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INDICATIONS FOR EMERGENT TRANSFUSIONS

INDICATIONS FOR EMERGENT TRANSFUSIONS. Manjushree Matadial DO Saint Joseph Hospital and Medical Center, April 27,2009. Red Blood Cells. Indications Hemoglobin less than 7.0 g/dl in the absence of coronary disease or ischemia

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INDICATIONS FOR EMERGENT TRANSFUSIONS

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  1. INDICATIONS FOR EMERGENT TRANSFUSIONS Manjushree Matadial DO Saint Joseph Hospital and Medical Center, April 27,2009

  2. Red Blood Cells • Indications • Hemoglobin less than 7.0 g/dl in the absence of coronary disease or ischemia • Hemoglobin less than 7.0 g/dl during surgery associated with major blood loss or impaired oxygen transport • Hemoglobin less than 8.0 g/dl in patients with chronic transfusion regimen or during marrow suppressive therapy

  3. Red Blood Cells • Hemoglobin less than 10.0 g/dl in select populations ie. Neonates, coronary disease or cerebrovascular disease • Age less than 40 with Hct = 24 • Age 40 – 60 with Hct = 27 • Age 60 – 70 with Hct = 30

  4. Pathophysiology • Consequences of Anemia • Increased cardiac output when Hgb < 7.0 g/dl in acute situations • Not the case in chronic anemia has been compensated • Increased oxygen extraction systematically at the capillary level

  5. Pathophysiology • Decreased hemoglobin decreases the oxygen delivery and the oxygen extraction ratio increases which maintains a constant oxygen uptake into the tissues • A hemoglobin below 3.0 g/dl increases the lactic acidosis

  6. Blood Products • Type and Screen • Determines the ABO and Rh status and the presence of antibodies • Takes anywhere from 5 mins – 30 mins • Risk of adverse reaction is 1: 1000 • Type O red cells are mixed with the patient’s serum

  7. Blood Products • Type and Cross • Determines ABO and Rh status as wells as adverse reactions to low incidence antigens—risk of reaction is 1 : 10,000 • Takes 60 mins • Type O red cells are mixed with the patient’s serum and the donor red cells are then mixed with the patient’s serum to determine incompatibility

  8. Transfusions • Type specific crossmatch • Type specific uncrossmatch • Type O Rh(-) used emergently

  9. Donor O A B AB Recipient O, A, B, AB A, AB B, AB AB Transfusions

  10. Blood Products • Whole blood • Contains 510 ml • PRBC’s • Prepared by centrifuging whole blood and removing 250 ml of plasma supernatant • Each unit of PRBC contains 200 ml of erythrocytes and 50 – 100 ml of plasma and CPD solution • The concentration of hemoglobin is 23-27 g/dl • 10 ml/kg will increase HCT by 10%

  11. Blood Products • Leukocyte-Poor Red Cells • Used in transfusing patients that are febrile • Patients with a history of non-hemolytic transfusion reactions (caused by antibodies to leukocytes in donor blood) • Transplant recipients or candidates • Patients requiring CMV (-) transfusions

  12. Blood Products • Washed Red Cells • These are packed cells washed with isotonic saline to remove leukocytes and residual plasma • The removal of plasma prevents allergic reactions caused by prior sensitization to plasma proteins in donor blood • Is to be used in patients with hypersensitivity reactions

  13. Blood Products • CMV (-) Blood • CMV infects many tissues ie. Blood, kidney, lung , liver and brain • Following patients are susceptible to transfusion-transmitted CMV primary infections and disease therfore they should receive CMV (-) blood

  14. Blood Products • CMV (-) Blood • Low birth weight neonates < 1200 grams • CMV seronegative pregnant women • CMV seronegative recipients of , or candidates for bone marrow or peripheral blood cell transplants • CMV seronegative HIV (+) patients

  15. Blood Products • CMV seronegative recipients of, or candidates for solid organ transplants • CMV PCR screening tool • A large portion of CMV seronegative donors are CMV PCR positive

  16. Blood Products • Irradiated • Prevents graft versus host disease in the immune compromised patients • Gamma irradiation eliminates the ability of lymphocytes to proliferate and preventing them from mounting and immune response to the host tissue

  17. Blood Products • Bone marrow and stem cell transplant recipients • Congenital T cell immunodeficiency syndromes: SCIDS, Wiskott-Aldrich, DiGeorge • Intrauterine transfusion • Neonatal exchannge transfusion

  18. Blood Products • Irradiated Cells • Premature neonates < 1200 grams • Transfusions from blood relatives • Patients with hematologic malignancies: ie.Hodgkin’s, Non-Hodgkin’s and acute leukemia and neuroblastoma

  19. Platelet Therapy • Indications for transfusions • Platelets < 10, 000 with no risk factor • Active bleeding • Bone marrow failure • Platelets < 20, 000 with the following risk factors: febrile, bleeding, ICH, antibiotic therapy

  20. Platelet Therapy • Indications • Surgery with a high risk of bleeding or an invasive procedure • Endoscopy with biopsy • Lumbar puncture • Surgical intervention

  21. Platelet Therapy • Indications • Platelet function defects ie CABG (maintain the platelets > 50, 000) • Bleeding/ massive transfusion (maintain the platelets > 100, 000 ) • Ie. DIC or CNS trauma

  22. Platelet Transfusion • Prepared by centrifuging fresh whole blood and suspending the supernatant pellet in a small volume • 1 unit of whole blood has 50 – 100 billion platelets in 50 ml of plasma • Stored up to 7 days • Effectiveness declines after 3 days • Transfused in (6-10 ) units at a time

  23. Cyropprecipitate Useage • Replaced in the following manner (5-10 ml/kg) • Replaces VIII (Hemophilia A), factor XIII, fibrinogen, fibronectin, and vWF • Used also in DIC and Trauma

  24. Fresh Frozen Plasma • Indications • Used in life threatening bleeding in patients on coumadin • Liver disease if bleeding with abnormal coagulation profile • Acute DIC • Following massive transfusions or CABG

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