Blood and blood productsplasma substitutes plasma expanders.pptx

Blood and plasma substitutes

1. B l oo d And B l ood Products

2. B l oo d And B l ood Products Blood is the connective tissue consisting of plasma and cellular components. Average human has 5 litres of blood i.e., 8% of total body weight. It is a transporting fluid that carries vital substances to all parts of the body.

3. Properties Of Blood Colour : Oxygen-rich blood : scarlet red bright crimson Oxygen-poor blood : purple red pH : 7.35–7.45 Temp : 38˚C or 100.4˚ F Viscosity : 5 times more viscous than water

4. Functions Of Blood

5. Blood Groups & Typing

6. CROSS MATCHING AKA test tube transfusion Blood matching - direct compatibility test donor RBC to recipient serum

7. Blood Transfusion Blood transfusion can be defined as the transfusion of the whole blood or its components from one person to the other. (Or) Transfusion is simply the transplantation of a tissue consisting of a suspension of cells in a serum . It involves the collection of blood from the donor and administration of the blood to the patient

8. Blood Transfusion Blood for transfusion is safe when : Donated by a carefully selected, healthy donor Free from infections Processed by reliable methods of testing, component production, storage and transportation Transfused only upon need and for the patient’s health and well being

9. Things To Be Noted Type and volume of each unit transfused Donation number Blood group of each unit transfused Time at which the transfusion of each unit commenced Signature of the individual responsible for administration of the blood Monitor the patient before, during and on completion of the transfusion Time of completion of the transfusion Transfusion reaction, if any and its management

10. Precautions To Be Taken During Blood Transfusion Use of Sterile Apparatus. Blood bag should be checked Temperature of blood to be transfused must be same as body temperature. Transfusion rate must be slow in order to prevent increase load on heart. Care full watch on the recipients condition for 10 mins

11. Blood transfusion Estimated Blood Volume( EBV):

12. Rationale of Blood transfusion Right blood product Right dose Right time Right reasons

13. Prevention Is Better Than Cure Perioperative blood loss and anaemia reducing blood lost at surgery through minimizing trauma, improving mechanical haemostasis Limiting phlebotomy to essential diagnostic tests, using microsample laboratory techniques; and giving antifibrinolytics , such as EACA or tranexamic acid ( Early dx and treatment of anemia like IDA

14. Phlebotomy The maximum volume of blood that may be collected is <15 % of body weight About 350- 450 ml is taken each time The withdrawal of blood takes 10-15 mins

15. Apheresis separating - cellular & soluble components of blood whole blood centrifuged to obtain components ( RBCs, platelets, plasma based on specific gravity). required component is collected & rest is returned to the donor Selective collection of RBCs/WBCs/platelets is called cytapheresis plasmapheresis- Selective collection of plasma

16. BLOOD PRODUCTS Red Cell Concentrate Platelet Concentrate Granulocyte Concentrate Fresh Frozen plasma Cryoprecipitate Cryo poor plasma Stored plasma Albumin Immunoglobulin Coagulation Factors Plasma Derivatives Plasma Components Cellular Components BLOOD

17. W h ol e B l ood Whole blood = Donor blood + Anticoagulant 1 Unit – 350 ml ; Anticoagulant (CPDA) - 49 ml Rich - coagulation factors Hct - 45% Stored at 2 - 6 ˚ c Shelf life - 35 days / 5 wks acute blood loss in major surgeries > 15% blood loss

18. Whole Blood INDICATIONS CONTRAINDICATIONS Acute blood loss with hypovolaemia Exchange transfusion - severe anaemia at birth - severe hyperbilirubinaemia Massive transfusion Cardiovascular bypass surgery Risk of volume overload in patients with: Chronic anaemia Incipient cardiac failure

19. PRBC Platelets and plasma are removed I unit - 330ml Increases Hb by 1 g/dl Hct – 65 - 75% Shelf life - 35 days Stored at 2 - 4 ˚ C in SAG-M ( Saline, adenosine, glucose, mannitol ) Older: CPD (CITRATE-PHOSPHATE-DEXTROSE) Increase oxygen carrying capacity

20. Indications Of Red Cell Concentrate Trauma – acute blood loss > 20% Anaemia Thalassemia Sickle cell disease

21. Platelets Concentrate Platelet rich plasma Stored at – 20 to 24 ˚ c ( Room temperature) Shelf life – 5 days I unit = 15 – 20 ml 1 unit Increases platelet count by 5000-10,000/L Reduces incidence of bleeding

22. Platelets Concentrate INDICATIONS CONTRAINDICATIONS Thrombocytopenia Drug induced Haemorrhage Prevention of spontaneous bleeding with counts < 20,000 Idiopathic autoimmune thrombocytopenic purpura (ITP) Thrombotic thrombocytopenic purpura (TTP) Untreated DIC Thrombocytopenia associated with septicaemia, or in cases of hypersplenism

23. Plasma Products Fresh frozen plasma Cryoprecipitate Factor VIII concentrate Factor IX concentrate Albumin Prothrombin complex concentrate (PCC) Anti-thrombin concentrate Gammaglobulins

24. Fresh Frozen Plasma Plasma collected from single donor or by apheresis and frozen within 8 hours of collection. 1 Unit – 200 - 250ml; 3% increase in CF Contains clotting factors ( Fibrinogen, Anti thrombin , Proteins C and S) , albumin and immunoglobulin. Stored at - 40 to - 50˚c Shelf life – 2 years Acellular-does not transmit intracellular infections

25. Indications Fresh Frozen Plasma First line therapy for treatment of coagulopathic haemorrhage Single clotting factor deficiency Multiple clotting factors deficiencies - DIC Massive transfusions Warfarin overdose Haemorrhagic disease of neonates TTP

26. CRYOPRECIPITATE Produced by controlled thawing FFP 10-20ml PACK FIBRINOGEN: 150-300 mg FACTOR VIII : 80-120 U VWF : 80-120 U Stored at ( -30) ° C Shelf life – 2 years Poled units (10 DONATIONS) - Raise fibrinogen by 1g/L

27. INDICATIONS OF CRYOPRECIPITATE 1 st choice for DIC Von Willebrand’s disease Fibrinogen deficiency

28. FACTOR VIII C ONCENTR A TE Indications : Hemophilia Problems : Allergic reactions H y pe r fibrino g en e mia after massive doses FACTOR IX C ONCENTR A TE Indications : Acute bleeding and perioperatively in Christmas disease Problems: Allergic reactions

29. Autologous blood Collection / infusion of client’s own blood Can be collected weekly as long as client’s Upto 3 weeks before surgery Hct - 45% Stored at 2 - 6 ˚ c Shelf life - 35 days

30. BLOOD COLD CHAIN DONATED WHOLE BLOOD OR PLASMA PREPARATION OF COMPONENT RED CELL TRANSPORT BOX AT +20 TO +24 FOR MAX.6hrs PLASMA PLATELET QUARANTINE STORAGE BLOOD REFRIDGERATOR +2 TO +6 BLOOD REFRIDGERATOR +2 TO +6 PLASMA FREEZER -30 OR LOWER PLASMA FREEZER -30 OR LOWER PLATELET AGITATOR +20 TO +24 PLATELET AGITATOR +20 TO +24 TRANSPORT BOX +2 TO + 10 TRANSPORT BOX LESS THAN -20 TRANSPORT BOX +20 TO +24 BLOOD RECIPIENT(PATIENT) STOCK STORAGE HOSPITAL BLOOD BANK

31. Duration for transfusion

32. Massive Blood Transfusion Replacement of a blood volume equivalent within 24 hours. >10 units within 24 hours Transfusion > 3 units in 1 hour Replacement of 50% of blood volume in 3‐4 hours A rate of loss >150 ml/hour

33. Uses of massive blood transfusion Severe trauma associated with Liver injury Vessel injury Cardiac injury Pulmonary injury Pelvic injury

34. Complications of massive transfusion Coagulopathy Hypocalcaemia Hyperkalaemia Hypokalaemia Hypothermia

35. Blood substitutes Also called artificial blood or blood surrogate A substance used to mimic and fulfill some functions of biological blood Aims to provide an alternative to blood transfusion Two types Biomimetic Abiotic

36. Biomimetic substitutes mimic the standard oxygen-carrying capacity of the blood and are haemoglobin based. Abiotic substitutes are synthetic oxygen carriers and are currently primarily perfluorocarbon based.

37. Complications of blood transfusion Adverse reactions of blood transfusion can be classified into : Immunological complications Non immunological complications Based on duration taken for the symptoms to occur they can be classified as: Acute Delayed They can also be classified as Non infectious complications Infectious complications

38. Complications of blood transfusion ACUTE (<24 HRS) DELAYED (>24HRS) IMMUNOLOGIC NON IMMUNOLOGIC IMMUNOLOGIC NON IMMUNO L OGIC He m ol y tic reaction Febrile non- hemolytic reaction Urticaria A n ap h ylactic reaction TRALI Septic Circulatory overload Metabolic Hypocalcemia Hyperkalaemia Metabolic alkalosis Air embolism He m oglobinaem i a , Hemoglobinuria He m ol y tic reaction Post transfusion purpura Graft vs host disease Infection Iron overload

39. TRANSFUSION RELATED ACUTE LUNG INJURY [TRALI] previously known as pulmonary hypersensitivity reaction Pathophysiology : transfusion of antibodies and/ or other non immunologic mediators to a susceptible patient The most frequently implicated antibodies are human leukocyte antigen (HLA) class I, HLA class II, and human neutrophil antibodies (HNA)5,7; these antibodies activate the leukocytes, which bind to the endothelium in the lungs, causing endothelial injury and edema

40. Treatment Of TRALI immediate cessation of the transfusion and stabilization of the patient are critical. Respiratory support may range from supplemental oxygen to intubation. Steroids have not been proven to be beneficial. TRALI reactions usually resolve over the course of a few days with only supportive measures being needed

41. Transfusion Associated Circulatory Overload [TACO] most common high-morbidity transfusion reaction risk of TACO increase with including older age, renal disease, cardiac disease, positive fluid balance, and critically ill status Pathophysiology : too much fluid is added to the system too quickly (or in volumes that cannot be tolerated) for the transfusion recipient. Pulmonary Edema And Respiratory Distress

42. Difference Between TRALI And TACO

43. Treatment Of TACO transfusion still running - should be stopped immediately Some case improve with simply stopping the infusion some form of respiratory support, at least temporarily Diuretics ; decrease in circulatory volume relieves cardiovascular stress, improving the pulmonary edema TACO can be prevented ,patients at risk of fluid overload at increased risk of TACO and should be transfused at a slow rate

44. References Guyton And Hall Textbook Of Physiology 14 th Edition Morgan & Mikhali’s 6 th Edition MILLERS anesthesia 7 th edition https://nrcs.org/donate-blood/#can-i-donate Uptodate Hand book of transfusion medicine; 5 th edition ,UK blood services WHO official site .

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