BLOOD TRANSFUSION

Dr KABERA Ren Family Physician Kabutare Hospital Rwanda

PLAN
Introduction Types Indication Dosage Complications Alternatives

INTRODUCTION
Donor screening : Hepatitis,HIV,Syphilis, ABO Rh Blood processing: Whole blood as raw material Storage & Preservation of blood & blood components Informed consent Pretransfusion testing:ABO,Rh Transfusion practice

INTRODUCTION
Kabutare : April to July 2013 ,282 BT 15 million transfusions are given yearly in the USA Rwanda/CNTS

INTRODUCTION
Indications Symptoms or signs of anemia, such as tachycardia, tachypnea, lethargy, and exercise intolerance. Level of hemoglobin/hematocrit. The anemia is acute or progressive onset. Coexisting cardiopulmonary problems or infections that might impair the patient's ability to tolerate the anemia. Specific blood components

TYPES

TYPES
Whole blood Packed red blood cells Frozen red blood cells Frozen fresh Plasma Granulocytes Platelets Cryoprecipitate Plasma derivatives

TYPES

TYPES

WHOLE BLOOD
Raw material 1 unit /400-500 mls Conservation 4o C for 35 days in citrate-phosphatedextrose-adenine Storage :Whole blood stored for over 24 hours has reduced levels of platelets and labile clotting factors (V and VIII).

WHOLE BLOOD
Acute bleeding >20-25% blood loss Exchange transfusion (Sickle Cell, Leukemia) Not indicated in chronic anaemia nor in hypovolaemia alone Dosage:10 to 15 mL/kg given over 2 to 4 hours Severe anemia and Heart failure 2mls/kg/hr The first 15 minutes cautious Dont exceed 4 hrs after thawing

PLATELETS

1 unit is 50 mls Dose: 1 unit of PC/10 kg wt. Storage: room temperature 22oc to 24oc 72 hrs. Risk of contamination bacterial growth

One unit increases the recipient's platelet count by 20 to 30 109/L

PLATELETS
Thrombocytopenia is a risk factor for hemorrhage, and platelet transfusion reduces the incidence of bleeding. Transfusion of platelets should be reserved for patients with counts <10 to 20 109/L or in surgical settings <50 109/L.

PACKED RED BLOOD CELLS

1 unit 200-300 mls Conservation-expiry 2OC to 6OC for 35 days In additives 42 days ( adenine-saline preservative solution) Open system 24 Hrs.

PACKED RED BLOOD CELLS

Indications : Symptomatic deficit of oxygen carrying capacity without volume expansion Haemostatic function Advantages Decreases Circulatory overload Metabolites, high titre antibodies Risk of immunisation

FROZEN RED BLOOD CELLS

RBC that have been preserved with a cryoprotective agent, usually glycerol, may be stored at -65C for up to 10 years The product must be transfused within 24 hours after thawing

FROZEN FRESH PLASMA

Fresh-Frozen plasma (FFP) is plasma separated and rapidly frozen to 18C or less. 1 year About 180 to 250 mL of plasma is obtained from a single unit of blood, and aliquots can be prepared for infants and small children. Dose 10-15mls/kg

FROZEN FRESH PLASMA

Replacement of multiple coagulation defects Immediate reversal of anticoagulant effect Thrombotic thrombocytopaenia

GRANULOCYTES
Storage at 20-24 ,Use after collection Infusion for 2-4 hours Indications Severe neutropenia (<500 microg/L) Resistance to antibiotics (24-48h) Decrease use due to Antibiotics

CRYOPRECIPITATE
Cryoprecipitate is formed when FFP is thawed, and each bag contains about 150 mg of fibrinogen and 80 units of factor VIII. Cryoprecipitate has been largely replaced by factor VIII concentrates in the treatment of hemophilia A. The major indication for cryoprecipitate is correction of hypofibrinogenemia, congenital factor XIII deficiency, and for DIC

CRYOPRECIPITATE
A common dose for Fibrinogen replacement is 1-1.5 units per 10kg patient body weight. The volume of one unit of cryoprecipitate is 30 40mls and up to 60mls. Cryoprecipitate should be administered at a rate of 5 10 minutes/unit.

PLASMA DERIVATIVES
Albumin, intravenous immunoglobulin, antithrombin, and coagulation factors. In addition, donors who have high-titer antibodies to specific agents or antigens provide hyperimmune globulins, such as anti-D (RhoGam, WinRho), and antisera to hepatitis B virus (HBV), varicella-zoster virus, CMV, and other infectious agents.

COMPLICATIONS
Hemolysis Recipient antibodies to transfused RBC Osmotic, thermal, or mechanical lysis of cells before infusion Nonhemolytic febrile reactions Recipient antibodies to WBC in blood product Cytokines in blood product Bacteria in blood product

COMPLICATIONS
Allergic Hyperkalemia Pulmonary edema Hypothermia

COMPLICATIONS
Viruses Hepatitis B, C Retroviruses: HIV-1 and HIV-2, human T-cell leukemia viruses, types I and II (HTLV-I/II) Cytomegalovirus (CMV), parvovirus, and Epstein-Barr virus (EBV) (mainly inimmunosuppressed recipients)

COMPLICATIONS
Bacteria Associated with asymptomatic bacteremia in blood donors (Yersinia enterocolitica, Salmonella, and other gram-negative organisms) Caused by contamination during collection (skin flora) or processing of blood Syphilis Parasites Malaria, Trypanosoma cruzi, leishmaniasis

REFERENCES
1.Rudolph's Pediatrics - 21st ed. (2002)Use of blood and blood products - susan A. Galel , J. Lawrence naiman 2. Corwin HL et al: The CRIT study: Anemia and blood transfusion in the critically illCurrent clinical practice in the United States. Crit Care Med 32:39, 2004 3. Taylor RW et al: Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med 34:2302, 2006 4. Blood Banking & Immunohematology , Maurene Viele, MD, & Elizabeth Donegan, MD. Blood Banking & Immunohematology 2001 5. Harrison's Internal Medicine > Chapter 107. Transfusion Biology and Therapy

BLOOD ALTERNATIVES
Volume expanders Growth factors Intra-operative or post-operative blood salvage Blood substitutes

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