Professional Documents
Culture Documents
Components
Dr. M. Mohandoss
Assistant Professor
Transfusion Medicine,
Malabar Cancer Centre, Thalaserry
Component Therapy
21/03/15
Whole Blood
Platelet Rich
Plasma
Method
Manual
Method
21/03/15
Apheresis
Buffy Coat
Method
Automation
MALABAR CANCER CENTRE
Red cells
PRP
RBC
21/03/15
Plasma
Platelet Conc.
FFP
PC
(RDP)
MALABAR CANCER CENTRE
PRP Method
Manual plasma expresser
21/03/15
Red cells
within
6 hrs
Plasma
RBC
Buffy coat
plasma
Soft spin
(1800 rpm x 7 min at 22oC)
Platelet Conc.
21/03/15
21/03/15
Sealers
Sealer
Sensor
Sensors
21/03/15
Press
Apheresis
To take away or Withdraw
Process in which blood is removed from a
subject and continuously separated into
component parts, allowing a desired
component (s) to be retained while the
remainder is returned to the subject
21/03/15
Principle of Apheresis
21/03/15
SDP Vs RDP
Decreased chances of TTI and alloimmunization
number of donor support required
Lesser Donor reactions
Ensures adequate dose
ABO matched platelet support
Consistent and standardized yield
= 1 adult dose
(3x 1011/ unit)
SDP
RDP
RDP
+ RDP +
RDP
RDP
RDP
= 1 adult dose
(4 x 1010/unit)
Storage
COMPONENTS
Packed red blood cells (PRBC)
Platelets (PLTS)
Fresh frozen plasma (FFP)
Cryoprecipitate (CRYO)
21/03/15
STORAGE
TEMPERATURE
+2 to 6C
+22 to +24C under
constant agitation
-30C or below
-30C or below
Case 1
A patient X (45yr Male) admitted following road
traffic accident
Suspected to have blunt abdominal injury and
internal bleeding
Shifted to OT Hb:8g%
Which component would you like to transfuse?
1. Whole blood
2. Packed Red Blood Cells
3. Fresh Frozen Plasma
four patients
5 units
1750 ml
5 units
250 ml
1 unit
200 ml
20 units 7,000 ml
20 units 400 ml
Case 2
A 4 year old boy with thalassemia is on
hypertransfusion therapy.
Since last 3 months patient gets fever and chills
following transfusion
Did not get any benefit with premedication
storage time
passenger leukocytes
Transfused Leukocytes
Cytokine production in
vivo
Circulating cytokine
Threshold
Exceeded
IL - 1
IL 6
IL 8
TNF-
FNHTR
RANTE
S
TGF-
GRO-
Leuko-depleted Blood
Components
Adverse Effects due to Leukocytes
Febrile Nonhemolytic Transfusion Reaction
HLA alloimmunization
Cytomegalovirus transmission and
Reactivation
TRIM (Immunomodulation)
Leukoreduction
Prestorage
Post storage
- Centrifugation: BC removal - Laboratory
- Filtration
- Bedside
Platelet refractoriness
Immunomodulation
Prevention of post-op bacterial
infection
Case 3
32 years / Male, fever since 6 days
Dengue Fever, no signs of bleeding
Platelet count 15,000/L
Hb: 13g/dL
PT, INR - normal
APTT are mildly elevated
Virus induced BM
suppression
Immune Mediated
Clearance
Increased
- Auto Ab ThrombocytopeniaConsumption
- Cross-reacting
antibodies
Platelet Dysfunction
Evidenced by the absence of ADP release
and impaired aggregation
Rate of alloimmunization
Decreased incidence of T T I
COST
1 dose
SDP
Case 4
Within 30 to 45 minutes
52 years / Male
Known case of cirrhosis post transfusion
- Patient developed severe
Patient was posted for endoscopy
breathlessness
Laboratory Values
- Oxygen saturation
Hb: 9.5g/dL,
declined
PT:20 sec
- Even with oxygen mask
INR: 1.6
he was tachypneic and
Transfused 2 units of FFP his condition continued
to worsen..
???....
Was FFP transfusion appropriate?
If yes was it a sufficient dose? (weight 60kg)
What was the condition that patient developed after
transfusion?
Minimally elevated PT-INR
Recommendations for FFP transfusion
Correction of acquired deficiencies of clotting factors
when the PT or aPTT ratio is >1.5
Liver disease: Active bleeding
Use of Combination of
Components
Case 1
Patient continues to bleed
Visceral injuries noted
Hemostasis not achieved
2 U PRBC
10
U
Cryoprecipitate
Composition
vol
10-20 ml
f VIII
65 - 80 IU/unit
vWF:Ag 70 - 80 IU/unit
Fibrinogen 200 mg /unit
Fibronectin 55mg/unit
factor XIII 20-30% of
original
Cryoprecipitate.
Major Indications
Hypofibrinogenemia
FXIII deficiency
Hemophilia A
von Willebrands disease
Dosage: 1 bag / 7kg body wt
Fibrinogen deficiency
FVIII : Desired factor increase x 0.5
* References:
Blood Transfus. 2007 Apr;5(2):75-84. doi: 10.2450/2007.0015-07
Med J Aust. 2003 Feb 3;178(3):117-21
Transfusion. 2010 Dec;50(12):2565-70. doi: 10.1111/j.15372995.2010.02757.x
Asian J Transfus Sci. 2010 Jan;4(1):25-7. doi: 10.4103/09736247.59387
5% 4.2% 22.6%
TACOAllo ATR
2.6%
HTR
7 8 9 10 11 12 13
Why transfuse?
Summary
Transfusion is a live tissue transplantation
Transfusion should not be dictated by lab values
alone but should also be based on the patients
clinical status
Determine the trigger and dose to be
administered
Thank you