Blood Components Dosage And Their Administration Effective blood

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

Whole Blood Processed within 8 hours ) Packed red blood cells Fresh frozen plasma Platelets

Component preparation n n Principle - Differential centrifugation Red cells n n n Bank plasma Fresh frozen Cryo supernate Platelets n n n Packed cells Red cells + additive Plasma n n 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 M e m Storage -2– 6 OC 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 1

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 – 10 gm% - 8 gm% 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 n Platelet units can be either n Random donor units n Apheresis units n 1 random donor unit contains 55 x 109 n 1 apheresis unit contains 240 x 109 platelets

Indications Production - Aplasia / Neoplasia Usage - TTP(thrombotic thrombocytopenic purpura), DIC(disseminated intravascular coagulation) Destruction – immune thrombocytopenic purpura. Sequestration – Hypersplenism

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

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

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

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 n

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 Indication Clinically significant deficiency of Factors II, V, X, XI q Replacement of multiple coagulation q factor deficiencies : liver disease , warfarin treatment, dilutional and consumption coagulopathy Contraindication Volume expansion Immunoglobulin replacement Nutritional support Wound healing 19

FRESH FROZEN PLASMA Precaution Acute allergic reaction are common Anaphylactic reaction may occur Hypovolemia alone is not an indication for use Dosage - Initial dose of 15 - 20 ml / kg Administration Must be ABO compatible, Rh not required Infuse as soon as possible after thawing ( within 6 hrs ) using standard blood administration set 30/11/49 20 MD-3 -49

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

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

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

DO`S • Complete the blood request form • Order blood in advance, if possible • Provide clear information on blood products being requested, number of units requested, reason for transfusion, urgency 24

Risk Benefit Analysis benefit > risk > benefit 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

Time Limits for Infusion Blood/ blood product Whole blood/ red cells Start infusion Complete infusion within 30 min. of within 4 hour removing pack (less in high from ambient temperature) refrigerator Platelet concentrates immediately within 20 min FFP within 30 min within 20 min 26

RECORDING OF TRANSFUSION Consent from patient and/or relatives Reason for transfusion Signature of the prescribing clinician Pre-transfusion checks of : patient’s identity, blood pack, compatibility label signature of the person performing the check Transfusion type and volume of component, donation number, blood group, time at which transfusion commenced, signature of person administering the transfusion Any transfusion reaction Return the transfusion slip to the blood bank 27