Blood Components Dosage And Their Administration

Effective blood transfusion therapy depends on availability of different blood components Components used separately or in combination can meet most patients transfusion needs and keep the risk of transfusion to minimum

Separation of blood components are desirable because 1. Separation of blood components allows optimal survival for each component 2. Allows transfusing specific blood components according to the need of the patient 3. Allows use of unnecessary component which may be contraindicated in a patient

4. Several patients can be treated from one unit of donated blood 5. Use of blood components supplements blood supply and adds to the blood inventory

Component preparation

Whole Blood Processed within 8 hours )

Principle - Differential centrifugation Red cells

Plasma + Platelets

Packed cells Red cells + additive Bank plasma Fresh frozen Cryo supernate

Plasma

Platelets

Packed red blood cells

Fresh frozen plasma

Platelets

Platelet rich concentrate Platelet rich plasma

Cryoprecipitate

Whole blood RBC Buffy

DEFINITIONS
BLOOD PRODUCT = Any therapeutic substance prepared from human blood WHOLE BLOOD = Unseparated blood collected into an approved container containing an anticoagulant preservative solution BLOOD COMPONENT = 1. A constituent of blood , separated from whole blood such as Red cell concentrate Plasma Platelet concentrates 2. Plasma or platelets collected by apheresis 3. Cryoprecipitate prepared from fresh frozen plasma

Blood Components

THE PRBC
Storage -26OC Unit of issue - 1 donation ( unit or pack ) Administration - ABO & Rh compatible - Never add medication to a unit - Complete transfusion within 4 hrs of commencement

M e m

Blood Components
2. Red cell concentrate ( packed red blood cells )- whole blood without plasma. Hct 55 -75 % , Hb approximately 20 g /100 ml

Indications
Trauma - Acute blood loss with > 20% loss of blood volume Surgery - Trigger 10gm% - 8gm% Rate of development of anemia, General condition and type of surger Radiotherapy

Dosage & Administration

Dosage - 1 unit/10 kg body wt Adult dose is 4-8 units Administration - Preferably ABO & Rh group specific but not essential Other groups can be used

PLATELETS
Platelet units can be either
Random donor units Apheresis units

1 random donor unit contains 55 x109 platelets 1 apheresis unit contains 240x109

Indications
Production - Aplasia / Neoplasia Usage - TTP(thrombotic

Guidelines for Platelet Tx.

Mild - 50,000-1,00,000/l Tx - usually not required Moderate - 20,000-50,000/l Tx-if symptomatic or has to undergo surgery/trauma Severe - < 20,000/l Risk of bleeding - high Prophylactic Tx

thrombocytopenic purpura), DIC(disseminated intravascular coagulation)

Destruction immune thrombocytopenic purpura.Sequestration Hypersplenism

Indications for platelet transfusion

IMPORTANT PRECAUTIONS

BLEEDING due to thrombocytopaenia Due to platelet dysfunction Prevention of spontaneous bleeding with counts < 20,000

Stored at 20-24 Degree celcius. Constantly agitated Only last for 5 days Infused in 30 mins

Fresh Frozen plasma

Fresh frozen plasma labile & nonlabile clotting factors, albumin and immunoglobulin. Factor VIII ( 8 ) level at least 70 % of normal fresh plasma level Storage - 20 C for 1 yr, - 65 C for 7 yrs. Before use thawed at 37 o C

Fresh frozen plasma Indications - Replacement of multiple coagulation factor deficiencies eg Liver disease Anticoagulant overdose Depletion of coagulation factors in pts receiving large volume transfusions DIC (disseminated intravascular coagulation)

FRESH FROZEN PLASMA

FRESH FROZEN PLASMA

Precaution
Acute allergic reaction are common Anaphylactic reaction may occur Hypovolemia alone is not an indication for use

Indication

Clinically significant deficiency of Factors II, V, X, XI Replacement of multiple coagulation

factor deficiencies :liver disease , warfarin treatment, dilutional and consumption coagulopathy

Contraindication
Volume expansion Immunoglobulin replacement Nutritional support

Dosage - Initial dose of 15 - 20 ml / kg Administration

Must be ABO compatible, Rh not required Infuse as soon as possible after thawing

Wound healing
19 30/11/49

( within 6 hrs )
using standard blood administration set
20 MD-3-49

FFP

Dosage & Administration for FFP

Dosage - 10-15 ml/Kg(Approx 2-3 bags for an adult) Administration - Thawed at +37o C before transfusion ABO compatible Group AB plasma can be used for all patient

Fresh Frozen Plasma Plasma collected from single donor units or by apheresis Frozen within 8 hours of collection -40o C Can last for a year

Do`s and Dont`s In Blood and Blood Components

DO`S Completethebloodrequest form Orderbloodinadvance,ifpossible Provideclearinformationonblood productsbeingrequested,numberof unitsrequested,reasonfortransfusion, urgency

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Risk Benefit Analysis

benefit > risk risk > benefit

Time Limits for Infusion

Blood/ blood product Whole blood/ red cells Start infusion Complete infusion

Hb gm/dl 4 5 6 7 8 9 10 11 12 13 14

why not transfuse

individual patient factors decide transfusion trigger

why transfuse

within 30 min. of within 4 hour removing pack (less in high from ambient temperature) refrigerator immediately within 30 min within 20 min within 20 min

Platelet concentrates FFP

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RECORDING OF TRANSFUSION
Consentfrompatientand/orrelatives Reasonfortransfusion Signatureoftheprescribingclinician Pretransfusionchecksof: patientsidentity,bloodpack,compatibilitylabel signatureofthepersonperformingthecheck Transfusion typeandvolumeofcomponent,donationnumber, bloodgroup,timeatwhichtransfusioncommenced, signatureofpersonadministeringthetransfusion Anytransfusionreaction Returnthetransfusionsliptothebloodbank
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