BLOOD TRANSFUSION REACTIONS BY DR BASHIR SOPORE KASHMIR

1. BLOOD & BLOOD PRODUCTS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE CHINKIPORA SOPORE KASHMIR EMAIL---drbashir123@gmail.com

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11. BLOOD PRODUCTS Cellular Components- Red Cells Platelets Granulocytes Plasma Components-Fresh Frozen plasma Cryoprecipitate Cryopoor plasma Stored plasma Plasma Derivatives- Albumin Immunoglobulin Coagulation Factors

12. Whole Blood (WB) • 1 Unit-450ml • No functional platelets • No labile coagulation factors • Whole blood is now rarely used for transfusion. • Rate of Blood Transfusion-3ml/kg/hr

13. Red Cell Concentrates • Also called Packed Red Cells • Platelets and plasma are removed • I Unit- 200- 250ml • Rate of Blood Transfusion -3ml/kg/hr

14. Leucoreduced Red Blood Cells Most plasma & 70-80% WBC (buffy coat) are Removed from whole blood.

15. Leucoreduced Red Blood Cells Suitable for patients requiring repeated transfusions. Prevent febrile non haemolytic reactions. • Rate of Blood Transfusion -3ml/kg/hr

16. Washed Red Blood Cells • RBC washed with 1-2 L Normal Saline • Washing removes plasma & other plasma constituents like plasma proteins , microaggregates, cytokines, and unwanted antibodies. • Most important eliminates antibodies • Prevent febrile non hemolytic reactions.

17. Washed Red Blood Cells Indications • Multitransfused patients with recurrent febrile reactions • Urticarial reactions • Anaphylactic reactions • IgA deficiency with IgA antibodies • Paroxysmal nocturnul hemoglobinuria • Patients with T activated cells by infections who require transfusion

18. Platelets Concentrate • The average lifespan of a platelet is normally just 5 to 9 days. If the number of platelets is too low, excessive bleeding can occur and too high leads to thrombosis-stroke, myocardial infarction, pulmonary embolism. etc

19. Platelets Concentrate • The unit of whole blood is centrifuged using settings that cause the platelets to become suspended in the "buffy coat" layer, which includes the platelets and the white blood cells.

20. Platelets Concentrate • The "buffy coat" is isolated in a sterile bag, then centrifuged again to separate the platelets and plasma from the red and white blood cells.

22. Platelets Concentrate • Platelets are not cross-matched unless they contain a significant amount of red blood cells (RBCs), which results in a reddish-orange color to the product.

23. Platelets Concentrate • Types of Platelets • Recovered platelets(Random donor platelets) • Apheresis platelets(single donor platelets)

24. Platelets Concentrate • Indications • All types of thrombocytopenia except TP(Thrombotic Thrombocytopenic Purpura) • HIT(Heparin Induced Thrombocytopenia)

25. Granulocytes (neutrophilis) • Granulocyte concentrate • Buffy coat

26. Buffy Coat • Layer between red cells & plasma also buffy coat contains platelets

27. Granulocytes • Some clinicians believe that some patients with very low neutrophil counts can benefit from infusion of granulocyte concentrates. Clinical trials have not so far established effectiveness of the treatment

28. Granulocytes • However granulocytes should still be considered for patients with severe neutropenia (<200/µl) and a documented life-threatening bacterial or fungal infection not responsive to appropriate antibiotic therapy.

29. Irradiated blood products • Irradiated Blood products are exposed to approximately 2500 rads of Gamma radiation to destroy the lymphocyte’s ability to divide.

30. Irradiated blood products • Donor lymphocytes proliferate and damage target organs, especially bone marrow, skin, liver, and gastrointestinal tract, as well as grafts or transplanted organs which ultimately can be fatal.

31. Irradiated blood products • Transfusion-associated graft-versus-host disease (TA-GVHD) has not been reported from transfusion of cryoprecipitate or fresh frozen plasma (FFP), thus these components do not require irradiation.

32. Irradiated blood products • Fresh plasma (not frozen) for transfusion should be irradiated if the patient is at risk for TA-GVHD.

33. Irradiated blood products • Absolute Indications • Bone marrow/ stem cell transplant • Intrauterine transfusions • Congenital immunodeficiency syndrome • Premature newborn • Neonatal exchange transfusion

34. Irradiated blood products • Appropriate Indication • Hematologic malignancies (leukemias) • Hodgkin’s Disease • Non-Hodgkin’s Lymphoma

35. Irradiated blood products

36. Blood warming • Warming is not necessary for routine transfusions. • Warming of blood increase red cell metabolism & bacterial growth. • Warm by electric warmer Indication • Exchange transfusion in neonates • Presence of cold agglutinins • Rapid infusion through CVP lines

38. Blood warming • As blood flows drop by drop it attains body temperature. • Don’t use hot water to warm.

39. PLASMA INFUSION • Plasma infusion contains all coagulation factors but has disadvantage that it contains along with it more and more plasma fluid which is often not desirable since it can cause volume expansion • There fore one can use FFP which has more coagulation factors and very less plasma fluid.

40. PLASMA INFUSION • Or one can use still better the cryoprecipitate which has more and more concentrated form of coagulation factors and minimal or no plasma at all. • And still more one can give specific factors without any mixture

41. Plasma components • Based on these observations we have now • Stored plasma without being frozen • Fresh Frozen plasma • Cryoprecipitate • Cryopoor plasma

42. PLASMA INFUSION • Since plasma infusion contains all coagulation factors it can therefore be indicated in patients with documented coagulation factor deficiencies and active bleeding.

43. PLASMA INFUSION • Deficiencies may be congenital like hemophilia or acquired secondary to liver disease, Warfarin anticoagulation, disseminated intravascular coagulation, or massive replacement with red blood cells and crystalloid/colloid solutions.

44. PLASMA INFUSION • Plasma infusion therefore was used to treat haemophilia before more concentrated forms like FFP & cryoprecipitate came into practice latest came specific concentrates like factor VIII itself & IX.

45. Fresh Frozen Plasma(FFP) • The liquid portion of whole blood is centrifuged and separated from red blood cells, while blood cells and platelets and is called plasma.

46. Fresh Frozen Plasma(FFP) • When plasma is still fresh, it is immediately frozen within eight hours of collection at – 18°C or -0 °Fahrenheit. • A single unit of fresh and frozen plasma separated from single unit of whole blood is also called “thawed plasma” and it contains all coagulation factors (thickened mass) in normal concentrations.

47. Fresh Frozen Plasma(FFP) • FFP contains the labile as well as stable components of the coagulation, fibrinolytic and complement systems; the proteins that maintain oncotic pressure and modulate immunity; and other proteins that have diverse activities.

48. Fresh Frozen Plasma(FFP) • In addition, fats, carbohydrates and minerals are present in concentrations similar to those in circulation. Used for single or multiple coagulation factor deficiencies

49. Fresh Frozen Plasma(FFP) • FFP is efficacious for treatment of deficiencies of factors II, V, VII, IX, X, and XI when specific component therapy is neither available nor appropriate.

50. Fresh Frozen Plasma(FFP) • FFP is useful in infants with secondary immunodeficiency associated with severe protein-losing enteropathy and in whom total parenteral nutrition is ineffectual.