TRANSFUSION THERAPY IN SPECIAL CONDITIONS Flashcards
Donation of blood by the intended recipient to reduce transfusion reactions and transmission of infectious diseases.
Autologous Transfusion
• Blood collected before surgery and stored for later use, either as liquid or frozen.
• Predeposit autologous donation
• Typically reserved for patients anticipating a need for transfusion.
• Predeposit autologous donation
• Collection of blood from the patient before surgery, replaced with fluid, then reinfused at the end of surgery.
• Intraoperative hemodilution
• Group O RBCs used for patients needing immediate transfusion when ABO and Rh type aren’t known.
• Emergency Transfusion
• Group O-negative RBCs preferred for females of childbearing potential.
Emergency Transfusion
• Additional blood units selected based on antibody screen after initial transfusion.
Emergency Transfusion
• Replacement of one or more blood volumes within 24 hours, usually around 10 units of blood in adults.
Massive Transfusion
• Premature infants frequently need RBC transfusions for laboratory tests and to treat anemia.
Neonatal Transfusion
Neonatal Transfusion
• Dose: [?] with specific considerations for blood units (age, compatibility, CMV status, hemoglobin S).
10 mL/kg over 2 to 3 hours
likely to be required when 30–40% blood volume is lost (approximately 2,000 mL in an adult)
Red cells
> 40% blood volume loss is immediately life-threatening.
Red cells
Pretranfusion compatibility testing should be done early
Red cells
It’s best practice to transfuse [?] of the same ABO and RhD group as the patient, however if there are insufficient supplies of the patient’s ABO group available locally, [?] of another ABO compatible group may be released by the Transfusion Service Provider.
Red cells
In an emergency situation, uncrossmatched Group O RhD negative red cells (especially for females of childbearing age) may be appropriate.
Red cells
Should be given through a blood warmer.
Red cells
to maintain PT & APTT ≤ 1.5x the normal range, or according to institutional viscoelastic testing algorithm
Fresh frozen plasma (FFP)
Usual dose is 15 ml/kg.
Fresh frozen plasma (FFP)
If the patient’s blood group is unknown, give group AB or group A FFPaccording to jurisdictional guidelines.
Fresh frozen plasma (FFP)
Allow 1/2 hour thawing time.
Fresh frozen plasma (FFP)
• FFP will not provide adequate fibrinogen to correct hypofibrinogenemia in a critically bleeding patient. This should be used.
Cryoprecipitate
• In obstetrics haemorrhage, early DIC is often present so consider it early in this situation.
Cryoprecipitate
• Usual dose is 3–4 g of fibrinogen which is roughly equivalent to 10 units of [?] or 5 units of [?]- your local Transfusion Service Provider can advise on the number of units to provide this dose.
whole blood cryoprecipitate
apheresis cryoprecipitate
• Allow up to 1/2 hour thawing time.
Cryoprecipitate
• Thrombocytopenia <50 x 109/L can be anticipated after two blood volume replacementdue to dilution and increased consumption.
Platelets
• Aim to keep the platelet count >50 x 109/L (or >100 x 109/L in situations such as CNS injury or diffuse microvascular bleeding).
Platelets
• The usual dose in an adultis 1 unit.
Platelets
• For life-threatening (critical organ) and clinically significant bleeds, the consensus is to use a combination of.
Prothrombinex-VF, Vitamin K and FFP
• Vitamin K1:
5–10 mg IV
• Prothrombinex (PTX-VF):
50 IU/kg
• Fresh frozen plasma: [?] if Prothrombinex-VF not available
150–300 mL or 15 mL/kg
• Note that the use of blood components in patients with critical bleeding is lifesaving, but increased volumes may be independently associated with
mortality and ARDS.
• [?] on specimen tubes compared to patient’s hospital armband at bedside to prevent mislabeling.
• [?] applied to tubes before leaving bedside to avoid errors.
Labels
require sterile, pyrogen-free transfusion sets with filters designed to retain harmful particles.
AABB standards
• Blood components infused slowly for [?], with close observation for reactions.
10-15 minutes
• Subsequent infusion should be as rapid as tolerated, ideally within [?].
4 hours
• Standard sets include a [?] to remove gross clots and cellular debris.
150-260 μm filter
• Mandatory use of [?] for all blood component transfusions.
blood administration filter
• Current good manufacturing practice (cGMP) regulations set by the FDA govern the entire process of blood component management, from receipt to transfusion.
cGMP Regulations
• These regulations provide standards for the collection, processing, storage, and distribution of blood and blood components.
cGMP Regulations
• Compliance with cGMP regulations is essential to maintain the quality, purity, and potency of blood products, minimizing the risk of adverse events during transfusion.
cGMP Regulations
• Each blood product is prepared and stored under specific conditions to preserve its purity and potency until the time of transfusion.
Optimizing Purity and Potency
• Proper storage temperatures and conditions are maintained to prevent degradation of components and ensure their efficacy.
Optimizing Purity and Potency
• Techniques such as leukoreduction (removal of white blood cells) and irradiation may be employed to enhance the safety and quality of blood components.
Optimizing Purity and Potency
1.Quality control parameters are established by regulatory bodies like the FDA and professional organizations like AABB.
Quality Control
2.These parameters encompass various aspects of blood component management, including collection methods, processing techniques, storage conditions, and testing protocols.
Quality Control
3.Regular quality control checks and audits are conducted to monitor compliance with established standards and identify any deviations that may affect product quality or patient safety.
Quality Control
1.Component indications refer to specific guidelines and criteria for the selection and transfusion of different blood components based on patient needs and clinical indications.
Component Indications
2.Indications help healthcare providers make informed decisions regarding the use of whole blood, packed red blood cells, platelets, plasma, and other blood products.
Component Indications
3.Adhering to component indications minimizes the risk of adverse transfusion reactions, such as hemolytic reactions, transfusionrelated acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO).
Component Indications
4.Indications may include factors such as patient diagnosis, hemoglobin level, platelet count, coagulation profile, and specific clinical scenarios (e.g., massive transfusion, neonatal transfusion).
Component Indications
• A single unit of packed red blood cells (pRBCs) is usually infused over 1 to 4 hours, depending on the transfusion rate and the patient’s tolerance.
Red Blood Cell (RBC) Transfusion:
• Multiple units of pRBCs may be administered sequentially, extending the overall duration of the transfusion session.
Red Blood Cell (RBC) Transfusion:
• Platelet transfusions are typically infused over 30 to 60 minutes per unit, but the duration may vary based on institutional protocols and patient factors.
Platelet Transfusion:
1.Fresh frozen plasma (FFP) or other plasma components are generally infused over 30 to 60 minutes per unit.
Plasma Transfusion
2.Additional plasma products, such as cryoprecipitate or prothrombin complex concentrate (PCC), may also be administered, each with its own infusion duration.
Plasma Transfusion
1.Whole blood transfusions, while less common than component transfusions, are typically infused over 1 to 4 hours, similar to pRBC transfusions.
Whole Blood Transfusion:
