This document provides information on various blood products and massive blood transfusion. It defines massive blood transfusion as replacing one entire blood volume within 24 hours or transfusing over 10 units of packed red blood cells in 24 hours. It describes components of blood like whole blood, packed red blood cells, plasma, platelets, and plasma derivatives. It discusses indications, storage, and risks of these products. It also outlines complications of massive transfusion like coagulopathy, hypothermia, acidosis, and circulatory overload and targets for resuscitation like maintaining hemoglobin, coagulation factors, platelets, pH, and temperature.
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
Blood, Blood transfusion and Blood products bijay19
This presentation give idea about blood, blood transfusion importance and things to note during transfusion...It shows various blood products, its indications and contraindications. the complication of blood transfusion
Blood product transfusion and massive transfusionpankaj rana
Blood transfusion
Plastic bag 0.5–0.7 liters containing packed red blood cells in citrate, phosphate, dextrose, and adenine (CPDA) solution
Plastic bag with 0.5–0.7 liters containing packed red blood cells in citrate, phosphate, dextrose, and adenine (CPDA) solution
ICD-9-CM 99.0
MeSH D001803
OPS-301 code 8-80
MedlinePlus 000431
[edit on Wikidata]
Blood transfusion is generally the process of receiving blood or blood products into one's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets.
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
Blood, Blood transfusion and Blood products bijay19
This presentation give idea about blood, blood transfusion importance and things to note during transfusion...It shows various blood products, its indications and contraindications. the complication of blood transfusion
Blood product transfusion and massive transfusionpankaj rana
Blood transfusion
Plastic bag 0.5–0.7 liters containing packed red blood cells in citrate, phosphate, dextrose, and adenine (CPDA) solution
Plastic bag with 0.5–0.7 liters containing packed red blood cells in citrate, phosphate, dextrose, and adenine (CPDA) solution
ICD-9-CM 99.0
MeSH D001803
OPS-301 code 8-80
MedlinePlus 000431
[edit on Wikidata]
Blood transfusion is generally the process of receiving blood or blood products into one's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets.
Seminar of U.V. Spectroscopy by SAMIR PANDASAMIR PANDA
Spectroscopy is a branch of science dealing the study of interaction of electromagnetic radiation with matter.
Ultraviolet-visible spectroscopy refers to absorption spectroscopy or reflect spectroscopy in the UV-VIS spectral region.
Ultraviolet-visible spectroscopy is an analytical method that can measure the amount of light received by the analyte.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
Richard's entangled aventures in wonderlandRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
(May 29th, 2024) Advancements in Intravital Microscopy- Insights for Preclini...Scintica Instrumentation
Intravital microscopy (IVM) is a powerful tool utilized to study cellular behavior over time and space in vivo. Much of our understanding of cell biology has been accomplished using various in vitro and ex vivo methods; however, these studies do not necessarily reflect the natural dynamics of biological processes. Unlike traditional cell culture or fixed tissue imaging, IVM allows for the ultra-fast high-resolution imaging of cellular processes over time and space and were studied in its natural environment. Real-time visualization of biological processes in the context of an intact organism helps maintain physiological relevance and provide insights into the progression of disease, response to treatments or developmental processes.
In this webinar we give an overview of advanced applications of the IVM system in preclinical research. IVIM technology is a provider of all-in-one intravital microscopy systems and solutions optimized for in vivo imaging of live animal models at sub-micron resolution. The system’s unique features and user-friendly software enables researchers to probe fast dynamic biological processes such as immune cell tracking, cell-cell interaction as well as vascularization and tumor metastasis with exceptional detail. This webinar will also give an overview of IVM being utilized in drug development, offering a view into the intricate interaction between drugs/nanoparticles and tissues in vivo and allows for the evaluation of therapeutic intervention in a variety of tissues and organs. This interdisciplinary collaboration continues to drive the advancements of novel therapeutic strategies.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
This presentation explores a brief idea about the structural and functional attributes of nucleotides, the structure and function of genetic materials along with the impact of UV rays and pH upon them.
2. BLOOD PRODUCT:
Any therapeutic substance prepared from human blood.
WHOLE BLOOD:
Unseparated blood collected into an approved container containing an
anticoagulant-preservative solution.
BLOOD COMPONENT:
A constituent of blood, separated from whole blood,
such as:
Red cell concentrate
Red cell suspension
Platelet concentrates
Fresh Frozen Plasma
Cryoprecipitate
PLASMA DERIVATIVE:
Albumin
Coagulation factor concentrates
Immunoglobulins
3. WHOLE BLOOD
A 450 ml whole blood donation contains Up to 510 ml total
volume (volume may vary in accordance with local policies)
450 ml donor blood
63 ml anticoagulant-preservative solution
Haemoglobin approximately 12 g/ml
Haematocrit 35%–45%
No functional platelets
No labile coagulation factors (V and VIII)
Infection risk: capable of transmitting any agent which has not
been detected by routine screening including HIV-1 and HIV-2,
hepatitis B and C , syphilis, malaria.
Storage is between +2°C and +6°C.
Shelf life ACD/CPD - 21 days CPDA-1: 35 days
SAG-M (saline+adenine+glucose+mannitol)- 42
Transfusion should be started within 30 minutes of removal
from refrigerator
4. Indications: Red cell replacement in acute blood loss with
hypovolaemia
Exchange transfusion
Patients needing red cell transfusions where red cell
concentrates or suspensions are not available
Contraindications: Risk of volume overload in patients with
Chronic anaemia
Incipient cardiac failure
Must be ABO and RhD compatible with the recipient
Complete transfusion within 4 hours of commencement
A unit of whole blood ( approximately 350ml) will increase haemoglobin
by about 0.75g/dl
while a unit of 450 ml by 1g/dl in an adult patient of about 60-70 kg
who is not actively bleeding.
In pediatric patients the transfusion of 8ml/kg will increase the
haemoglobin by approx. 1g/dl
5. RED CELL CONCENTRATE (‘Packed red
cells’, ‘plasma-reduced blood’)
150–200 ml red cells from which most of the plasma has been
removed
Haemoglobin approximately 20 g/100 ml (not less than 45 g
per unit)
Haematocrit 55%–75%
Infection risk & Storage: Same as whole blood
Indications: Replacement of red cells in anaemic patients
Use with crystalloid replacement fluids or colloid solution in
acute blood loss
6. RED CELL SUSPENSION
150–200 ml red cells with minimal residual plasma to which
±100 ml normal saline, adenine, glucose, mannitol solution (SAG-
M) or an equivalent red cell nutrient solution has been added
Haemoglobin approximately 15 g/100 ml (not less than 45 g
per unit)
Haematocrit 50%–70%
Infection risk, Storage: Same as whole blood
Shelf life – 42 days
Indications: Same as red cell concentrate
7. LEUCOCYTE-DEPLETED RED CELLS
A red cell suspension or concentrate containing <5 x 106 white
cells per pack, prepared by filtration through a leucocyte-depleting
filter
Haemoglobin concentration and haematocrit depend on whether
the product is whole blood, red cell concentrate or red cell
suspension
Leucocyte depletion significantly reduces the risk of
transmission of cytomegalovirus (CMV)
Infection risk : same as whole blood
Storage: 4+/-2 °C for 35 days
Minimizes white cell immunization in patients receiving repeated
transfusions
Indicated in patients who have two or more previous febrile
reactions to red cell transfusion
8. PLATELET CONCENTRATES
1) Random donor platelets (prepared from whole blood donations)
Single donor unit in a volume of 50–60 ml of plasma should contain:
At least 55 x 109 platelets
<1.2 x 109 red cells
<0.12 x 109 leucocytes
Pooled unit: platelets prepared from 4 to 6 donor units ‘pooled’ into one
pack to contain an adult dose of at least 3 × 1010 platelets in 150-200 ml
plasma.
2) Apheresis Platelets: Obtained by apheresis.
One apheresis platelet concentrate is equivalent to 6 random donor
platelet concentrates and hence the number of donor exposures is
reduced.
Apheresis platelets contain 3 × 1011 platelets in 150-300 ml of plasma
Infection risk : Same as whole blood. Bacterial contamination affects
9. Storage: Up to 72 hours at 20°C to 24°C. Do not store at 2°C to 6°C.
Indications :Amegakaryocytic thrombocytopenia, Drug or radiation
induced hypoplasia, functional platelet abnormalties, viral diseases
associated with thrombocytopenia e.g. Dengue, Disseminated
intravascular coagulation
Dosage
Random Donor Platelets:
Adult: 1 unit/10 kg body weight ( minimum 6 units)
1 unit raises 5000-10,000 platelets/ul
Child: 1 unit/10 kg body weight
1 unit raises 20,000 platelets/ul
Neonate: 1 unit/2.5 kg body weight
1 unit raises 75,000-1,00,000 platelets/ul
Apheresis platelets:
Adult: 1 unit , raises 25000-30,000 platelets/ul
To be infused generally within 4 hours, because of the risk of bacterial
proliferation. Must not be refrigerated before infusion as this reduces
platelet function.
10. FRESH FROZEN PLASMA
Pack containing the plasma separated from one whole blood donation
within 6 hours of collection and then rapidly frozen to –25°C or colder
FFP of 175-250 ml contains
70-80 units/dl of factor VIII, factor IX, vWF and other clotting factors.
Fibrinogen 200-400 mg
Infection risk : If untreated, same as whole blood
Very low risk if treated with methylene blue/ultraviolet light inactivation
Storage: At –25°C or colder for up to 1 year
Before use, should be thawed in the blood bank in water which is
between 30°C to 37°C.
Dosage: Initial dose of 15 ml/kg.
Labile coagulation factors rapidly degrade; use within 6 hours of
thawing
11. Indications: Replacement of multiple coagulation factor
deficiencies: e.g.
— Liver disease
— Warfarin (anticoagulant) overdose
— Depletion of coagulation factors in patients receiving
large volume transfusions
Disseminated intravascular coagulation (DIC)
Thrombotic thrombocytopenic purpura (TTP)
12. CRYOPRECIPITATE
Prepared from fresh frozen plasma by collecting the precipitate
formed during controlled thawing at +4°C and resuspending it in
10–20 ml plasma
10-20 ml contains Factor VIII 80 – 120 IU, Fibrinogen 150 – 250
mg
Von-Willebrand Factor 40 – 70 % 0f original FFP, Fibronectin
55 mg, Factor XIII 20 – 30 % 0f original.
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
Must be infused within 6 hours of thawing
Each unit of Cryo raises Factor VIII by 2%, to achieve plasma
factor VIII rise of 20%, 10units/kg have to be infused
13. 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)
— Factor XIII
As a source of fibrinogen in acquired coagulopathies:
e.g. disseminated intravascular coagulation (DIC)
14. PLASMA DERIVATIVES
ALBUMIN:
Preparations
Albumin 5%: contains 50
mg/ml of albumin
Albumin 20%: contains 200
mg/ml of albumin
Albumin 25%: contains 250
mg/ml of albumin
Indications:
nephrotic syndrome
liver disease with fluid
overload
IMMUNOGLOBULINS
Concentrated solution
of the IgG antibody
component of plasma
Indications
Idiopathic autoimmune
thrombocytopenic purpura
Treatment of immune
deficiency states
Hypogammaglobulinaemia
Prevention of specific
infections
15. FACTOR VIII CONCENTRATE
Factor VIII ranges from 0.5–20
iu/mg of protein.
Vials of freeze-dried protein
labelled with content, usually
about 250 iu of Factor VIII.
+2°C to +6°C up to stated expiry
date
Indications:
• Treatment of haemophilia A
Treatment of von Willebrand’s
disease: use only preparations
that contain von Willebrand
Factor
Factor IX
• Vials of freeze-dried protein
labelled with content, usually
about 350–600 iu of Factor IX
• +2°C to +6°C up to stated
expiry date
Indications
• Treatment of haemophilia B
(Christmas disease)
Immediate correction of
prolonged ✔
prothrombin time
16. MASSIVE OR LARGE VOLUME BLOOD
TRANSFUSIONS
Replacement of one entire blood volume within 24h
Transfusion of >10 units of packed red blood cells (PRBCs) in
24 h
Transfusion of >20 units of PRBCs in 24 h
Transfusion of >4 units of PRBCs in 1 h when on-going need is
foreseeable
Replacement of 50% of total blood volume (TBV) within 3 h.
MASSIVE TRANSFUSION PROTOCOL
designed to interrupt the “lethal triad”
HYPOTHE
-RMIA
ACIDOSIS
COAGULO
-PATHY
17. Massive transfusion protocols are activated by a clinician in
response to massive bleeding.
Generally this is activated after transfusion of 4-10 units.
Massive transfusion protocols have a predefined ratio of RBCs,
FFP/cryoprecipitate and platelets units (random donor platelets)
(e.g. 1:1:1 or 2:1:1 ratio) for transfusion.
COMPLICATIONS OF MASSIVE TRANSFUSION
Problems secondary to volume resuscitation
Inadequate resuscitation: Hypoperfusion leads to lactic
acidosis, systemic inflammatory response syndrome (SIRS),
disseminated intravascular coagulation and multiorgan
dysfunction.
Transfusion Associated Circulatory Overload: This is a well-
known condition that occurs due to rapid transfusion of blood or
blood products.
18. Dilutional coagulopathy:
During haemorrhagic shock, there is fluid shift from the
interstitial to the intravascular compartment that leads to dilution
of the coagulation factors. This is further accentuated when the
lost blood is replaced with fluids.
Citrate toxicity:
• 80 ml of citrate phosphate dextrose adenine solution present in
each blood bag
contains approximately 3 g citrate. A healthy adult can metabolise
this load in 5 min.
• Hypoperfusion or hypothermia associated with massive blood
loss can decrease this rate of metabolism leading to citrate
toxicity.
• Unmetabolised citrate can then lead to hypocalcaemia,
hypomagnesemia and worsen the acidosis.
• Hypocalcaemia can lead to myocardial depression that
• Calcium supplementation is thus required in most cases.
19. Hyperkalaemia:
Potassium concentrations in PRBCs can range from 7 to 77
mEq/L depending on age of stored blood.
Development of hyperkalaemia will depend on the underlying
renal
function, severity of tissue injury and rate of transfusion.
At transfusion rates exceeding 100-150 ml/min, transient
hyperkalaemia is frequently seen.
Hypothermia:
Factors contributing to hypothermia include infusion of cold
fluids and blood and blood products.
Hypothermia leads to decreased citrate metabolism and
decreased platelet function contributing coagulopathy.
Hypomagnesemia: Citrate also binds to magnesium and can
lead to hypomagnesaemia which can further accentuate effects of
hypocalcaemia
20. Acidosis
Acidosis directly reduces activity of both extrinsic and intrinsic
coagulation pathways.
A pH decrease from 7.4 to 7.0 reduces the activity of FVIIIa and
FVIIa by over 90% and 60% respectively.
Late complications
Respiratory failure
Transfusion related acute lung injury (TRALI): The risk of TRALI
increases with the number of blood and blood products transfused.
SIRS
Sepsis
Thrombotic complications
21. Targets of resuscitation in massive blood loss
Mean arterial pressure (MAP) around 60 mmHg, systolic
arterial pressure 80-100 mmHg (in hypertensive patients one
may need to target higher MAP)
Hb 7-9 g/dl
INR <1.5; aPTT <42 s
Fibrinogen >1.5-2 g/L
Platelets >50 × 10 /L
pH 7.35-7.45
Core temperature >35.0°C