BLOOD

TRANSFUSION
AND
COMPONENT
THERAPY

PROF.DR.K.MADHAVAN MD
DEPARTMENT OF GENERAL
MEDICINE
HISTORY
 1628 English physician William Harvey
discovers the circulation of blood.
 Shortly afterward, the earliest known blood
transfusion is attempted.In 1665 The first
recorded successful blood transfusion occurs
in England: Physician Richard Lower keeps
dogs alive by transfusion of blood from other
dogs.
 In 1818,British obstetrician James Blundell
performs the first successful transfusion of
human blood to a patient for the treatment of
postpartum hemorrhage.
BLOOD PRODUCT
 Any therapeutic substance prepared
from human blood
WHOLE BLOOD
 Unseparated blood collected into an
approved container containing an
anticoagulant-preservative solution
BLOOD COMPONENTS
 1. A constituent of blood, separated
from whole blood, such as:
o Red cell concentrate
o Red cell suspension
o Plasma
o Platelet concentrates
 2. Plasma or platelets collected by
apheresis
 3. Cryoprecipitate, prepared from fresh
frozen plasma: rich in Factor VIII and
fibrinogen
PLASMA DERIVATIVE
Human plasma proteins prepared under
pharmaceutical manufacturing
conditions, such as:
■ Fresh Frozen Plasma
■ Albumin
■ Coagulation factor concentrates
■ Immunoglobulins
WHOLE BLOOD
 450 ml donor blood
 63 ml anticoagulant-preservative solution
 Haemoglobin approximately 12 g/ml
 Storage: Between +2°C and +6°C in
approved blood bank refrigerator, fitted with
a temperature chart and alarm
 Administration
o Must be ABO and RhD compatible with the
recipient
o Never add medication to a unit of blood
o Complete transfusion within 4 hours of
commencement
 Indications:
 Red cell replacement in acute blood loss
with hypovolaemia
 Exchange transfusion
 Patients needing red cell transfusions
where red cell concentrates or
suspensions are not available
 Contraindications
 Cardiac failure
RED CELL CONCENTRATE
 150–200 ml red cells from which most of
the plasma has been removed
 Haemoglobin approximately 20 g/100 ml
(not less than 45 g per unit)
 Haematocrit 55%–75%
 Indications
o Replacement of red cells in anaemic
patients
o Use with crystalloid replacement fluids
or colloid solution in acute blood loss
PLATELET CONCENTRATES
 Single donor unit in a volume of 50–60
ml of plasma should contain:
 At least 55 x 10^9 platelets
 <1.2X 10^9 red cells
 <0.12X 10^9 leucocytes
 SDP: platelets prepared from one
donation
 RDP: platelets prepared from 4 to 6
donor units ‘pooled’ into one pack to
contain an adult dose of at least 240 x
109 platelets
 Storage: Up to 72 hours at 20°C to 24°C
(with agitation)
 Indications:
o Treatment of bleeding due to :
o Thrombocytopenia ,Platelet function defects
o Prevention of bleeding due to
thrombocytopenia, such as in bone marrow
failure
 Contraindications:
 Not generally indicated for prophylaxis of
bleeding in surgical patients
 ITP, TTP, DIC,
 Thrombocytopenia associated with
septicemia
 Dosage: 1 unit of platelet
concentrate/10 kg body weight: in a 60
or 70 kg adult, 4–6 single donor units
containing at least 240 x 109 platelets
should raise the platelet count by 20–40
x 109/L
 Administration:
 Should be infused over a period of about
30 minutes
 Must not be refrigerated before infusion
as this reduces platelet function
FRESH FROZEN PLASMA
 Pack containing the plasma separated
from one whole blood donation within 6
hours of collection and then rapidly frozen
to –25°C or colder
 Usual volume of pack is 200–300 ml
 Storage:
o At –25°C or colder for up to 1 year
o Before use, should be thawed in the blood
bank in water which is between 30°C to
37°C.
o Higher temperatures will destroy clotting
factors and proteins
 Indications:
 Replacement of multiple coagulation
factor deficiencies:
 Liver disease
 Warfarin (anticoagulant) overdose
 Depletion of coagulation factors in
patients receiving large volume
transfusions
 Disseminated intravascular coagulation
(DIC)
 Thrombotic thrombocytopenic purpura
(TTP)
 Dosage : 15 ml/kg
 Administration:
 No compatibility testing required
 Labile coagulation factors rapidly
degrade; use within 6 hours of thawing
CRYOPRECIPITATE
 Prepared from fresh frozen plasma by
collecting the precipitate formed during
controlled thawing at +4°C and
resuspending it in 10–20 ml plasma
 Contains about half of the Factor VIII and
fibrinogen in the donated whole blood:
e.g. Factor VIII: 80–100 iu/ pack;
fibrinogen: 150–300 mg/pack
 Storage :At –25°C or colder for up to 1
year
 Indications
 As an alternative to Factor VIII
concentrate in the treatment of
inherited deficiencies of:
 von Willebrand Factor (von Willebrand’s
disease)
 Factor VIII (haemophilia A)
 Factor XIII
 As a source of fibrinogen in acquired
coagulopathies: DIC
 Administration:
 No compatibility testing required
 use within 6 hours of thawing
HUMAN ALBUMIN
 PREPARATION
- Albumin 5% contains 50mg /ml of
albumin
- Albumin 20% contains 200mg/ml of
albumin
 INFECTION RISK: No risk

 INDICATION:
1.Replacement fluid in therapeutic
plasma exchange.
2.Treatment of diuretic resistant edema
in DCLD and Nephrotic syndrome.
 ADMINISTRATION:
-No compatibility testing required.
-No filter needed.
FACTOR VIII
CONCENTRATE
 Prepared from large pools of donor
plasma.

 INFECTION RISK: Nil except

Hepatitis A and Parvo
virus

 Uses: Haemophilia A
Von willebrand disease

 STORAGE: +2 TO +6 Degrees
IMMUNOGLOBULIN
 INDICATION:
1. ITP/ Immune disorders
2.Immune deficiency states.
3.Hypogammaglobulinemia
4.HIV related disease.
RED CELL TRANSFUSION
 Carries a serious risk of hemolytic
transfusion reactions.
 Blood products can transmit infectious
agents including HIV, HepB, HepC,
malaria, Chagas disease.
 Can get contaminated with bacteria-
very dangerous if manufactured and
stored incorrectly.
PLASMA TRANSFUSION
 Can transmit most infections like whole
blood.
 Can cause transfusion reactions.
 Very few clinical indications.Risks
outweigh clinical benefits.
TIME LIMITS FOR
TRANSFUSION

PRODUCT START INFUSION COMPLETE

INFUSION
WHOLE BLOOD Within 30 minutes Within 4 hours (or
of removing pack less in high
from refrigerator ambient
temperature)
PLATELET Immediately Within 20 minutes
CONCENTRATES
FFP As soon as Within 20 minutes
CRYOPRECIPITATE possible
WARMING BLOOD
 Required only when:
1.Large volume transfusion
-Adults >50ml/kg/hr
-Children > 15ml/kg/hr
2.Exchange transfusion in infants
3.Patients with clinically significant cold
agglutinins.

 Normal slow transfusion –NO WARMING

REQUIRED.
ADVERSE EFFECTS OF
TRANSFUSION
 All suspected acute transfusion reactions
should be reported immediately to the blood
bank and to the doctor who is responsible
for the patient.
 Acute reactions may occur in 1% to 2% of
transfused patients
 Bacterial contamination in red cells or
platelet concentrates is an under-recognized
cause of acute transfusion reactions
 Transfusion-transmitted infections are the
most serious delayed complications of
transfusion.
ACUTE TRANSFUSION
REACTIONS
IMMEDIATE TREATMENT
 Slow the transfusion.
 Administer antihistamine IM
 If no clinical improvement within 30
minutes or if signs and symptoms
worsen, treat as category 2.
IMMEDIATE TREATMENT
 Stop transfusion.
 Notify the blood bank.
 Send blood unit with infusion set, freshly
collected urine and new blood samples
from opposite vein.
 Antihistamine
 Antipyretic
 IV corticosteroids and bronchodilators if
needed.
 No improvement- treat as category 3.
IMMEDIATE TREATMENT
 Stop the transfusion.
 Replace the infusion set and keep the IV
line open with normal saline.
 Normal saline at 20-30 ml/kg to maintain
systolic BP.
 Maintain airway ,give high flow Oxygen
 Give adrenaline (1:1000 ) 0.01mg/kg body
weight by slow IM.
 IV corticosteroids and bronchodilators.
 Diuretic: Furesemide 1mg/kg IV
 If features of DIC are present give
cryoprecipitate /platelets/ FFP.
INVESTIGATING ACUTE
TRANSFUSION REACTIONS
Record the following information on the
patient ’s notes
 Type of transfusion reaction
 Length of time after the start of
transfusion that the reaction occurred
 Volume, type and pack numbers of the
blood products transfused.
DELAYED COMPLICATIONS
OF TRANSFUSION
 Signs appear 5 –10 days after
transfusion:
 Fever
 Anaemia
 Jaundice
 Occasionally haemoglobinuria.
 Severe, life-threatening delayed
haemolytic transfusion reactions with
shock, renal failure and DIC are rare.
TAKE HOME MESSAGE
 PCV Once issued by blood bank transfusion
should be commenced within 30 minutes and
completed within 4 hours.
 Platelet should be transfused immediately and
should be completed within 20 minutes.
 FFP and cryoprecipitate should be transfused
immediately and should be completed within
20 minutes.
 Platelet concentrate should never be placed in
refrigerator.
 Do not administer blood pack if appears
abnormal or damaged or placed out of
refrigerator for more than 30 mins.
 Severe reactions occurs in the first 15
minutes . Hence, careful monitoring of
the patient in first 15 minutes is
essential.
 Report all transfusion reactions to the
blood bank immediately
KEY POINTS
 Used correctly, transfusion can be life
saving; inappropriate use can
endanger life

 Transfusion is only one element in

patient’s management
QUESTIONS
 What is plasma pheresis? What are the
indications?

 When do you use leucocyte-depleted

red cells?

 A 30-year old male post MVR

replacement on warfarin therapy
presence with nose bleed and
hematuria. His INR is 18. What is the
immediate line of management?
THANKYO
U