WHOLE BLOOD VIS A VIS COMPONENTS Why we

WHOLE BLOOD VIS A VIS COMPONENTS

Why we should not use whole blood • Whole blood has plasma which is a source of numerous infections and antibodies not native to the recipient. • Plasma of whole blood does NOT have any platelet , coagulation factors because stored blood at 2 -8 C loses all the above components.

• Plasma will cause volume overload and may lead to cardiac failure specially in heart patients • Hematocrit of PRBC is higher as compared to whole blood • PRBC maximizes blood resource( one donation can help four people ). Avoids unnecessary and inappropriate transfusions

• Fresh blood is not recommended ( Fresh blood has more virulent infections which can be transmitted to the patient ) Screening for HIV, Hbs. Ag and HCV is not possible

Whole Blood • It is now used rarely in current practice in the UK or U. S. A, although in many countries it accounts for most transfusions. • Almost all whole blood donations are processed to separate red cells, platelets and plasma.

Appropriateness of transfusion • May be life-saving • May have acute or delayed complications • Puts patient at risk unnecessarily • ‘ The transfusion of safe blood products to treat any condition leading to significant morbidity or mortality, that cannot be managed by any other means’.

Inappropriateness of transfusion • Giving blood products for conditions that can otherwise be treated e. g. anaemia • Using blood products when other fluids work just as well • Blood is often unnecessarily given to raise a patient’s haemoglobin level before surgery or to allow earlier discharge from hospital. These are rarely valid reasons for transfusion.

Inappropriateness of Transfusion • Patients’ transfusion requirements can often be minimized by good anaesthetic and surgical management. • Blood not needed exposes patient unnecessarily • Blood is an expensive, scarce resource. Unnecessary transfusions may cause a shortage of blood products for patients in real need.

Problems faced • Too few donors • Lack of equipment • Insufficient products • Insufficient reagent • Infectious disease testing

Recommendations • Increase public awareness about need for blood and hence the number of voluntary donors • Continue to encourage relatives to donate for patients* • Increase the number of mobile clinics • Extend the opening hours for blood collecting

Recommendations • Management of stocks of blood and blood products • Maintenance and replacement of equipment • On-going training of Haematology Lab Staff • Better management of reagents for- infectious disease testing, antigens etc. • Improved record keeping • Move to electronic record keeping

Conclusion • ‘Primum-non-nocere’ • Weigh risks and benefits • Haemoglobin level is not the sole indicator for transfusion • Use of appropriate products for the various conditions • Personal ethics

Whole Blood § Volume : 350 / 450 ml excluding anticoagulant § Shelf life 35 to 42 days § HCT : 40 ± 5% § Increment of 1 gm/dl Hb § Plasma volume ~ 200 to 240 ml § Plasma contain ABO antibodies § No viable platelets, labile coagulation

WHOLE BLOOD Indication - Acute , active blood loss with hypovolemia - Exchange transfusion Contraindication - Risk of volume overload : Chronic anaemia. ardiac failure MD-3 -49 14