This document discusses blood component transfusion. It defines blood components as any therapeutic substance prepared from human blood, including whole blood, red blood cells, platelets, plasma, cryoprecipitate, and growth factors. It describes how whole blood is separated into components through centrifugation. It provides indications, storage requirements, and dosages for transfusing various blood components in pediatric patients. Potential complications of transfusion like acute reactions, late infections, and iron overload are also summarized. The document concludes with SKMCH&RC transfusion protocols.
3. What is history of transfusion?
What are Blood components ?
How are the blood component separated ?
What are the Indications for transfusion ?
What is the dose of administration in paeds?
What are complications?
How to minimize the errors?
What are the SKMCH protocol?
4. Blood transfused in humans since mid-1600’s
1828 – First successful transfusion
1900 – Landsteiner described ABO groups
1916 – First use of blood storage
1939 – Levine described the Rh factor
HISTORY OF TRANSFUSIONS
5. BLOOD components
Any therapeutic substance prepared from human blood
WHOLE BLOOD
Unseparated blood collected into an approved container
containing an anticoagulant preservative solution
BLOOD COMPONENT
• RBCs
• platelets
• Plasma
• Cryoprecipitate
• GCSF
• Human albumin 4.5%
DEFINITIONS
11. Storage
On 4° for up to 35 days
Indications
Massive Blood Loss/Trauma/Exchange Transfusion
Considerations
Donor and recipient must be ABO identical
Dosage
10 to 20 ml /kg
Never add medication to a unit
WHOLE BLOOD TRANSFUSION
12. Storage
4° for up to 42 days, can be frozen
Indications
Many indications ie anemia Hb < 7, hypoxia, etc.
dosage
Dose 10 to 15ml/kg Usually transfuse over 2-4 hours
or
Volume required = required rise in Hb in g/dl x wt in kg x 4
or
3-4 mls/kg of red cells raises Hb by 1g/dl
PRBCS TRANSFUSION
13. Storage
Up to 5 days at 20-24°
Indications
Lumbar puncture - transfuse prior to LP to bring platelets > 50 x 109/l.
Major surgery - maintain platelet count > 50 x 109/l (critical sites; brain,
spine, eyes > 100 x 109/l).
Minor surgery - maintain platelet count at >50 x 109/l
Line insertion - > 50 x 109/l.
Line removal - > 50 x 109/l.
Bone marrow trephine - Usually no need to transfuse - discuss with
operator. In some patients (e.g. aplastics or ITP), platelet transfusion
should be avoided if possible.
Bone marrow aspirate - no need to transfuse.
PLATELETS TRANSFUSION
14.
15. Dosage of platelets
10-20mls/kg for children
There may be a higher requirement in the following circumstances:
Active haemorrhage
Sepsis
Splenomegaly
Consumptive coagulopathy – e.g. DIC
PLATELETS TRANSFUSION
CONTINUE…
16. Storage
FFP--12 months at –18 degrees or colder
Indications
Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease,
exchange transfusion, massive transfusion,warfarin overdose, INR > 1.5 TO 2
befor surgery
Dose : 10-20mls/Kg
Considerations
Plasma should be recipient RBC ABO compatible
In children, should also be Rh compatible
Usual dose is 20 cc/kg to raise coagulation factors approx 20%
FFP TRANSFUSION
17. Rich source of Factor VIII, von Willebrand’s factor and fibrinogen
Stored at -400C
Dose of cryoprecipitate
5 ml/kg
Cryoprecipitate is available in most ABO groups
Use within 4h of thawing
use
Haemophilia (Factor VIII deficiency)
Fibrinogen deficiency & dysfibrinogenaemia
Von Willebrand’s disease
CRYOPRECIPITATE
18.
19. Rich in protein
This may be stored for several months in liquid form at 40C
Suitable for replacement of protein e.g. following severe burns ,liver
disfuntion
HUMAN ALBUMIN 4.5 PER CENT
20. INDICATION & DOSE
In severe neutropenia in myelosuppresive chemotherapy
Initially 5mcg/kg/SC & can increase 5mcg/kg every cycle till anc10,000/mm3
BONE MARROW TRANSPLANT
10mcg/kg/day IV over 4 to 24 hours
IN SEVERE CHRONIC NEUTROPENIA
SITE
Abdomen (not around umbbilicus) ,thighs ,hips ,arm (rotate the site)
Keep refrigerated and do not shake before administration
G-CSF (FILGRASTIM
21. 21
Blood/ Start infusion Complete infusion
blood product
Whole blood/ within 30 min. of within 4 hour
red cells removing pack (less in high
from ambient temperature)
refrigerator
Platelet immediately within 20 min
concentrates
FFP within 30 min within 20 min
Time Limits for Infusion
28. Causes
Pulmonary microvascular occlusion by microaggregates of platelets,
leucocytes and fibrin
Presentation
Fever, breathlessness, nonproductive cough, hypoxemia
TRANSFUSION RELATED
ACUTE LUNG INJURY
29. Delayed haemolytic Transfusion reaction
Occurs in patients whose level of antibodies to antigen is so low that it escapes
detection by pretransfusion screen. Following transfusion , the secondary
immune response raises the antibody titre to a level that results in delayed
destruction of transfused cells
Presentation- fever falling Hb, jaundice & haemoglobinuria after 5-10 days
SENSITIZATION
Development of antibodies to donated white cells & platelets
GRAFT-VERSUS-HOST DISEASES
Occurs in immunodeficient patients
Immunocompetent patients after tansfusion of blood from a relative
Disease is caused by T-lymphocytes
Prevented by administrating gamma-irradiated cellular components to
immunodeficient patients & blood from relative should be gamma irradiated
LATE COMPLICATIONS
30. Every unit of blood contains 250 mg of iron
Repeated transfusions cause iron overload of monocyte-macrophage system
Becomes significant after 100 units
Involves liver, pancrease, myocardium and the endocrine glands
Treatment
Chelation therapy with desferrioxamine
HAEMOSIDEROSIS
31. Transmission of infective diseases
Serum hepatitis virus
HIV
Bacterial infection-result of faulty storage
Malaria
INFECTIVE COMPLICATIONS
32. Arrange required blood product as you suspect any need
If a patient need blood in emergency doctor can request blood bank
Patient can get blood at exchange basis too
We take consent for all type of blood transfusion when patient admit on
floor
Written orders for blood transfusion should be given by Dr
Repeat the sample after completion of transfusion
If any reaction occur manage the patient immedietly
Fill the blood reaction form and send the blood sample for culture and
recross match and remaining blood to the blood bank
Document the probelum online
HOW DO WE DO IT IN SKMCH
&RC