Importance of

Blood

And

Blood Component

Therapy By Dr Rashmi Sood Consultant Transfusion

Medicine delhi heart & lung

institute New Delhi.

Use of Blood and Blood Components

as a Medicine has come a long way!!!!

AIM OF Todays Programme

1) To create awareness of the vital role of

blood transfusion

in

saving lives

and

improving the health

of millions of people each year.

AIM OF Todays Programme

2) To motivate more people to

become REGULAR REPEAT

VOLUNTARY DONORS

so that no one suffers

for the want of blood.

THEME

MORE BLOOD MORE LIFE

NEED FOR BLOOD

In Delhi, need is about 4 lakh units of

blood every year and collection is

3.75 lakh units.

Majority of it comes from

replacement donors.

Voluntary donation is about 27

percent as compared to 45 percent

at the national level.

How much Blood do we have?

On average, an adult has about five to six liters

of blood in their circulation.

The total blood volume is based on body mass. Formula is 70 X Body Weight for MALES. 66 X Body Weight for FEMALES.

Blood in a person

E .g. A male of body weight 75 Kg has

75 x 70 =

5250ml or 5.25 litres of blood.

Why screen before Blood Donation????

For the safety of both

the donor

and

the potential recipient .

Who can Donate Blood?

Age : Between 18 to 60 years of Age.

Weight : At least 45 Kg.

Hemoglobin: 12.5gm%.

Frequency of Donations: Minimum interval between

donations is 3 months.

Health: In good health and feeling well.

Screening: At the time of donation a number of

questions are asked to determine donor eligibility.

1.Voluntary-non remunerated. 2.Replacement or relative.3.Professional or commercial.

62 countries in the world have entire collection Of blood by voluntary blood donation. In India approx. 50% is by Voluntary Blood Donation

Screening criteria

Medical history

Preliminary health check

Temporary Deferral

Permanent deferral

Tale of the red fluid called blood !!!!

The Three Formed Elements

What is BLOOD?

The fluid circulating throughout the body.

Carrier of carbon dioxide and oxygen

to and from the lungs.

Carries nourishment to the tissues.

And Takes away waste products to

Kidneys.

Components of Blood

The blood circulating is referred to as

‘Whole Blood’.

Whole Blood is made up of several different

components each with specific applications .

WHOLE BLOOD IS just a RAW MATERIAL

Red cells, white cells and platelets suspended in plasma as seen under MICROSCOPE

WHOLE BLOOD

VERSUS

COMPONENTS

Presently only 30-35 percent

blood is being used as separate

components .

It should increase

to

70-75 percent

each component is given

When specifically needed

Rationalizing the use of blood

and

preventing unnecessary wastage.

Imagine the outcome without the availability of these drugs!!!!

What are Red Cells?

Constitute the majority of cells in the blood.

Approximately a quarter of the cells in the human

body are red blood cells.

WHY RED IN COLOUR?

These cells' cytoplasm is rich in hemoglobin, an

iron-containing biomolecule that can bind oxygen

and is responsible for the blood's red color.

FUNCTION: Travel throughout the body,

deliver oxygen to tissues and remove

carbon dioxide to the lungs.

This role of the red cells (transporting

oxygen) is essential to prevent damage

to organs.

Where are Packed Red Cells used ?

Ask the parents of a thallesemic child.

Ask the family members of a kidney failure patient.

Ask the patients of severe anaemia (Whole Blood

Increases Chances of Circulatory Overload).

Ask the patients of Haemolytic Anaemia.

Packed Red Cells

Ask the patients undergoing Cancer

treatment(Hypoplastic and Aplastic

Anaemia).

Ask the patients undergoing

Cardiac surgery .

Ask the patients undergoing Knee replacement.

Ask the patients of Road accidents .

Packed Red Cells

Packed Red Blood Cells Contraindications!!

LRBC should not be used:

1) When anemia can be corrected with

specific medications, e.g., iron, B12, folic

acid, erythropoietin, etc

2) For volume replacement.

What are Platelets?

Platelets are colorless,irregularly shaped bodies found in blood.

Platelet Functions

The primary role of

platelets is to prevent

bleeding in injured

blood vessel walls by

forming an

aggregate at

the site of injury.

Platelet Functions

Platelets can also

participate in blood

coagulation,

inflammation

and wound healing.

Why platelets ? Can’t just fresh blood do the job ?

Ask a cancer Physician.

Ask a Physician treating patients with bleeding due to severely

decreased production or abnormal function of platelets , as in

Leukaemia

Hypoplastic Anaemia

Chemotherapy

Bone marrow transplantation

Marrow Infiltration eg. Carcinoma , Leukaemia

Drug induced or Radiation induced hypoplasia

Platelets

Ask a Physician treating bleeding

patients with platelet consumption or

dilutional thrombocytopenia

eg.Massive Transfusion with stored

blood.

Platelets

Can be given prophylactically to patients with rapidly

falling or low platelet counts, less than 10 x 109/L

(10,000/mL), secondary to cancer or chemotherapy.

Useful in selected cases of postoperative bleeding

with platelet count less than 50 x 109/L (50,000/mL).

Viral disease associated with Thrombocytopenia

eg.Dengue.

Platelets

Useful in functional platelet abnormalities.

PlateletsContraindications :

If bleeding is unrelated to decreased numbers

or abnormal platelet function.

In patients with consumption of endogenous

and exogenous platelets, such as in

Thrombotic Thrombocytopenia Purpura (TTP)

or Idiopathic Thrombocytopenia Purpura (ITP),

unless the patient has a life threatening

hemorrhage.

Platelets-Preparation:

Platelets are prepared from whole blood.

Platelets may also be obtained by

apheresis.

Platelets are suspended in a small

amount of the original plasma.

Platelet Incubator and Agitator

Need to be stored with constant agitation.

What are White Cells?

White blood cells travel throughout the body

and protect against bacteria and viruses.

There are different types of white blood cells

(granulocytes, macrophages and lymphocytes).

The lymphocytes help with immune defense.

White blood cells can also carry some viruses

and bacteria.

Who uses White cells ?

Easily obtained by

Granulocytapheresis.

Ask an intensive care physician who

is struggling to save a neutropaenic

patient refractory to all antibiotics.

What is Plasma?

Plasma is a protein-salt solution that acts

as a transportation medium for the other

blood components.

The red cells, white cells, and platelets are

suspended in the plasma.

Plasma is a straw colored clear liquid that

is 90% water.

Plasma-Functions

Plasma helps with clotting, fighting

infection, maintaining blood pressure

and immunity. In addition, it

contains minerals (e.g., sodium and

potassium).

Plasma-Preparation

Fresh frozen plasma is separated

from whole blood and frozen within 8

hours of collection (approx. 250 mL).

It can also be obtained from by

apheresis (approx. 500 mL).

Can’t one just use fresh blood?

Ask a physician involved in the care

of a cirrhotic patient

Ask a Transfusion specialist wishing

to do an exchange on a young TTP

patient

Fresh Frozen Plasma (FFP)Function:

Fresh frozen plasma contains the clotting

factors that are necessary for hemostasis.

Plasma also has volume expansion and

oncotic properties.

Fresh frozen plasma contains a normal

concentration of fibrinogen and the labile

coagulation factors VIII and V.

Fresh Frozen Plasma Indications :

1.In bleeding patients with multiple

coagulation factor deficiencies

secondary to liver disease,DIC and massive

blood transfusion.

2.Patients on anticogulant

drugs like Warfarin sodium

and Dicumarol are deficient in

Indications

functional Vit.K dependent coagulation factors

II,VII,IX

and X.If these patients are bleeding or need

emergency surgery.

3.FFP is used in antithrombin deficiency,inherited

or acquired after oral contraceptive use or in

patients with liver disease.

Indications

4.FFP is used in infants with secondary immunodeficiency

associated with severe protein losing enteropathy .

5.FFP is used in patients who have to undergo emergency

bypass surgey and are on anticoagulants.

6.FFP is indicated for massive transfusion (replacement of the

patient’s blood volume in < 24 hours) with a

demonstrated deficiency of Factor VIII and V, otherwise

frozen plasma is adequate.

Indications

7.Fresh frozen plasma is indicated in

exchange transfusion in neonates.

Cryoprecipitate (Cryo):

Cryo is prepared from fresh frozen plasma.

A source of coagulation factors :

• Factor VIII : In acquired deficiency eg DIC , massive

transfusion and congenital deficiency as in Hemophilia A.

• Factor V, Factor XIII.

• Von Willebrand Factor in Von-Willebrands disease.

Fibrinogen and fibronectin are present in Cryo.

Cryo can be used to make fibrin glue.

Cryoprecipitate (Cryo)

What is an Apheresis Donation?

Apheresis means to selectively collect

a blood component

(red cells,

platelets,

white cells

or plasma)

Platelets Plasma

Principle of APHERESIS Donation

A specific blood component

is selected

and

separated

by the machine

(most commonly platelets or plasma)

Advantages :

The components that are not

required are returned to the donor.

Relatively large amounts of the

single component can be selectively

collected.

PLASMA EXCHANGE &RED CELL exchange

1) Therapeutic Plasma exchange

indicated in Myasthenia crisis , Guillain Barre

Syndrome, Thrombotic thrombocytopaenic

purpura, Haemolytic uraemic syndrome etc.

2) Red cell exchange for falciparum

malaria,sickle cell anaemia.

Irradiated blood components

Prevents Transfusion Associated Graft vs. Host Disease.

Irradiation for:

– Units from blood relatives

– Allo/Auto Hematopoietic Progenitor Cell Transplant

Recipients

– Intrauterine transfusion

– Neonates undergoing exchange transfusion

– Hodgkin’s Disease

– Cellular immune deficiency disorders

– Solid Organ Transplants

FRACTIONATED PLASMA PRODUCTS 

INCLUDE :

1) ALBUMIN HUMAN SERUM ALBUMIN

2) PLASMA PROTEIN FRACTION

3) IMMUNOGLOBULINSIMMUNE SERUM GLOBULINSPECIFIC Igs (HYPER IMMUNE)

4) COAGULATION PROTEINSF VIII,IX, VIIACTVATED F IX COMPLEX/ F VIII

5) PROTEASE INHIBITORSAT III, CI ESTERASE INHIBITOR

RECOMBINANT BLOOD PRODUCTS:

1)Recombinant factor VIII e.g. Recombinate

2)Recombinant factor IX e.g. Benefix

3) Recombinant factor VII (Novoseven)

4) vWF, ATIII

5) Alpha1 protease inhibitor

6) Hb vaccines

7) R Hb

8) Haemopoietic growth factors

EPO,G-CSF, GM-CSF,TPO,ILs,TNF

THANK

YOU…….