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Blood Components and Blood Transfusion

1) Red blood cell concentrates (PRBC) are the most commonly transfused blood component and are indicated to treat anemia and maintain hemoglobin levels in various patient populations and conditions. 2) Proper administration of PRBC transfusions requires informed consent, monitoring before, during, and after transfusion for any adverse reactions, and following guidelines for transfusion rates and storage/discard times. 3) Adverse transfusion reactions can occur acutely or delayed and range from mild to potentially fatal, requiring immediate treatment and investigation of the implicated blood component.

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150 views

Blood Components and Blood Transfusion

1) Red blood cell concentrates (PRBC) are the most commonly transfused blood component and are indicated to treat anemia and maintain hemoglobin levels in various patient populations and conditions. 2) Proper administration of PRBC transfusions requires informed consent, monitoring before, during, and after transfusion for any adverse reactions, and following guidelines for transfusion rates and storage/discard times. 3) Adverse transfusion reactions can occur acutely or delayed and range from mild to potentially fatal, requiring immediate treatment and investigation of the implicated blood component.

Uploaded by

joseph
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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BLOOD COMPONENTS AND

BLOOD TRANSFUSION
BY DR. F.REMTHANGPUII
LAYOUT OF PRESENTATION
• Blood component classification
• Indications of PRBC transfusion
• Administration
• Monitoring
• Adverse transfusion reactions
• Summary
COMPONENTS OF BLOOD
RED CELL CONCENTRATES(PRBC)
• Centrifugation of whole blood followed by
removal of platelet rich plasma or Apheresis.
• Stored at 2 – 8 degree celsius. (Blood must not
be stored in a ward refrigerator under any
circumstances).
• Shelf life 21 – 42 days.
• 1 unit PRBC = 150 – 200ml and Hct = 55-75%.
• 10 – 15ml/kg over 4 hours
THALASSAEMIA INTERNATIONAL FEDERATION
TIF PUBLICATION NO. 20
INDICATIONS OF PRBC TRANSFUSION
• General pediatrics populations
• Neonates
• Critically ill patients
INDICATIONS
General pediatrics populations
• Hb <=4g/dl or Hct 12%
• Hb 4 – 6 g/dl or Hct 13 – 18% if any of following clinical
features:
- Clinical features of hypoxia
- Acidosis (usually causes dyspnoea)
- Impaired conciousness
- Hyper-parasitemia (>20% malarial parasite)
• Hct <30%, requiring CPAP or mechanical ventilation
>0.35 FiO2
• Features of cardiac decompensation due to anemia
INDICATIONS (CONT..)
Neonates
• DVET
• Removal of 85% of neonates RBC
• 25 – 45 % of bilirubin and/or maternal alloantibody
• Stored or reconstituted WB
• Type – O Rh – negative blood cross-matched against
the mother
• Fresh blood (preferably < 3 days , CPD(A) )
• Push pull method with single vascular access
• Max. 5ml/kg at a rate not exceeding 5ml/kg every 3
mins
• Durations 1 – 2 hours
INDICATIONS ( CONT..)
• Partial exchange transfusion
Polycythemia :
PRBC(ml)= Blood vol. x weight x Expected Hct – Observed Hct
Hct of blood – observed Hct
Immune hydrops with anemia ( Hb <10 g/dl)
PRBC(ml) = Blood vol. x weight x observed Hct – Expected Hct
Observed Hct
• Critically ill child or child at risk for critical
illness:
• Hemorhagic shock : transfuse PRBC : plasma :
platelets in ratio of 2 :1:1 or 1: 1: 1
• Non-hemorrhagic shock :
• - Hb < 5g/dl : transfuse
• - Hb 5 – 7 g/dl : basedon clinical judgement
• Hb >= 7g/dl :
1. Hemodynamically stable -
• No transfusion:
-general critically ill
-post operative
-respiratory failure except ARDS
-sepsis/recent septic shock
-non – life threatening bleeding
-requiring RRT
CONT..
Hb >=7
• Acute brain injury : consider transfusion if Hb
7 – 10 g/dl
• Oncology and HSCT : consider transfusion if
Hb <= 7 - 8 g/dl
• Use clinical judgement:
-Allo – auto –immune hemolytic anemia
-Severe ARDS
-ECMO/VAD
• Cardiac disease :
– Uncoreccted CHD : transfuse RBC to maintain Hb 7 – 9 g/dl
– Biventricular repair : no transfusion
– Single ventricle : no transfusion if Hb >9g/dl and adequate
oxygenation and normal end organ function
– Congenital/acquired myocardial dysfunction : use clinical
judgement
– Pulmonary hypertention : use clinical judgement

2. Not hemodynamically stable : Use clinical judgement


• Thalasemia :
 Confirm diagnosis
 Laboratory criteria : Hb <7 on 2 occations, 2
weeks apart
 Clinical criteria irrespective of Hb level: Hb >7
with any of the following
Facial changes
Fracture
Poor growth
Clinically significant extramedulary hematopoesis
• Maintain pre transfusion Hb 9 – 10.5 or 11 –
12 for patients with cardiac complications
• Keep post transfusion Hb below 14 – 15
• Transfuse every 2 – 5 weeks
• Sickle cell anemia :
• Stroke
• Acute chest syndrome
• Abnormal transcranial doppler
• Hb < 10 before surgical procedure
• Maintain Hbs < 30%
• Exchange transfusion is prefer over simple
transfusion
St. Jude Children’s Research Hospital, Departments
of Hematology
KEY STEPS DURING ADMINISTRATION
1. Informed consent
2. Complete requisition form
3. Blood sample for pre – transfusion testing
4. Administration
5. Monitoring
6. Completion of transfusion
Duration times for transfusion:
Blood products Start transfusion Complete transfusion
Whole blood/PRBC Within 30 mins of <=4 hours discard unit if
removing from refrigerator this period is exceeded
Platelet concentrate immediately Within 30 mins
FFP As soon as possible Within 30 mins
cryoprecipitate As soon as possible Within 30 mins
Rates of transfusion
• Whole blood/PRBC : 2 – 5 ml/kg/hour
• Platelets/plasma : 1 – 2 ml/min
• Blood unit must be discarded if :
• Out of refrigerator for more than 30 mins
• The seal is broken
• Any sign of henolysis , clotting or
contaminations
Administration of blood products
• Maintain detail records :
• Type and volume
• Donation number
• Blood group
• Time of transfusion
• Signature of the individual responsible for
administration
• Monitor before , during and on completion
• Time of completion
• Identify and respond immediately to adverse effect
• Records details of any transfusion reaction
MONITORING
• Before starting the transfusion
• 15 mins after starting the transfusion
• At least every hour during transfusion
• 15 mins after transfusion
MONITORING( CONT.. )
• Before , during and on completion of
transfusion, records :
• Patients general appearance
• Temperature
• Pulse
• BP
• Respiratory rate
TRANSFUSION NOTES
OTHER ASPECTS OF TRANSFUSION
• WARMING OF BLOOD:
• Keeping the patient warm is more important than
warming blood
• Warming blood is not beneficial when transfusion is
slow
• Warmed blood required in :
• - Large volume rapid transfusion:
• - Adults : more than 50ml/kg/hour
• - more than 15ml/kg/hour
• - Exchange transfusion in infants
• - Clinically significant cold agglutinins
• Pre – medication usually not recommended
• Delay or mask signs and symptoms of acute
transfusion reaction
• Use separate IV lines for any intravenous fluid
• Use of fresh blood :
• - to avoid biochemical overload
• - Renal and liver dysfunction
• - Massive blood transfusion
• - Raised plasma potassium
• - Neonate requiring exchange transfusion
SPECIAL PRBC PREPARATION
• Leukoreduction
• Gamma irradiation
• Washed RBC
ADVERSE EFFECTS OF TRANSFUSION
• Transfusion reactions
• Acute TR (<24hours)
• Delayed TR (>24 hours)
• All TR except urticarial allergic and febrile non-
hemolytic reactions are fatal and require
urgent treatment
ACUTE TRANSFUSION REACTIONS
INVESTIGATIONS
• Immediately report category – 2 and 3 reactions
• Record :
- Type of transfusion reaction
- Time when reaction occurred
- Volume, type and bag no.
• Send blood samples for
• - repeat ABO and RhD group
• - repeat antibody screen and crossmatch
• - complete blood count
• - coagulation profile
• - DAT
• - urea and creatinine
• - electrolytes
• Return the following to blood bank ;
• - blood bag and transfusion set
• - blood culture
• - first specimen of patients urine
• - complete report form
• 24 hours urine sample

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