Escolar Documentos
Profissional Documentos
Cultura Documentos
Pre-Donation Process
Pre-donation Counseling
1.
2.
3.
4.
Post-donation Counseling
1.
2.
Voluntary self-exclusion
Confidential
(CUE)
unit
3.
4.
Donor Selection
Donor screening encompasses the:
exclusion
Technical Standard
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
HIV
HBsAg
HCV
Malaria
Syphilis
ISBT
Good health
Age: 17 y.o. (Henry), 16-17 y.o.
(Harmening)
New donor: 16-60 y.o. before 61st
birthday
Regular donor: up to 70 y.o. before
71st birthday
Body weight of 110 lbs. or 50 kgs.
Maximum of 10.5 ml/kg
Temperature 37.5oC or 99oF
Pulse
50-100
beats/minute
(no
pathologic cardiac abnormalities) low
pulse rate for athletes (high exercise
tolerance)
Blood
pressure
180 mmHg/100
mmHg
Technical
Standard
(160
mmHg/<100mmHg)
Hemoglobin 12.5 g/dL and 38 %
hematocrit (1.053 copper sulfate
solution)
Female: 125 g/L-minimum
175 g/L-maximum
Male:
135 g/L-minimum
185 g/L-maximum
No evidence of alcohol intoxication
Venipuncture sites should be free of
lesions
No evidence of parenteral drug abuse
Deferral
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
5.
6.
7.
8.
9.
10.
11.
12.
13.
6.
7.
previous
donation of 200 ml and 450 ml is from
6-8 weeks or longer respectively
Major operation/blood transfusion
12
months
after
operation
or
transfusion
Skin lesions at venipuncture site
after skin lesion have completely
healed tooth extraction 1 year
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14.
15.
1.
2.
3.
2 weeks
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48 hours
16 weeks
12 months
No Deferral
Immunization
with
recombinant
vaccines
toxoids or dead organisms if asymptomatic
including primary prophylaxis against the
following if the donor is symptom-free & febrile:
Antrax, Paratyphoid, Cholera, Diptheria,
Pneumococcus, Hep. A, HBV, influenza,
lyme disease, polio, pertussis, plague,
rabies
1 year
Rocky mountain, spotted fever tetanus and
typhoid injection
ABO/Rh typing
Antibody screening
Transfusion
Transmitted
diseases
testing:
Syphilis
Hepatitis B, C
Malaria
HIV-1, HIV-2
HTLV-1, HTLV-2
T. cruzi antibodies (chagas
disease)
West Nile virus
CLD, prions
Frequency of Donation
Quantity of Donation
Phlebotomy
1.
2.
3.
4.
5.
6.
ACD
CPD
Improvement on ACD
Less acidic than ACD, improved cell
viability
Better preservative of ATP
Less citrate ions, less citrate toxicity
Adenine
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Mannitol
Hemovigilance
CPD
CPD-A1
CP2D
CPD-AS (adsol)
Heparin
ACD
21 days
35 days
21 days
42 days
2 days
21 days
Donor Reactions
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1st to be discovered
Citrate the acid provides the correct pH,
dextrose provides nutrition for cell
metabolism
donation,
blood
component
therapy, blood cell serology and
blood transfusion therapy.
Operationally
divided:
CBC
Total Protein estimate
Protein analysis
o Total serum or plasma CHON
o Electrophoresis
o Quality
of
single
CHONs
especially albumin and IgG
Total CHON should not be less than
60g/L
is
Whole
Blood
(vein)
Blood Transfusion
Hemapheresis
Apheresis
Is
a
multidisciplinary
specialty
encompassing all aspects of blood
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lymphocytes
Whole
Blood
granulocytes
erythrocytes
Blood components
Autologous Transfusion
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Intraoperative Salvage
Therapeutic hemapheresis
Transfusion
Medicine
Remaining
components
Types of Transfusion:
Medicine
platelets
1. Blood centers
Recruits and collect blood from donors
and manufactures and distribute blood
components
2. Transfusion services
Perform pretransfusion compatibility
testing,
select and issue blood
components for patients and provide
medical support
Apheresis Donor
Transfusion
plasma
Directed Transfusion
Anticoagulant
added
Emergency Transfusion
Neonatal Transfusion
Removes
unbound
IgG
antibody,
bilirubin and antibody coated RBC
Corrects anemia and replaces fetal RBC
the adult RBC which have better
release of O2 to the tissues
Patients
who
are
rapidly
or
uncontrollably bleeding may require
immediate transfusion
Group O RBCs are selected
Group O (-) if patient is a female of
child bearing age
A Rh (-) male can be switched to Rh (+)
if few O (-) units are available / if
massive transfusion is required
Transfusion in Oncology
Speed of Transfusion
Exchange Transfusion
15 drops = 1 mL
60 drops/minute, 60/15 x 60= 240 mL
of blood can be transplanted in 1 hour
1 unit can be transfused in 2 hours or
450-500 cc done in 2 hours
Blood warmers
Centrifugation Speed
TAKE NOTE:
Vital sign
Blood pressure
Temperature
Hematocrit and Hemoglobin
Urine output
Coagulation status
Blood Components
Type
Whole Blood
Description
Clinical Indication
A product in which all of the red cells and Massive transfusion where both red cell mass and
most of the plasma from the original
plasma volume are required
Replacement of the O2 carrying capacity and
unit remain
maintenance of the intravascular bleeding
Red Blood Cells packed RBC with reduced plasma volume to increase O2 carrying capacity of blood in patients
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Volume
540 mL
Shelf Life
CPD 21 days, CPD A1
35 days @ 1-6oC
260 mL
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35 days @ 1-6oC
340 mL
42 days @
1-6oC
180 mL
24 hours @
1-6oC
250 mL
10 years @ -65oC to
-200oC and 24 hours @ 16oC after washing
Volume
similar to
original unit
320 mL
1 year @ 1-6oC
50-70 mL
200-400 mL
Volume
similar to
original
component
200-300 mL
24 hours @ 20-24oC
all coagulation factors, complement and When specific coagulation factor deficiency where
other plasma proteins
coagulation factors are not available
Bleeding due to multiple coagulation factor deficiency
(liver failure, DIC, Coumadin toxicity)
Cryopoor
component
remaining
after Used in patients with hemolytic uremic syndrome,
Plasma
cryoprecipitate is prepared
thrombotic thrombocytopenic purpura
minimal concentration of fibrinogen factor
VIII and vWF
Cryoprecipitate
Congenital or acquired deficiencies of fibrinogen and
factor XIII deficiency
Used in vWF and hemophilia A when virus inactivated
factor concentrates are not available
Maybe beneficial in bleeding due to uremic platelet
dysfunction not responding to desmopressin,
estrogens
factor XIII deficiency, unresponsive to dialysis
Factor VIII
available in several degrees of purity
moderate to severe hemophilia
(Lyophilized) All products are lyophilized
Fractionation of pooled donor plasma
200-260 mL
1 year @ -18oC
200 mL
10-15 mL
25 mL of
sterile
diluent for
reconstituti
on
25 mL of
sterile
diluents for
reconstituti
on
2 years @ 2-8oC
Volume per
manufacture
rs
directions
200 mL
2 years @ 2-8oC
Granulocyte
Pheresis
Fresh Frozen
Plasma
plasma derived and recombinant proteins Plasma derived factor IX complex is used to treat
are available
hemophilia B and patients with inhibitors to VIII and
Factor IX complex: Factor II, VII, IX and
IX
other proteins
Factor IX, human purified by immuno
affinity chromatography from pooled
human plasma contains other traces of
proteins
Recombinant Factor IX
Antithrombin Prepared from pooled human plasma by Treatment for prophylaxis of thrombic events in patient
III Concentrate
modified cold ethanol fractionation
with congenital antithrombin deficiency (DIC, heparin
resistance, sepsis, deep vein thrombosis, pulmonary
embolism)
Solvent/Deterg plasma similar to contents as in FFP
S/D treatment of plasma is to inactivate lipid
ent Treated
Minimal content of high-molecular weight
enveloped viruses (HIV/HCV)
Plasma
similar to FFP
vWF
Donor Plasma as in FFP, stored and released for similar to FFP
Retested
use after donor has been retested
Factor IX
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200-260 mL
2 years @ 2-8oC
Frozen Plasma
Allergic (1-2%)
Host Disease (TA-GVHD) and related
donor
(1 : 7, 000)
5. Transfusion Associated-Graft Versus
Host Disease (TA-GVHD) and unrelated
Immediate
hemolytic
transfusion
donor (1: 39, 000)
reaction
&
Delayed
hemolytic
transfusion reaction (1 : 6, 000)
Transfusion
Reaction
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*Extravascular Hemolysis
Errors
Associated
Reaction
1.
2.
3.
4.
with
Transfusion
Immediate
Hemolytic
Reaction (IHTR)
Transfusion
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Type
Intravascular Hemolysis
Description
Extravascular Hemolysis
Types of DHTR
1. Secondary
(anamnestic)
response
to
transfused RBCs
Occurring 3-7 days
from the time to
transfusion to cause
extravascular
hemolysis
2. Primary
Alloimmunization
Patient has no past
history of pregnancy,
transfusion
or
transplant
Febrile Nonhemolytic
Transfusion Reaction
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Allergic Transfusion
Reaction *uticarial
Anaphylactic and
Anaphylactoid Reaction
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immune response
Anaphylaxis can range from mild
urticarial (hives) and pruritus to
severe shock and death
Attributed
to
IgA
deficiency,
patients who have developed
anti-IgA
from
transfusion
/
pregnancy
Any organ can be involved (lungs,
blood vessels, nerves, skin and
GIT)
DISTINGUISHING FEATURES OF
ANAPHYLACTIC
AND
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Rarely
severe
with
angioneurotic
edema,
laryngeal
edema
and
bronchial asthma
Identify the manifestations on allergic
reaction aminophylline, epinephrine
or corticosteroid maybe given
Temporary
cessation
of
blood
component transfusion
ANAPHYLACTIC
diarrhea
ANAPHYLACTOID
periobital swelling, dyspnea and
perilangyngeal edema
Fever is absent
Sign and symptoms occur after Serum sample of the patient can be
immunoelectrophoresed
to
transfusion of just few ml of
determined
IgA
levels
or
plasma or plasma containing
immunodiffusion to identify subclass
blood components
Antibody
Noncardiogenic
Cause is not well understood TRALI is characterized by chills, cough,
Pulmonary Reaction
(*idiophatic)
fever, cyanosis, hypotension, inc
(TRALI)
Most
consistent
finding
is
respiratory distress
*Noncardiogenic
leukocyte
antibodies
in Mild resolving after a few days severe
Pulmonary Edema (NCPE)
donor/patient plasma
rapidly progressive pulmonary failure
- Leukocyte antibody in donor / Sera from donor and patient should be
*Transfusion-Related
patient plasma could initiate
*Acute Lung Injury
tested for anti-leukocyte antibodies
complement
mediated
(TRALI)
pulmonary endothelial injury
Pulmonary
- Anti-leukocyte antibodies could
*Hypersensitivity
react with leukocytes to trigger
Reaction
the complement system to
*Allergic Pulmonary
produce C3a and C5a
Edema
*this would cause tissue basophils
and
platelets
to
release
histamine
and
serotonin
resulting in leukocyte emboli
aggregating in the lung
Transfusion-Associated TACO is an iatrogenic (physician- Dyspnea, coughing, orthopnea, chest
Circulatory overload
caused) transfusion reaction
discomfort, headache, restlessness,
(TACO)
Transfusion of a unit at too fast at
tachycardia, systolic hypertension,
a rate
abnormal electrocardiogram results
Hypercalemia leads to congestive Transfusion
should
be
stopped
heart failure and pulmonary
immediately slowest possible rate
edema
must be used
IV line should be maintained, patient
may be placed in a sitting position
ECG and chest X-ray assess cardiac and
pulmonary status
Central nervous pressure and vital
signs should be monitored
Bacterial Contamination Low frequency, rapid onset and Appear rapidly during transfusion or
Reaction
will lead to death
within about 30 minutes after
Most are caused by Yersenia
transfusion
Reaction
is
termed
as
WARM
enterolitica (CDC)
Commonly caused by endotoxin
characterized by dryness and flushing
Fever,
hypotension,
shaking,
chills,
cold temperatures (psycrophilic)
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*Pseudomonas
Escherichia coli
enterolitica
and
species,
Yersenia
and anxiety
laboratory test for electrolyte levels: Cs,
blood pH, glucose, U/A, hemoglobin,
hematocrit, platelet, CL, PT and PTT
Heterogenous
of
transfusion
reaction may include:
*physical RBC damage
*depletion
and
dilution
of
coagulation factors and platelets
*hypothermia,
citrate-toxicity,
hypokalemia and air embolism
can
result
in
intravascular
hemolysis
factor VII decline in activity
Delayed Nonhemolytic Transfusion Reaction
Alloimmunization
Result from prior exposure to Maybe mild, slight fever and falling
donor blood components
hemoglobin and hematocrit levels
Adverse effect of blood transfusion Severe platelet refractoriness with
Lymphocyte memory is involved,
bleeding
production of IgM and IgG Antibody screening
If HLA antibodies are suspected,
antibodies
Secondary exposure, production of
lymphocyte
panels
and
large amounts IgG rising in the
lymphocytotoxic antibody procedures
1st 2 days after reexposure to the
are performed on patients serum
Thorough patient history of past
antigen
Antibody produced attaches to the
transfusion,
transplantation
and
antigenic surface and may
pregnancies are important
interact with the complement
system or RES or MPS (monocyte
phagocytic system)
Post Transfusion Purpura Rare
complication
of
blood Occur about 1-2 weeks after transfusion
transfusion, usually involving Thrombocytopenia can be severe <10,
000/mm3
platelet concentrates
Characterized by a rapid onset of Hematuria, melena, vaginal bleeding
have been reported
thrombocytopenia as result of
anamnestic
production
of Platelets transfusion for severe cases
Platelet count and coagulation support
platelets alloantibody
US usually occurs in multiparous Patients sera should be tested for
platelet-specific
antibodies,
HLA
females
antibodies
and
lymphocytotoxic
7-14 days lag time between
antibodies
transfusion
and
onset
of
thrombocytopenia
Physically/Chemically
Induced Transfusion
Reaction
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hemolysis
Infusion of blood components with 4 hours
Adherence to policies and procedures regarding
blood component collection, storage, handling and
preparation
Corticosteroids,
exchange
transfusion
and
plasmapheresis
IV immunoglobulin therapy
Through patient history of prior transfusion and any
adverse reaction
transplantation (rare)
Death is usually caused by
infection
or
hemorrhage
secondary to bone marrow
aplasia
RISK GROUPS:
Iron Overload
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Appear
about
3-30
days
post Corticosteroid,
cyclosporine,
methotrexate,
transfusion up until 2 months
azathioprine and anti-thymocyte globulin
Pancytopenia, fever, elevated liver Irradiated blood components
enzymes, copious watery diarrhea,
skin errythmia desquamation
Tissue biopsies, lab test for liver
function
Observation for infection or coagulation
abnormalities should be monitored
Patients experiencing lymphopenia
HLA typing to confirm the presence of
or bone marrow suppression
donors cells in the patients circulation
Fetus
receiving
exchange
transfusion
Individuals
with
congenital
immunodeficiency syndromes
Patient with certain hematologic
and oncologic disorders
Patient
receiving
blood
components from blood relatives
Caused by proliferation of T-cell
lymphocytes from donors blood
responding to major and minor
histocompatibility antigens in the
patient
Patient
with
cell
immediate
immunodeficiency are at risk of
not
being
able
to
reject
transfused lymphocyte
Patient
who
have
an
HLA
haploidentical type donor (1st
degree relatives)
Long term complication of packed Muscles weakness, fatigue, weight loss, Removal of accumulated tissue in iron stores
RBC transfusion
mild jaundice, anemia, mild diabetes Subcutaneous infusion of desferrioxamine (ironKnown
as
Transfusion
chelating agent)
and cardiac arrhythmias
Assessment of storage iron level
Hemosiderosis
Each unit of RBC has about 225
(ferritin) and other iron studies should
mg iron
performed
Patients chronically dependent on Tissue strains for iron in tissue biopsies
RBC transfusion support
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and
Depending
on
the
Preliminary
Investigation results, more specimen may
be required:
m)
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