Blood and Blood Products Flashcards
Definitions of
Blood Product:
Blood Component:
Plasma Derivative:
- *Blood Product:**
- any product derived from human blood
- 1) Blood Component: in bag*
- a blood product manufactured in a local blood centre that is derived from a single donation or a small pool (4-6 donation)
- Includes Red cells, platelets and fresh frozen plasma
- 2) Plasma Derivative: in bottle*
- a blood product manufactured from a large pool of plasma donations (1000s) using industrial type systems
What are the priorities for the National NZ blood service?
Where do we collect blood
- There are sites all over NZ
- A very regulated environment to avoid the failures ofthe past
- Blood components are treated as registered medicines
The key relationship the Blood service has is _______.
What do they produce?
CSL Behring Australia
- Plasma fractionator based in Melbourne
- Get plasma from NZBS →manufacture into a range of plasma derivatives for use in NZ
- Products include;
- Factor VIII (biostate)
- Factor IX (monofix, Prothrombinex)
- IV immunoglobulin (Intragram P)
- Human Albumin Solution
What’s our primary concern and how is this done?
Maintaining a Safe Blood Supply
There is a huge range of pathogens that can contaminate blood.
The principle of the ‘voluntary non-remunerated donor’ is to
decrease the useage of paid doners.
Paid Donation is associated with:
- -Increased risk of blood bourne virus transmission
- Exploitation of the poor and disadvantaged.*
It creates and solidifies community to donate it without reward.
How does theNZ blood donations service create National Self Sufficiency?
It involves a country taking active steps to meet requirements for blood and blood products from its own resources
therefore NZ is:
- Self-sufficient in blood components
- Largely self-sufficient for main types of plasma derivatives
The Precauionary principle.
Because biological products are associated with risk, it can never be said that blood and blood product useage is absolutely without risk and therefore perfectly safe.
Preventative action should be taken when there’s evidence that a potential disease causing agent is or maybe blood bourne.
What is the criteria a blood donor must meet?
- Between 16-70 years of age
- Be in good general health
- are able to donate every 12 weeks
- Selection process involves:
- completion of a health questionnare
- interview with a registered nurse
- Haemaglobin check
- There’s a guidebook from Europe that is used as a guide
Within donor selection, we are aiming to protect:
- The Potential Recipient
- Identify medical and lifestyle factors that might increase the risk to the potential recipient
- The Donor
- Identify health problems that might increase the risk of complications from donation
Men who have had sex with other men can donate blood _______ after the event. Why if this done
Men who have had sex with other men can donate blood 12 months after the event.
This is because no test is perfect and it’s important to remember that donations contain a large amount of biological product. Biological markers of a virus often don’t show for a while after infection, called the “Window Period” where we may not detect the virus!
If they donate during the Window Period, they have the ability to transmit infection! Therefore there’s a responsibility to NZ BLOOD to exclude this possibility.
Once the blood is donated, what do we test for?
- ABO, Rh(D) type and antibody screen
- Test for Major Blood-Bourne Viruses*
- Hep B surface antigen** and **Nucleic acid test for HBV DNA
- Hep C antibody** and **Nucleic acid test for HCV RNA
- HIV 1/2** **antibody** and **Nucleic Acid test for HIV-1 RNA
- HTLV antibody (1st time donors only )
- Serological test for syphilis: good risk factor for high risk sexual behaviour
What are the risks and Window Periods of HIV and Hep B and C ?
You would think the risk of testing for HIV or Hep B/C in NZ is 1 every 10 years.
Actual risk appears to be lower.
There’s no recorded case of HIV since HIV anti-body testing was founded in 1985
Hep B/C no know transmissions since 1992
These are low as a consequence of the safety measures put in place
The Health and Disability Code for patients requires?
Why is it there?
Requires:
- Patients to recieve information concerning their treatment
- Informed consent to be provided before treatment commences
Blood component is ?
In NZ all blood components are ________ prior to transfusion.
Blood component: blood product manufactured from a single donation or small pool, for the purpose of direct transfusion to a patient.
In NZ all blood components are leucodepleted prior to transfusion.
This involves the removal of WBC via filtration.
The selection of blood components requires
- Blood group of patient to be known
- May involve specific compatibility testing
The development of plastic Bags means we can get ________
Closed systems which enables us to split whole blood into its components
- Take the Whole Blood
-
Centrifuge it:
- Red cells to bottom
- Plasma goes to top
- Platelets may be in plasma dependent on speed
- Take plasma off top, collect platelet rich plasma
- Place Red cell Preservative Solution atop Red cells
- You know have 3 seperate Blood components and 3 patients can be treated!
How does Temperature affect differe Blood components?
Their viability is all best at different temperatures!
By seperating and storing them aat different temps we can maximise outcomes.
Prescribing checklist is?
Asks questions about the patient prior to transfusion.
Over the last few years there’s been a major reduction in transfusion rates of Red blood cells in NZ. THis is due to 2 reasons
- Concern over patients transfused by ‘older blood’
- RBCs stored >2 weeks had sig. increased risk of post-operative complications as well as reduced short/long term survival!
- Increasing recognition that a restrictive approach over a conservtive one is associated with at least as good or even better clinical outcomes
- By maintaing patients haem at >70g/l it was jsut as good as transfusion for a patient!
- Give single unit, check haem, then only transfuse more if needed!
When deciding whether to transfuse Red cell, the patients haemaglobin, although important, should not be the sole deciding factor
You also need to consider…
- Signs and symptoms of hypoxia
- Ongoing Blood loss
- Risk of anaemia
- risk of transfusion
Also
Patients Cardiopulmonary Reserve: if pulmonary function is abnormal you may have to transfuse at a higher threshold
Volume of Blood Loss: Clinical assessent should attempt to quantify bloodloss before/during/after surgery to ensure maintenence of normal blood vol.
Oxygen Consumption: This may be affected by a number of factors including fever, anaesthesia and shivering, could increase
Atherosclerotic Disease: Criticial arterial stenosis to major organs, partycularly the heart ma modify indication for the use of red cells
Hb levels and Tranfusion?
If Hb < 70g/l you should be asking; “why wouldn’t I transfuse this patient”
If Hb < 100g/l you should be asking; “why am I transfusing this patient”
One unit, reassess Hb and transfuse again if neccesary
Why would we transfuse platelet?
- Bone Marrow Failure
- Only done when Platelet count <10x109/L (norm is 150-400x109)
- If patient febrile/other risk factors do it at <20x109/L
- Surgery
- <50x109/L for normal surgery
- <100x109/L if surgery is high risk (ocular and neuro)
- Platelet Function Disorder
- may be appropriate in inherited/acquired, platelet count unlikely to be helpful.
- Bleeding
- Massive Haemorrage /trauma
- <50x109/L
FFP donor selection?
FFP selection works the opposite way to Red cell transfusion.
We select units of plasma that don’t have antibodies directed against the red cells of the recipient becaus ein this setting the antibodies will destroy the patients red cells.
NZBS no longer provides group O FFP as this would have the higest risk containing both Anti-a and anti-B
Indiccations for FFP
- Treatment of the multiple coagulation deficiencies associated with acute DIC or bleeding
- most frequent scenario we will transfuse for.
*
- most frequent scenario we will transfuse for.
What are plasma derivatives and what are they used for?
Blood products manufactured using industrial processes involving large plasma pools (7.5-10 tonnes)
- Highly regulated
- Manufacturing involves at least 1 and hopefully 2+ dedicated viral inactivation steps.
- so although the large pool size increases risk, these steps lower it!
- Current safety profile good
What are the main plasma derivatives in NZ?
Factor VII (biostate): for those with haemophilia
Factor IX : reverses warfarin affect
