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Principles of Blood Transfusion & Applications

Principles of Blood component/ Pr oduct replacement Pretransfusion Tests – for RBC transfusion
Principle From patient From donor Cross-matching
1 Identify cause of deficien cy
ABO, Rh ABO, Rh GXM
2 Replace only deficiency compone nt Antibody screening GSH
3 Blood produ ct should be as safe as posible Antibody identification

Blood compone nts & plasma derivatives

Whole blood is collected into plastic bag (contain anti-coagulant, preservative) Ordering Blood
Citrate Bind plasma Ca2+
Prevent activation of coagulation cascade
Phosphate Maintain red cell 2,3-DPG
Dextrose Substrates for metabolic processes of cellular comp onent
Blood component = a product separated from a single unit of whole blood
Plasma derivative = blood product separated from large volume of pooled plasma
Blood compone nts Blood pr oducts
Not 100% safe – HIV window period Manufactured, Safer, No
microorganisms
Red cell conce ntrates Coagulation factor concentrates
Platelet concentrates • Factor VIII (8) concentrates
Fresh frozen plasma (Hemophilia A)
• Factor IX (9) concentrate
(Hemophilia B)
Cryoprecipitate Albumin
Cryosupernatant Immunoglob ulin

Preparation of blood components from whole blood Plasma Derivatives (Blood products)
Human albumin solutions 5%, 20%, 25%
Indication
• Replacement fluid in therapeutic plasma exchange
• Diuretic-resistant oedema treatment (in hypoproteinaemic patient –
nephrotic syndrome)
• Volume replacement
• Burns
• Hypoalbuminaemia
Coagulation Factors
Factor VIII concentrate
Factor IX concentrate
Prothrombin con centrate (PCC)
Immunogloblin
Intramuscular use Anti-RhD IV use
(IM) Immunoglobulin
(Anti-D RhIG)
Specific antibodies to Prevention HDN in ITP/ other immune
infectious agents RhD negative mothers disorders
Screen 4
• Hepatitis B
HIV
• Rabies
Hepatitis B,C
• Tetanus
Syphilis
Immune de ficiency Immune de ficiency state
Malaria/ Parasite (not compulsory) state
Hypogammaglobulinaemia
Blood loss – signs, symptoms, indications for transfusion
HIV-related disease
Volume Lost Clinical signs Preparation of choice
mL Total Blood
Volume
500 10% None No transfusion or crystalloid solution
1000 20% Tachycardia Crystalloid solution or colloid or RBC if
necessary
1500 30% BP ↓ Crystalloid solution + Colloid + RBC or
blood if available
2000 40% Shock Crystalloid solution + Colloid + RBC or
blood if available

Patient & Donor RBC - selection by ABO, Rh type

Patient Donor
A A,O
B B,O
AB A, B, AB, O
O O
Rh +ve Rh +ve, Rh –ve
Rh –ve Rh -ve

Patient & Donor Plasma - selection by ABO

Recipient Donor
O O, A, B, AB
A A, AB
B B, AB
AB AB
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Whole Blood Platelet concentrate (from whole blood)
1 unit = 450 ml + 63 ml anticoagulant Content
Storage – 2-6 °C Volume – 50-60 ml
Life span – 35 days Platelet – 55x10ଽ
Changes occur during storage Leukocytes – 0.05 x10଺ /L
1. Red cells RBC contamination – 0.02 x10ଽ /L
a. Lose ATP Storage - <5 days (22°C, continous agitation)
b. Lose 2,3-DPG Dose – 4-6 units in adult OR 1 unit/10 kg body weight
2. White cells Increment – 5-10 x10ଽ per unit platelet
a. Granulocyte – lost phagocytic, bactericidal properties (after 4-6h Plateletpheresis
collection) Volume – 150-300 ml
b. Do not lose antigenic properties Platelet – 300 x10ଽ (6 single donations)
i. Capable of sensitizing recipient No RBC contamination
ii. Cause non-hae molytic febrile transfusion reaction Minimal WBC contamination
3. Platelets 1 unit = 1 therapeutic dose
a. Lose haemostatic fun ction (within 48h) Role of platelet - 1° homeostasis
4. Coagulation factors Normal platelet count – 140-450 x10ଽ /L
a. Factor V & Factor VIII lose coagulant activity (50%) (within 48- Indication
72h storage) Treatment of bleeding (thrombocytopenia/ abnormal platelet function)
5. Biochemi cal changes Prophylactic platelet transfusion (based on platelet count)
a. ↑ K+ < 100 x૚૙ૢ /L <50 x૚૙ૢ /L < 10 x૚૙ૢ /L
b. ↑ H+ Undergoing major Newborn state Prophylactic use with
6. Microaggregates surgery minor bleeding/ stable
Plasma coagulation
a. Aggregates of aged platelets, leucocytes, fibrin strands formed patients
abnormality
b. Cause transfusion related lung injury (TRALI) Surgery within previous Fever/ Severe infection
Indication 48h
Exchange transfusion in infants for haemolytic disease of new born Minor surgical
Acute hypovolemia (haemorrhagic shock)/ Blood loss >30%
procedure/ invasive
Massive transfusion procedure
Not indicated
Red cell concentrate (Packed cell)
Idiopathic thrombocytopenia purpura (u nless life threatening bleeding)
Prepare by removing 200ml of plasma from Whole Blood after centrifugation
Thrombotic thrombocytopenic purpura
Storage – 2-6 °C
Half life – 35 days Fresh Frozen Plasma (FFP)
Increment – 1-1.5gm/dl per unit Prepare within 6h of collection
Types Freeze at -30°C for 1 year
Red cell concentrate Leukocyte γ irradiated Washed red Properties
reduced red cell red cell blood cells Volume – 200 ml
Symptomatic Prevent non- Prevent TA- Severe allergic Prior to use, FFP is thawed in water bath
anaemia haemolytic GVHD (bone reaction Thawed plasma should be used < 2h
Iron, Folate, B12 febrile marrow following Contains all coagulation factors
deficiency anaemia transfusion transplant, transfusion Factor VIII
(rare, except in reaction (due to immune Sodium
elderly patients with antibodies to compromised, Potassium
Angina, CCF) white cells & neonate) Glucose
Hypoproliferative platelets in Hypersensitive Citrate
anaemia recipients to plasma Indications
• Malignancy exposed to Replacement of single coagulation factor deficien cy
• Chemotherapy previous
(when specifi c factor con centrates not available)(Factors II, VII, X, XI, XIII)
/ radiotherapy transfusion, Vitamin K deficiency with bleeding episodes (haemorrhagic disease of newborn)
Aplastic pregnancies)
• Acute disseminated intravascular coagulation
anaemia, MDS, Thrombotic thrombocytopenic purpura (at least 3L/ day)
myelofibrosis Microvascular bleeding (following massive blood transfusion)
Haemolytic anaemia Prevent Paroxysmal Not indicated in
(rare, except sensitization nocturnal Volume expander/ nutritional supplement
anaemia poorly (marrow haemo- Albumin supplementation
tolerated & Hb < transplantation) globinuria Hypogammaglobulinaemia correction
7g/dL) Haemophilia, vWD, congenital procoagulant, anticoagulant factor deficiency
Not indicated in ↓ Transmission (virally inactivated, recombinant factor conce ntrates are preferred)
• Undiagnosed/ of disease Bleeding only, Prolonged PT only, Prolonged APTT only
asymptomatic (cytomegalovirus
anaemia , cJD) Cryoprecipitate
• Anaemia Obtained from 1 single donation of fresh plas ma
responsive to Rapid freezing within 6h of collection
haematinic Subsequent thawing at 4-8 °C
• For volume Removal of cryosupernatant
expansion Properties
• Post operative Volume – 20 ml
Hb > 8g/dL Contain
• Factor VIII
• Fibrinogen
• Factor XIII
• vWF
Storage -30°C (1 year)
Administration – need to be thawed in water bath & used within 2h
Involves preparation of fibrin glue
Indications
Von Willebrand’s disease
Hypofibrinogenemia
DIC