THE RATIONAL USE OF BLOOD AND BLOOD PRODUCTS
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THE RATIONAL USE OF BLOOD AND BLOOD PRODUCTS. Presentation Aims. To discuss the following: The various components available from blood The rational use of blood and its components Problems faced Proposals for improved blood product usage. Blood is an amazing fluid Keeps us warm

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THE RATIONAL USE OF BLOOD AND BLOOD PRODUCTS

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The rational use of blood and blood products

THE RATIONAL USE OF BLOOD AND BLOOD PRODUCTS


Presentation aims

Presentation Aims

  • To discuss the following:

    • The various components available from blood

    • The rational use of blood and its components

    • Problems faced

    • Proposals for improved blood product usage


The rational use of blood and blood products

  • Blood is an amazing fluid

  • Keeps us warm

  • Provides nutrients for cells, tissues and organs

  • Removes waste products from various sites


Blood components

Blood components

  • Packed red blood cells(PRBC)

  • Platelets ( PRP )

  • Fresh Frozen Plasma (FFP)

  • Cryoprecipitate ( CP )

  • Cryo poor plasma ( CPP)


Theoretical yield of components

Theoretical Yield of components

  • 1 unit of blood theoretically gives

    • 1 unit FFP

    • 1 unit PRBC’s

    • 1 random donor unit Platelet


The rational use of blood and blood products

Rational Use of Blood

RATIONAL

  • Right product

  • Right dose

  • Right time

  • Right reasons


The rational use of blood and blood products

Logic(Rationale behind Rational use of blood)

  • Economy -Scarcity of resource

  • 1 in 4 get blood component

  • Safety -Inherent risks involved

  • in transfusion therapy

  • 1 in 2 million gets HIV

  • Scientifically appropriate

  • Haematinic in nutritional anemia


The rational use of blood and blood products

Guidelines For Promoting Component Therapy

  • Definite indication - A blood transfusion should never be ordered unless it is worth the risk

  • Single unit transfusion – has no significant therapeutic benefit

  • Use of fresh blood - should be avoided because of increased risk of infections (TTI)


The rational use of blood and blood products

1. Give only what is needed

  • Red cellsO2 carrying capacity (Anemia)

  • PlateletsThrombocytopenia

  • FFPMultiple clotting factor deficiency

    • CRYOHemophilia A


  • The rational use of blood and blood products

    2. Different Storage Conditions

    Comp.Temp. Shelf life

    Red cells4-60 C 35 days

    FFP/CPP - 40 0 C 1 year

    Platelets 22-240C on platelet agitator 5days

    CRYO- 400C 1 Year


    The rational use of blood and blood products

    3. Conservation of Scarce Resource

    • Separation of whole blood in 3-4 components

    • Benefits more than one patient at a time.


    The rational use of blood and blood products

    Centrifugation

    Principle

    Sediment of blood cells depend on their size as well as the difference of their density from that of the surrounding fluid, viscosity of medium, flexibility of the cells which are temperature dependent

    MD-3-49


    Whole blood vs packed red cells

    Whole blood vs Packed red cells


    The rational use of blood and blood products

    Why whole blood not rational

    • Maximize blood resource

    • Whole bloodone patient

    • Component therapyfour patients

    • packed red cellsthalassemia

    • plasmaliver disease / burns

    • plateletsthrombocytopenia

    • cryoprecipitatehemophilia

    • Specific storage requirements of components

      • Whole blood + 40C

      • Components

      • platelets + 20 – 24 oC

      • cryoprecipitate & FFP - 30oC

      • red cells + 2 – 80C


    The rational use of blood and blood products

    Why whole blood not rational

    • Better patient management

      • concentrated dose of required component

      • avoid circulatory overload

      • minimize reactions

  • eg. Requirement of platelets to raise count from 20 to 50,000/ul

    • fresh whole blood5 units1750 ml

    • random platelets5 units250 ml

    • apheresis platelets1 unit200 ml

  • Decreased cost of management

    • except for the cost of bag, other expenses remain same


  • The rational use of blood and blood products

    “Fresh blood” – a misconception

    • What is “fresh blood”?

      • unit kept at 4oC for 4 hours is no longer “fresh”

      • storage lesions in different constituents due

        to storage temp

  • Increased risk of disease transmission

    • intracellular pathogens (CMV, HTLV)

      survive in leukocyte in fresh blood

    • syphilis transmission

      Treponema can not survive > 96 hours in stored blood

    • malaria transmission

      malarial parasite can not survive > 72 hrs in stored blood


  • The rational use of blood and blood products

    “Fresh blood” – a misconception

    • Immunological complication due to WBCs

      in fresh blood

      • TA-GvHD – 90% fatality

      • TA-immunomodulation

      • alloimmunization

  • Logistics

    • no time for component preparation

    • less time for infection screening

    • increased chances of error


  • Compatibility

    Compatibility

    • The clinician should;

    • complete all required details on the blood request form

    • 2. accurately label blood sample tubes

    • 3. check the identity of the patient, the product and the documentation at the patient’s bedside before transfusion.


    Warming blood

    Warming Blood

    • No evidence that warming blood is beneficial to the patient when infusion is slow


    The rational use of blood and blood products

    Summary

    • No place for Whole Blood in clinical medicine

    • Discourage single unit / fresh blood

    • Component preparation and use is the demand of time

    • Promotion of judicious use of blood / components

    • Promote autologous use of blood


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