role of blood components in clinical practice

8/4/2019 Role of Blood Components in Clinical Practice

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Dr. Sanjay Upreti

Assistant Professor

Department of Pathology


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What is Blood component


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Whole Blood vs ComponentsWhole blood- red cells suspended in a proteinsolution

Wastage More side effects

Not available in western countries

Components

Specific Therapy

More patients can be benefitted

Increased shelf life


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Whole blood

Red cells Plasma Platelets

(Fresh frozenplasma (FFP)

Cryoprecipitate Cryosupernatant

plasma (CSP)F lX*

ImmuneGlobulin

Albumin

Fractionatedproducts

F Vlla*

F Vlll*

Granulocytes

* Now available as recombinant products


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BloodProducts

Whole blood

Red cellcomponent

Plateletcomponent

Plasma products

Component derivatives

Red blood cell

conc./suspension

(PRBC)

Single donation

unit (PC)

Fresh frozen

plasma (FFP)

Albumin

Washed Red

Cells Conc.

Pooled unit Liquid plasma Coagulation

factors

Leucocyte

depleted red cells

Single donor

apheresisplatelets (SDAP)

Cryoprecipitate immunoglobulins

Frozen red cells - irradiated PC Cryo poor

plasma

- irradiatedPRBC

Viral inactivatedlasma


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Composition Whole blood Red cell concentrate

(PRBC)

Red cell suspension

Preparation Separate plasma at 2-

60C under

gravity/centrifugation

Separate plasma and

add additive soln. e.g.

ADSOL

1 unit increase Hb by 1gm% 1-1.5gm% 1-1.5%

Volume (ml) 350-450 150-200 150-200

Maximum storage

time at 2-60C

35 days : CPDA 35 days: CPDA 42 days-ADSOL

Advantages Easier to prepare Low viscosity, more

shelf life

Disadvantages Higher viscosity Expensive


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PRBC Indications-

Component of choice for virtually all patients with a

deficit of oxygen carrying capacity, e.g., blood loss oranemia.

Transfusion Trigger-

>10 gm/dl- Probably no transfusion required

7-10 gm/dl- Transfusion may be requierd


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Storage lesions Viability

2-3 DPG Levels

Potassium plasma Hb

REVERSIBLE No or very little clinical significance


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Washed RBCWashed with NS

Removes 99% of plasma proteins, electrolytes and

antibodies No significant leukoreduction.

20% cells lost

Use within 24 hours.


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Washed RBCsIndications-

IgA Deficient individuals

Repeated allergic reactions Intrauterine transfusion

Pts with T activated cells

Very occassionaly- severe autoimmune hemolytic

anaemia


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Leukodepleted RBC < 5 x 10 6Leukocyte/unit

Reduce the risk of

1. Febrile non hemolytic reactions2. CMV Transmission

3. HLA Allo-immunization leading to plateletrefractoriness.


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Leukodepleted RBC1. Filteration

Prestorage leukodepletion

Leukodepletion at time of issue Bedside leukodepletion

2. Buffy Coat Removal


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Irradiated Blood Components

Indication- To prevent TA- GVHD

Usually due to use of fresh whole bloodfrom related donors/ immuno-compromised pts

Pathophysiology- escape of donor Tlymphocytes present in cellular blood

components in the recipient & subsequentclonal expansion of these cells with immunedestruction of host tissues.


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s/s- fever,dermatitis, erythroderma, hepatitis,enterocolitis, pancytopenia, hypocellular marrow,

Instrument- Blood irradiator

Dose- 25Gy Irradiation indicated for-

1. all relative donors

2. immunocompromised patients

3. neonates undergoing exchange transfusion

4. Pts with Hodgkins disease

5. Pt of CLL receiving fludarbine phosphate


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Platelets TransfusionIndications

Bleeding d/t thrombocytopenia/abnormal platelet

functions Prophylactically- 10,000/cumm instable pts.

Platelet transfusion trigger -50,000/cumm for mostsurgeries.

Neurosurgery/ophthalmic surgery- 100,000/cumm


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Effectiveness of platelet

transfusion 1 unit of platelet concentrate will increase the platelet

count by 5-10K in the average adult;

Dose:1 unit platelet concentrate per 10 kg body weight

or 1 unit apheresis platelets Patients repeatedly transfused - alloimmunized and

refractory to platelet transfusion-HLA matched orcross-matched platelets may be required


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Platelets TransfusionContraindications

ITP

Platelet refractoriness TTP

Heparin induced thrombocytopenia

role of blood components in clinical practice

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