Blood Component Therapy

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Blood Component Therapy

• Salwa I Hindawi
• MSc FRCPath CTM
• Director of Blood Transfusion Services
• KAUH . Jeddah

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RBC Agglutination
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ABO type

• Pt Cells Pt Serum
• vs vs
• anti-A anti-B Acells Bcells
• A 0 0 40
• B 0 0 11
• AB 0 0 4
• 0 0 0 45

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BLOOD COMPONENT THERAPY

• It is the transfusion of specific blood
  components required by the patient.
• Principles
• Use blood products only when it is essential.
• Replace only the deficient component, if
  possible.
• Identify the cause and nature of the deficiency
  and if possible, treat it.

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Platelets rich plasma
Platelets concentrate
2nd centrifugation
Whole blood
Whole blood
Whole blood
1stcentrifugation
FFP for clinical use
Red Cell concentrate
FFP for fractionation
Fresh plasma
Optimal additive solution
Cryoprecipitate
Red cells in OAS
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Blood COMPONENTS AVAILABLE FROM THE BLOOD BANK

• Whole blood
• Packed RBCs
• Platelets
• Single donor platelets (Apheresis)
• Fresh Frozen Plasma (FFP)
• Cryoprecipitate

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Indication for Red Blood Cells Transfusion

• Red blood cells are component of choice to
  maintain an adequate supply of oxygen to meet
  tissue demands.One unit increase the haemoglobin
  level by 1g/dL in a 70kg recipient.

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Indication for Transfusion of Whole Blood

• Fresh whole bloodlt5 days old is often used for
  exchange transfusion in newborns.
• Stored whole blood can be used in actively
  bleeding patients who have lost gt 30-40 of their
  blood volume.

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Indication for red blood cells Transfusion

• Symptomatic anaemia
• Acute blood lossgt30-40 of blood volume.
• Pre-operative Hblt 8g/dl and operative procedure
  associated with major blood loss.
• Evidence of inadequate oxygen delivery.

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Administration and Dose

• Red blood cells transfusion has to be grouped
  specific Rh specific, if not one of alternative
  compatible group.
• This component must be administered through a
  suitable transfusion set (170 mM filter).
• Dose of 4ml/kg raises venous Hb by about 1g/dl.

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Specifications

• Whole blood volume 450mls63mls of CPD-A1
  anticoagulant.
• Packed RBCs volume 250mls50mls.
• Hct0.55-0.75.
• Anticoagulant CPD-A1 store at 4c2c for 35
  days.
• SAG-M for 42 days.

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Indication for Platelet Transfusion

• Decrease platelet production (Bone marrow
  failure)
• Therapeuticfor patient who are bleeding
  associated with BMF caused by either disease,
  therapy or irradiation.
• Prophylactic gt10x 109/L to decrease morbidity in
  patients with thrombocytopenia due to B.M.F.

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Cont, Platelet Transfusion

• In acute D.I.C (Disseminated intravasculr
  coagulation).
• In neonatal alloimmune thrombocytopenia (NAIT)
  from donor known to be negative for the
  appropriate HPA or mother platelet.
• Platelet function disorders or thrombocytopenia
  lt50x 109/L going for invasive procedure, for
  operation in critical sites such as the brain or
  eyes the platelet count should be raised to
  100x109/L.
• In massive blood transfusion, the platelet count
  to be maintained above 50x109 /L.

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Administration of Platelet Concentrate

• ABO compatible platelet are preferred but not
  necessary.
• Platelet concentrate should be transfused as soon
  as possible after reaching the ward with standard
  blood transfusion sets with 170 mm filters.
• The transfusion should normally be completed
  within 30 minutes.
• Observation during platelet transfusion should
  include pulse temperature before after
  transfusion.

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Indications For The Use Of FFP

• Definite indication
• Replacement of single factor deficiencies
• Immediate reversal of warfarin effect
• Vitamin K deficiency
• Acute disseminated intravascular coagulation
• Thrombotic thrombocytopenic purpura
• Inherited deficiencies of inhibitors of
  coagulationat, protein S, protein C.
• CI esterase inhibitor deficiency

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Conditional uses of FFP

• FFP is only indicated in the presence of bleeding
  and disturbed coagulation.
• Massive transfusion
• Liver disease
• Cardiopulmonary bypass surgery
• Special Paediatric indications
• sever sepsis, DIC.

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Administration of FFP

• 1unit of FFP APPROXIMATELY 200 ML
• Dose 12-15 ml/kg
• Should be administered within 2 hours of thawing.
• PT PTT used for monitoring in addition to the
  clinical assessment.
• ABO compatible FFP should be used. Compatibility
  testing is not required.
• Group O should only be given to group O
  recipient.
• Group A or B FFP can be given to group O
  recipient.
• Group AB FFP should be reserved for group AB
  recipients and for emergencies.

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Indications for The Use Of Cryoprecipitate1-co
ngenital or Acquired Fibrinogen
Deficiency.2-Haemophilia A, vonWillebrands
Disease.3-factor X111 Deficiency4-disseminated
intravascular coagulopathy(DIC).
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Administration of Cryoprecipitate

• 1 unit of cryo approximately 10-20ml
• Adult dose equivalent to 10 units of cryo
• For factor replacement the dose can be calculated
  according to the volume of the factor in the
  concentrate.
• Fibrinogen 150-300mg/pack
• Von Willebrand factor 80-120u/pack
• Factor V111c 80-120u/pack
• Factor X111 20-30 of factor X111 present in the
  FFP.
• Should be ABO compatible to avoid risk of
  haemolysis caused by donor antiA or antiB.
• Should be administered within 4 hours of thawing.

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Platelet, ApheresisAn adult dose of
Platelets prepared from anticoagulated blood
which is separated into components by apheresis
machine with retention of the platelets and a
portion of the plasma.The remaining elements may
be returned to the donor
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Specification   Volume 200 800
mlsPlatelet count gt 240 x 109 / unitLeucocyte
count lt 5 x 108 / unit PH at end of shelf life
6.4-7.4 Availability On request.Shelf life
storage 5 days at 22 2c gently agitated
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