A number of groups have issued clinical practice guidelines for blood component therapy in an effort to improve transfusion practices, minimize the incidence of adverse transfusion reactions, and decrease costs. This slideshow by Dr Somnath Longani, Consultant, Midland Healthcare & Research Center Lucknow explains about the Blood Component Therapy in detail.

1. Blood Component
Therapy
Dr. Somnath Longani
MBBS,MD

2. Historical Time Line
• 1628 English physician William Harvey discovers the circulation of
blood
• 1665 first recorded blood transfusion dog from other dog
• 1667 was transfusing blood of animal to human
• 1901- Karl Landsteiner’s discovery of ABO grouping and foundation
for scientific transfusion practices
• 1920’s - Development of anti-coagulation solutions to store donated
blood
• 1950’s - Disposable plastic systems for collection and aseptic
separation of blood components

3. Blood Components
Role of Whole Blood ???

4. REPLACING BLOOD LOSS
Blood loss should be replace with crystalloid or colloid
• Risk Of Adverse Reactions
• Use Screened Blood
• Avoid Blood Transfusions as much as possible

5. CRITERIA OF BLOOD TRANSFUSION
• Hemoglobin concentration below 7 with
symptom
• <7gm/dl pt with ventillator
• <10gm/dl CAD, Pulmonary disease
• <9gm/dl old age pt
• Acute blood loss>25% of blood volume

6. BLOOD VOLUME
Neonate
 Premature 95ml/kg
 Full term 85ml/kg
Infant 80ml/kg
Adult
 Men 75ml/kg
 Women 65ml/kg

7. BLOOD GROUPS
• Human red cell membrane contain 300
different antigenic system
• Blood transfusion only ABO and Rh system
• Other red cell antigen systems include Lewis p
Kidd kell Duffy
• These antigens rarely cause serious hemolytic
reaction

8. COMPATIBILITY TEST
• Indirect coombs test test use for blood
transfusion
• Serum of pt mix with red blood cell and finally
anti human globulin added
• Agglutination occur indirect coombs test is
positive
• Require 45 min

9. • CROSS MATCH
• Donor red cell mix with recipient serum
• Emergency transfusion

10. • Packed RBC
– Anticoagulant – CPDA / CPD
– Volume – 350ml
– Shelf life – 35 days
– HCT – 60-80%
PRBC transfusion

11. • Alternative AS-1(ADSOL) AS-3(Nutrice) it
extend shelf life to 6weeks
• Hypertonic glycerol solution for up to 10 years
• Red cell normally stored at 1-6 c

12. Administration of PRBC
• Cross matching
• Patient identification
• Catheter size
– >22G
– Separate line
• Use Filter

13. Administration of PRBC
• Method
– Universal precautions
• Volume
– Depends on indication
– 10-15ml/kg  Hb by 1-2gm/dl
• Infusion time – 4hr
• Monitor

14. Platelet Transfusion
Types
• Isolation from a unit of donated
blood (RDP) (50-60ml)
• Apheresis from a donor (SDP)
(150-300ml)
• 1 SDP ~ 4-6 RDP

15. Platelet Transfusion
• Indications
– <50000/mm3 and bleeding
– <50000/mm3 and invasive procedure
– <10000-20000/mm3
• Storage : Room temperature (20-24c)
• Shelf life: 5 days

16. FRESH FROZEN PLASMA
• Plasma Frozen At –18 to -300 C within 8 hrs
• Shelf life – 1yr
• Stable Clotting Factors as well as Factor VIII
• 35 - 50 ml
• ABO matching

17. FFP- INDICATIONS
Indications
• Hereditary clotting factor deficiencies
• Von Willebrand disease
• Acquired coagulation defects
– severe liver disease
– DIC
– Severe Vitamin K deficiency bleeding
• On Warfarin therapy
• Dose – 10-15ml/kg
• Goal to achieve 30% of normal coagulation factor

18. CRYOPRECIPITATE
• Cryoprecipitate is prepared by thawing FFP between 1ºC
and 6ºC and recovering precipitate
– Factor VIII 80 – 100 IU /Bag,
– Fibrinogen 150 –300 mg/pack

19. INDICATIONS
• Von Willebrand Disease
• Hemophilia A
• Factor XIII deficiency
• DIC
• Dys & Hypofibrinogenemia
• One Unit per 7 – 10 Kg. BW

20. Granulocyte Transfusion
• Prepared by leukophresis
• Neutropenic pt with bacterial infection not
responding to antibiotic
• Very short life span
• Daily transfusion of 1010 granulocyte
• G-CSF GM-CSF

21. Complications of Blood
Transfusion

22. Types
• Infection
• Transfusion reactions
• Circulatory overload
• Metabolic
• Iron overload

23. Infection
• Viral infection
Hep B,Hep C, HIV,CMV,Parvo virus
• Parasitic infection
Malaria, Toxoplasmosis,Chagas disease
• Bacterial infection
Gram + Staphalococcus,Gram – Yersenia and
Citrobacter

24. Transfusion reactions
1. Acute Hemolytic
reaction
Awake patients-
Chills,fever,nausea,
chest and flank pain
Anaesthetised patient
Hypotension,tachycardia,
haemoglobinurea ,oozing
blood from surgical site

25. Management
• Stop transfusion
• Recheck
• Put urinary catheter
• Osmotic diuresis

26. 2. Delayed haemolytic reaction
Extravascula hemolysis
 2-20 days after transfusion
 Generally mild
 Symptoms:Malaise,Jaundice,Fever

27. Transfusion reactions
2. Febrile reaction
– Related to the presence of cytokines produced by donor
leukocytes
Due to platelet or white cell
Manage by Leukoreduction
transfusion
3. Allergic reaction
– Vary in severity from mild hi
wheels and itching to fatal
anaphylaxis
– More common with plasma and platelet transfusions

28. Anaphylactic reaction
• Rare1:150000 transfusion
• Typically in IgA deficient pt
• Receive IgA containing blood
• Treatment-epinephrine fluids ,corticosteroid
• Transfuse IgA free blood

29. Transfusion Associated Lung Injury
(TRALI)
• With in 6 hours of transfusion
• Incidence 1:5000 transfusion
• Acute hypoxia and non cardiogenic pulmonary
edema
• Especially platelet and FFP
• Alveolar capillary membrane damage
Manegment-

30. GRAFT Vs HOST Disease
• Immunocompromised patient
• Contain lymphocytes against compromised
host
• Use-leukocyte filter, irradiation

31. Massive Blood Transfusion
• Transfuse one to two time the pt blood
volume or 10 to 20 unit
• Coagulopathy
• Citrate toxicity
• Hypothermia
• Serum potasium concentration

32. Autologous Transfusion
• Patient undergoing elective surgical procedure
• High probability of blood transfusion
• Collection usually started 4-5 weeks prior
• Allowed to donate until 11gm/dl
• Minimum 72 hrs required plasma volume
return to normal
• 3 or 4 unit collected

33. Blood Salvage
Reinfusion
• Uses in cardiac, major vascular,orthopedic
surgery
• Blood aspirated and collected in reservoir
• Mix with heparin
• Red cell washed concentrated to remove debris
• Hematocrit concentration 50-60%
• Contraindication septic contamination
,malignancy

34. If possible always avoid a
transfusion……
Risk of infections/ reactions
Transfusion may prove fatal
(TRALI)

35. If transfusion is must…
Use appropriate blood component
not just blood

36. THANK YOU