33. use of blood products
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This document discusses principles of clinical transfusion practice and recent advances. It provides guidelines for use of blood products like packed red cells, platelet concentrates, fresh frozen plasma, cryoprecipitate, and discusses transfusion risks. Randomized controlled trials show restrictive transfusion strategies are at least as effective as liberal strategies, with lower mortality. Acute transfusion reactions and their management are outlined. The document also presents three clinical cases and asks what should be done in each case.
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33. use of blood products
- 1. Use of blood products Dr Revathi Raj
- 2. Principles of clinical transfusion practice Transfusion - part of patient’s management National guidelines / individual needs Minimise blood loss Hb value should not be a sole consideration for transfusion Clinician takes sole responsibility Record reason for transfusion Trained person to administer
- 3. Transfusion should be prescribed only when benefits clearly outweigh the risks
- 5. Packed red cells Each unit raises haemoglobin up by 1 gm Shelf life 35 days
- 6. Platelet concentrates Shelf life of 4-5 days ABO compatible if possible 1 unit/10 kg body weight Apheresis platelets are 6-10 times superior
- 8. Fresh frozen plasma Stored at –25 C for up to 1 year No compatibility testing required Replacement of multiple clotting factor deficiencies Hypovolaemia alone is not an indication for use
- 9. Recent advances Solvent detergent FFP – Octoplas Methylene blue FFP
- 10. Cryoprecipitate Rich in fibrinogen and factor VIII Lower volume Increased donor exposure
- 11. Leucodepletion Removes white cells using a filter Reduces risk of viral transmission and alloimmunisation
- 12. Red cell and platelet filters
- 13. Irradiation Kills leucocytes Reduces risk of transfusion associated graft versus host disease
- 14. Who is at risk of TAGvHD? Bone marrow transplantation Congenital immunodeficiency Hodgkin’s disease Foetus Related donor transfusions Fludarabine therapy
- 15. Factor concentrates Human albumin solutions 4.5% and 20% Factors VIII, IX, X, VII, protein C and S Fractionation and filtration Virally inactivated
- 16. Fresh whole blood – fact and fancy No viable platelets Reduced levels of clotting factors like IX, VIII and V Plasma transmits most of the infections in whole blood / immune complications
- 17. Fresh whole blood - current indications Exchange transfusion in newborn Advanced renal or liver disorders
- 18. RCT • A multicentre, randomised, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators,Canadian Critical Care Trials Group. Critical Care Program, University of Ottawa, ON, Canada.
- 19. 838 critically ill patients Hb 7 or 9 gm 30 day mortality lower in transfusion restricted patients
- 20. • A restrictive strategy of red- cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients, with the possible exception of patients with acute myocardial infarction and unstable angina.
- 21. Acute transfusion reactions Acute haemolytic transfusion reaction Infusion of a bacterially contaminated unit Transfusion- associated lung injury Severe allergic reaction
- 22. Acute haemolytic transfusion reaction Feeling of apprehension Agitation Flushing Pain at venepuncture sites Pain abdomen / flank or chest
- 23. Acute haemolytic transfusion reaction… Fever Hypotension Generalised oozing from puncture sites Haemoglobinaemia Haemoglobinuria
- 24. Management Stop transfusion Check vitals Preserve unit of blood Take blood cultures / repeat group / crossmatch / cbc / coagscreen / biochem / ldh / urinalysis IV saline infusion Keep urine output > 100 ml/hour DIC managed with appropriate components
- 25. Bacterial contamination Fever>1.5 C from baseline Sustained hypotension Fluids Broad spectrum antibiotics FFP / platelets guided by coag
- 26. Severe allergic reaction Oxygen Chlorpheniramine Hydrocortisone Adrenaline Salbutamol nebs Suspect IGA deficiency
- 27. TRALI Clinical Picture Noncardiogenic pulmonary edema Dyspnea, cyanosis, hypotension, fever, chills Develops within 1-2 hours of transfusion. Usually present by 4-6 hours Difficult to distinguish from Acute Respiratory Distress Syndrome
- 28. TRALI… Aetiology Antibodies against granulocyte, HLA class I or class II antigens Biologically active lipids in stored cellular blood components Pulmonary oedema arises from capillary injury rather than volume overload
- 29. TRALI… Investigations Hypoxaemia with respiratory alkalosis Bilateral pulmonary infiltrates persisting for 7 days at least No fluid overload / cardiac compromise
- 30. TRALI… Treatment Supportive ventilatory assistance Maintenance of haemodynamic status (e.g., saline infusion) Diuretics are contraindicated
- 31. Other complications Delayed haemolytic transfusion reaction Post transfusion purpura Transfusion associated graft versus host disease
- 32. HOW CAN WE HELP? Education Avoid unnecessary transfusions Dedicated multiple satellite packs Avoid using first time donors for transfusing infants Salvage techniques Autologous predeposit Recombinant erythropoietin Blood substitutes
- 33. Case 1 26 year old primip, bleeding profusely post partum Tachycardic, BP 80/40, conscious Labs Hb 5.4, WBC 16,000, Platelets 150,000
- 34. Case 2 20 year old student Drowsy, febrile, extensive petechiae after a brief illness Hb 8.2, WBC 6000, platelets < 5000, PT,PTT,Fibrinogen normal, creatinine 1.8
- 35. Peripheral smear
- 36. Case 3 32 year old male Admitted with suspected dengue fever Hb 17, WCC 3100, Platelets 12,000, extensive petechiae, PT 13/13, PTT 49/37 What do we do?
- 37. Thank you