Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Transfusion Medicine and Blood Bank 10 Rational Use of Blood PPT-Powerpoint Presentations and lecture notes
Rational Use of Blood
and Blood Components
Best Transfusion is
"No Transfusion"
Why Avoid Blood Transfusion?
? Infection Risk
? HIV, Hepatitis
? Other Complications
? Febrile reactions
? Allergic, urticarial reactions
? Clerical Errors
? ABO mismatch
? Immunologic Issues
? TA-GvHD
? Immunosuppression
? Religious Reasons
Misconceptions and Myths
? Whole blood
? "Fresh" Blood
? Empirical Transfusion
? Nutritional Anemia
? Pre Surgical
? Wound Healing
? Enhancement of well being
Why whole blood not rational
? Maximize blood resource
Thalassemia
one unit of whole blood
Bleeding
Aplastic anemia
Hemophilia
? Better patient management
? concentrated dose of required component
? avoid circulatory overload
? minimize reactions
? Specific storage requirements of components
? Red Blood cel s
+2-60 C
? Platelets
+220 C
? Fresh frozen plasma
- 300 C
? Decrease cost of management
? except for the cost of bag, other expenses remain same
Whole Blood Vs Packed Red Cel s
Parameter
Whole blood
Packed red cells
Volume
350 ? 450 ml
200 ? 240 ml
Increment in Hb
1 -1.5 gm/dl
1 -1.5 gm/dl
Red cell mass /ml
Same as PRBC
Same as WB
Viable platelets
No
No
Labile factors
No
No
Plasma citrate
++++
+
Allergic reactions
++++
+
FNHTR
++++
+
Risk of TTI
++++
+
Waste of components
Yes
No
"Fresh blood" ? misconception.
v What is "fresh blood"?
? varying definition
? any unit kept at 4oC for 4 hours is no longer "fresh"
vIncreased disease transmission
? Intracel ular pathogens (CMV, HTLV) survive in leukocyte in fresh
blood
? Syphils transmission- tryponema can't survive > 96 hours in stored
blood ( JAMA,95)
? Malaria transmission- malaria parasite cannot survive > 72 hours in
stored blood (Mol ison)
"Fresh blood" ? misconception.
v Immunological complication due to WBCs in fresh blood
? Transfusion Associated-Graft vs Host Disease ? 90% fatality
? TA-immunomodulation
? Al oimmunization- Red cel / platelet
v Logistics
? no time for component preparation
? less time for infection screening
? storage lesions in different constituents due to storage temp
Rational Use of Blood
? Right product
? Right dose
? Right time
? Right reasons
Answer 4 Qs before transfusion
? Why to transfuse ?
benefit > risk
patients symptoms Vs lab levels
prophylactic Vs therapeutic
? What to transfuse ?
whole blood
NO
components / fractions
? How much to transfuse ?
Single unit
NO
? How to transfuse ?
use of filter
rate of transfusion
warming
Packed Red Cel s (PRBC)
Symptomatic deficiency of oxygen carrying
capacity or tissue hypoxia
Appropriate use of Packed red cel s
? Should be ABO and Rh compatible
? Clinical judgment- a vital role
? Co-existing conditions ? age, general health, cause of anemia, its
severity and chronicity
? Not for conditions like Iron/ B12/ Folate deficiency
PRBC - Triggers
? Preoperative / peri-procedural : Hb< 6g/dl
Hb 6- 10 g/dl
(bleeding, cardio resp. disease)
? Symptomatic chronic anemia : Hb < 6 g/dl
? Acute blood loss : > 40% blood loss
> 30% continued
blood loss or on
respiratory support
Neonates
? Hemoglobin
? <12g/dl in first 24 hrs
? <12 g/dl with intensive support care
? <11 g/dl with chronic oxygen need
? < 7 g/dl in a stable infant
? Blood loss
? Stable infant > 10% loss of estimated volume
? Unstable infant > 5% loss of estimated blood volume
PRBC - Dosing
? One unit of compatible RBC ?1 g/dl or Hct by 3%
? Neonates
Dose ? 10- 15 ml/kg
Increase Hb - 2-3 g/dl
Issues in red cel transfusion
One unit of PRBC
? Vol 250 ml
? Hct 65%
? Raise Hb by 1 gm/dl
? 200 mg iron
? 70% post transfusion survival
Age of blood
? concerns regarding K level
? decreased post transfusion survival
Specific conditions
? intrauterine transfusion
< 3 days old
? thalassemics
< 5 days
? open heart surgery
< 10 days
Cardinal principles in red cel transfusion in
chronic
anemia
? Evaluate etiology of anemia - AIHA, IDA
? Do not transfuse just on the basis of given Hb level
? Try to establish whether Signs / Symptoms are due to anemia
? Determine if Signs / Symptoms of anemia are al eviated by
transfusion
? Determine that temporary relief of symptoms warrants continued
transfusion
Platelets
?Stored at room temperature (20?-22?C)
?Shelf life ? 3-5 days
?Judicious use
?Group specific
Appropriate Transfusion of Platelets
? Symptomatic platelet problems
? Number related ? eg. Aplastic anemia
? Function related ? eg. Glanzmann's thrombasthenia
? Do not treat the number in isolation ?
eg Chronic ITP with no bleeds
? Prophylactic in specific situations
? CNS, eye surgery, other major surgeries, acute leukemia, patients on
chemoradiotherapy
Dose: 1 RDP/10 Kg
Platelet- Triggers
Condition
Platelet count
Prophylaxis against bleeding
< 10,000/?l
Bedside invasive procedures
< 50,000/?l
Neurosurgical procedures,
< 100000/?l
Ophthalamic surgeries
Massive Transfusion
< 50,000/?l
Neonates ? Prophylactic Platelet Triggers
Term Neonates
? Clinical y stable - 20,000/?l
? Clinical y sick - 30,000/?l
Preterm Neonates
? Clinical y stable - 30,000/?l
? Clinical y sick - 50,000/?l
Contraindications
? Thrombotic Thrombocytopenic purpura
? Heparin induced thrombocytopenia
? Immune Thrombocytopenic purpura
Fresh Frozen Plasma
Appropriate Transfusion of FFP
? Replacement of multiple factors: DIC, liver disease, warfarin reversal,
snake bite
? PT/ INR should be determined
? Dose: 10-15 ml/kg
? Not for volume expansion
? Not for nutritional support/ hypoproteinemia
Cryoprecipitate
? Out of group can be transfused but preferably ABO compatible
? RhD type need not be considered
? Thawed Cryoprecipitate transfused within 6 hours
? Indicated for bleeding associated with fibrinogen deficiency and
factor XI I deficiency
? Hemophilia A or von Willebrand disease when appropriate substitute
not available
? Bleeding with fibrinogen levels< 100mg/dl
? Dose - one unit/10 kg body weight
? Raises fibrinogen concentration by 50 mg/dl
Choice for ABO Blood Groups
Patient type
Donor PRBC
Donor FFP
Donor PC
O Positive
O
O,B,A,AB
O,B,A,AB
A Positive
A,O
A,AB
A,AB,O,B
B Positive
B,O
B,AB
B,AB,O,A
AB Positive
AB,B,A,O
AB
AB,B,A,O
Choice for Rh Blood group
? Rh (D) negative patient transfused with Rh (D) positive components
PRBC
Only as a life saving measure and with consent
from treating physician & patient's relative
FFP
No anti-D immunoprophylaxis required
PC
Anti D immunoprophylaxis required
(300 ?g anti-D gives protection for 7
plateletpheresis units or 30 Rh (D) positive
platelet concentrates for 6 weeks)
Cross matching: Special Circumstances
Clinical urgency
Immediate
Minutes
Within an hour
Group O Rh neg
ABO & Rh D type
ABO & Rh D type
Packed RBCs
Group specific blood
Complete crossmatch
Immediate spin
(5-10 min)
crossmatch
( 15-20) min)
If units are issued without X match ? written consent of physician to be taken,
-complete X match protocols followed after issue
Take Home Messages
? No place for Whole Blood in clinical medicine
? Component preparation and use is the demand of time
? Best Transfusion is "No Transfusion"
? Promotion of judicious use of blood / components
4 Audit of transfusion practices
4 CME on use of components
4 Promote autologous use of blood
4 Discourage single unit / fresh blood
Thank You
This post was last modified on 08 April 2022