1.Dr. Jyoti prajapatiGuided by dr. S.S. Yadav

2. INTRODUCTION Blood transfusion is one of the oldest forms of therapy. Critical care frequently requires the urgent use of large numbers of blood component, often as a lifesaving supportive measure Blood component transfusion plays a very important role in modern transfusion. Through modern medical methods, many kinds of blood components are separated from whole blood. 3. The routine separation of donor blood intocomponents and plasma fraction has made itpossible for blood banks to provide the specializedblood products required for the support of patients in multiple treatment modalities. The infusion of blood component is called component transfusion or blood component therapy. 4. TYPESBlood- Fresh Whole BloodReconstituted whole bloodBlood ProductsCellular Components- Red Cell Concentrates Platelet Concentrates Granulocyte ConcentratePlasma Components- Fresh Frozen plasma Cryoprecipitate Stored plasmaPlasma Derivatives- Albumin Immunoglobulin Coagulation Factors 5. Fresh Whole Blood o Light spin,C(within 8 hrs)Packed Red Cells Platelet Rich PlasmaoHeavy spin,C Platelet Concentrate Fresh Plasma oStore atCFreeze(FFP) 6. In some special cases, whole blood, usually in theform of reconstituted whole blood, can be used. However, in most cases blood components arepreferred because each component has specificoptimal storage conditions and component therapymaximizes the use of blood donations. 7. WHOLE BLOOD contains RBCs and plasma clotting factors. Few units are stored as whole blood. can be reconstituted from a unit of RBCs and FFP. stored at 1C to 6C and coagulation factors decay atthis temperature. should be no more than 5 to 7 days old. Platelets in are cleared rapidly following transfusion. reconstituted whole blood lacks significant quantitiesof plateletsIndications. Exchange transfusions. Surgery Massive transfusion, trauma can be used as a substitute for blood components. 8. Packed Red Blood Cells (PRBCs) After plasma is separated from red cells by centrifugationof 350 ml whole blood, the RBC component has a volumeof about 200 ml and Hct of about 80 %. The whole blood is spun to sediment out the RBCs, andmost of the plasma is removed by pushing it into a pre-attached satellite bag. Genarally 100 to 110 mL of a nutrient additive solution isadded back to the packed RBCs, creating an additive RBCproduct that has a final hematocrit of 55% to 60%. These solutions prolong the shelf life of the RBC productfrom 21 days (packed RBCs in CPD) to 42 days (additiveRBCs). 9. Available forms of RCCsThe following forms of RCCs are available for thetreatment of anaemia. RBC concentrates. RBC concentrates deprived of the buffy coat. RBC concentrates with additive solutions. RBC concentrates deprived of the buffy coat and resuspended in additive solutions. Washed RBC. Leucodepleted RBC. Frozen RBC. Apheretic RBC. Irradiated RBC. 10. PRBCs are the most commonly used blood productin neonatal transfusions. Red blood cells (RBCs) are transfused to increasethe oxygen-carrying capacity of the blood and, tomaintain satisfactory tissue oxygenation. Guidelines for RBC transfusions in children andadolescents are similar to those for adults. 11. Indications for transfusion of PRBCs are mainlyresolution of symptomatic anemia and forimprovement of tissue oxygenation. Tissue oxygenation depends on cardiacoutput, oxygen saturation and hemoglobinconcentration. Once cardiac output and oxygen saturation areoptimal, tissue oxygenation can only be improvedby increasing the hemoglobin level. The guidelines for transfusion of PRBC varyaccording to age, level of sickness and hematocrit. 12. Factors other than hemoglobin concentration to be considered in the decision to transfuse RBCs include: (1) Patients symptoms, signs, and functional capacities,(2) The presence of cardiorespiratory, vascular, and central nervous system disease(3) The cause and anticipated course of the anemia(4) Alternative therapies, such as recombinant human erythropoietin (EPO) therapy, which is known to reduce the need for RBC transfusions and to improve the overall condition of children with chronic renal insufficiency and preterm infants. 13. Blood component therapy in newbornThe total blood volume of neonates is small, although the volume is higher per kg of body weight than that of older children or adults. (85 ml/kg for full-term and 100 to 105 ml/kg for pre-term). . 14. Blood transfusion in pre-term infants, is often givenfor the anaemia of prematurity, associated withdelayed renal production of erythropoietin due todecreased sensitivity to lower haematocrit levels. These neonates may require multipletransfusions, increasing the risk of infectiousdisease transmission, through multiple donorexposures. alloimmunization Studies have shown that multiple transfusion frommultiple donor in preterms is associated withincreased risk of ROP and BPD. 15. Stable neonates do not require RBCtransfusion, regardless of their blood hemoglobinlevel, unless they exhibit clinical problemsattributable to anemia. symptomatic anemia causestachypnea, dyspnea, tachycardia, apnea andbradycardia, feeding difficulties, and lethargy. However, anemia is only 1 of several possiblecauses of these problems, and RBC transfusionsshould only be given when clinical problems areattributable to the anemia. 16. Measures to reduce multiple blood transfusions in preterminfantsIn preterm and sick neonates, needing multipletransfusion , aliquots from a single donor can begiven as sequential transfusions.This is done practically by reserving a bag of freshPRBC for up to 7 days for a newborn andwithdrawing small amounts required repeatedlyfrom that bag under laminar flow using a sterileconnecting device, into a fresh blood bag.The PRBC bag is immediately resealed under thelaminar flow, and can be reused for withdrawingsimilar small quantities of blood for up to 7 days. 17. Choosing the blood group for neonatal transfusions.a.. Mothers sample should be tested for blood groupand for any atypical red cell antibodies.b. ABO compatibility. Though ABO antigens may be expressed onlyweakly on neonatal erythrocytes, neonates serummay contain transplacentally acquired maternalIgG anti-A and/or anti-B. 18. Choosing the blood group for neonatal transfusions.c. Blood should be of newborns ABO and Rh group.It should be compatible with any ABO or atypicalred cell antibody present in the maternal serum.d. In exchange transfusions for hemolytic disease ofnewborn-, blood transfused should be compatiblewith mothers serum.If the mothers and the babys blood groups arethe same, use Rh negative blood of babys ABOgroup.In case mothers and babys blood group is notcompatible, use group O and Rh negative blood for 19. Volume and rate of transfusion: Volume of packed RBC = Blood volume (mL/kg)x (desired - actual hematocrit)/ hematocrit oftransfused RBC If more volume is to be transfused, it should bedone in smaller aliquots. The dose is 5 to 20 mL/kg transfused at a rate ofapproximately 5 mL/kg/hour. In chronic anemia and cardiovascular compromisedose is 5ml/kg at the rate of 1-3ml/kg/hr. 20. It has been seen that transfusion with PRBC at adose of 20 mL/kg is well tolerated and results in anoverall decrease in number of transfusionscompared to transfusions done at 10 mL/kg inpreterm and VLBW infants. There is also a higher rise in hemoglobin with ahigher dose of PRBCs. in infants and newborn, one unit of RCC( 10 ml/kg)increases Hb by 3g/dl. 21. Properties of RBC products used in neonataltransfusion: RBCs should be freshly prepared and should notbe more than 7 days old. concerns with old RBCs are high 2, 3-DPGconcentration and higher tissue extraction ofoxygen, hyperkalemia, and a reduced RBC lifespan. 22. Guidelines for packed red blood cellstransfusion thresholds for preterm neonates ( nnf protocol) Less than 28 days of age and 1. Assisted ventilation with FiO2 more than 0.3: Hb 12.0 gm/dL or PCV less than 40% 2. Assisted ventilation with FiO2 less than 0.3: Hb 11.0 g/dL or PCV less than 35% 3. CPAP: Hb less than 10 gm/dL or PCV less than 30% More than 28 days of age and 1. Assisted ventilation: Hb less than 10 gm/dL or PCV less than 30% 2. CPAP: Hb less than 8 gm/dL or PCV less than 25% 23. Guidelines for packed red blood cellstransfusion thresholds for preterm neonates ( nnf protocol)Any age, breathing spontaneously and 1. On FiO2 more than 0.21: Hb less than 8 gm/dLor PCV less than 25% 2. On Room Air: Hb less than 7 gm/dL or PCV lessthan 20% 24. INFANTS WITHIN THE FIRST 4 MOOF LIFE Hemoglobin of