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Rational Use of Blood
ComponentsDr. M. Mohandoss
Assistant Professor
Transfusion Medicine,
Malabar Cancer Centre, Thalaserry
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Component Therapy
1. ptimal preser!ation of in !itro function of blood
". #$cient utili%ation of blood donations
"1&'(&1) MA*ABAR CA+C#R C#+TR#
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Methods of Component Preparation
hole Blood Apheresis
Platelet RichPlasmaMethod
Bu-y CoatMethod
ManualMethod
Automation
"1&'(&1) MA*ABAR CA+C#R C#+TR#
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Platelet Rich Plasma (PRP) method
Whole blood
Soft spin within
(1800 rpm 6 hrs x 9 min at 22oC)
Red cells Platelet rich plasma (PRP)
Hard spin(3000 rpm
x 7 min at 22oC)
Plasma Platelet Conc.
(RDP)
PRP
RBC
PRP
PCFFP
"1&'(&1) MA*ABAR CA+C#R C#+TR#
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PRP Method
• Manual plasma expresser
"1&'(&1) MA*ABAR CA+C#R C#+TR#
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Bufy Coat method
Whole blood
Hard spin within
(3000 rpm 6 hrs x 9 min at 22oC)
Red cells Bufy coat plasma
Soft spin(1800 rpm x 7 min at 22oC)
Platelet Conc. WBC with ew RBC
Plasma
RBC
"1&'(&1) MA*ABAR CA+C#R C#+TR#
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Benets of Bu-y coat method
• Platelet yield impro!ed a lot
• Reduced BCs in product
• RBC contamination drasticallydecreased
"1&'(&1) MA*ABAR CA+C#R C#+TR#
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Blood Component #/tractor
0ensors
0ealers
0ensor
0ealer
Press
"1&'(&1) MA*ABAR CA+C#R C#+TR#
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Principle of Apheresis
"1&'(&1) MA*ABAR CA+C#R C#+TR#
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SDP Vs RDP•Decreased chances of TTI and alloimmunization
• ↓ number of donor support required
• Lesser Donor reactions
• Ensures adequate dose
• ABO matched platelet support
• Consistent and standardized yield
RDP RDPRDPRDPRDP RDP
SDP
= 1 adult dose3x 1011/ unit)
! 1 adult dose(4 x 1010/unit)
% %%%%
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0tora3e
"1&'(&1) MA*ABAR CA+C#R C#+TR#
CMP+#+T0 0TRA6# T#MP#RATUR#
Pac7ed red blood cells 4PRBC5 8" to 9:C
Platelets 4P*T05 8"" to 8";:C underconstant a3itation
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Answer 4 Qs before transfusion
• hy to transfuse ?
• benet @ ris7
• patients symptoms s lab le!els
• prophylactic s therapeutic
•
hat to transfuse ?• hole blood &'• components & fractions 4
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Case 1
A patient 4;)yr Male5 admitted folloin3 roadtra$c accident
0uspected to ha!e blunt abdominal in2ury and
internal bleedin30hifted to T EbFG3
hich component ould you li7e to transfuse?
1. hole blood
". Pac7ed Red Blood Cells
(.
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hole blood in TruesenseE.
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hole blood is notholeH
• After ";hrs of stora3e B essentially
becomes red cells suspended in a proteinsolution
•
Chan3es in PlateletsB stored at ;:C I platelets rapidly lose!iability
After G hrs I in !i!o sur!i!al reduced to " days
• 6ranulocytes J Monocytes I function reducedithin Ghrs and disinte3rates ithin ";hrs
• Microa33re3ates increase in number
•
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hy hole blood is notrational?
Maximie blood resource
hole blood one patient
component therapy four patients
Pac7ed red cells thalassemiaPlasma li!er disease & burns
Platelets thrombocytopenia
Cryoprecipitate hemophilia
Decrease cost o manaement
e/cept for the cost of ba3, other e/pensesremain same
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hy hole blood is notrational?Better patient manaement
concentrated dose of reLuired component
a!oid circulatory o!erload
minimi%es reactions
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hy hole blood is notrational?#/ample 1F ReLuirement of platelets to raise
count from "' to )','''&ul
fresh hole blood ) units 1)' ml
random platelets ) units ")' mlapheresis platelets 1 unit "'' ml
#/ample "F ReLuirement of fKKK to stop bleed inhemophilic patient
fresh hole blood "' units,''' mlcryoprecipitate "' units;'' ml
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Modern transfusion therapyEE.means component therapy
• ptimal preser!ation of in !itro function ofblood
• More e-ecti!e treatment by specicreplacement of deciency
• #$cient utili%ation of blood donations
• "he proper use o blood re*uires+,
Nnoled3e of pathophysiolo3y of conditionbein3 treated
Kdentication of the specic deciency neededby the patient
Choice of appropriate component for therapy
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Case "
A ; year old boy ith thalassemia is onhypertransfusion therapy.
0ince last ( months patient 3ets fe!er and chillsfolloin3 transfusion
Did not 3et any benet ith premedicationE
hich component ill you recommend for transfusion?
Krrradiated PRBC
*eu7oltered PRBC
Minor phenotype matched cells
Blood from his family member
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storage time
passenger leukocytes
Cytokine generation in stored
PC
Circulatin cyto#ine
-&"R
Threshold
Exceeded
/0 , 12
/0 3 4
/0 3 5
"&-, 6
R7&"89
":-,2
:R',6
Tr ansfused Leukocytes
Cytokine production in
vivo
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*eu7o=depleted BloodComponents
7d;erse 8fects due to 0eu#ocytes
•
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Kndications for *eu7oreducedblood
• Recommended•
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Clinical Kndications
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Case (
• (" years & Male, fe!er since 9 days
• Den3ue
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Thrombocytopenia
Virus induced BMsuppression
Increased
Consumption
latelet !ysfunction
"#idenced by t$e absence of A! releaseand impaired aggregation
Immune MediatedClearance
% Auto Ab
% Cross%reactingantibodies
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SDP
RDP
1 dose
ABO / Rh, HLA / HPA matching possible
Monitoring of dose feasible
Fewer donor exposures
Decreased incidence o ! ! "
↓ Rate of alloimmunization
COST
Apheresis Deri!ed Platelet Concentrates
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Case ;
• )" years & Male
• Nnon case of cirrhosis
• Patient as posted for endoscopy
• *aboratory aluesbF Q.)3&d*,
PTF"' sec
K+RF 1.9• Transfused " units of
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???....
as
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Definite indications for the use of FFP .ingle factor deficiency w$ere specific factor conc is not
a#ailable Immediate re#ersal of warfarin effect
Acute !IC TT
Conditional use of FFP in the presence of bleeding &
disturbed coagulation
Massi#e transfusion Li#er disease wit$ acti#e bleeding
No ustifications for the use of FFP /ypo#olemia 0utritional support Treatment of immunodeficiency states
BCSH guidelines for use of FFP
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Case !
atient continues to bleed*
Visceral in1uries noted *
/emostasis not ac$ie#ed*
2se of Combination of
Components
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< = PRBC
!"
#
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Massi!e Transfusion Protocol
To standardi%e blood product support durin3the early chaotic phase of
resuscitationE.
Allo early administration of bloodcomponents, especially
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Cryoprecipitate
Composition
!ol 1'="' ml
f KKK 9) = G' KU&unit
!
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CryoprecipitateE.
Ma2or Kndicationsypobrino3enemia
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Current Transfusion Practice
Rate of Knappropriate transfusions
RBCF 19 = )).(
PlateletsF 1( = ;G.
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Problems of Knappropriate Use
• ealth ris7 associated ith transfusion
• Cost of mana3ement
• Unnecessary pressure on the supply of blood
0T Report
"'1"
''()*
+T% '()*
,T%
-('*
+llo
.*
T+C/
> 4)? were pat$ological reactio
w$ic$ may not pre#entable
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Ris7 s Benets of Transfusion
0enefit 1 %isk %isk 1 0enefit
/b 6g;dL7 4 ) @ 9 :( :: :3 :
&$y not transfuse &$y transfuse
e#ersiblein s$ort term
Additional factors in comproof o,ygen transport
Indi#idual patient
factors determine
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0ummary
Transfusion is a li#e tissue transplantation
Transfusion s$ould not be dictated by lab #alues
alone but s$ould also be based on t$e patientDsclinical status
!etermine t$e trigger and dose to be
administered
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Gie blood !"en it is reall#ne$essar#
Gie t"e %atient onl# !"at isneeded
"han# you
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