principles of blood products and tranfusion.

1. By
B.S.Sanjana

2. BLOOD PRODUCT = Any therapeutic substance
prepared from human blood.
WHOLE BLOOD = Unseparated blood collected
into an approved container, containing an
anticoagulant preservative solution.
BLOOD COMPONENTS ARE
A constituent of blood , separated from whole
blood such as
• Red cell concentrate/Packed Red blood Cells
•Platelet concentrates
•Fresh Frozen Plasma
•Cryoprecipitate
•Granulocyte Transfusion.

3. Whole Blood:
• Storage
– up to 35 days
• Indications
– Massive Blood Loss/Trauma
– Donor and recipient must be ABO
identical.
Adverse Effects:
•It loses 50% of platelets after 6 hrs
•Granulocyte lose function by 24 hrs
•Circulatory volume overload
O negative is the product of choice
for emergency transfusion.

4. THE PACKED RED BLOOD CELLS:
Recommended temperature for
transfusion- 33˚to 35˚C
DOSE- 10ml/kg will increase Hb conc by
2.5-3g/dl.Maximum volume-15ml/kg.
Administration-
- ABO & Rh compatible
-Infuse over 2-4 hrs.
INDICATIONS:
•To increase O2 delivery in anemic
patient
•In event of acute blood loss ≥25-40%
blood volume.

5. PLATELET TRANFUSION:
For prevention and treatment of
hemorrhage in thrombocytopenic states.
Dosage - 1 unit/10 kg body wt,
Adult dose is 4-8 units.
Administration - Preferably ABO
& Rh group specific

6. Storage
– Up to 5 days at 20-24˚C
Should be administered over 30 mins
• Indications
– Thrombocytopenia, Plt is 10 – 20,000/mm³
– Bleeding and Plt <50,000/mm³
– Invasive procedure and Plt <50,000/mm³
– 1 unit/10 kg of body weight increases Plt
count by 50,000
– Donor and Recipient must be ABO identical

7. The platelets are separated from the plasma by
centrifugation.
• Platelets are supplied either as single donor units
or as a combination of multiple donors known as
random donor platelets.
• One unit of platelets will increase the platelet
count by 5 to 10,000/mm³.
• Platelet viability is optimal at 22° C but storage is
limited to 4-5 days.
• Platelets have both the ABO and HLA antigens.
ABO compatibility is ideal but not required.
(incompatibility will shorten the life span of the
platelet)

8. FRESH FROZEN PLASMA
• Contents—Coagulation Factors
• Storage
– It can be stored for 1yr at –18˚C
• Indications
– Coagulation Factor deficiency, fibrinogen
replacement, DIC, liver disease, massive
transfusion.
•ABO compatibility is required,Rh typing is
not necessary.
– FFP must be thawed at 36˚-38˚C before
administration.
Dose-10 to 15ml/kg over 30 to 120 mins.

9. CRYOPRECIPITATE:
– Precipitate formed/collected when FFP is thawed.
• Storage
– After collection,refrozen and stored up to 1 year at
-18˚C.
•It contains fibrinogen,Factor VIII,Factor XIII and von
Willebrand’s factor.
• Indications
– Fibrinogen deficiency
–VonWillebrands Disease
– Factor VIII or XIII deficiency
– hemophilia (if factor VIII is not available)
• Considerations
– ABO compatible preferred (but not limiting)
DOSE- 1 unit/5-10 kg of recipient body wt.

10. GRANULOCYTE TRANSFUSION:
• Prepared at the time for immediate
transfusion (no storage available)
• Indications –
severe neutropenia associated with
infection that has failed antibiotic therapy.
• Complications
– Severe allergic reactions
– Can irradiate granulocytes for GVHD
prevention

11. ADVERSE REACTIONS TO TRANSFUSION
• Hemolytic Transfusion Reactions (AHTR)
• Febrile Non Hemolytic Reactions (FNHTR)
• Allergic Reactions
• TRALI(Transfusion related acute lung injury)
• Post transfusion Infections

12. Acute Hemolytic Transfusion Reactions
(AHTR)
• Occurs when incompatible RBC’s are transfused into
recipient who has pre-formed antibodies (usually ABO
or Rh)
• Antibodies activate the complement system, causing
intravascular hemolysis
.
• Symptoms occur within minutes of starting the
transfusion
• Labelling error is most common problem
• Can be fatal

13. Symptoms of AHTR
• High fever/chills
• Hypotension
• Back/abdominal pain
• Tachycardia
• Hemoglobinuria
• Pallor
MANAGEMENT
• STOP TRANSFUSION
• ABC’s
•Run IVF
• Monitor and maintain BP
• Give diuretic
• Send remaining blood back to Blood Bank

14. Febrile Nonhemolytic Transfusion
Reactions (FNHTR)
•It is rise in patient temperature >1˚C during or
within 2 hrs of completion of transfusion.
•Fever occurs due to pyrogenic cytokines from
recipient’s granulocytes.
MANAGEMENT:
•Discontinue transfusion
•Administer paracetamol and anti-histamines.

15. Allergic reactions/urticaria
•It can range from cutaneous manifestation
to anaphylaxis.
•Isolated urticaria is the commonest
reaction.
•It is due to reaction of patient’s IgE
antibody to foreign proteins in donor
plasma.
•Management:
•Mild (i.e hives,itching)-antihistamines to be
given and transfusion is restarted.
•Severe anaphylaxis-stop transfusion ABC’s
and give steroids.

16.  Transfusion related acute lung
injury(TRALI)
It is rare and life threatening complication
with plasma containing components.
Due to presence of HLA specific antibodies in
donor plasma.
Usually occurs 1 to 2 hrs to up to 6 hr after
start of transfusion.
Characterized by-
 bilateral pulmonary edema
 Hypoxemia,fever
 Tachycardia
 Hypotension
 cyanosis

17. MANAGEMENT
• Supportive care for acute respiratory distress
syndrome including positive pressure
ventilation.
• Resolution occurs within 48 hrs.

18. The other adverse effects are:
• Transfusion associated circulatory
overload
• Metabolic abnormality secondary to
blood transfusion
• Dilutional coagulopathies
• Post-transfusion infections