[23] CHAPTER X LESSON 1 Flashcards
is a broad term that encompasses all aspects of the transfusion of patients.
“Transfusion therapy”
Each blood component has specific indications for
use, expected outcomes, and other considerations
are considered drugs because of their use in treating diseases
Blood and blood products
The transfusion of blood cells is also [?], in that the cells must survive and function after transfusion to have a therapeutic effect.
transplantation
Transfusion therapy is used primarily to treat two conditions:
inadequate oxygen-carrying capacity because of anemia or blood loss and insufficient coagulation proteins or platelets to provide adequate hemostasis.
Preparation: Approx. 450mL of blood with anticoagulant (CPD or CPDA-1)
Whole Blood
Shelf life: CPD- 21 days at 1 to 6 degrees Celsius; CPDA-1: 35 days
Whole Blood
A unit of blood must be transfused within 24 hours if the seal on the bag is broken to remove plasma.
Whole Blood
Dilution: Eight parts circulating blood to one-part anticoagulant (8:1)
Whole Blood
Composition: RBC, plasma, WBC and platelets
Whole Blood
Indication: replace the loss of both RBC mass and plasma volume in actively bleeding patients
Whole Blood
Contraindication: not for patients with severe chronic anemia
Whole Blood
For a 70-kg (154-lb) adult, each unit of whole blood should increase the hematocrit level 3% or hemoglobin 1 g/dL.
Whole Blood
The increase is greater in a smaller person and less in a larger one.
Whole Blood
Preparation: Each unit of pRBC’s contains approximately 250 mL
Red Blood Cells
Prepared by removing 200 to 250 mL of plasma from a unit of WB.
Red Blood Cells
Shelf life: Cells prepared in an open system must be transfused within 24 hours
Red Blood Cells
If cells are prepared using the close system, they have the same expiration date as the original unit of the WB.
Red Blood Cells
Composition: RBC, reduced plasma, WBC and platelets
Red Blood Cells
Average hematocrit: 65-80%
Red Blood Cells
Indication: Increasing RBC mass requiring increased oxygen carrying capacity
Red Blood Cells
Critical level: 6g/dL or less
Red Blood Cells
Contraindication: well compensated patients (chronic renal failure)
Red Blood Cells
RBCs should not be used to treat nutritional anemia such as
o iron deficiency
o pernicious anemia, unless the patient show signs of decompensation (need for increased oxygen carrying capacity)
RBC transfusion is not to be used to enhance general well-being
o promote wound healing
o prevent infection
o expand blood volume when oxygen-carrying capacity is adequate, or prevent future anemia.
Increase:
o Hemoglobin level:
o Hematocrit level:
o Hemoglobin level: 1 g/dL
o Hematocrit level: 3%
In pediatric patients, a dose of 10 to 15 mL/kg will increase:
o Hemoglobin:
Hematocrit:
o Hemoglobin: 2 to 3 g/dL
o Hematocrit: 6% to 9%
Advantages over WB:
1. Equal oxygen carrying capacity in [?]
2. Significant reduction in level of [?] (safe transfusion of group O cells to nongroup O recipients)
3. Significant reduction in levels of [?] in patients with cardiac, renal or liver disease
half volume
isoagglutinin
acid, citrate and potassium load
Average unit of RBC contains approx. 2x109 leukocytes
Leukocyte- Reduced RBCs
Donor leukocytes may cause the following:
[?] transfusion reactions
Transfusion-associated [?]
Transfusion-related [?]
In addition, human leukocyte antigens (HLA) are responsible for [?]
Leukocytes may harbor [?]
Febrile nonhemolytic
graftversus-host disease
immune suppression
HLA alloimmunization
cytomegalovirus
To reduce HLA alloimmunization and CMV transmission, the leukocyte content must be reduced to less than 5 × 106
Leukocyte- Reduced RBCs
Use of leukocyte reduction filters
Leukocyte- Reduced RBCs
Decrease febrile nonhemolytic transfusion reactions
ACCEPTED
Decrease hospital length of stay
CONTROVERSIAL
Decrease alloimmunization to white blood cell antigens
ACCEPTED
Decrease incidence of wound infections postsurgery
CONTROVERSIAL
Decrease transmission of cytomegalovirus (CMV)
ACCEPTED
Decrease incidence of cancer recurrence postsurgery
CONTROVERSIAL
For neonates in the treatment of anemia secondary to spontaneous fetomaternal hemorrhage, obstetric accidents and internal hemorrhage
RBC aliquots
Reduced risk of TAGVHD in patients receiving allogeneic bone marrow transplants
Irradiated RBCs
Preparation: 70% of the original WBCs removed and at least 70% of the original RBC’s are left.
WBC poor RBC
Methods of obtaining leukocyte poor RBCs: centrifugation, filtration and washing
WBC poor RBC
WBC poor RBC
Reduction is done to avoid the following:
- Febrile non-hemolytic transfusion reactions
- HLA alloimmunization
- TRALI
- Transfusion related graft vs host disease
- Transfusion related immune suppression
Shelf-Life: Closed system- same as the original unit of blood; Open system: 24 hours
WBC poor RBC
WBC poor RBC
Donor WBC may harbor:
o CMV
o EBV
o HIV
o HTLV
Therapeutic uses: In addition to increasing RBC mass, leukocyte poor RBC’s also minimize febrile transfusion reactions in patients who have leukocyte antibodies as well as reducing CMV transmission.
WBC poor RBC
Preparation: Plasma is removed from WB after centrifugation
Washed RBC’s
Washing: removes plasma proteins
Washed RBC’s
Shelf Life: Washed RBC’s have a shelf life of 24 hours after the original unit is opened
Washed RBC’s
Stored at 1-6 degrees Celsius
Washed RBC’s
Washed RBC’s
Indications:
- Patients with [?]
- [?]
- Patients who have [?] to ordinary units of RBCs
IgA deficiency and anti-IgA antibodies
Anemia
severe allergic transfusion reactions
Preparation: RBC’s to be frozen are collected in CPD, CPDA-1. Should be frozen within 6 hours
Frozen deglycerolized RBC
Composition: RBCs, no platelets, no plasma
Frozen deglycerolized RBC
o Begins with thawing the cells at 37 degrees Celsius, then washing multiple times in a gradient concentration of saline, beginning with hypertonic concentrations and ending with an isotonic solution containing glucose.
Deglycerolization
o One unit of deglycerolized RBCs contain approximately 180 mL of cells.
Deglycerolization
Shelf Life: Stored between 1 and 6 degrees Celsius and must be transferred within 2 hours of deglycerolization.
Frozen deglycerolized RBC
Frozen with the use of glycerol
Frozen deglycerolized RBC
Freezer temperature
-65 degrees Celsius
High glycerol (40% weight per volume)
Freezer temperature
-120 degrees Celsius
Low glycerol (20% weight per volume)
Frozen deglycerolized RBC
Indications:
- Increase [?]
- Minimize [?]
- Use of [?]
red cell mass
febrile or allergic transfusion reactions
prolonged RBC blood storage
Allows for long term storage of rare blood donor units, autologous units
Frozen deglycerolized RBC
Extended shelf-life: 10 years
Frozen deglycerolized RBC
Deglycerolizing removes nearly all WBC and plasma
Frozen deglycerolized RBC
Should be used within 24 hours
Frozen deglycerolized RBC
Preparation: PRP is separated at RT by centrifugation from RBCs within 6 hours of collection of WB.
The PRP is then centrifuged, and the resulting PPP supernatant is removed, which leaves approx. 50 mL of plasma with the platelet concentrate.
Shelf Life: Platelets are stored at RT with continuous gentle agitation
Indications for Platelet Transfusion
1. [?] with bleeding or invasive procedure
2. Chemotherapy for malignancy (?)
3. Disseminated intravascular coagulation (?)
4. Massive transfusion (?)
Thrombocytopenia
decreased production, less than 5,000 to 10, 000/uL
increased destruction, less than 50,000/uL
platelet dilution, less than 50,000 to 100,000/uL
For adults: 6 to 8 units (single dose)
Platelet Concentrate
Pooled specimen (in a single bag) must be transfused within 4 hours
Platelet Concentrate
Each unit: 5.5 x 1010
Platelet Concentrate
Each unit must increase the count 5,000 to 10,000/uL in a 70kg man in a 70kg man
Platelet Concentrate
Washed platelets: remove plasma proteins transfused within 4 hours
Platelet Concentrate
Preparation: may be prepared by Leukapheresis or from a freshly drawn donor unit.
Granulocyte Concentrate
Administer corticosteroids to the donor 12-24 hours prior
Granulocyte Concentrate
increase the number of circulating granulocytes by pulling them from the marginating pool
Granulocyte Concentrate
Hydroxyethyl starch -sedimentating agent: increase separation between WBC and RBC facilitating recovery of buffy coat
Granulocyte Concentrate
Granulocyte Concentrate
Indications:
- Neutrophil count [?]
- [?] unresponsive to antibiotic
- Reversible [?]
- Reasonable chance for [?]
- Neonates with[?]
less than 500/uL
Septicemia or bacterial infection
bone marrow
patient survival
impaired neutrophil function
Shelf-life: 24 hours after separation at RT
Granulocyte Concentrate
should be transfused ASAP because their half-life is only 6 hours
Granulocyte Concentrate
Granulocyte Concentrate
Dose:
o Adults:
o Neonates:
o Adults: one WBC concentrate daily for 4 days or more
o Neonates: once or twice
Contains all coagulation factors
Fresh Frozen Plasma
Should be ABO compatible with the recipient’s RBC; not necessarily of same Rh type
Fresh Frozen Plasma
Preparation:
o Must be frozen within 8 hours of collection
o Plasma is immediately frozen at or below -18 degrees Celsius
Fresh Frozen Plasma
Shelf Life: 1 year if stored at -18 degrees Celsius
Fresh Frozen Plasma
Plasma should be stored at or below -18 degrees Celsius
Fresh Frozen Plasma
It should be thawed at 37 degrees Celsius and transfused within 24h of thawing.
Fresh Frozen Plasma
Thawed FFP should be stored between 1 to 6 degrees Celsius it is not transfused immediately.
Fresh Frozen Plasma
Fresh Frozen Plasma
Indications:
1) [?]
2) [?]
3) [?]
4) [?]
5) [?]
6) single factor deficiency: [?]
liver failure
DIC
vitamin K deficiency
warfarin toxicity/ overdose
massive transfusion
Factor XI deficiency
Liquid plasma or cryoprecipitate poor plasma and small amounts of factors V and VIII
Plasma: Thawed/Liquid
Plasma: Thawed/Liquid
Indications:
o Treatment of stable coagulation deficiency factors (?)
o Source of plasma for patients undergoing [?]
II, VII, IX, and X
plasma exchange
Separated from WB at any time during the unit’s shelf life up to 5 days after the expiration date.
Plasma Derivatives
Plasma may be pooled, purified or fractioned into albumin or plasma protein fraction.
Plasma Derivatives
Shelf Life: Plasma derivatives have a shelf life of 5 years at 1 to 6 degrees Celsius
Plasma Derivatives
Therapeutic Uses: Volume expanders
Plasma Derivatives
Contains fibrinogen, factor VIII, factor XIII, vWF, and fibronectin
Cryoprecipitate
Used primarily for fibrinogen replacement
Cryoprecipitate
AABB: [?] of fibrinogen for each unit of cryoprecipitate
150 mg
should contain greater than or equal to 80 IU of factor VIII in each unit.
Cryoprecipitated antihemophilic factor (AHF)
Pooled cryoprecipitated AHF: [?] are pooled
5 units
Each pool: [?] of fibrinogen
750-1250 mg
Each unit of cryoprecipitate must contain at least [?] of factor VIII.
80 units
was used to treat patients with von Willebrand disease, a deficiency of vWF.
Cryoprecipitate
Cryoprecipitate
Fibrinogen replacement may be required in patients with
1.[?]
2. [?]
3. Rare patients with [?]
Liver failure
DIC or massive transfusion
congenital fibrinogen deficiency
Recombinant Human Product: Factor VIIa
o Indications:
-Inhibitors in [?]
- [?]deficiency
- [?]deficiency
Liver disease
Warfarin overdose
- [?]
hemophilia A or B
Factor VII
Acquired factor VII
Massive hemorrhage
From fractionation and lyophilization of pooled plasma
Factor VIII Concentrate
Stored at ref temp and is reconstituted with saline
Factor VIII Concentrate
Patients with hemophilia A or factor VIII deficiency have spontaneous hemorrhages that are treated with recombinant or human plasma–derived factor VIII replacement.
Factor VIII Concentrate
Indications: Treat patients with hemophilia A, von Willebrand’s disease
Factor VIII Concentrate
Factor IX complex (prothrombin complex)
Factor IX Concentrate
Prepared from pooled plasma using various methods of separation and viral inactivation
Factor IX Concentrate
Contains: Factors II, VII, IX and X
Factor IX Concentrate
Indication:
[?]
[?]
[?]
[?]
Hemophilia B/factor IX deficiency
Factor VII or X deficiency (rare)
Selected patients with factor VIII inhibitors or reversal of warfarin overdose
The dose is calculated in the same manner as that for [?], using the assayed value of [?] on the label, with the caveat that half the dose of [?] rapidly diffuses into tissues and half remains within the intravascular space, so the initial dose must be doubled.
factor VIII concentrate
factor IX
factor IX
The immunologically active lymphocytes present in most blood components can create special problems for immunocompromised patients.
Irradiation
Irradiating blood products can help reduce the risk of GVHD and other complications
Irradiation
Irradiation Indications for Use
o Patients receiving [?]
o [?] recipients who have been immunosuppressed
o Low [?]
o Patients with genetically [?]
chemotherapy or radiotherapy
Organ transplantation
birth weight neonates
deficient immune systems
Blood components should be irradiated immediately before transfusion
Irradiation
Doses of 1500-5000 rad are usually used
Irradiation
Expiration date of 28 days from the date of irradiation or the original outdate of unit, whichever is sooner.
Irradiation
Blood components are irradiated with gamma radiation to prevent graft-versus-host disease, which requires three conditions to occur:
1. Transfusion or transplantation of [?]
2. Histocompatibility differences between graft and recipient (?)
3. Usually, an [?]
immunocompetent T lymphocytes
major or minor HLA or other histocompatibility antigens
immunocompromised recipient1
Equipments used in blood component preparation:
- Blood Separator
- Apheresis Equipments
- Blood Irradiators
The Plasma Extractor is used to express blood components from collection containers.
Blood Separator
The spring-loaded front panel exerts pressure on the collection container.
Blood Separator
an apparatus that separates out one particular constituent and returns the remainder to the circulation
Apheresis Equipments
Expose the blood to Caesium-137 in a blood irradiator machine.
Blood Irradiators
radiation sensitive film that gives visual indication of dose received should be used at each irradiation procedure
Blood Irradiators
