Download MBBS Transfusion Medicine and Blood Bank Presentations 10 Rational Use of Blood Lecture Notes

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