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BLOOD BANKING. 1- BLOOD PRODUCTS 2- AUTOLOGOUS TRANSFUSION M. H. Shaheen Maadi Armed Forces Hospital. BLOOD COMPONENTS. I- Red Cells: For oxygen carrying capacity II- Plasma : For coagulation proteins III- Platelets: For microvascular bleeding. RED CELL COMPONENTS. 1- Whole blood

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blood banking

BLOOD BANKING

1- BLOOD PRODUCTS

2- AUTOLOGOUS TRANSFUSION

M. H. Shaheen

Maadi Armed Forces Hospital

blood components
BLOOD COMPONENTS

I- Red Cells: For oxygen carrying capacity

II- Plasma : For coagulation proteins

III- Platelets: For microvascular bleeding

red cell components
RED CELL COMPONENTS

1- Whole blood

2- Red cell concentrates (Packed RBC)

3- Washed red cells

4- Leukocyte depleted red cells

5- Frozen red cells

whole blood
WHOLE BLOOD
  • Anticoagulant:

CPDA-1

  • Shelf Life:

35 days At 1-6 * C

  • Volume:

450 ml blood Plus

63 ml CPDA=

510 ml

cont whole blood
Cont… WHOLE BLOOD
  • Poor in coagulation proteins & platelets
  • Corrects oxygen carrying capacity and volume simultaneously
  • Indicated for the management of trauma and extensive blood loss
  • One unit of whole blood increases Hct by 3% and Hb level by ~ 1 gm
fresh whole blood
FRESH WHOLE BLOOD
  • Less than 5 days old
  • Indications:

- Exchange transfusion

- Major surgery with massive blood loss

- Liver transplantation

- Open heart surgery in infants

2 red cell concentrates packed red cells
2- RED CELL CONCENTRATES(Packed red cells)
  • Production:

from whole blood; Plt. & plasma are produced

  • Shelf life: 35 days

+ nutrient= 42 days

  • Volume: ~ 200 ml
cont packed red cells
Cont…. Packed Red Cells

Indications:

  • Correction of oxygen carrying capacity
  • Chronic anemia
  • Before major surgery
  • Trauma and emergency transfusion
3 leukocyte depleted red cells
3- Leukocyte Depleted Red Cells
  • Preparation:

Nylon wool filters

  • Indication:

Non-hemolytic febrile reactions

4 washed red cells
4- Washed Red Cells
  • Manual and automated washing systems
  • Must be transfused before 24 hours
  • Washing removes plasma proteins and reduce allergic transfusion reactions
  • indicated in recurrent an/or sever reactions
4 frozen red cells
4- Frozen Red Cells
  • Production: Red cells + Cryoprotective
  • Storage: Liquid nitrogen or Freezers
  • Preparation prior to transfusion: Thawing washing and addition of glucose
  • Transfusion: Within 24 after preparatoin
  • Indications:

- Rare blood groups

- Subgroup antibodies

appropriate transfusion practice of red cell products in various surgical settings
Appropriate Transfusion Practiceof Red Cell Products in various surgicalsettings
  • One unit of red cells : 3% increment in Hct

increases Hb level by ~ 1gm

  • Do not measure Hb &/or Hct before 2 hours
  • Factors adversely affecting the benefit from transfused red cells:

- Continued blood loss

- Hemolysis; immune mediated & mechanical

- Suppression of erythropoiesis

red cell transfusion in acute blood loss
Red Cell Transfusion in Acute Blood Loss
  • Blood loss of < 10% of total blood volume:

No replacement therapy

  • Loss Up to 20% : Replace by crystalloids
  • Loss > 25% : Require red cell transfusion
  • Preoperative Hb < 10 gm: Historical gold standard for red cell transfusion
  • Each case must be evaluated individually
ii platelet preparations
II- PLATELET PREPARATIONS

1- Platelet Concentrates

2- Apheresis Platelet Units

appropriate transfusion practice of platelet concentrates
Appropriate Transfusion practice of Platelet Concentrates
  • Unit of Platelet Transfusion:

- Conventional requirement is 6 units of

pooled platelet concentrate

- Apheresis platelet unites are largely

dependent on donor parameters

  • Single donor (apheresis) platelets have low risk to recipients than do pooled platelets
platelet transfusion dose
Platelet Transfusion Dose
  • Apheresis Platelets contains 3 x 10^11 Plts
  • Six units of pooled platelet concentrate=

6 ( 5.5 x 10^10) Plts

  • Appropriate transfusion requirement for normal size individual
  • Post-transfusion increment of ; 5 - 8 x 10^9 /L
cont platelet transfusion dose
Cont… Platelet Transfusion Dose
  • Approximately one unit of platelet concentrate for each 10 kg body weigh
  • Objective in the preoperative period:

Platelet count > 60,000 x 10^6 /L

  • Post-transfusion platelet survival:

6 - 8 days

iii plasma derivatives
III- PLASMA DERIVATIVES
  • Plasma products commonly requested:

1- Fresh Frozen Plasma (FFP)

2- Cryoprecipitate

3- Fibrin Glue

  • Plasma and its derivatives represent a valuable source in transfusion practice
  • Plasma production:

Manually, Aphersis, Industrial fractionation

1 fresh frozen plasma ffp
1- Fresh Frozen Plasma (FFP)
  • Storage: 18 * C for up to 1 year
  • Transfusion: Thawed over 20 - 30 min
  • Validity: 24 hours after thawing
indications of ffp
Indications of FFP

1- Multiple acquired coagulation defects:

  • Liver disease
  • Massive transfusion
  • DIC
  • Rapid reversal of warfarin effect

2- Plasma Infusion or exchange:

  • TTP
  • HUS

3- Congenital coagulation defects

2 cryoprecipiate
2- Cryoprecipiate
  • Production: FFP thawed at 4* C
  • Storage:

At 18 * C for 1 year

  • Properties:

contains fibrinogen, F VIII and vWF

  • Indication:

Fibrinogen deficiency & hemophilia A

3 fibrin glue
3- Fibrin Glue
  • Topical hemostatic blood product
  • Production:

1- Cryoprecipitate

2- Thrombin

  • Cut , tailored and pasted
  • Indication:

Hemostatic and sealant in cardiac , vascular and other surgical procedures

autologous blood transfusion
AUTOLOGOUS BLOODTRANSFUSION
  • HISTORY:

- Remote: 100 years ago

- Recent: HIV In 1980 th.

advantages
ADVANTAGES
  • Eliminates transfusion transmitted diseases (Hepatitis and HIV)
  • Prevention of transfusion immunologic reactions
  • Enhanced recovery from postoperative anemia
  • High cost benefit

LIMITATION:

  • Risk of blood donation in some cardiac patients
methods of collection of autologous blood donations
Methods of Collection of Autologous Blood Donations

1- Preoperative

2- Intraoperative blood salvage

3- Intraoperative hemodilutionn

1 preoperative autologous transfusion
1- Preoperative Autologous Transfusion
  • Autologous donation once a week

- Normal erythropoiesis

- Adequate iron supply

  • Large volume if cryopreservation is available
  • Well tolerated even in by some high risk donors
  • Limitation: Anemia developing during the donation interval (Erythropoietin may help)
  • In USA , less than 2% require allogeniec blood for elective surgery
2 intraoperative blood salvage
2- Intraoperative Blood Salvage

1- Systems without washing:

- Modified suction devices

- Simple and cheap

2- Washing systems:

- combined suction device and continuos flow

centrifugal system

- Processing of large blood volume

- Save ~ 50% of allogeneic blood requirements

3 intraoperative hemodilution
3- Intraoperative Hemodilution
  • Collection of autologous blood just before the start of surgery
  • Value in open heart surgery:

- Saving of platelet number and function

- Reduction of red cell loss

- Improves tissue perfusion and oxygenation

- Less expensive than preoperative donations