blood product utilisation in icu .pptx

blood product utilisation in icu

1. Blood product utilization in ICU Dr Swarna Deepak K

2. WHAT ARE BLOOD PRODUCTS? A blood product is Therapeutic substance derived from human blood, including whole blood and other blood components for transfusion, and plasma-derived medicinal products (PDMPs).

3. COMPOSITION OF BLOOD

4. What is safe transfusion?

5. PREPARATION OF BLOOD PRODUCTS

6. BLOOD PRODUCTS Whole blood Red cell concentrate(PRBC) Platelet concentrate Fresh frozen plasma(FFP) Cryoprecipitate Immunoglobulins Factor concentrates Fibrinogen concentrate Albumin

7. SCENARIO-1 A n 18 year old boy, had an RTA admitted to emergency with open fracture of femur and multiple abrasions His pr-120, bp-100/60 mmhg C onscious oriented R equiring oxygen support Keeping in mind his active blood loss which blood product is preferred

8. WHOLE BLOOD Whole blood Although in many countries it still accounts for most transfusions Whole blood is rarely used in many developed countries Whole blood has a shelf life of 35 days and typically, 70ml of citrate preservative solution is added to 420 ml blood.

9. PACKED RED CELLS Packed red cells - by removing between 150-200ml of citrated plasma from a unit of whole blood. 1 unit- H aematocrit of between 60-70%. (About 300-350 ml) Shelf life- 42 days Storage temperature- 2-6 degrees Additive solutions - AS-1 ( Adsol ), AS-3 ( Nutricel ), and AS-5 ( Optisol ), and saline-adenine-glucose (SAG) or SAG-mannitol ( SAGM)

10. L oss of 2,3-diphosphoglycerate (2,3-DPG) L eading to increased haemoglobin affinity for oxygen (left shift of the oxygen dissociation curve) R educed oxygen delivery to the tissues. loss of membrane integrity - (Potassium leaks ) A unit of packed red cells - haematocrit by 3% and haemoglobin by 1 g/dl.

11. RECOMMENDATION C ritically ill patients if not actively bleeding- restrictive transfusion strategy . U nnecessary when Hb > 9g/ dL . When Hb range 7-9 g/ dL -RBC transfusion is not associated with improved survival. The decision to transfuse should be based on the patient’s clinical condition(CAD- 10 g/dl, CKD-6 g/dl) Transfuse when H b < 7 g/Dl C linical reassessment is advised

12. SCENARIO-2 A patient on warfarin therapy for atrial fibrillation presented to emergency with GI bleed and is having INR of 8 what is the blood product of choice in this patient as the patient is hemodynamically stable

13. FRESH FROZEN PLASMA FFP is collected as the supernatant after centrifuging a donation of whole blood. Shelf life- 1 year S torage temperature -30 ˚C. Frozen packs are brittle and should be handled with care. Thawed using -dry oven (10 minutes), microwave (2-3 minutes) or a water bath (20 minutes). Thawed FFP is best used immediately

14. Recommendations and indications for FFP transfusion Correction of excessive microvascular bleeding - PT > 1.5 times normal, an INR > 2.0, or aPTT > twice normal. Urgent reversal of warfarin therapy when human prothrombin complex is unavailable Correction of known coagulation factor deficiencies for which specific coagulation factor concentrates are unavailable. DOSE 10-15 ML /KG (USUAL) 5-8 ML/KG(FOR WARFARIN REVERSAL)

15. SCENARIO 3 CASE OF APLASTIC ANAEMIA PRESENTED TO EMERGENCY WITH PANCYTOPENIA, WITH EPISTAXIS AND ORAL BLEED PLATELET COUNTS ARE 30 K , WITH HEMOGLOBIN – 8 g/Dl PATIENT IS HEMODYNAMICALLY STABLE WHICH IS THE PRODUCT OF CHOICE?

16. PLATELET CONCENTRATE Two types – according to collection method 1. Pooled platelets(RDP). 2. Apheresis platelets(SDP) Platelets last for 3-5 days S tored on an agitator at 22˚C 1 Unit- 30-50 ml

17. RECOMMENDATIONS PROPHYLAXIS Critically ill patient without bleeding when the platelet count is <20 K To maintain the platelet count at 50 K in patients undergoing surgery or invasive procedures In qualitative platelet function disorders BLEEDING PATIENTS Thrombocytopenia secondary to marrow failure is considered a contributory factor When the platelet count is < 50K

18. Scenario 4 C ase of septic shock admitted in icu with multiple ionotrope support D eveloped bleeding manifestation like upper gi ,nasal bleed and bleeding through endotracheal tube P atient on investigation was found to have deranged coagulation parameters with inr-5, and fibrinogen -80 B lood products for management of this patient

19. CRYOPRECIPITATE FFP is thawed to refrigerator temperature (4˚C) a precipitate forms R ich in high molecular weight proteins, including factor 8, von Willebrand factor, factor 13 and fibrinogen Stored at -30 degree Shelf life 2 years

20. R ecommendations Fibrinogen concentration < 100mg/dl in the presence of excessive microvascular bleeding. To correct excessive microvascular bleeding in massive TRANSFUSION For patients with von Willebrand’s disease and congenital fibrinogen deficiencies.

21. TRANSFUSION REACTIONS

22. TYPES OF TRANSFUSION REACTIONS Acute Transfusion Reactions Mild  allergic Anaphylactic   Febrile non-hemolytic   Acute hemolytic transfusion reactions Transfusion-associated circulatory overload (TACO ) Transfusion-related acute lung injury Delayed Transfusion Reactions Delayed hemolytic transfusion reaction Transfusion-associated graft-versus-host disease

23. ALLERGIC (mild) Attributed to hypersensitivity to a foreign protein in the donor product .

24. MANAGEMENT

25. TACO Fluid overload secondary to transfusion

26. THANK YOU