Rational Use of Blood and Blood Products

Blood
Blood - specialized bodily fluid delivers nutrients/oxygen to cells transports waste products away Medical terms related to blood often begin with haemo- or haemato (from the Ancient Greek word (haima) for "blood"). Considered a specialized form of connective tissue, given its origin in the bones Presence of potential molecular fibers in the form of fibrinogen.

Blood
In vertebrates, it is composed of blood cells (RBC, WBC, Platelets) suspended in a liquid called blood plasma. Plasma, which comprises 55% of blood fluid, is mostly water (90% by volume) Contains dissolved proteins glucose mineral ions hormones carbon dioxide (main medium for excretion

a - erythrocytes b - neutrophil c - eosinophil d - lymphocyte

Types of Blood Products

Whole Blood Packed Cells

White Cells
Platelets

Fresh Frozen Plasma

Cryoprecipitate Other Components

Whole Blood
Contents RBCs WBCs Platelets Plasma Clotting factors depending on storage time

Whole Blood
All around the world, most countries have stopped giving whole Blood to the patients for the following reasons: More likely carrier of diseases Frequency of serious shortages of blood, it is considered imprudent to use whole Blood Most patients require only one particular component. Better patient management by giving only the necessary component

Utilizing normal Blood storage techniques, Blood products have a greater shelf life than whole Blood; Blood filtration and other techniques help to make Blood safer

Blood products can often be infused regardless of ABO Blood group.

Packed Cells
Obtained by spinning down whole blood Contents

RBCs
20% Plasma Indications Replace Hb and O2 carrying capacity with less volume usually for Hb<7g

Severe anemia, blood loss, CHF

Packed Cells

Preferred choice for correcting Anemia and even correcting acute blood loss Leuco-depleted packed cells are becoming common to reduce risk of complications - Infective risk for CJD and also immune complications

Platelets
Contents
Platelets WBCs

Plasma
Indications

Low platelet counts <20,000 but if patient bleeding, can transfuse at higher values

Platelets
Platelets - essential for the coagulation of Blood Platelets - stored at room temperature. Heat or cold storage will render platelets inactive. Require continuous gentle agitation. Can be stored at the Blood center for up to five days. When received for transfusion, both pooled and apheresis platelets will expire in less than four hours.

Effect of Platelet Product and Patient Weight on Platelet Increment

Patient weight (in kg) 20 45 70 90

Single whole Blood platelet concentrate

Standard apheresis of four pooled whole Blood platelets

17,600

8,800

5,900

4,400

70,400

35,200

23,500

17,600

Large apheresis or six pooled whole Blood platelets

105,600

52,800

35,200

26,400

Granulocytes
Contents
WBCs 20% Plasma

Indications
Life-threatening decreases in WBC count

Not Practiced in Malaysia

Fresh Frozen Plasma

Contents
Complete profile of Clotting factors Fibrinogen Prothrombin Albumin Globulins

Fresh Frozen Plasma

Indications Clotting factor deficiency

1 ml of FFP per Kg pt weight will increase clotting factors by around 1%

DIVC Volume expansion - superceded by other colloids eg gelatin/starch

Cryoprecipitate
Contents Factors VIII and XIII, Fibrinogen Indications Hemophilia A Fibrinogen deficiency Factor XIII deficiency

Cryoprecipitate
Contents

Factors VIII and XIII, Fibrinogen

Indications

Hemophilia A
Fibrinogen deficiency Factor XIII deficiency DIVC

Other Factors
Factors II, VII, IX, and X Indications

Hemophilia B
Liver disease

Bleeding tendencies

BLOOD COMPONENT Red cells (AS-1)

CONTENTS RBC w/ appx. 25 mL of plasma; 100 mL of saline; additive solution (adenine, mannitol). Hct 60% Platelets; includes some WBC; 50 mL of plasma, a few RBC (Hct less than .005)

VOLUME

SHELF LIFE**

340 mL 42 days 4o C

Platelet concentrate

50 mL

5 days 20o C

Platelet apheretic

Platelets; includes some WBC; 300 mL of 300 mL 5 days 200 C plasma; a few RBC Plasma proteins, all coagulation factors, complement 150 mg of fibrinogen, at least 80 units of factor VIII, von Willebrand factor, factor XIII, fibronectin 225 mL 1 year 18o C

Fresh frozen plasma

Cryoprecipitate

15 mL

1 year 18o C

Blood Transfusion
Blood must be typed prior to administration
ABO Antigens A Antigen B Antigens A and B Antigens Type A Type B Type AB

No Antigens

Type O

Blood Transfusions
Plasma Antibodies Agglutinate (Clump) Cells of other Types Type A = B Antibodies (Clumps B or AB) Type B = A Antibodies

(Clumps A or AB)

Blood Transfusions
Type AB = No Antibodies (Clumps Nothing) Type O = A and B Antibodies (Clumps everything except O)

Blood Transfusions

O Negative = Universal Donor

AB Positive = Universal Recipient

Blood Transfusions
Rh Factor 85% of Population

Rh Positive
15% of Population Rh Negative Rh Negative patients produce Rh antibodies only if exposed to Rh Positive blood

Blood Transfusions
Erythroblastosis Fetalis Rh Negative mother exposed to Rh Positive fetal blood during delivery Mother produces Rh Antibodies

Antibodies cross placenta during subsequent pregnancy

Fetal blood hemolyses

Blood Transfusions

Erythroblastosis Fetalis Prevented by administration of Rhogam to mother

Transfusion Complications

Fever
Most common reaction Donor WBC incompatibilities

Management :
Stop transfusion if severe

Antipyretics if mild

Signs/Symptoms
Itching Urticaria Chills Fever

Allergic Reactions

Facial edema
Wheezing Anaphylactic shock

Allergic Reactions
Management Oxygen

IV fluids
Epinephrine

Antihistamines

Hemolytic Reaction
Chills, fever Low back pain Headache

Chest pain
Dyspnea Cyanosis Restlessness, anxiety Hypotension Red urine

Hemolytic Reaction
Management Stop transfusion Treat shock Volume replacement Mannitol Send blood from patient and bag to blood bank for checking

Volume Overload
Signs/Symptoms
Cough
Chest pain Dyspnea Distended neck veins Coarse creps

Frothy sputum

Volume Overload
Management Slow infusion Diuretics Vasodilators

Massive Transfusion Coagulation Disturbances Complications Platelet/Clotting factor

deterioration
Citrate Intoxication Hypocalcemia Metabolic Alkalosis Hyperkalemia RBCs Lyse/Release K+

Transfusion Complications
Acid/Base Imbalances Banked blood gradually acidifies Poor tissue Oxygenation Loss of 2,3 DPG

Transfusion Complications
Hypothermia Inadequate warming during transfusion Viral Hepatitis Risk rises with each unit

Blood Transfusion
IV catheter 18g or larger No fluid other than saline D5W lyses RBCs RL contains calcium/triggers clotting Two persons confirm ABO/Rh Blood filter in administration set

Blood Transfusion
Infusion pumps Excessive pressure can cause hemolysis Rewarming above 380C can cause hemolysis Never add medications directly

Blood and Products

Blood should be used responsibly and carefully
Appropriately used can save lives Over transfusion and wrong use is a waste of resources and put patients at risk of complications Always consult if unsure of indication