blood and blood product

• Blood and blood products

  • Whole blood
  • Red cell concentrate
  • Plasma
  • Platelet concentrates
  • Cryoprecipitate
  • Albumin
  • Coagulation factor concentrates
  • Immunoglobulins
• Whole blood


  Unseparated blood collected into an approved container containing an anticoagulantpreservative solution

  
• Whole blood


  • There have been few widely accepted indications for whole blood in modern transfusion practice
  • Whole blood is not available from most blood banks in the United States
  • Dose: 6 ml/kg of WB raise Hemoglobin level 1 g/dl
  • One unit of WB will raise the hemoglobin of an average-size adult by ~ 1g/dl
  • During donation, blood is collected into a sterile, disposable, plastic pack which contains an anticoagulant-preservative solution
  • During storage, metabolism continues in the red cells and platelets, while some plasma proteins lose their biological activity

  
• Effects of storage on whole blood

  • Reduction in the pH (blood becomes more acidic)
  • Rise in plasma potassium concentration (extracellular K+)
  • Progressive reduction in the red cell content of 2,3 diphosphoglycerate (2,3 DPG)
  • Loss of all platelet function in whole blood within 48 hours of donation
  • Reduction in Factor VIII to 10–20% of normal within 48 hours of donation
• Packed RBCs


  The commonly utilized blood product, providing oxygencarrying capacity in cases most of acute or chronic blood loss
• Packed RBCs


  • Simple and inexpensive to prepare
  • It has a high ratio of red cells to plasma (high viscosity) thereby increasing the time required for transfusion through a small gauge needle or cannula
  • The white cells are a cause of febrile non-haemolytic transfusion reactions in some patients
• Leukocyte-depleted red cells


  Special leukocyte filters can be used to remove virtually all the white cells
• Leukocyte-depleted red cells


  • Reduces acute transfusion reactions
  • Reduces cytomegalovirus infection (CMV)
  • Cost: special blood packs and equipment are required
  • More skill and operator training is needed

  
• PRBCs transfusion guidelines

  1. Hemodynamic instability: Ongoing bleeding with unresponsive (or incompletely responsive) to infusion of 2- 3 Liters crystalloid

  2. Hemodynamically Stable: ICU Patients: Hemoglobin <7 g/dL, Post-Operative: Hgb ≤8 g/dL, Cardiovascular Disease: Hgb ≤8 g/Dl

  3. Dose: 4 ml/kg of RBC increase Hemoglobin level 1 g/dl

  4. One unit of RBC will raise the hemoglobin of an average-size adult by ~ 1g/dl

  5. Transfuse slowly for first 15 minutes

  6. Complete transfusion within 4 hours

  
• White cell transfusions have no proven clinical uses
• White cell transfusions


  • May be indicated in neutropenic patients with bacterial infections not responding to antibiotics
  • Transfused granulocytes have a very short circulatory life span, so that daily transfusions of 10 10 granulocytes are usually required
• Plasma


  • This is separated from whole blood and frozen at –25°C or colder within 6–8 hours of donation in order to preserve its labile coagulation factors (Factors V and VIII)
  • Fresh frozen plasma can be stored for at least one year or longer if low temperatures can be maintained
  • When plasma is stored at a temperature of 2–6°C, the labile clotting activity of Factors V and VIII will decline to 10–20% within 48 hours
• Plasma transfusion


  1. Dosage: Initial dose of 15 ml/kg

  2. Indications: International normalized ratio (INR) >1.5 with anticipated invasive procedure or surgery, massive hemorrhage, emergent reversal of anticoagulant (warfarin) therapy, treatment of isolated factor deficiencies, correction of coagulopathy associated with liver disease

  
• Platelets


  • The platelet count at 1 hour post transfusion of a unit of platelets should increase by 5,000 to 10,000 platelets/µL
  • Platelets separated from plasma obtained from 4–6 donations of whole blood are often pooled to produce a therapeutic dose of platelets for an adult platelet apheresis unit, by 30,000–60,000 × 10 9/L

  
• Platelet transfusion


  1. Dosage: 1 unit of platelet concentrate/10 kg body weight

  2. Indications: Thrombocytopenia or Dysfunctional platelets with active bleeding or bleeding tendency, Neurosurgical procedures: 100,000 platelets/µL, Vaginal delivery and minor surgical procedures: <50,000/µL, Massive transfusion: < 50,000 platelets/µL, Disseminated intravascular coagulation: 20,000–50,000 /µL

  
• Cryopreciptate


  • Cryoprecipitate is obtained from a single donation of FFP at about 4°C and is rich in factor VIII, von Willebrand factor (VWF), factor XIII, and fibrinogen
  • Cryoprecipitate is usually administered as a transfusion of 10 single units
  • Each 5- to 15-mL unit contains over 80 units of factor VIII and about 200 mg of fibrinogen

  
• Cryoprecipitate transfusion


  Indications: Hemophilia A, von Willebrand disease, Hypofibrinogemia, Uremic bleeding

  
• Complications of blood transfusion

  • Immune Complications
  • Infectious Complications
  • Massive Blood Transfusion Complications

  
• Immune Complications


  • Hemolytic reactions
  • Nonhemolytic reactions
• Hemolytic reactions


  Primarily due to sensitization of the recipient to donor red cells, white cells, platelets, or plasma proteins
• Acute hemolytic reaction


  Usually due to ABO blood incompatibility, with a reported frequency of approximately 1:38,000 transfusions

  
• Management of hemolytic reaction

  1. Stop the transfusion immediately and notify the blood bank

  2. Recheck the unit against the blood slip and the patient's identity bracelet

  3. Draw blood to identify hemoglobin in plasma, repeat compatibility testing, and obtain coagulation studies and a platelet count

  4. Insert a urinary catheter and check the urine for hemoglobin

  5. Initiate osmotic diuresis with mannitol and intravenous fluids

  
• Delayed hemolytic reaction

  Generally mild and is caused by antibodies to non-D antigens of the Rh system or to foreign alleles in other systems such as the Kell, Duffy, or Kidd antigens
• Nonhemolytic immune reactions

  • Febrile Reactions
  • Urticarial Reactions
  • Anaphylactic Reactions
  • Transfusion-Related Acute Lung Injury (TRALI)
  • Graft-Versus-Host Disease
  • Post-Transfusion Purpura
  • Transfusion-Related Immunomodulation
• Transfusion-Related Acute Lung Injury (TRALI)


  Presents as acute hypoxia and noncardiac pulmonary edema occurring within 6 h of blood product transfusion, thought to be due to transfusion of antileukocytic or anti-HLA antibodies

  
• Infectious complications


  • Viral Infections: Hepatitis C, Acquired Immunodeficiency Syndrome (AIDS), Cytomegalovirus (CMV) and Epstein–Barr virus
  • Parasitic Infections: malaria, toxoplasmosis, and Chagas' disease
  • Bacterial Infections: Both gram-positive (Staphylococcus) and gram-negative (Yersinia and Citrobacter) bacteria
• Complications of massive blood transfusion

  • Coagulopathy
  • Hypothermia
  • Citrate Toxicity
  • Acid–Base Balance
  • Serum Potassium Concentration