI declines in activity after 7days with no activity after 14days • Factor VII declines after 14 days while factor II and fibrinogen are stable for 21 days pH • Increases because of lactic acid from glycolysis • pH at 20days is about 6.8 Plasma Hb increases because of leakage
- 35. Donation and collection of blood Donors should be between 18-65 and over 51kg in weight, should be: 1. Fit • Haemoglobin of over 13.5g/dl in males and over 12.5gIdl in females. • No major operation in the last 6 months. • No pregnancy within the last 12 months. • No blood donation in the past 6 months. • No clinical malaria in the past one (1) month in endemic areas. • No blood transfusion within the past 12 months. • Free from severe hypertension, splenomegaly, • hepatomegaly, bleeding disorder or allergic conditions such as asthma.
- 36. 2. Free of history or clinical evidence and not carriers of the following diseases: – Viral hepatitis – HIV infection – Syphilis 3. Unvaccinated within the last 3 weeks and must not to any of the risk groups for HIV infection e.g.. – homosexual, – IV. drug abusers or – prostitutes and their clients.
- 37. Administration of blood • Assess patient’s clinical need for blood, and when required. • Inform patient and/or relatives about proposed transfusion • Request for the transfusion and fill it accurately and legibly • Obtain and correctly label a blood sample for compatibility testing • Collect the blood, crosscheck it and transfuse immediately Responsibility of the Doctor • Initially 20 -30drops/min • Can be increased to 60 -80drops/min if no reactions occurs • Elderly and very young 40drops/min • In acute blood loss with shock the rate can be increased Rate of transfusion
- 38. Time limit for transfusion Whole blood / PRBC • Start within 30 minutes of removing from refrigerator • Transfuse within ≤ 4 hours • Discard unit if this period is exceeded Platelet concentrate • Start transfusion immediately • Transfuse over 30 minutes FFP/cryoprecipitate • Transfuse over 30 minutes
- 39. Monitoring of transfusion • Before starting the transfusion (baseline observation). • 15 minutes after starting the transfusion. • At least every hour during transfusion. • Carry out a final set of observations 15 minutes after each unit has been transfused. Monitor the patient: • Shivering, • Flushing • Chest Pain • Shortness of breath • Feel anxious Encourage patient to notify the following symptoms
- 40. Complications of blood transfusion Immediate transfusion reaction • Febrile non hemolytic transfusion reaction FNHTR • Hemolytic transfusion reaction HTR • Transfusion associated lung injury TRALI • Allergic and anaphylactic reaction • Bacterial contamination • Circulation overload • Cardiac arrest • Air embolism
- 41. Delayed transfusion reaction • Delayed hemolytic transfusion reactions DHTR • Post-transfusion thrombocytopaenic purpura • Immunosuppression. Due probably to transfused leucocytes. • Post transfusion graft versus host disease • Thrombophlebitis. • Transfusion transmissible infections TTI • Iron overload (Transfusion hemosiderosis)
- 42. Febrile Non haemolytic rxn Description: • Within 30-60min of starting transfusion • Usually due to • Incompatibility between antigens on donor WBC and ab in recipient plasma • endotoxins or pyrogens from transfusion set Clinical features: • Fever, Chills, rigors, nausea and vomiting Management • Stop transfusion temporarily • Investigate to exclude hemolytic reaction and septicemia • Give antihistamine and antipyretic (PCM) • Leucocytes depletion of the unit
- 43. Haemolytic reaction • It is hemolysis of donor cells by antibiotics in recipient cells • Occurs as a result of clerical errors or ABO incompatibility • Haemolysis causes shock, release of free Hb, ADP and platelet factor 3 Description • Sensation of heat and pain along the vein being used • Headache • Rigors and fever: • Dyspnoea and constricting pain in the chest • Pain in the loins, oliguria or anuria, haemoglobinuria • Shock with hypotension, tachycardia, sweating • Jaundice after some hours. • In the anaesthetized, hypotension in spite of adequate correction of blood loss and diffuse oozing of blood from the operation site. Clinical features
- 44. Haemolytic rxn contd Management • Stop the transfusion process immediately • Collect blood for regrouping and cross-matching with donor blood • Give iv fluid normal saline immediately • Establish diuresis • Alkalinize urine with sodium bicarbonate • Fresh frozen plasma to reverse DIC if present • The first urine the patient passes is also collected and examined for features of hemolysis
- 45. Allergic reaction Occurs in 2% of transfusion Due to allergens (donor plasma protein) Presents with • Urticaria • Myalgia • Cough with facial edema • Chest pain • Hypotension Management • Stop transfusion and give antihistamine and corticosteriod • Premedication in future transfusion • Adrenaline can be given in severe cases
- 46. Delayed transfusion Reaction Delayed Haemolytic reaction • Occurs few days after transfusion • Characterized by mild jaundice and a drop in Hb • Due to stimulation of Ab or haemolysis of old RBC • No treatment is needed but be investigated Post transfusion thrombocytopaenic purpura • Occurs 7-10days after transfusion • Due to Ab against platelets • Presents with petechia and bleed from mucous membranes • Resolves spontaenously but prednisolone can be given in severe cases
- 47. Massive transfusion Replacement of one or more of the patient’s total blood volume within 24hr or about 5L in an adult Problems • Circulation overload • Cardiac arrhythmias and arrest • Bleeding diathesis • Reduced O2 delivery due to decreased 2,3DPG Solution • Patient receiving massive blood transfusion • Platelet and FFP (1 unit for 5units of banked blood) • 10mls of 10% calcium gluconate for every litre of blood
- 48. Alternatives to blood transfusion PLASMA SUBSTITUTES • Stable plasma protein • Albumin • Dextran • Synthetic gelatin colloids (Haemaccel, Gelofusine • Hydroxyethyl starch preparations (Hetastarch, Pentastarch) Red cell substitutes • Diaspirin cross-linked haemoglobin
- 49. conclusion Transfusion of blood can saves life, however an error in blood transfusion at the same time can take it.
- 50. References • Sanjeev Sharma, Poonam Sharma, and Lisa N. Tyler: Transfusion of blood and blood products: indications and complications, AAFP. March 2011; 15;86(6):719-724 • Blood transfusion safety –WHO. www.who.int/ bloodsafety/en/ • Blood transfusion guidelines updated by AABB – www.medscape.com/viewarticle/870198 • Baja’s principles and practice of surgery vol 1 5th Edition 2015
Editor's Notes
- Blood is a vital physiology fluid that circulates in the heart and blood vessels carrying nourishment & O2 to and bringing away waste products from the cell Blood transfusion is an important part of day‐to‐day clinical practice.. However, due to resource constraints, it is not always possible for the blood product to reach the patient at the right time. The major concern from the point of view of both user (recipient) and prescriber (clinician) is for safe, effective and quality blood to be available when required. It is well known that errors in blood transfusion practices can lead to serious consequences for the recipient in terms of morbidity and mortality. The majority of errors occur due to incorrect sampling of blood from a patient, fetching the wrong unit of blood for a patient and transfusing blood inappropriately. These clinical transfusion guidelines describe protocols for the collection of blood samples for blood grouping and cross matching, and for the collection, storage and administration of blood and blood products.
- Blood is a special connective tissue that is located in the circulatory system. BLOOD TRANSFUSION is a life saving procedure which involves the safe transfer of blood and/or its components from a donor to a recipient.
- Blood product is the therapeutic product derived from human blood or plasma and produced by a manufacturing process, it is usually obtained from multiple donor units of plasma by fractionation. Whole blood unit of donor blood is collected in a suitable anticoagulant-preservative solution, it contains blood cells and plasma Fresh Blood is a blood that is collected and transfused within 3hrs of collection. It has all its constituents preserved i.e. platelets, leucocytes, factor V and VIII. Massive blood transfusion is the replacement of one or more of the patient’s total blood volume within 24hr or about 5L in an adult.
- Safe blood Blood for transfusion is considered safe when it is: Donated by a carefully selected, healthy donor Free from infections that could be harmful to the recipient Processed by reliable methods of testing, component production, storage and transportation Transfused only upon need and for the patient’s health and wellbeing
- Autologous blood transfusion is the collection and re-infusion of the patient's own blood or blood components. Homologous, or more correctly allogenic, blood transfusions involves someone collecting and infusing the blood of a compatible donor into him/herself
- The BCSH guideline on PAD only recommends its use in ‘exceptional circumstances’, and lists the following indications for PAD: Patients with rare blood groups or multiple blood group antibodies where compatible allogeneic (donor) blood is difficult to obtain. Patients at serious psychiatric risk because of anxiety about exposure to donor blood. Patients who refuse to consent to donor blood transfusion but will accept PAD. Children undergoing scoliosis surgery (in practice, most specialist units now use other blood conservation measures).
- The BCSH guideline on PAD only recommends its use in ‘exceptional circumstances’, and lists the following indications for PAD: Patients with rare blood groups or multiple blood group antibodies where compatible allogeneic (donor) blood is difficult to obtain. Patients at serious psychiatric risk because of anxiety about exposure to donor blood. Patients who refuse to consent to donor blood transfusion but will accept PAD. Children undergoing scoliosis surgery (in practice, most specialist units now use other blood conservation measures).
- In ANH several units of blood are collected into standard blood donation packs immediately before surgery (usually in the operating room) and the patient’s blood volume is maintained by the simultaneous infusion of crystalloid or colloid fluids. The blood is stored in the operating theatre at room temperature and reinfused at the end of surgery or if significant bleeding occurs. ANH is most often used in cardiac bypass surgery where the immediate postoperative transfusion of ‘fresh whole blood’ containing platelets and clotting factors is seen as an advantage. Reported hazards of ANH include fluid overload, cardiac ischemia and wrong blood into patient errors. Mathematical modelling suggests ANH is most effective as a blood conservation measure in surgery with major blood loss – now uncommon in elective cardiac surgery. Systematic reviews of published trials have found no significant reduction in exposure to donor transfusions compared to standard care or other blood conservation techniques and the safety of ANH remains unclear.
- ICS should not be used when bowel contents contaminate the operation site and blood should not be aspirated from bacterially infected surgical fields. Because of concerns about cancer cell reinfusion and spread, manufacturers do not recommend ICS in patients having surgery for malignant disease. However, extensive clinical experience suggests this is not a significant risk although it is recommended to reinfuse the red cells through a leucodepletion filter.
- PCS is mainly used in orthopaedic procedures, especially after knee or hip replacement and in correction of scoliosis. Blood is collected from wound drains and then either filtered or washed in an automated system before reinfusion to the patient. The simple filtration systems for reinfusion of unwashed red cells are mainly used when expected blood losses are between 500 and 1000 mL. With these infusion volumes concerns about adverse effects on blood coagulation have not been confirmed in routine practice. Clinical staff must be trained and competency assessed to use the device, accurately document the collection and label the pack at the bedside. Collection of salvaged blood must be completed within the manufacturer’s specified time (usually 6 hours) and the reinfusion must be monitored and documented in the same way as donor transfusions.
- Whole blood is now rarely used for transfusion. Blood component therapy makes clinical sense as most patients require a specific element of blood, such as red cells or platelets, and the dose can then be optimised. A blood component is a constituent of blood, separated from whole blood
- Description: 450 mL whole blood in 63 mL anticoagulant‐preservative solution of which Hb will be approximately 1.2 g/dL and haematocrit (Hct) 35‐45% with no functional platelets or labile coagulation factors (V and VIII) when stored at +2°C to +6°C. Infection risk: Capable of transmitting an agent present in cells or plasma which was undetected during routine screening for TTIs, i.e. HIV, hepatitis B & C, syphilis and malaria. Storage: Between +2°C and +6°C in an approved blood bank refrigerator, fitted with a temperature monitor and alarm. Indications: Red cell replacement in acute blood loss with hypovolaemia. Exchange transfusion. Contraindications: Risk of volume overload in patients with: Chronic anaemia. Incipient cardiac failure.
- Contraindications: Risk of volume overload in patients with: Chronic anaemia. Incipient cardiac failure.
- The blood is centrifuged at 3000rev/min and the removed. 150‐200 mL red blood cells from which most of the plasma has been removed. Hb concentration will be approximately 20 g/100 mL (not less than 45 g per unit) and Hct 55‐75%. Infection risk: Same as for whole blood. Storage: Same as for whole blood. Indications: Replacement of red cells in anaemic patients. Indicated in chronic anaemia, anaemia in the setting of renal or liver failure to prevent fluid overload A unit should raise Hb by approximately 1g/dl in a 70kg adult
- AABB 2016 GUIDELINES PUBLISHED IN JAMA (JOURNAL OF THE AMERICA MEDICAL ASSOCIATION}
- Description: PCs are prepared from units of whole blood that have not been allowed to cool below +20°C. A single donor unit consists of 50‐60 mL plasma that should contain ≥55 x 109 platelets. Unit of issue: PCs may be supplied as a pooled unit, i.e. platelets prepared from 4‐6 donor units containing at least 240 x 109 platelets. Infection risk: Bacterial contamination affects about 1% of pooled units. Storage: PCs may be stored for up to 5 days at +20°C to +24°C (with agitation). PCs require continuous agitation during storage, on a platelet shaker and in an incubator that maintains the required storage temperature. Dosage: 1 unit of platelet concentrate/10 kg; for an adult of 60‐70 kg, 4‐6 single donor units containing at least 240 x 109 platelets should raise the platelet count by 20‐40 x 109/L. Increment will be less if there is splenomegaly, disseminated intravascular coagulation (DIC) or septicaemia. Indications: Treatment of bleeding due to: Thrombocytopenia. Platelet function defects. Prevention of bleeding due to thrombocytopenia as in bone marrow failure. Contraindications: Idiopathic autoimmune thrombocytopenic purpura (ITP). Thrombotic thrombocytopenic purpura (TTP). Untreated DIC. Thrombocytopenia associated with septicaemia, or in cases of hypersplenism. Use in bone marrow failure: Treatment of bleeding, thrombocytopenic patients. Prophylactic use in thrombocytopenic patients. - Maintain platelet count >10 x 109/L in non‐bleeding, non‐infected patient. - Maintain platelet count >20 x 109/L in infected/pyrexial patient.
- Indication Asymptomatic severe thrombocytopenia (platelet count < 10,000/μL) For bleeding patients with less severe thrombocytopenia (platelet count < 50,000/μL) For bleeding patients with platelet dysfunction due to antiplatelet drugs but with normal platelet count For patients receiving massive transfusion that causes dilutional thrombocytopenia Contraindications: Idiopathic autoimmune thrombocytopenic purpura (ITP). Thrombotic thrombocytopenic purpura (TTP). Untreated DIC. (plateletes are used up) Thrombocytopenia associated with septicaemia, or in cases of hypersplenism.
- Administration: Platelet concentrates after pooling should be infused as soon as possible because of the risk of bacterial proliferation. Depending on the condition of the recipient, a unit should be infused over a period of not more than 30 minutes. Do not give platelet concentrates prepared from RhD positive donors to an RhD negative female with childbearing potential. Give platelet concentrates that are ABO compatible, whenever possible.
- Description: FFP is plasma prepared from whole blood, either from the primary centrifugation of whole blood into red cells and plasma or from a secondary centrifugation of platelet rich plasma. The plasma is rapidly frozen to –25°C or colder within 8 hours of collection and contains normal plasma levels of stable clotting factors, albumin, immunoglobulin and Factor VIII at a level of at least 70% of normal fresh plasma. Unit of issue: 200‐300 mL. Infection risk: Capable of transmitting any agent present in cells or plasma which was undetected by routine screening TTIs, including HIV, hepatitis B and C, syphilis and malaria. Storage: FFP is stored at –25°C or colder for up to 1 year. Before use, it should be thawed in the blood transfusion centre between +30°C and +37°C.
- Definite indications: Replacement of a single coagulation factor deficiency, where a specific or combined factor concentrate is unavailable or contraindicated. Immediate reversal of warfarin effect where prothrombin complex concentrate is unavailable. Thrombotic thrombocytopenic purpura. Inherited coagulation inhibitor deficiencies where specific concentrate is unavailable. C1 esterase inhibitor deficiency where specific concentrate is unavailable. Conditional indications: Massive blood transfusion. Acute DIC if there are coagulation abnormalities and patient is bleeding. Liver disease, with abnormal coagulation and bleeding – prophylactic use to reduce prothrombin time (PT) to 1.6‐1.8 x normal for liver biopsy. Cardiopulmonary bypass surgery – use in the presence of bleeding but where abnormal coagulation is not due to heparin. Routine perioperative use is not indicated. Severe sepsis, particularly in neonates (independent of DIC). Plasmapheresis. Precautions: Acute allergic reactions are not uncommon, especially with rapid infusions. Severe life‐threatening anaphylactic reactions occasionally occur. Dosage: 15 mL/kg. Administration: Should be ABO compatible. Infuse as soon as possible after thawing. Labile coagulation factors rapidly degrade; use within 6 hours of thawing. FFP may be beneficial if PT and/or partial thromboplastin time (PTT) >1.5 times normal. FFP for volume expansion carries a risk of infectious disease transmission and other transfusion reactions (e.g. allergic) that can be avoided by using crystalloid or colloid solutions.
- Description: Cryo‐AHF is prepared from FFP by collecting the precipitate formed during controlled thawing at +4°C and re‐suspending in 10‐20 mL plasma. It is stored at –25°C or colder for up to 1 year after the date of phlebotomy. Cryo‐AHF contains about half the Factor VIII and fibrinogen as a pack of fresh whole blood: e.g. Factor VIII: 80‐100 iu/ pack; fibrinogen: 150‐300 mg/ pack. Infection risk: As for plasma, but a normal adult dose involves at least 6 donor exposures. Storage: At –25°C or colder for up to 1 year. Indications: As an alternative to Factor VIII concentrate in the treatment of inherited deficiencies of: von Willebrand Factor (von Willebrand’s disease). Factor VIII (haemophilia A). As a source of fibrinogen in acquired coagulopathies; e.g. DIC. Can be used in isolated Factor XIII deficiency. 15 Ameliorate platelet dysfunction associated with uraemia. Used topically as a fibrin sealant. Administration: ABO compatible product should be used. After thawing, infuse as soon as possible. Must be transfused within 6 hours of thawing.
- Diffuses out of RBC to plasma at 1mmol/day For 20days of storage, K conc is abt 25mmol/l Na conc in plasma is increased cos of Na citrate in CPD anticoagulant
- Assess patient’s clinical need for blood, and when required. Inform patient and/or relatives about proposed transfusion and record in patient’s notes. 18 Also record indications for transfusion in patient’s notes. Select blood product and quantity required (i.e. whole blood/PRBC/FFP/PC) and complete request form accurately and legibly. Enter the reason for transfusion on the form, so that the blood centre can check that the product ordered is the most suitable with regard to diagnosis. Obtain and correctly label a blood sample for compatibility testing. Send the blood request form and blood sample to the blood bank. When the blood product that was ordered arrives, transfuse it as soon as possible to avoid having to store it. However, if the blood product is not used immediately, store it under the correct storage conditions. Cross check the identity of the patient and the blood product: – Patient and documentation. – Blood / blood products.
- Table 2: Duration times for transfusion Blood products Start transfusion Complete transfusion Whole blood / PRBC Within 30 minutes of removing from refrigerator ≤ 4 hours Discard unit if this period is exceeded Platelet concentrate Immediately Within 30 minutes FFP As soon as possible Within 30 minutes Cryoprecipitate As soon as possible Within 30 minutes
- For each unit of blood transfused,Monitor the patient: - Before starting the transfusion (baseline observation). - 15 minutes after starting the transfusion. - At least every hour during transfusion. - Carry out a final set of observations 15 minutes after each unit has been transfused. Encourage pt to notify if he or she becomes aware of symptoms such as Shivering, Flushing Chest Pain Shortness of breath Feel anxious