Dr Shahnawaz Leghari

1. BLOOD AND IT’S COMPONENT
THERAPY

2. BLOOD :
INTRODUCTION:
Blood is a specialized fluid which consist of liquid and cellular elements.
Liquid part is specialized protein rich fluid known as plasma
Cellular elements which are suspended in it are
o RBC
o WBC
o PLATELETS
Total circulatory blood volume is about 8% of body weight.

3. Functions :
• Deliver oxygen to tissues.
• Nutrients and constitutional elements such as A.A. to tissue.
• Remove waste products
• Acts as a highway for hormones to reach their destined target
tissue.
• Forms blood clots and prevent itself from being lost excessively.

5. RED BLOOD CELLS :
 Carry hemoglobin in circulation.
 Biconcave disks in shape.
 Life span of 120 days.
 Average RBC count is approx.: 5.4 million/microliter in male
and 4.8 million/microliter in female.
 Diameter is 7.5 micrometer.
 Thickness is 2 micrometer.

6. Characteristics Of Red Blood Cells:
MALE FEMALE
HCT 47 42
RBC 5.4 4.8
HB 16 14
MCV 87 87
MCH 29 29
MCHC 34 34
MCD 7.5 7.5

7. WHITE BLOOD CELLS :
There are various types of white blood cells. These are
 Polymorphonuclear leukocytes (most abundant cells)
o Neutrophils
o Eosinophils
o Basophilic.
 Lymphocytes.
 Monocytes.
Acts as powerful defense against tumor and infectious agent.
Range 4000-11000 per microliter.

8. PLATELETS :
 Range 200000-500000 per microliter.
 Small granulated bodies that lack nuclei and
aggregate at site of injury.
 Diameter is 2-4 micrometer
 Half life is 4 days.

9. PLASMA :
1. It’s a remarkable fluids which contains
o Ions.
o Inorganic molecules.
o Organic molecules.
 Consist of 5% of body weight.
 Few plasma proteins are mention below
o Albumin
o Globulin
o Fibrinogen

10. NORMAL VALUES FOR THE CELLULAR
ELEMENTS IN HUMAN BLOOD
CELLS Cells/μL Approximate Normal Percentage of Total White
Cells
Total White Blood Cells
Granulocytes
9000 4000–11,000
Neutrophils 5400 3000-6000 50-70
Eosinophils 275 150-300 1-4
Basophils 35 0-100 0.4
Lymphocytes 2750 1500-4000 20-40
Monocytes 540 300-600 2-8
Erythrocytes
Male 5.4 * 106
Female 4.8 * 106
Platelets 300000 200000-500000

13. History of blood transfusion :
1492 Pope innocent VIII suffers a stroke and receive a blood transfusion from 3 10 years old boy. All of them died later.
1665 Richard lower in oxford conducts the first successful canine transfusion.
1667 Jean-Baptiste denis reports successful sheep-human transfusions.
1678 Animal and human transfusion are banned in France because of poor result.
1818 James Blundell perform 1st successful/documented human transfusion in a woman suffering post-partum haemorrhage.
1901 Karl Landsteiner discovers ABO system.
1914 Belgian physician albert hustin performed first non-direct transfusion using sodium citrate as anti-coagulant
1926 British Red Cross instituted the first blood transfusion service in world.
1939 Rhesus system was identified and recognized as major cause of transfusion reactions.

15. COMPONENTS OF BLOOD :
A constituent of blood, separated from whole blood.
few are listed below :
 Packed red cells.
 Fresh Frozen Plasma.
 Cryoprecipitate.
 Platelets
 Granulocyte transfusion.
 Prothrombin complex concentrates.
 Factor 8 concentrate
 Factor 9 concentrate
 Other plasma fractions :
 Albumin
 Gamma globulin

16. COMPONENTS THERAPY AND THEIR
INDICATIONS:
1. Whole blood:
 Although its ideal to replace the lost blood with whole
blood
 Nowadays its rarely used.

18. PACKED RED CELLS:
a. Main aim of transfusion here is to increase the oxygen-carrying capacity
of blood in anemic or bleeding patients.
b. Packed red blood cells are spun down and concentrated packs of red
blood cell s
c. Each unit is approx. 330ml and has hct of 50-70%
d. 1 unit increase Hb by .08-1 g/dl or Hct 3%
e. Stored at 2-6 Celsius.

19. PERIOPERATIVE RBC TRANSFUSION
CRITERIA :
Hb Level Indications
< 6 Probably will benefit for transfusion
6-8 Transfusion unlikely to be benefit in the absence of bleeding
or impending surgery
> 8 No indication for transfusion in the absence of other risk
factors

20. PLATELETS :
 Prepared either from whole blood by centrifugation or by platelet
pheresis of single or multiple donors.
 Supplied as a pooled platelet concentrate and contain about 250*109
/l
 Stored for 5 days at 20-24 celsius.
 1 unit of platelets increase the platelet count by approx.: 30-
50*109/l .
 Indications:
Non-bleeding, stable inpatients : 10*109/l
Non-bleeding stable outpatients : 20*109/l
Major invasive procedures or bleeding : 50*109/l
Operation at critical sites such as brain and eyes : 100*109/l.

21. Contraindication for Platelet transfusion :
Autoimmune idiopathic thrombocytopenic purpura
Thrombotic thrombocytopenic purpura.
Heparin induced thrombocytopenia
Bleeding due to coagulopathy

22. FRESH FROZEN PLASMA :
 Prepared by removing from fresh blood and freezing it at -30 celsius
to preserve liable clotting factors.
 It contains normal levels of all coagulation factors.
 Frozen with in 8 hours of collection
 Stored at -40 - -50 celsiuS
 Usual dose is 10-20ml/kg
 Volume is approx.: 200-250ml.

23. Indication
PT or aPTT 1.5 Times normal in a bleeding patient.
Warfarin overdose with life threatening bleeding
Patients with multiple coagulation defects resulting from
hepatic insufficiency.
DIC
Factors def for which specific factors conc: are unavailable
Liable clotting factors have been depleted by transfusion of
very large volumes of old blood stored.

24. CRYOPRECIPITATE :
It’s a supernatant precipitate of FFP.
Contents : factor 8,13, VWF and fibrinogen
1 unit = 20 ml of volume
1 unit increases fibrinogen conc: by 7-8mg/dl
Usually administered in pool of 5 to 10 units
Stored at -30 celsius
Shelf life of 2 years.
Indications :
DIC
Low fibrinogen states

25. GRANULOCYTE CONCENTRATES :
Prepared from whole blood as buffy coats
Uses:
Patients with severe neutropenia with definitive evidence of
bacterial infections.

26. PROTHROBIN COMPLEX
CONCENTRATES :
These are highly purified concentrates prepared from pooled
plasma
Prepared with two formulations
3 factors: 2,9 and 10
4 factors: 2,7,9 and 10
Indications:
Emergency reversal of anticoagulant warfarin therapy in
uncontrolled hemorrhage.
Treatment or prophylaxis of bleeding in congenital deficiency
of vitamin k dependent factor

27. FACTOR 8 AND 9 CONCENTRATION:
Freeze dried preparations
Prepared from large pools of plasma
Indications:
Hemophilia
Von Willebrand's disease (where recombinant factors aren’t
available)

28. ALBUMIN :
Two preparations :
Human Albumin Solution 4.5%
Human Albumin Solution 20%
Indications:
Acute severe hypoalbuminemia
Replacement of fluid for plasma exchange
20% albumin solution is particularly useful for nephrotic syn and
liver disease who are fluid overloaded and resistant to diuretics

29. COMPLICATIONS:
IMMUNOLOGICAL NON-IMMUNOLOGICAL
Alloimmunization and incompatibility Transmission of infection:
Red Cells:
 Immediate haemolytic transfusion reaction
 Delayed haemolytic transfusion reaction
Viruses:
HAV,HBV,HCV,HI
V,HHV8
Parasites:
Malaria,
toxoplasmosis
Bacteria
Yersinia
enterocolitica
Staphylococcus
spp
Leukocytes and platelets :
 Non haemolytic transfusion reaction
 Post transfusion purpura
 Poor survival of transfused platelets and granulocytes
 Graft versus host disease
 Lung injury (TRALI)
Iron overload due to multiple transfusion
Massive transfusion
Thrombophlebitis
Circulatory failure due volume overload
(TACO)
Plasma proteins:
Urticarial and anaphylactic reactions

30. MODIFICATIONS OF BLOOD PRODUCTS:
 Leukoreduction :
 CMV- Seronegative :
 Gamma-irradiation :
 Washing :