Blood transfusion part 1

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  • World war, post partum,
  • Which is collected and stored 4 weeks before surgery, at once or in parts when patients HB is low.
  • Principle being either detection of antigens on the RBC called as front typing
  • A little something on bombay blood group…For blood transfusion people with bombay blood group need same blood or auto transfusion is advisable when ever possible
  • Donor selectionAge>17, hb > 12.5, normal BP,Pulse, Not suffering from any disease / on antibiotic since
  • 8 weeks between donation
  • Reconstituted whole blood is used for neonatal exchange transfusions, most commonly for hemolytic disease of the newborn. It is sometimes used during pediatric cardiovascular surgery as well as in neonatal hemodialysis.
  • Citrate, phosphate buffer, dextrose, adenine.†Adenine, dextrose, saline, mannitol (most plasma removed and replaced with additive solution).Adenine and mannitol renal toxicityMannitol acts as diuretic so there will be fluctution in cerebral blood flowPreterm neonates CPDA 1 is better
  • (1) “fresh” red blood cells (RBCs) or wholeblood, (2) cytomegalovirus (CMV) “safe” components,(3) leukocyte-reduced blood components, (4) irradiatedcellular components, (5) units that are negative forhemoglobin S, (6) volume-reduced platelet products,and (7) components that are packaged into smallvolume containers.
  • Severe thalassemia-homozygous beta thalassemia major.Occationallythalassemiaintermedia.Pre transfusion hb level is maintained at 9-10g/dl-suppress extramedullaryhemopoiesis and excessive absorption of iron from gut.Posttransfusion h 14g/dl should not rise above it-icrease blood viscosity and risk of thrombosis.
  • Not indicated as a roytine to raise Hb. & for specific indications.But for specific indications.Don’t raise >10g/dl=raise viscosity
  • unless life threatening.
  • Open system is used for the preparation.
  • by clostridia,streptococcus or pneumococcus infections
  • Gamma irradiation Inactivate T-Lymphocytes & proliveration.Cesium,cobalt,x-ray irradiators-minimun dose 25Gy gamma irradiation. Neonates- within 24 hours.
  • INFANTS WITHIN FIRST 4 MONTH OF LIFE
  • It is better to avoid blood transfusion in chronic anemia.because increased risk of volume overload & cardiac failure.so we shoul correct the cause first.if the anemia is due to nutritional deficiency & we can correct it with hematinics.or it is due to hook worm infestation.then we should treat that.we should not give more than required amount.here the aim of blood transfusion is not to raise hemoglobin to normal level but to treat life threatening hypoxaemia. cardiafc failure.3-5ml/kg. Iv frusemide in the dose of 1mg/kgbody weightbefore the transfusion.
  • Decreased number donor exposure to the patient in apheresisFewer lymphocytes thanequivalent dose of plateletconcentrates
  • Plt adhesion to wall, shortens bleeding timeIn TTP can cause stroke and miHit increases thrombogenic effect
  • No factor 8 & fibrinogen
  • Produced comerciallyFractionation facilities is noot aailable inn sri lanka.Necssary before invasive procedures,tooth extraction,surgery.Before hemarthrosis aspiration.
  • Fluid overloaded and resistant to diuretics.
  • Platelet 24 times a yearRbc once in 16 weeks bt at once 2 RBC concentrated can be collected
  • Contraindicated in patient getting amphoterisine B as it will cause increased lung toxicity.
  • Blood transfusion part 1

    1. 1.  Introduction  Blood groups and grouping methods  Cross matching  Blood collection  Blood components  Whole blood  Red blood concentrate  Platelet  FFP  And others  Apheresis
    2. 2. History of Transfusion  Blood transfused in humans since mid-1600’s  1818 – First successful human blood transfusion  1900 – Landsteiner described ABO groups  1918 – First use of blood storage.  1939 – Levine described the Rh factor
    3. 3. INTRODUCTION  Blood transfusion is one of the oldest forms of therapy.  Critical care frequently requires the urgent use of large numbers of blood component, often as a lifesaving supportive measure.  Blood component transfusion plays a very important role in modern transfusion.  Through modern medical methods, many kinds of blood components are separated from whole blood.
    4. 4.  The routine separation of donor blood into components and plasma fraction has made it possible for blood banks to provide the specialized blood products required for the support of patients in multiple treatment modalities.  The infusion of blood component is called component transfusion or blood component therapy.
    5. 5.  Each blood donation can help as many as 4 people  43732 blood donations in one day is the world record held by INDIA (Haryana) in 2010
    6. 6. Types Autologous Allogenic
    7. 7. Autologous  Transfusion of patients own blood.  Can be undertaken by 1. Autologous pre deposit donation 2. Intra operative normovolaemic hemodilution. 3. Intra operative cell salvage 4. Post operative cell salvage
    8. 8. Indications  Where patients have formed multiple alloantibodies, particularly those to high frequency antigen, so that selection of compatible allogenic unit is not practical.  Any surgeries which might need post surgical transfusion. Advantages  Safe,  No risk of disease transmission  Rare blood group.
    9. 9. Contraindications  Infections or risk of bacteraemia  Aortic stenosis  Angina  Significant cardiac or pulmonary disease  Coronary heart disease  Cyanotic heart disease  Uncontrolled HTN
    10. 10. Blood groups  Major  ABO  Rh  Minor  Duffy blood group  I blood group  Kell blood group  Kidd  Lewis  Lutheran  MNS  Bombay blood group
    11. 11. ABO- A, B, AB, O Rh- D, c, C, e, E
    12. 12. Blood groups
    13. 13. Blood grouping methods: Landsteiner’s law : 1. The first law holds true for all types of blood grouping. 2. The second law is a fact for ABO blood groups. 3. The Rh and other blood groups do not follow the second part of Landsteiner's law.
    14. 14. Cont.. Three manual methods can be used when performing blood grouping  Glass slide or white porcelain tile  Glass test tube  Microwell plate or microplate Newer techniques  Column technique (sephadex gel)  Solid phase tests
    15. 15. FRONT TYPE –what’s on the cells? Agglutination indicates presence of antigen
    16. 16.  BACK TYPE – what’s in the serum?  Agglutination indicates presence of antibody
    17. 17. INTERPRETATION OF RESULTS
    18. 18. Bombay blood group • First discovered in Bombay by Dr.Y.M.Bhende • Individuals with the rare Bombay phenotype (hh) do not express H antigen (also called substance H), the antigen which is present in blood group O.  Persons will lack H, A & B antigens on RBC & whose plasma contains antiH, antiA & antiB  Present in about 4 per million of human population generally.  In Mumbai it is 1 in 10,000  More common in India.
    19. 19. Cross matching  The two main functions of the cross-match test can be cited as, I- It is a final check of ABO compatibility between donor and patient. 2-Detects clinically significant unexpected antibodies.
    20. 20.  Major cross-match test, consisting of mixing the patient’s serum with donor RBCs.  Minor cross-match test, consisting of mixing the donor’s plasma with patient’s RBCs  The minor cross-match test has been completely eliminated in most blood banks, because donor samples are screened beforehand for the more common Antibodies.
    21. 21. Immediate Spin Technique (IST)  Detects only IgM antibody, reactive at 22oC.  Clinically significant IgG antibody reactive at 37oC not detected Patient serum 2 drops Donor RBC 1 drop, 5% Immediate centrifuge ABO incompatibility 22o C
    22. 22. Conventional AHG-crossmatch Patient serum 2 drops Incubation 37oC, 1 hr Donor RBC 1 drop, 5% 3 washes Centrifuge 2 drops AHG Mix properly Agglutination = incompatible No agglutination = compatible Detects clinically significant (IgG) antibody
    23. 23. Serological cross match Phase Detects IS phase ABO incompatibilities AHG phase Rh, Duffy, Kidd, others Points to remember:  Preserve recipients serum & donor red cell segment for a week. However, fresh sample of the patient is needed after 48 hrs of transfusion
    24. 24.  No compatibility testing required for platelets and plasma components  Only ABO matching is required for fresh frozen plasma  No need for compatibility, ABO and Rh matching for platelet concentrates and cryoprecipitate
    25. 25. Clinical urgency Immediate Within an hour(45 min)Minutes (15) Group O Rh neg Packed RBCs ABO & Rh D type Group specific blood ABO & Rh D type Complete crossmatch Cross matching: Special Circumstances
    26. 26. Blood collection Types of donor 1. Replacement 2. Voluntary donor Volume collected- 350 to 450 Ml ( according to weight)
    27. 27. 28 Blood collection process Registration Donor provides identification and demographic information Donor reads information about blood donation (Educational material) Donor consents to blood donation Health history and limited physical examination Health history questions asked by blood center staff Blood pressure, pulse and hemoglobin levels are checked Donation Arm is cleansed Blood is drawn (6-10 minutes) Needle is removed Recovery Rest ~ 15mins Snacks 1 2 3 4 Average donation process takes just under one hour
    28. 28. Mandatory screening test 1. HBsAg 2. Anti HCV 3. Anti HIV 1 and 2 4. VDRL 5. Malaria parasite
    29. 29. Blood collection bag
    30. 30. Blood processing Differential Centrifugation First Centrifugation Whole Blood Main Bag Satellite Bag 1 Satellite Bag 2 RBC’s Platelet-rich Plasma First Closed System
    31. 31. Differential Centrifugation Second Centrifugation Platelet-rich Plasma RBC’s Platelet Concentrate RBC’s Plasma Second
    32. 32. Fresh Whole Blood Packed Red Cells Light spin, o C(within 8 hrs) Platelet Rich Plasma Platelet Concentrate Fresh Plasma Store at o C Freeze(FFP) Heavy spin, o C
    33. 33. TYPES Blood- Fresh Whole Blood Reconstituted whole blood Blood Products Cellular Components- Red Cell Concentrates Platelet Concentrates Granulocyte Concentrate Plasma Components- Fresh Frozen plasma Cryoprecipitate Stored plasma Plasma Derivatives- Albumin Immunoglobulin Coagulation Factors
    34. 34. WHOLE BLOOD  Contains RBCs and plasma clotting factors.  Only few units are stored as whole blood.  Can be reconstituted from a unit of RBCs and FFP.  Once WB has been stored for 24 hours at 4°C, platelet function is lost.  Furthermore, by day 21 of storage, factors V and VIII lose 5% to 30% of their activity
    35. 35. However, in most cases blood components are preferred because each component has specific optimal storage conditions and component therapy maximizes the use of blood donations. Stored at 2°C to 6°C.
    36. 36. Indications. Only use whole blood for patients who have  a symptomatic deficit in oxygen-carrying capacity combined with hypovolemia of sufficient degree to be associated with shock, particularly in clinical situations where the transfusion of viable platelets and therapeutic levels of labile coagulation factors are also required. (Massive trauma)
    37. 37. Packed Red Blood Cells (PRBCs) The whole blood is spun to sediment out the RBCs, and most of the plasma is removed by pushing it into a pre-attached satellite bag. After plasma is separated from red cells from 350 ml whole blood, the RBC component has a volume of about 200 ml and Hct of about 80 %.
    38. 38. Generally 100 to 110 mL of a nutrient additive solution is added back to the packed RBCs, creating an “additive RBC” product that has a final hematocrit of 55% to 60%. These solutions prolong the shelf life of the RBC product from 21 days (packed RBCs in CPD) to 42 days (additive RBCs). PRBCs are the most commonly used blood product in transfusions. Red blood cells (RBCs) are transfused to increase the oxygen-carrying capacity of the blood and, to maintain satisfactory tissue oxygenation.
    39. 39. Available forms of RCCs The following forms of RCCs are available for the treatment of anaemia.  RBC concentrates.  RBC concentrates deprived of the buffy coat.  RBC concentrates with additive solutions.
    40. 40.  RBC concentrates deprived of the buffy coat and re suspended in additive solutions.  Washed RBC.  Leukocyte depleted RBC.  Frozen RBC.  Aphaeretic RBC.  Irradiated RBC.
    41. 41. ANTICOAGULANT-PRESERVATIVE SOLUTIONS (Additive solutions) Function : (1) Maintain blood products in an anticoagulated state, (2) Support the metabolic activity of red cells and maintain function of cellular constituents while in storage, and (3) Minimize the effects of cellular degradation during storage.
    42. 42. Red Cell Concentrates Indications  Treatment of symptomatic anemia  Prophylaxis in life-threatening anemia  Restoration of oxygen-carrying capacity in case of hemorrhage  RBC are also indicated for exchange transfusion 1. Sickle cell disease 2. Severe parasitic infection (malaria, babesiosis) 3. Severe methemoglobinemia 4. Severe hyper bilirubinemia of newborn
    43. 43. Red Cell Concentrates Thalassemia  Periodic regular blood transfusions  Every 3 to 4 weeks.  Pre transfusion Hb level -9-10g/dl  Post transfusion Hb should not rise >14g/dl
    44. 44. Red Cell Concentrates Thalassemia  Annual blood consumption=total blood transfused over 12 months/ patient’s weight in middle of the year.  If blood consumption is >200ml/kg/ year splenectomy should be considered
    45. 45. Sickle cell disease Indications for simple top up transfusion  Severe anemia / hemolysis  Splenic or hepatic sequestration  Stroke (chronic transfusion) Indications in surgery  Organ transplantation  Eye, major abdominal surgery Raising HB >10g/dl will cause increase in viscosity.
    46. 46. Red Cell Concentrates Dose for blood transfusion-10ml/kg cardiac failure-5ml/kg Increase Hb by~ 2 g/dl Rate of Blood Transfusion -3ml/kg/hr, slow for 1st 15 min.  NEVER mixed with  Calcium containing solutions  May cause clumping or clots  Dextrose  May cause hemolysis or clumping
    47. 47. Leucoreduced Red Blood Cells  Most of the plasma & 70-80% WBC (buffy coat) is removed.  WBC : <5  102 /mm3  Hct : 50–60 %  Volume : 350 ml  Shelf life : 35 to 42 days  Stored at 2- 60c
    48. 48. Preparation techniques  Centrifugation  Saline washing  Freezing and deglycerolisation  Spin- cool filtration  Leukocyte filtration* ( Pre storage or during transfusion )
    49. 49. Indication  Prevention of febrile non-haemolytic transfusion reactions (FNHTRs) caused by the presence of antibodies to white blood cells:  - patients with recurrent FNHTR;  - patients who need prolonged transfusion support. (Thalassemia)  Reduction of the incidence of 1. CMV transmission, 2. Epstein-Barr virus (EBV) and 3. Human T-cell lymphotrophic virus type I (HTLV-I), Which are transmitted by the cellular components of the blood (primarily the leukocytes)
    50. 50.  Reduction of the risk of rejection in candidates for haematopoietic stem cell transplantation.  Intrauterine transfusions and transfusions to premature babies, neonates, and infants up to 1 year.  Candidates for renal transplantation.
    51. 51. Washed Red Blood Cells  RBC washed with 1-2 L Normal Saline  Removes residual plasma.  RBC : 20% reduced  WBC count: <5  102 /mm3  Prevents febrile non hemolytic reactions.  Washing eliminates antibodies, metabolic & other plasma constituents  To be transfused within 24 hours.
    52. 52. Washed Red Blood Cells Indications  Multiple transfused patients with recurrent febrile reactions  Urticarial reactions  Anaphylactic reactions  IgA deficiency with IgA antibodies  Patients with T activated cells by infections who require transfusion.
    53. 53. Irradiated blood products  Irradiation of all cellular products with min 25 Gy units.  Inactivate T-Lymphocytes  Prevent GVHD  Shelf life-28 days
    54. 54. Indications  Bone marrow/ stem cell transplant  Intrauterine transfusions  Congenital immunodeficiency syndrome  Premature newborn  Neonatal exchange transfusion-give within 24 hours.
    55. 55.  History of treatment with purine analogues (anti cancer) and related drugs  Fludarabine  2CDA (Cladribine®)  Deoxycoformycin (Pentostatin®)  Clofarabine (Clolar®)  Bendamustine (Treanda®)  Nelarabine (Arranon®)  Hodgkin disease
    56. 56. Frozen RCCs  Indicated in patients with complex immuno haematological profiles in the absence of compatible donors.  Blood is collected, RBCs separated and can be frozen using glycerol and stored up to 10 years  To use, must be thawed and washed.
    57. 57.  RBCs frozen in 40% glycerol, stored at -65°C  RBCs frozen in 20% glycerol, stored at -120°C  After thawed and washed, unit expires in 24 hours and cannot be re-frozen
    58. 58. Guidelines for Paediatric red cell transfusions Neonates and Infants  Hb< 13.0 g/dL and severe pulmonary disease  Hb < 10.0 g/dL and moderate pulmonary disease  Hb < 13.0 g/dL and severe cardiac disease  Hb < 10.0 g/dL and Perioperative, critical care  Hb < 8.0 g/dL and symptomatic anemia
    59. 59. Guidelines for Paediatric red cell transfusions Children and adolescent  <8 g/ dL hemoglobin  No specified hemoglobin  <10 g/dL hemoglobin  <8 g/dL hemoglobin  <8 g/dL hemoglobin  Perioperative, critical care  >25% of Acute blood loss  Acute or chronic anemia and severe cardio respiratory disease  Symptomatic chronic anemia  Bone marrow failure
    60. 60. ABO group selection for RBC Transfusion Recipient ABO Group Component ABO Group 1st Choice 2nd Choice 3rd Choice 4thChoice A A O None None B B O None None AB AB A B O O O None None None Oh (Bombay Group) Oh None None None
    61. 61. Chronic Anaemia  In anemias that are likely to be present from a long time, it is also important to balance the detrimental effects of anemia on growth and development v/s the potential toxicity associated with repeated transfusions.  With chronic anaemia, the decision to transfuse RBCs should not be based solely on blood haemoglobin levels because children compensate well and may be asymptomatic despite low haemoglobin levels.  Patients with iron-deficiency anaemia are often treated successfully with oral iron alone, even at haemoglobin levels of <5 g/dL.
    62. 62. When to transfuse in chronic anemia? Transfusion should be considered in a asymptomatic child with a Hb level of less than 4 g/dL. • Transfusion should be considered in a child with a Hb level of less than 5 g/dL with clinical signs of cardiac or respiratory distress . Only increases in heart rate or respiratory rate alone may be normal compensatory mechanisms and are not necessarily indications for transfusion.
    63. 63. . • Blood is not generally recommended for children with a Hb level between 4 and 5 g/dL who are clinically stable.  These children should be admitted for evaluation and treatment of the cause of their anaemia and should be monitored closely for changes in Hb level and signs of decompensation.  Treat the cause as infection , nutritional and mild blood loss anaemia with specific therapeutic agents as indicated (iron, folic acid, B12).
    64. 64.  Respiratory distress is unlikely to be due to chronic anaemia if the Hb level is 5 g/dL or greater. • Children should be transfused with 10 to 15 ml/kg of PRBCs.  Transfusions must be given slowly (over a 4 hour period. At the rate of 2-3 ml/kg/hr.  Monitored closely to avoid volume overload.  Diuretics should be used if the patient is in congestive cardiac failure.
    65. 65. Platelets Concentrate Types of Platelets 1. Recovered platelets(Random donor platelets) 2. Apheresis platelets(single donor platelets)
    66. 66. Platelets Concentrate Random donor platelets Made from units of whole blood by centrifugation. Prepared by 2 methods 1. Platelet rich plasma 2. Buffy coat removal  I unit :50109 platelets  Volume: 50 ml  The storage time from collection to transfusion of platelets (RDPs) is 5 days.
    67. 67. Platelets Concentrate Single donor platelets  Made from single donor  Apheresed using cell separator machine  1 unit SDP = 6 units RDP  Volume of 1 unit SDP: 200-350 ml  SDPs can be stored for up to 5 days.  Stored at 22*C
    68. 68. Recommendation for platelets use  Platelets should never be filtered through a micropore blood filter before transfusion.  Should be transfused as rapidly as pt can tolerate 1 unit/20 min.  ABO compatible platelet is preferred.  The usual recommended dose of platelets for neonates is 1 unit of platelets per 10 kg body weight, which amounts to 5 mL/kg.  The predicted rise in platelet count from a 5-mL/kg dose would be 20 to 60,000/cubic mm.
    69. 69. Indications Thrombocytopenia: quantitative defects  Prophylactic transfusion for PLT <10k  Platelets < 20,000 and bone marrow infiltration, severe mucositis, DIC, anticoagulant therapy.  For invasive procedure, trauma , bleeding with PLT count <50k  Rapidly falling PLT count with bleeding  Platelet dysfunction: qualitative defects  Uremia  Aspirin ingestion  Post- Cardiopulmonary Bypass
    70. 70. Contraindication  Single anatomic site is thought responsible for the bleeding.  Although not absolutely contraindicated, ITP patients are unlikely to benefit from platelet transfusion due to rapid immune-mediated peripheral platelet destruction.  Bleeding >5 Ml/ Kg/ Hr, needs surgical intervention.  Thrombotic Thrombocytopenic Purpura  Heparin Induced Thrombocytopenia
    71. 71. ABO group selection for Platelet Transfusion Recipient ABO Component ABO 1st Choice 2nd Choice 3rd Choice 4thChoice A A AB B O B B AB A O AB AB A B O O O A B AB
    72. 72. Fresh frozen plasma  Source plasma  Recovered plasma
    73. 73. Content  Plasma proteins  Albumin  Immunoglobulins  Complement  Coagulation factors (2, 7, 9, 10, 8, 13, vWF, fibrinogen)  ~400 mg fibrinogen.
    74. 74.  Its use is appropriate to restore hemostatic levels of coagulation proteins resulting from multiple factor deficiency.  Each unit contains 200-250 mL.  Frozen within 8 hrs of collection  Stored -18º C for up to 1 year  Once thawed, can be kept at 2-6º C for 24 hrs
    75. 75. Indications  Treatment of multiple coagulation factor deficiencies  Massive transfusion  Trauma  Liver disease  DIC
    76. 76.  Warfarin reversal prior to emergent invasive procedures (5-8 ml/kg)  PT/PTT > 1.5x normal  DOSE: 10-15 ml/kg.
    77. 77. Thaw at o C & heavy spin Fresh Frozen Plasma Cryoprecipitate -Refrozen within hr -Store at < - o C Cryoremoved Plasma Freeze - o C immediately Stored at - o C
    78. 78. Cryoprecipitate  Cold insoluble white precipitate that forms when FFP is thawed at 1-6º C  Once thawed, kept at room temperature  CONTAINS:  80 to 150 IU of Factor 8:C (anti hemophilic factor)  250 mg fibrinogen  Von Willebrand Factor  Fibronectin  Factor XIII
    79. 79. Cryoprecipitate Each unit =10-15 mL Dosage – 1 unit for every 5 to 10 Kgs.  Indications:  Deficiency of fibrinogen (DIC), Factor VIII (Hemophilia A) or XIII, Von Willebrand factor deficiency  Improve platelet function in uremia  Afibrinogenemia,  Protein C deficiency and protein S deficiency when specific factor replacement is not available.  post streptokinase therapy (hyper-fibrinogenolysis)
    80. 80. Cryopoor Plasma Contains  Stable clotting factors (2, 7, 9, 10)  No factor 5, 8 & fibrinogen Indication  Replacement in plasma exchange for TTP
    81. 81. ABO group selection for Plasma/FFP Transfusion Recipient ABO Component ABO 1st Choice 2nd Choice 3rd Choice 4thChoice A A AB None None B B AB None None AB AB None None None O O AB A B
    82. 82. Plasma derivatives  Factor VIII  Factor IX  Factor VIII- vWF concentrates 1. Factor VIII Indication- Hemophilia A Loading dose, maintenance dose Loading dose = desired factor VIII level – patient’s baseline level  Body weight(kg)/2
    83. 83. Plasma derivatives 2.Factor IX Indication- Hemophilia B Loading dose + maintenance dose Loading dose=desired factor IX level – patient’s baseline level  Body weight(kg)
    84. 84. Plasma derivatives 3.Factor VIII- vWF concentrates  Indications-  Type IIB & severe type III Von Willebrand’s disease  Mild disease-FFP  Moderate disease-cryoprecipitate
    85. 85. Plasma derivatives Albumin 2 preparations  Human albumin solution4.5%(plasma protein fraction)  Human albumin solution20%(salt poor albumin) Indications  Nephrotic syndrome  Liver disease with fluid overload
    86. 86. Plasma derivatives Immunoglobulin Normal immunoglobulin  Prepared from normal plasma  Indication :  Hypo gamma globulinaemia  Infections  Immune thrombocytopenic purpura Specific immunoglobulin  Obtained from donors with high titers of antibodies  Eg- anti-D, anti-hepatitis B& anti-varicella zoster
    87. 87. Apheresis  Apheresis is the process by which the required component of whole blood is separated and collected from the donor using an automated blood cell separation device.  Components that can be donated by apheresis include  Platelets (platelet pheresis),  Plasma (plasma pheresis),  leucocytes (leuco pheresis) and  Red blood cells (erythrocyto pheresis).
    88. 88. Automated apheresis blood separators may be used for donation or therapeutic applications
    89. 89. Indications  Severe clotting deficiency (including DIC) with bleeding  Severe clotting deficiency in a neonate undergoing an invasive procedure  Vitamin K deficiency with bleeding  Dilutional coagulopathy with bleeding  Severe anticoagulant protein deficiency
    90. 90. Granulocyte Transfusions Granulocyte concentrates are collected from single donors by use of a blood cell separator. Each concentrate contains approximately 10 10 granulocytes. Granulocytes are fragile and may be stored no longer than 24 h.  The usual concentrate contains about 250 ml of plasma and has a Hct of 15 to 20 percent. ABO compatibility is necessary.
    91. 91.  GTX is recommended only when infections are clearly unresponsive to antimicrobial drugs, infected children with sustained bone marrow failure (malignant neoplasms resistant to treatment, aplastic anemia, and hematopoietic progenitor cell transplant recipients) may benefit when GTX is added to antibiotics.  The use of GTX for bacterial sepsis unresponsive to antibiotics in patients with severe neutropenia (<0.5 × 109/L) is supported by many controlled studies .
    92. 92. Guidelines for Pediatric Granulocyte Transfusions CHILDREN AND ADOLESCENTS  Neutrophils of < 500/mm3 and bacterial infection unresponsive to appropriate antimicrobial therapy  Qualitative Neutrophil defect and infection (bacterial or fungal) unresponsive to appropriate antimicrobial therapy INFANTS WITHIN THE FIRST 4 MO OF LIFE Neutrophils of < 3000/mm3 (1st wk of life) or < 1000/mm3 (thereafter) and fulminant bacterial infection
    93. 93. Human serum albumin HSA is comprised of 96 percent albumin and 4 percent α-and β –globulin. Dose is 0.5- 2 gm/kg Indications –  Hypovolemic shock,  Hypotension associated with hypovolemia in liver failure or protein-losing conditions,  Inadequate diuresis in fluid overloaded hypoproteinemic patients.
    94. 94. INTRAVENOUS IMMUNOGLOBULIN  IVIG is a concentrated purified solution of immunoglobulins with stabilizers such as sucrose.  Contain >90% immunoglobulin G (IgG) with small amounts of immunoglobulin M (IgM) and immunoglobulin A (IgA)
    95. 95. Indications.  Alloimmune disorders  Congenital immunodeficiency syndromes.  Hyper immune immunoglobulins- several infectious agents including Varicella-zoster virus and respiratory syncytial virus, rabies.  Severe sepsis Dosing ==of 500 to 900 mg/kg.

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