blood ho training module

Rational Use of Blood Rational Use of Blood and Blood Productsand Blood Products

Blood - specialized bodily fluid delivers nutrients/oxygen to cellstransports waste products away

Medical terms related to blood often begin with haemo- or haemato (from the Ancient Greek word αἷμα (haima) for "blood").Considered a specialized form of connective tissue, given its origin in the bones Presence of potential molecular fibers in the form of fibrinogen.

BloodBlood

In vertebrates, it is composed of blood cells (RBC, WBC, Platelets) suspended in a liquid called blood plasma. Plasma, which comprises 55% of blood fluid, is mostly water (90% by volume)Contains

dissolved proteinsglucosemineral ionshormonescarbon dioxide (main medium for excretion

BloodBlood

a - erythrocytesb - neutrophilc - eosinophil

d - lymphocyte

Types of Blood ProductsWhole BloodPacked CellsWhite CellsPlateletsFresh Frozen PlasmaCryoprecipitateOther Components

Whole BloodWhole BloodContentsContents

RBC’sRBC’sWBC’sWBC’sPlateletsPlateletsPlasmaPlasmaClotting factors depending on storage Clotting factors depending on storage timetime

Whole BloodAll around the world, most countries have stopped giving whole Blood to the patients for the following reasons:

More likely carrier of diseasesFrequency of serious shortages of blood, it is considered imprudent to use whole Blood

Most patients require only one particular component.

Better patient management by giving only the necessary component

Utilizing normal Blood storage techniques, Blood products have a greater shelf life than whole Blood;Blood filtration and other techniques help to make Blood saferBlood products can often be infused regardless of ABO Blood group.

Packed CellsPacked CellsObtained by spinning down whole bloodObtained by spinning down whole bloodContentsContents

RBC’sRBC’s20% Plasma20% Plasma

IndicationsIndicationsReplace Hb and OReplace Hb and O22 carrying capacity with carrying capacity with less volume usually for Hb<7gless volume usually for Hb<7gSevere anemia, blood loss, CHFSevere anemia, blood loss, CHF

Packed Cells

Preferred choice for correcting Anemia and even correcting acute blood lossLeuco-depleted packed cells are becoming common to reduce risk of complications - Infective risk for CJD and also immune complications

PlateletsPlateletsContentsContents

PlateletsPlateletsWBC’sWBC’sPlasmaPlasma

IndicationsIndicationsLow platelet counts <20,000 but if Low platelet counts <20,000 but if patient bleeding, can transfuse at higher patient bleeding, can transfuse at higher valuesvalues

PlateletsPlatelets - essential for the coagulation of BloodPlatelets - stored at room temperature. Heat or cold storage will render platelets inactive. Require continuous gentle agitation.Can be stored at the Blood center for up to five days. When received for transfusion, both pooled and apheresis platelets will expire in less than four hours.

Effect of Platelet Product and Patient Weight on Platelet Increment

Patient weight (in kg) 20 45 70 90

Single whole Blood platelet concentrate

17,600 8,800 5,900 4,400

Standard apheresis of four pooled whole Blood

platelets

70,400 35,200 23,500 17,600

Large apheresis or six pooled

whole Blood platelets

105,600 52,800 35,200 26,400

GranulocytesGranulocytesContentsContents

WBC’sWBC’s20% Plasma20% Plasma

IndicationsIndicationsLife-threatening decreases in WBC countLife-threatening decreases in WBC countNot Practiced in MalaysiaNot Practiced in Malaysia

Fresh Frozen PlasmaFresh Frozen PlasmaContentsContents

Complete profile of Clotting factorsComplete profile of Clotting factorsFibrinogenFibrinogenProthrombinProthrombinAlbuminAlbuminGlobulinsGlobulins

Fresh Frozen PlasmaFresh Frozen PlasmaIndicationsIndications

Clotting factor deficiencyClotting factor deficiency1 ml of FFP per Kg pt weight will 1 ml of FFP per Kg pt weight will increase clotting factors by around 1%increase clotting factors by around 1%

DIVCDIVCVolume expansion - superceded by other Volume expansion - superceded by other colloids eg gelatin/starchcolloids eg gelatin/starch

CryoprecipitateCryoprecipitateContentsContents

Factors VIII and XIII, FibrinogenFactors VIII and XIII, FibrinogenIndicationsIndications

Hemophilia AHemophilia AFibrinogen deficiencyFibrinogen deficiencyFactor XIII deficiencyFactor XIII deficiency

CryoprecipitateCryoprecipitateContentsContents

Factors VIII and XIII, FibrinogenFactors VIII and XIII, FibrinogenIndicationsIndications

Hemophilia AHemophilia AFibrinogen deficiencyFibrinogen deficiencyFactor XIII deficiencyFactor XIII deficiencyDIVCDIVC

Other FactorsOther Factors

Factors II, VII, IX, and XFactors II, VII, IX, and XIndicationsIndications

Hemophilia BHemophilia BLiver diseaseLiver diseaseBleeding tendenciesBleeding tendencies

BLOOD COMPONENT CONTENTS VOLUME SHELF LIFE**Red cells (AS-1) RBC w/ appx. 25 mL of plasma; 100 mL

of saline; additive solution (adenine, mannitol). Hct 60%

340 mL 42 days 4o C

Platelet concentrate Platelets; includes some WBC; 50 mL of plasma, a few RBC (Hct less than .005)

50 mL 5 days 20o C

Platelet apheretic Platelets; includes some WBC; 300 mL of plasma; a few RBC

300 mL 5 days 200 C

Fresh frozen plasma Plasma proteins, all coagulation factors, complement

225 mL 1 year 18o C

Cryoprecipitate 150 mg of fibrinogen, at least 80 units of factor VIII, von Willebrand factor, factor XIII, fibronectin

15 mL 1 year 18o C

Blood TransfusionBlood TransfusionBlood must be typed prior to administration Blood must be typed prior to administration ABO AntigensABO Antigens

A Antigen A Antigen Type AType AB Antigens B Antigens Type BType BA and B Antigens A and B Antigens Type ABType ABNo Antigens No Antigens Type OType O

Blood TransfusionsBlood TransfusionsPlasma Antibodies Agglutinate (Clump) Plasma Antibodies Agglutinate (Clump) Cells of other Types Cells of other Types Type A = B Antibodies Type A = B Antibodies

(Clumps B or AB)(Clumps B or AB)Type B = A AntibodiesType B = A Antibodies

(Clumps A or AB)(Clumps A or AB)

Blood TransfusionsBlood Transfusions

Type AB = No AntibodiesType AB = No Antibodies(Clumps Nothing)(Clumps Nothing)

Type O = A and B AntibodiesType O = A and B Antibodies(Clumps everything except O)(Clumps everything except O)


O Negative = Universal DonorO Negative = Universal DonorAB Positive = Universal RecipientAB Positive = Universal Recipient

Blood TransfusionsBlood TransfusionsRh FactorRh Factor

85% of Population85% of PopulationRh PositiveRh Positive

15% of Population15% of PopulationRh NegativeRh Negative

Rh Negative patients produce Rh Rh Negative patients produce Rh antibodies only if exposed to Rh Positive antibodies only if exposed to Rh Positive bloodblood


Erythroblastosis FetalisErythroblastosis FetalisRh Negative mother exposed to Rh Rh Negative mother exposed to Rh Positive fetal blood during deliveryPositive fetal blood during deliveryMother produces Rh AntibodiesMother produces Rh AntibodiesAntibodies cross placenta during Antibodies cross placenta during subsequent pregnancysubsequent pregnancyFetal blood hemolysesFetal blood hemolyses


Erythroblastosis FetalisErythroblastosis FetalisPrevented by administration of Rhogam Prevented by administration of Rhogam to motherto mother

Transfusion Transfusion ComplicationsComplications

FeverFeverMost common reactionMost common reactionDonor WBC incompatibilitiesDonor WBC incompatibilitiesManagement : Management :

Stop transfusion if severeStop transfusion if severeAntipyretics if mildAntipyretics if mild

Allergic ReactionsAllergic ReactionsSigns/SymptomsSigns/Symptoms

ItchingItching

UrticariaUrticaria

ChillsChills

FeverFever

Facial edemaFacial edema

WheezingWheezing

Anaphylactic shockAnaphylactic shock

Allergic ReactionsAllergic ReactionsManagementManagement

OxygenOxygenIV fluidsIV fluidsEpinephrineEpinephrineAntihistaminesAntihistamines

Hemolytic ReactionHemolytic ReactionChills, feverChills, fever

Low back painLow back pain

HeadacheHeadache

Chest painChest pain

DyspneaDyspnea

CyanosisCyanosis

Restlessness, anxiety Restlessness, anxiety

HypotensionHypotension

Red urineRed urine

Hemolytic ReactionHemolytic ReactionManagementManagement

Stop transfusionStop transfusionTreat shockTreat shockVolume replacementVolume replacementMannitolMannitolSend blood from patient and bag to blood Send blood from patient and bag to blood bank for checkingbank for checking

Volume OverloadVolume OverloadSigns/SymptomsSigns/Symptoms

CoughCough

Chest painChest pain

DyspneaDyspnea

Distended neck veinsDistended neck veins

Coarse crepsCoarse creps

Frothy sputumFrothy sputum

Volume OverloadVolume Overload

ManagementManagementSlow infusionSlow infusionDiureticsDiureticsVasodilatorsVasodilators

Massive Transfusion Massive Transfusion ComplicationsComplications

Coagulation DisturbancesCoagulation DisturbancesPlatelet/Clotting factor deteriorationPlatelet/Clotting factor deterioration

Citrate IntoxicationCitrate IntoxicationHypocalcemiaHypocalcemiaMetabolic AlkalosisMetabolic Alkalosis

HyperkalemiaHyperkalemiaRBC’s Lyse/Release KRBC’s Lyse/Release K++


Acid/Base ImbalancesAcid/Base ImbalancesBanked blood gradually acidifiesBanked blood gradually acidifies

Poor tissue OxygenationPoor tissue OxygenationLoss of 2,3 DPGLoss of 2,3 DPG


HypothermiaHypothermiaInadequate warming during transfusionInadequate warming during transfusion

Viral HepatitisViral HepatitisRisk rises with each unitRisk rises with each unit

Blood Blood TransfusionTransfusion

IV catheter 18g or largerIV catheter 18g or largerNo fluid other than salineNo fluid other than saline

DD55W lyses RBC’sW lyses RBC’s

RL contains calcium/triggers clottingRL contains calcium/triggers clottingTwoTwo persons confirm ABO/Rh persons confirm ABO/RhBlood filter in administration setBlood filter in administration set

Blood Blood TransfusionTransfusion

Infusion pumpsInfusion pumpsExcessive pressure can cause hemolysisExcessive pressure can cause hemolysis

Rewarming above 38Rewarming above 3800C can cause C can cause hemolysishemolysisNeverNever add medications directly add medications directly

Blood and Products

Blood should be used responsibly and carefullyAppropriately used can save livesOver transfusion and wrong use is a waste of resources and put patients at risk of complicationsAlways consult if unsure of indication

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