3. transfusion medicine

7/30/2019 3. Transfusion Medicine

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TransfusionMedicine


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Lecture Overview

Background

Blood collection

Blood component manufacture

Pre-transfusion testing

Transfusion administration Transfusion reaction


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Background

Multidisciplinary specialty:

Blood donation

Blood component preparation

Blood cell serology

Blood transfusion therapy

Transfusion medicine (operationally):

Blood Center

Transfusion services Hospital Blood Bank


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Transfusion

Donor

Blood/blood

component

Recipient


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Blood Collection

Donor criteria established to protect donor &

recipient.

Collection in a manner to minimize the risk ofbacterial infection.

The rate of blood flow must be sufficient enough

to prevent blood clot during phlebotomy. Volume of blood withdrawn


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Phlebotomy :


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Requirements of Allogeneic Donor Qualification

Category Criteria

Age > 17 years

Blood Pressure < 180 mmHg systolic; < 100 mmHg diastolic

Pulse 50-100/min, w.o pathologic irregularities

Temperature < 37oC

Hemoglobin > 12.5 g/dL

General medical history Free of major organ disease, cancer, abnormal bleeding

tendency

Pregnancy Defer for 6 months

Recipient of blood transf/tissuetransplant

Defer for 12 months

Vaccination ?

Infectious disease ?


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DONOR

Registration

Selection :

Might the procedure be harmful to the

donor ? Might the donors blood be a risk to the

recipient ?

Medical History/limited physicalexamination (miniphysical)performed on the day of donation.


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Donor reaction :

Informed consent

Risks of procedure :

Vasovagal reaction

Hematoma

Tests to be performed on the donors

blood


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Blood

Proper

identification

Removed Processing

/test

Storage


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Blood Component Manufacture

1. RBC

2. Plasma3. Cryoprecipitated AHF

4. Platelet Concentrate

5. Leukocyte Component6. Leukocyte-Reduced Blood Component

Whole blood donation component

Special component; Pathogen reduction


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Preparation of blood components

Prepared from whole blood

using large refrigerated centrifuges


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Whole Blood

PRC Plasma

FFP

Cryoprecipitate

WRC

PRCPRP

PC

Blood components

Blood derivates


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RBC

Removal of plasma by centrifugation

Anticoagulant: CPDA-1 (+dextrose

& adenine to preserve RBC ATP

level)

Store up 35 days at 1-6 C


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Biochemical changes during liquid

storage

pH drops

2,3-DPG decrease

Plasma potassium rises

Plasma sodium decrease

Plasma hemoglobin increase

Greatest concern during massive &

neonatal transfusion


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Plasma

In liquid state storedin 1-6 C loss labile clotfactor (FV & F VIII)

Frozen for extended

preservation -18oCFresh Frozen Plasma

(FFP) thawed at 37 C


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Cryoprecipitated AHF

Cold insoluble portion of plasma

remaining after FFP thawed at

refrigerator temperature.

Contain:

Approx 50% of FVIII (80 IU)

20-40% fibrinogen

Von Willebrand factor

F XIII

Treatment for Hemophilia


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Platelet Concentrate

Contain at least 5.5 X 10.10

platelet/unit (produced by

apheresis 3 X 10.11)

Store at room temp (20-24 C)agitation up to 5 days

Contain:

Small amount of red cell

30-50 ml plasma


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Leukocyte Component

Granulocyte:

Prepared by apheresis

Store at room temp 24 hrs.

Better given soon after collected

Mononuclear cells:

Apheresis

Source of hematopoietic progenitor

cells (HPCs) for autologous/allergenic

transplantation.


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Leukocyte-Reduced Blood Component

Leukocyte in PRC/PC cause

adverse effects (febrile nonhemolytic

transfusion reaction, immunization to

leukocyte antigens)

Universal leukocyte reduction:

< 5 X 10.6/unit RBC

< 8.3 X 10.5/unit WB

Filtration


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Pre transfusion testing :

General consideration

Antibody screen

Crossmatch

Selection of units

Interpretation of compatibility testing


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Blood Processing Tests

ABO and Rh typing

Antibody testing (red cell antibodies)*

Transfusion-Transmitted Diseases :

HIV

Hepatitis B (HBsAg)

Hepatitis C (HCV)

Syphillis (VDRL)


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Transfusion reactions

Non hemolyticTransfusion reactions

Hemolytic Transfusion reactions


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Non hemolyticTransfusion reactions

Febrile non hemolytic t.r

Allergic reaction

Anaphylactic reaction

Bacterial contamination

Circulatory overload

Transfusion-Related Lung Injury

Post Transfusion Purpura

Hemosiderosis

Graft-versus-Host disease


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HemolyticTransfusion reactions

Acute non immune hemolytic t.r

Acute immune hemolysis t.r


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Alternatives to blood transfusion

Hemopoietic Growth Factors &

Cytokines :

Erythropoietin, interleukin

Substituted for RBC and platelet:

RBC : perfluorocarbons, polymerized

hemoglobin solution

Platelet : HLA-stripped platelet, liquidCold stored platelet


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Hemapheresis

Process of removing normal or

abnormal blood constituents from

circulating blood.

Divided into :

Cytapheresis (removal of the cellular

component)

Plasmapheresis (removal of the plasmafraction)


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Hemapheresis

machine


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Donor/patient complications common

to all hemapheresis procedures :

Citrate reactions

Allergic, anaphylactoid, anaphylactic

reactions

Angiotensin Converting Enzyme inhibitors Hypovolemia and vasovagal reactions

Hydroxyethyl starch and coagulopathy

Air Embolus


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Blood Banking

Tissue Banking


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Tissue Bank & Progenitor Cells

The products of tissue bank :

Extend life

Improve the quality of life

Clinical applications of allogeneic

tissue and the types of tissue

available grown exponentially in

the last 2 decade.


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Sources of Tissue

Living donors : Individuals who donate for their own use

(autologous HPCs)

Directed donors for a given individual (sperm

donation) Altruistically for unknown recipients (surgical

discard bone or sperm donation)

Cadaveric donors :

- bone, skin, cardiac valves, eye tissue- obtained several24 hours after death (if the

body refrigerated)


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Tissue Bank Activities :

Donor screening :To ensure the quality of the tisuue

obtained (bacterial,viral,genetic disease)

Cryopreservation :To extend the usable storage period of

the material being frozen by reducingthe metabolic demand of the cells at the

lower temperatures without any loss ofviability due to either the freezing orthawing procedures.


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Tissue Bank :

Skin tissue

Musculoskeletal tissue

Cardiac valves

Cornea

Reproductive tissue

Hematopoietic Progenitor Cell (HPC)

Bone marrow Peripheral blood progenitor cells

Umbilical cord blood


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WHO : Blood is R E D

R

E

D

are

expensive

angerous

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