Chapter 15 Transfusion Therapy

Modern Blood Banking & Transfusion Practices
6th Edition
Chapter 15
Transfusion Therapy
Copyright 2012 F.A. Davis Company

6th Edition
Transfusion Therapy
Used primarily to treat two conditions
Inadequate oxygen-carrying capacity because of
anemia or blood loss
Insufficient coagulation proteins or platelets to
provide adequate hemostasis
Individualized plan for each patients needs
Specific blood components to meet these
needs
6th Edition
Whole Blood
Used to replace the loss of both RBC mass and
plasma volume
Rapidly bleeding patients can receive whole blood,
although most commonly RBCs and plasma are used
and are equally effective clinically
Contraindications to the use of whole blood
Anticipated increases in hemoglobin and hematocrit
with whole blood transfusion

6th Edition
Red Blood Cells (RBCs)

Indicated for increasing the RBC mass in
patients who require increased oxygen-
carrying capacity
Symptoms requiring RBC transfusion
Trigger values of hemoglobin indicating a need for
transfusion
Contraindications
Anticipated increases: hemoglobin 1 g/dL and
hematocrit 3%
Effects of different additive solutions
6th Edition
Leukocyte-Reduced RBCs
Used to reduce HLA alloimmunization, CMV
transmission, FNHTR, TA-GVHD, and
transfusion-related immune suppression
Indications for use of leukocyte-reduced RBCs
Leukocyte content must be reduced to less than
5 106 by use of leukocyte reduction filters

6th Edition
Washed and
Frozen/Deglycerolized RBCs
May be used with patients who have anaphylactic
transfusion reactions to ordinary units of RBCs
The washing process removes plasma proteins, the cause
of most allergic reactions.
Freezing RBCs allows the long-term storage of rare blood
donor units, autologous units, and units for special
purposes, such as intrauterine transfusion.

6th Edition
Platelets and Plateletpheresis

Platelet transfusions are indicated for patients
with thrombocytopenia or abnormally
functioning platelets.
Bacterial testing requirements
Plateletpheresis components are prepared
from one donor and must contain a minimum
of 3 1011 platelets.
Anticipated increases in platelet count: 5,000 to
10,000/L

6th Edition
Refractory Patients
If the 10-minute increment platelet count
increase is less than 50% of that expected on
two occasions, the patient is considered
refractory.
Positive platelet crossmatches and/or positive
HLA antibody screen is considered evidence
of alloimmunization.

6th Edition
Refractory Patients (contd)

Corrected platelet count increment
determination
Consideration of ABO, HLA- and platelet-
specific antigens in platelet transfusions

6th Edition
Granulocytes Pheresis
Criteria have been developed to identify
patients who are most likely to benefit from
granulocyte transfusions.
Fever, neutrophil counts less than 500/L,
septicemia or bacterial infection unresponsive to
antibiotics, reversible bone marrow hypoplasia, and
a reasonable chance for survival
Requirement for crossmatch
Patient monitored for resolution of symptoms and
clinical evidence of efficacy

6th Edition
Plasma
Includes fresh frozen plasma, plasma 24 (frozen
within 24 hours) and thawed plasma
Use in treatment of single and multiple coagulation
deficiencies
Use in Vitamin K deficiency or Warfarin overdose
Use in liver disease or liver failure
Use in treatment of DIC
Plasma and plasma 24 contain all coagulation factors

6th Edition
Plasma (contd)
Congenital coagulation factor deficiencies
rarely treated with plasma
Dose requirement for surgical procedures and
serious bleeding can cause pulmonary edema as
a result of volume overload.
Coagulation factor unit definition and
determination

6th Edition
Plasma (contd)
Use in plasma exchange therapy
Plasma should be ABO-compatible with the
recipients RBCs.
Rh type can be disregarded.

6th Edition
Cryoprecipitate
Used primarily for fibrinogen replacement
AABB requirements for fibrinogen content:
150 mg of fibrinogen and 80 units of Factor
VIII/unit
Determination of transfusion requirements

6th Edition
Cryoprecipitate (contd)
Mild or moderate Factor VIII deficiency now
treated with desmopressin acetate
Virus-safe Factor VIII with assayed amounts of
Factor VIII and vWF available to treat patients
with von Willebrands Disorder

6th Edition
Factor VIII
Patients with Hemophilia A or Factor VIII
deficiency are treated with Factor VIII.
Preparation of Factor VIII
Treatment of Factor VIII for transfusion
Calculation of the required dose of Factor VIII
Only Factor VIII products labeled as containing
vWF should be used for patients with von
Willebrands Disorder.

6th Edition
Factor IX
Factor IX complex (prothrombin complex) is
prepared from pooled plasma.
It is recommended for factor IXdeficient patients
(Hemophilia B), patients with Factor VII or X
deficiency (rare), and selected patients with Factor
VIII inhibitors, or for reversal of Warfarin overdose.
Dose is calculated in the same manner as that for
Factor VIII concentrate.

6th Edition
Antithrombin and Other

Concentrates
Antithrombin concentrates are licensed for use in
the United States for patients with hereditary
deficiency of antithrombin.
Human plasma derived Protein C concentrates are
approved for use in hereditary deficiency states.
Recombinant human activated Factor VII (rFVIIa)
has been used in patients with a wide variety of
bleeding disorders.
6th Edition
Albumin
Prepared by chemical and physical
fractionation of pooled plasma
Available as a 5% or a 25% solution, of which
96% of the protein content is albumin
Use in patients requiring volume replacement
Use as replacement fluid in plasmapheresis
Use in treatment of burn patients
6th Edition
Immune Globulin
Used for patients with congenital
hypogammaglobulinemia and for patients
exposed to Hepatitis A or measles
Immune globulin prepared from pooled plasma
is primarily IgG
Calculation of recommended dose
Recommended administration methods

6th Edition
Leukocyte-Reduced Cellular Blood

Components
Leukocyte-reduction filters are designed to remove
more than 99.9% of leukocytes from RBCs and
platelet products.
The goal is fewer than 5 106 (1 106 in Europe)
leukocytes remaining in the RBC unit.
Leukocyte-reduced RBCs and platelets can be used to
prevent febrile nonhemolytic transfusion reactions,
prevent or delay the development of HLA antibodies, and
reduce the risk of transmission of CMV.

6th Edition
CMV-Negative Cellular Blood

Components
CMV-negative or leukocyte-reduced components
are indicated for recipients who are CMV-negative
and at risk for severe sequelae of CMV infections.
CMV-negative pregnant women
Allogeneic CMV-negative bone marrow and
hematopoietic progenitor cell transplant recipients
Premature infants weighing less than 1200 g

6th Edition
Irradiated Cellular Blood

Components
Blood components are irradiated with gamma
radiation to prevent Graft Versus Host Disease
(GVHD), as in these conditions
Transfusion or transplantation of immunocompetent T
lymphocytes
Histocompatibility differences between graft and
recipient (major or minor HLA or other histocompatibility
antigens)
Usually, an immunocompromised recipient

6th Edition
Irradiated Cellular Blood

Components (contd)
Common after allogeneic bone marrow or
hematopoietic progenitor cell
transplantation, GVHD is a syndrome
affecting mainly skin, liver, and gut.
Patients at risk for TA-GVHD
Immunocompetent recipients at risk for TA-
GVHD

6th Edition
Surgical Blood Order Schedule,

Type and Screen
Disadvantages of crossmatching for procedures with
a low likelihood of requiring transfusion
Advantages of Type and Screen
Positive effects on Crossmatch to Transfusion (C/T)
Ratio of Type and Screen
Considerations for patients with positive antibody
screen results

6th Edition
Autologous Transfusion
Donation of blood by the intended recipient
Reduces the possibility of transfusion reaction or
transmission of infectious disease
Predeposit of blood by the patient
Intraoperative hemodilution
Meticulous attention to hemostasis and salvage of
shed blood during surgical procedures

6th Edition
Emergency Transfusion
Used in patients who are rapidly or uncontrollably
bleeding, losing more than 20% of their blood
volume
Use of Group O Rh negative and Rh positive RBCs
Completion of Antibody Screen
The condition of most patients allows determination
of ABO and Rh type and selection of ABO- and Rh-
typespecific blood for transfusion
6th Edition
Massive Transfusion
The replacement of one or more blood volumes,
or about 10 units (adults) within 24 hours
Impact of patients clinical status and lab results.
A patient in critical condition and a limited supply of
type-specific blood may require a change in ABO or
Rh types.
An Rh-negative woman, of potential childbearing
age, should receive Rh-negative RBC products as long
as possible.

6th Edition
Neonatal Transfusion
Premature infants frequently require transfusion
of small amounts of RBCs to replace blood
drawn for laboratory tests and to treat the
anemia of prematurity.
Required amount of blood is calculated.
Various methods are available for preparing small
aliquots for transfusion.
The aliquot must be labeled clearly with the name
and identifying numbers of the patient and donor.

6th Edition
Neonatal Transfusion (contd)

The blood must be fully tested as done for adults.
Blood units less than 7 days old are preferred to
reduce the risk of hyperkalemia and to maximize the
2,3-diphosphoglycerate levels.
CMV-seronegative or leukocyte-reduced is used to
prevent CMV infection.
There are various requirements for use of irradiated
blood.
Infants who are hypoxic or acidotic should receive
blood tested and negative for Hemoglobin S.

6th Edition
Transfusion in Oncology
Bone marrow suppression
Infiltration and replacement of the bone marrow
with malignant cells
Effects of repeated RBC and platelet transfusions on
need for rare RBC units and/or HLA-matched
plateletpheresis components
Risk of TA-GVHD

6th Edition
Coagulation Factor Deficiencies

Hemophilia A
Hemophilia B
von Willebrands Disorder
DIC
Platelet function disorders
Uremia
Patients undergoing renal dialysis

6th Edition
Blood Administration
Requirements for positive identification during lab
testing; before and during administration
Need to reduce clerical errors
Use of blood filters
Adjustment of rate of infusion
Use of blood warmers
Procedures followed after transfusion is complete

6th Edition
Hospital Transfusion Committee

The Joint Commission requires all blood
transfusions be reviewed for appropriate use.
Appropriate criteria for blood transfusion have been
published, serving as a guide for conducting audits of
the transfusion process.
The Committee reviews transfusion practices
and transfusion reactions, and ensures that
appropriate procedures are in place and are
followed by hospital personnel.

Chapter 15 Transfusion Therapy

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Chapter 15 Transfusion Therapy

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Modern Blood Banking & Transfusion Practices

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Red Blood Cells (RBCs)

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Platelets and Plateletpheresis

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Refractory Patients (contd)

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Antithrombin and Other

Copyright 2012 F.A. Davis Company

Leukocyte-Reduced Cellular Blood

Copyright 2012 F.A. Davis Company

CMV-Negative Cellular Blood

Copyright 2012 F.A. Davis Company

Irradiated Cellular Blood

Copyright 2012 F.A. Davis Company

Irradiated Cellular Blood

Copyright 2012 F.A. Davis Company

Surgical Blood Order Schedule,

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Neonatal Transfusion (contd)

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Coagulation Factor Deficiencies

Copyright 2012 F.A. Davis Company

Copyright 2012 F.A. Davis Company

Hospital Transfusion Committee

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