Administration of Blood and Blood Component

Administration of Blood and Blood Component

Dr.Azarm

Blood Products

روشهايصحيح مصرفخون

كاهش منظور بهترانسفوزيونهاي

ضروري غيرDr.Azarm

استخون الزم چراو خونيصحيح وفراوردههاي

مصرفشوند؟ هدفمند------------------------------------

اهدا -1 بايد بلكه نيست ساختني خون .شود

و -2 نميشود فراوري خون جا همه دردسترسنمي باشد در .

3- ندارد وجود اماده كننده اهدا .هميشه

مد -4 بايد هميشه خون عوارضانتقالباشد .نظر

Dr.Azarm

مهم نكاتخون و فرآورده هاي خون بايد در اسرع وقت •

تزريق شود. دقيقه يا بيشتر 30چنانچه فرآورده اي براي •

در دماي اتاق قرار گيرد نبايد تزريق شود. خون و فرآورده هاي خون نبايد در داخل•

اتاق پرستاري ذخيره شود مگر در يخچالمواقع خاص مانند اتاق عمل يا در اتاق

recovery. باز (RBC)چنانچه به هر علت واحد خون•

نشود و در دماي مناسب قرار داشته باشد و دقيقه، به بانك 30در فاصله زماني كمتر از

خون برگردد مي توان از آن استفاده كرد.

مهم نكاتخون نبايد در داخل ظرف حاوي آب داغ •

قرار گيرد زيرا اين عمل باعث هموليز گويچه هاي سرخ و آزاد شدن پتاسيم از

گويچه هاي سرخ مي شود كه مي تواند براي زندگي بيمار مخاطره آميز باشد.

فرآورده اي كه ذوب شده نبايد دوباره منجمد •شود و بايد هرچه زودتر مصرف شود. در

صورتي كه به هر دليل تاخيري در تزريق رخ دهد، بايد در دماي محيط نگهداري شده و در

ساعت مصرف شود.4عرض نظارت، توجه:• مرحله دقيقه 15مهم‌ترين

. مي‌باشد تزريق اول

Whole Blood

Dr.Azarm

Whole Blood

Description:• Up to 510 ml total volume

• 450 ml donor blood

• 63 ml anticoagulant-preservative solution

• Haemoglobin approximately 12 g/ml

• Haematocrit 35%–45%

• No functional platelets

• No labile coagulation factors (V and VIII)

Infection risk

Not sterilized, so capable of transmitting any agent present in cells or plasma which has not been detected by routine screening for transfusion-transmissible

infections, including:

HIV-1 and HIV-2, hepatitis B and C,

other hepatitis viruses, syphilis, malaria and Chagas

disease

Storage

• Between +2°C and +6°C in approved blood bank refrigerator, fitted with a temperature chart and alarm

• During storage at +2°C and +6°C, changes in composition occur resulting from red cell metabolism

• Transfusion should be started within 30 minutes of removal from refrigerator

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

Risk of volume overload in patients with:

• Chronic anaemia

• Incipient cardiac failure

Administration

• Must be ABO and RhD compatible with the recipient

• Never add medication to a unit of blood

• Complete transfusion within 4 hours of commencement

RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-reduced blood’)

Description• 150–200 ml red cells from which most of the

plasma has been removed

• Haemoglobin approximately 20 g/100 ml

• Haematocrit 55%–75%

Infection risk

• Same as whole blood

Storage

• Same as whole blood

Indications

• Replacement of red cells in anaemic patients

• Use with crystalloid replacement fluids or colloid solution in acute blood loss

تزريق به نياز كه موارديندارد وجود

•A :آهن كمبود با همراه آنمي•B :پرنيسيوز آنمي•C :تغذيه‌اي كمبود•D :گوارشي جذب عدم•E : زخم ترميم•F :فوالت B12 و كمبود•G :ارثي همولتيك آنمي•H :عمومي حال بهبود براي

جا يا گوارش دستگاه از فعال خونريزي كه هنگامي بدن فقط ديگر يبيماراني چنين در البته داريم تزريق به نياز هدفتصحيح باشد

بيمار نيست هموگلوبين كه باشد حدي در هموگلوبين بلكه. باشد داشته پايدار حياتي عالئم

از كمتر سن با بيماران ماه 4در

از كمتر همراه 13هموگلوبين دسي‌ليتر در گرميا و ريه و قلب سيانوتيك و بيماري‌هايشديد با

از كمتر قلبهموگلوبين در 10نارسايي گرممتوسط ريوي بيماري‌هاي با همراه دسي‌ليتر

بيشاز حاد و سريع رفتن دست حجم% 10ازخون

از كمتر همراه 8هموگلوبين ليتر دسي در گرمآنميعالمت‌دار با

بايستي * و مي‌باشد پيشنهاد يك راهنماها بايستي اين و مي‌باشد پيشنهاد يك راهنماها اينتصميم تنهايي به نوزاد هر مورد تصميم در تنهايي به نوزاد هر مورد كرد در كرد گيري گيري ..

از كمتر هموگلوبين كه 10در دسي‌ليتر در گرمبزرگهستند جراحي عمل .كانديد

كودكان و : نوزادان

در‌كودكان‌با‌سن‌‌ماه4بيشتر‌از‌ از • كمتر جراحي عمل از قبل در 8هموگلوبين گرمزير هماتوكريت يا و هموگلوبين% 25دسي ليتر يا و

عاليم 8زير با همراه كه عمل از بعد دسي ليتر در گرم. باشد خوني كم نشانه هاي و

از • بيش حاد و سريع رفتن دست از يا و % 15كاهشبه كه هيپوولمي نشانه هاي و عاليم وجود يا خون حجم

نداده پاسخ كلوئيدي يا كريستالوئيد مايعات تزريقباشد.

از • كمتر بيماري 13هموگلوبين در دسي ليتر در گرم) - تنفسي ) دسترين سيانوز ريوي قلبي شديد

از • كمتر در :8هموگلوبين دسي ليتر در گرم

از • كمتر در :8هموگلوبين دسي‌ليتر در گرمراديوتراپي( • يا تحتشيمي‌درماني كه بيماراني الف

) استخوان. ) مغز نارسايي هستندبه ( • كه هستند مزمن كم‌خوني دچار كه بيماراني ب

كم نشانه‌هاي و عاليم يا نداده‌اند پاسخ طبي درمان. دارند خوني

عروقي • حوادث نظير سيكل‌سل عوارضبيماريعمل Acute chest syndromمغزي، براي آمادگي و

جراحي.هتروزيگوت • يا و هموزيگوت بتاتاالسمي بيماران در

آنميشديد دچار تاالسمي انواع ساير از بيشتر كهرشد مانند عوارضي از جلوگيري براي مي‌شوند

كاهش و رشد سرعت در بهبود و استخوان نابهنجارمحدودة در هموگلوبين است بهتر آهن گرم 10بار

. نبايد تزريق از قبل البته شود كنترل دسي‌ليتر دراز بيشتر تا 5/9هموگلوبين باشد دسي‌ليتر در گرم

. شود جلوگيري آهن افزايشبار از

Administration

• Same as whole blood

• To improve transfusion flow, normal saline (50–100 ml) may be added using a Y-pattern infusion set

RED CELL SUSPENSION

Description• 150–200 ml red cells with minimal

residual plasma to which ±100 ml normal saline, adenine, glucose,mannitol solution (SAGM) or an equivalent red cell nutrient solution has been added

• Haemoglobin approximately 15 g/100 ml• Haematocrit 50%–70%

• Infection: risk Same as whole blood

• Storage: Same as whole blood• Indications: Same as red cell concentrate

• Contraindications: Not advised for exchange transfusion of neonates. The additive solution may be replaced with plasma, 45% albumin or an isotonic crystalloid solution, such as normal saline

• Administration : Same as whole blood

• Better flow rates are achieved than with red cell concentrate or whole blood

Frozen RBCs

• Add cryoprotectant glycerol to RBCs followed by appropriate freezing (-65°C or lower) allows storage of RBCs for 10 years.

• When Cells needed, unit thawed and washed with saline to remove glycerol. Washing “enters” storage bag-unit can be stored for only 24 hours at 1° to 6°C after thawing.

• Used primarily to maintain supplies of uncommon RBC phenotypes needed by patients with alloantibodies against frequently occurring RBC antigens

• Military uses to maintain emergent blood supplies.

Leukocyte Poor RBCs

Leukocyte-Reduced Red Blood Cells

Description• A red cell suspension or concentrate containing

<5 x 106 white cells per pack, prepared by filtration through a leucocyte-depleting filter

• Haemoglobin concentration and haematocrit depend on whether the product is whole blood, red cell concentrate or red cell suspension

• Leucocyte depletion significantly reduces the risk of transmission of cytomegalovirus (CMV)

Indications

• Minimizes white cell immunization in patients receiving repeated transfusions but, to achieve this, all blood components given to the patient must be leucocyte-depleted

• Reduces risk of CMV transmission in special situations

• Patients who have experienced two or more previous febrile reactions to red cell transfusion

Contraindications

• Will not prevent graft-vs-host disease:

for this purpose, blood components should be irradiated where facilities are available (radiation dose: 25–30 Gy)

Administration• Same as whole blood

• A leucocyte filter may also be used at the time of transfusion if leucocyte-depleted red cells or whole blood are not available

Washed RBCs

• Washed RBCS are RBCs washed with saline to remove most of the plasma.

• Washed RBCs are not leukoreduced.• Indications-patients who have had severe allergic

reactions associated with transfusion or immunoglobulin A (IgA) deficiency.

• Washed RBCs must be given through a standard blood filter, can transmit hepatitis and other infectious diseases

• Because bag must be entered to introduce saline, washed RBCs must be given within 24 hrs of preparation.

Irradiated WB or RBCs

• Blood components exposed to standard dose of ionizing radiation to make viable lymphocytes unable to engraft (to reduce GvH) in premature newborns or highly immunocompromised patients (e.g., bone marrow or solid organ transplant).

• “Although no significant adverse red cell structural events have been noted, mild functional impairment manifested by significant leakage of potassium and accumulation of plasma hgb has been noted after gamma irradiation.”

• ASA Questions and Answers About Transfusion Practice- 2002

خون كردن گرمطي • بيشتر يا و خون حجم يك كه مواردي جايگزين 24در ساعت

. ميزان به خون حجم يك مي نامند ماسيو را خون تزريق ml/Kgشود،حدود 75 .ml 5000يا مي شود زده تخمين

•Exchange Transfusion نوزادانداراي • بيمار كه صورتي سرد Abدر دماي در واكنش دهنده Cold)هاي

Antibody). باشد •. باشد داشته آريتمي بيمار كه زمانيسرعت • با خون كه زماني يا 30براي ml/minute 50براي دقيقه

سرعت و بزرگساالن براي كودكان ml/Kg/hour 15بيشتر براي. باشد شده تنظيم

جراحي • عمل طول در بيماران فاز Bypassبراي re-warmingدرفرآيند • يا درماني Red cell exchangeپالسمافرزيسكودكان • و نوزادان در خون تزريقسرما • از ناشي وازواكتيو يا رينود سندرم

Use of RBCs in Massive Transfusion

• If 50-75% blood volume replaced by type 0 Blood (10 U RBCS in adult)-

• May need to continue with type 0 blood-

• “Otherwise, risk of major cross-match reaction increases.

• Patient may have received enough anti-A or anti-B antibodies to precipitate hemolysis if A,B, or AB units subsequently given”

• Smith, C.(2003)Current Practices in Fluid and Component Therapy ITACCS. Seminar-Massive Transfusion

Massive Transfusion Massive Transfusion

Give blood products as a ratio 1 dose : 1 dose : 1 dose : 1 dose

5 RBC : 2 FFP : 6 RD PLT : 10 Cryo ________________ )1 PPH( _________ Hgb PT PTT Plt Ct Fib

FFP

Description

• Pack containing the plasma separated from one whole blood donation within 6 hours of collection and then rapidly frozen to –25°C or colder

• Contains normal plasma levels of stable clotting factors, albumin and immunoglobulin

• Factor VIII level at least 70% of normal fresh plasma level

FFP

• Collected by centrifugation of whole blood, or by apheresis as a single donor unit (taken for plasma, or as a by product of RBC or platelet apheresis)

• Must be frozen within 6 hours of collection,can be kept frozen for a year, takes 20-30 minutes to thaw,

• Before use, should be thawed in the blood bank in water which is between 30°C to 37°C. Higher temperatures will destroy clotting factors and proteins

• is then kept at 1-6° and transfused within 24 hours

FFP

• Need ABO Compatibility, but Rh Neg patients can receive Rh Pos FFP

• 4-5 Units of platelets, one unit WB all have same a similar quantity of coagulation factors as unit of FFP (except for labile factors lost to cold storage in WB)

Indications

• Replacement of multiple coagulation factor deficiencies: e.g.

—Liver disease

—Warfarin (anticoagulant) overdose

—Depletion of coagulation factors in patients receiving large volume transfusions

• Disseminated intravascular coagulation (DIC)

• Thrombotic thrombocytopenic purpura (TTP)

Precautions

• Acute allergic reactions are not uncommon, especially with rapid infusions

• Severe life-threatening anaphylactic reactions occasionally occur

• Hypovolaemia alone is not an indication for use

FFP

• Goal- to raise level of clotting factor to 30% of normal

• Takes 10-15 cc/kg

• Rapid reversal of coumadin 5-8cc/kg FFP (Vitamin K would take 12-18 hours)

• Clin Anes Procedures-Mass Gen-2002

Cryoprecipitate

Description

• 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; factor XIII: 40 to 60 U/pack

Cryoprecipitate

• Shelf life-Frozen: 1 yr (<–30°C)Thawed: Give within 6 hours

• Preferable to be ABO compatible (AABB) May have RBC fragments that can sensitize Rh-D neg patients

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: e.g. disseminated intravascular coagulation

Cryoprecipitate

• A dose of 1 unit (bag) of cryoprecipitate per 7-10 kg body weight raises fibrinogen levels by at least 50 mg/dL.

• The half-life of fibrinogen is 3 to 5 days; additional doses given on the basis of lab test results.

Platelets

Description

Single donor unit in a volume of 50–60 ml of plasma should contain:

• At least 55 x 109 platelets

• <1.2 x 109 red cells

• <0.12 x 109 leucocytes

Unit of issue

May be supplied as either:

• Single donor unit: platelets prepared from one donation

• Pooled unit: platelets prepared from 4 to 6 donor units ‘pooled’ into one pack to contain an adult dose of at least 240 x 109 platelets

Infection risk• Same as whole blood, but a normal adult dose

involves between 4 and 6 donor exposures

• Bacterial contamination affects about 1% of pooled units

Storage • Up to 72 hours at 20°C to 24°C (with agitation)

unless collected in specialized platelet packs validated for longer storage periods; do not store at 2°C to 6°C

• Longer storage increases the risk of bacterial proliferation and septicaemia in the recipient

Indications

• Treatment of bleeding due to:

— Thrombocytopenia

— Platelet function defects

• Prevention of bleeding due to thrombocytopenia, such as in bone marrow failure

از • كمتر بيمار پالكت‌هاي تعداد كه صورتي 000/10دراز كمتر يا ميكروليتر همراه 000/20در و ميكروليتر در

. باشد تب باكاهشيافته • استخوان مغز در پالكت توليد كه مواردي

بين يا و باشد 000/10 -000/20باشد ميكروليتر دربيماراني يا و خوني بدخيمي‌هاي داراي بيماران مانند

. بوده‌اند كموتراپي تحت كهاز • كمتر براي 000/50شمارشپالكت ميكروليتر در

. كوچك جراحي‌هاياز • كمتر براي 000/80شمارشپالكت ميكروليتر در

. بزرگ جراحي‌هاياز • كمتر در 000/50شمارشپالكت ميكروليتر در

. دارند فعال خونريزي كه بيمارانياز • كمتر در 000/50شمارشپالكت ميكروليتر در

. داشته‌اند قرار وسيع ترانسفوزيون تحت كه بيمارانياز • كمتر در 000/50شمارشپالكت ميكروليتر در

قرار تهاجمي اعمال مورد است قرار كه بيمارانيمي‌گيرند.

از • كمتر پالكت ميكروليتردر 000/100شمارش در: زير خصوصيات از يكي داراي كه بيماران

• a :رتين خونريزي• b :مغز خونريزي• c :پاس باي جراحي تحت دچار (By-Pass)افراد كه

. شده اند خونريزياز • بيش سيالن زمان پالكت 5/7با شمارش با دقيقه

بيماران در تهاجمي جراحي اعمال يا خونريزي طبيعي،پالكت كيفي اختالل دچار

خونريزي • مرحله از جلوگيري براي حاد لوكمي درمان درانتهايي( Episode Major Bleedingوسيع ) فاز جز به

Platelet Transfusion:

Response evaluation to plt transfusion:

Corrected Count Increment:

( CCI)

CCI= Plt increment multiply BSA/ Number of plt transfused

Platelet Transfusion:

Response Evaluation:

CCI must be at least 7500 one hour and

4500 ,20 hours after transfusion.

So if it doesn’t occur we can say that patient has platelet resistance.

Contraindications

• Not generally indicated for prophylaxis of bleeding in surgical patients, unless known to have significant pre-operative platelet deficiency

• Not indicated in: — Idiopathic autoimmune thrombocytopenic purpura (ITP) —Thrombotic thrombocytopenic purpura (TTP) — Untreated disseminated intravascular coagulation (DIC) — Thrombocytopenia associated with septicaemia, until treatment has commenced or in cases of hypersplenism

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

• Increment will be less if there is:

— Splenomegaly

— Disseminated intravascular coagulation

— Septicaemia

Administration

• After pooling, platelet concentrates should be infused as soon as possible, generally within 4 hours, because of the risk of bacterial proliferation

• Must not be refrigerated before infusion as this reduces platelet function

• 4–6 units of platelet concentrates (which may be supplied pooled) should be infused through a fresh standard blood administration set

• Special platelet infusion sets are not required• Should be infused over a period of about 30 minutes• Do not give platelet concentrates prepared from RhD

positive donors to an RhD negative female with childbearing potential

• Give platelet concentrates that are ABO compatible, whenever possible

Complications

• Febrile non-haemolytic and allergic urticarial reactions are not uncommon, especially in patients receiving multiple transfusions

PLATELET CONCENTRATES (collected by plateletpheresis)

Description• Volume 150–300 ml• Platelet content 150–500 x 109, equivalent to 3–10

single donations• Platelet content, volume of plasma and leucocyte

contamination depend on the collection procedure

Unit of issue

• 1 pack containing platelet concentrates collected by a cell separator device from a single donor

Infection risk

Same as whole blood

Storage• Up to 72 hours at 20°C to 24°C (with agitation)

unless collected in specialized platelet packs validated for longer storage periods; do not store at 2°C to 6°C

Indications

• Generally equivalent to the same dose of platelet concentrates prepared from whole blood

• If a specially typed, compatible donor is required for the patient, several doses may be obtained from the selected donor

Dosage• 1 pack of platelet concentrate collected from a single

donor by apheresis is usually equivalent to 1 therapeutic dose

Administration

• Same as recovered donor platelets, but ABO compatibility is more important: high titre anti-A or anti-B in the donor plasma used to suspend the platelets may cause haemolysis of the recipient’s red cells

That’s all, folks!