TRANSFUSIONMEDICINE

DR. AYESHA JUNAID

MBBS,MCPS,FCPS.Professor of Pathology

Consultant HaematologyIncharge Blood Transfusion Services

SIH

TRANSFUSION REQUIREMNT

ONLY APPROPRIATE TRANSFUSION

Transfusion of safe blood products to treat a condition leading to significant

morbidity /mortality that could not be prevented or managed effectively by

other means

TRANSFUSIONMEDICINE

Blood Transfusion can be fatal if incorrectly administered

TRANSFUSION

Haematological malignancies 15% of all red cell units transfused

to haematological diseases are transfused for Malignant disorders

Effect of the disease itself Myeloablative /myelosuppressive

effects of specific treatment

Indications for RCC, Plts,FFPNO UNIVERSAL TRIGGER FOR TRANSFUSION

Clinical judgment Quality of life indices Approach to the management and

prevention of complications

BLOOD COMPONENTS Whole blood Packed red blood cells Leukodepleted red cells Washed red blood cells Platelets concentrates Single-donor/Random-donor Irradiated blood products

(red blood cells and platelets concentrates) Leukocyte (granulocyte) concentrates

BLOOD COMPONENTS

Plasma components/products Fresh-frozen plasma (FFP) Cryoprecipitate Factor concentrates (VIII, IX) albumin Immune globulins

Blood Components

Whole Blood

Red Blood cells, Platelets and White Blood Cells all suspended in Plasma constitute

Whole Blood.

Whole Blood Unit

After centrifugation whole blood

separates into the plasma and platelets on top and packed red blood cells on the bottom.

A plasma expresser is used to literally squeeze the plasma and platelets off the top and leave only the red

blood cells in the original bag.

PLASMA SEPARATION

Blood Components

Packed Red Blood Cells

Random donor Platelets

Plasma Product

RBC Components Packed RBCs(RCC)

Approx. 1/2 the volume of Whole Blood Same RBC mass therefore same oxygen

carrying capacity Total Volume 250ml Expiration Date 35-42 days

CPDA 1 - 35 days closed system AS-1 - 42 days closed system Open System - 24 hours

RBC Components continued…

LEUKOCYTE REDUCED RBC’S Removal of leukocytes from RBC

component to <5.0 X 106 per unit1. Leukopoor filtration2. Washing3. Freezing and Deglycerolization

Leucodepletion

Removal of majority of white cells is leucodepleton.

Purpose : To reduce incidence of febrile illness and alloimmunization after transfusion.

Platelets

Random-donor platelets concentrates (RPC)

Single-donor platelets concentrates

(SPC)

PLATELETS CONCERTERATES

They are harvested by cell separators or from individual donor units of blood.

Need of transfusion is in patients with thrombocytopenia , active bleeding or platelet dysfunction .

For prophylaxis the platelet count should be more than 5-10 x109/ l

Platelet transfusion should be avoided in autoimmune thrombocytopenic purpura.

Platelet Components: Random Donor Platelets

Prepared from a Whole Blood (WB) componentStep 1: Soft (light) Spin (2-3 min at 3200 rpm) to keep the platelets in the plasma. Step 2: Hard (heavy) Spin (5 min at 3600 rpm) to aggregate platelets. Express off all but 55- 65 ml of plasma and let platelets rest and resuspend on counter (room temp) for 1-2 hours before aggitation.

Platelet Components

Includes Random donor platelets, Single donor platelets and Pooled Platelets.

Platelet Components

Random Donor Platelet At least 5.5 x 1010 platelets/unit Single Donor Platelet - Apheresis At least 3.0 x 1011 platelets/unit Suspended in 300 ml plasma

SINGLE DONOR PLATELET APHARESIS

Platelet Components

Pooled Platelets Process of pooling Random Donor Platelets

into a central bag. Typically done for adult patients. Need a common “Pool” number on the unit. (Remember we are pooling many donors who each have a unique donor number.)

Pool anywhere from two to twenty units. Expiration changes from 5 days to 4 hours -

Need to be sure the floor is ready to transfuse before pooling.

Plasma Components

Fresh Frozen Plasma Plasma expressed from Whole Blood, needs

to be frozen within 8 hours (6 hrs for ACD) of collection for CPDA-1 anticoagulant.

Frozen at -18oC: Frozen at -65oC: Thawed: 150-250 ml total volume Contains all clotting factors

HUMAN PLASMA PREPARATIONS

Fresh frozen plasma ( FFP) , is mainly used for replacement of coagulation factors ( when specific concentrates are unavailable )

FFP are also given after massive transfusion , DIC , in liver disease .

TRANSFUSION REQUIREMNT IN LEUKEMIC PATIENTS

Review your decision Irradiated Leukodepleted CMV negative Single donor Platelets TO THE CORRECT PATIENT