Lecture 14 Blood transfusion history and Blood products 2.pptx

For Mlt students

1. Awal Mir M.Phil MLS, PhD Scholar TRANSFUSION HISTORY BLOOD PRODUCTS

2. The first successful animal to animal transfusion , was performed by Richard Lower at Oxford in February 1665 Direct transfusion from the carotid artery of one dog to the jugular vein of another by insertion of quills into the blood vessels The first animal to human transfusion was performed by Denis in 1667 3 TRANSFUSION HISTORY

3. He administered the blood of a lamb to a 15-year old boy named Arthur Coga Blundell (1790-1877) was the first to state clearly that only human blood should be used for human transfusion The first well-documented transfusion with human blood took place on September 26, 1818 Thus beginning of modern transfusion ere 4 TRANSFUSION HISTORY

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5. In 1900, Karl Landsteiner observed that the sera of some persons agglutinated the red blood cells of others He identify ABO blood groups A, B, and O for the first time In 1913, Ottenberg suggested preliminary blood testing, uses of anticoagulant will reduces transfusion “ accidents The M, N, and P systems were described in the period between 1927 and 1947 6 TRANSFUSION HISTORY

6. The Rh system was discovered in connection with an unusual transfusion reaction. In 1939, Levine and Stetson A blood transfusion service, organized by the Republican Army during the Spanish Civil War ( 1936-1939) Component and derivative therapy began during World War II 7 TRANSFUSION HISTORY

7. Blood components not only saved lives but also transmitted diseases (HBV, HCV, HIV) So safe blood transfusion concept was established Safe blood which does not harm the patient during or after transfusion of blood 8 TRANSFUSION HISTORY

8. Transfusion medicines or transfusion therapy” is a broad term that comprises all aspects of the transfusion of patients Blood and blood products are considered drugs because of their use in treating diseases As with drugs, adverse effects may occurs I t is most dangerous medicines, never transfuse unless it is life saving 9 BLOOD TRANSFUSION

9. S teps in safe blood transfusion Right doctor request (complete bio-data, transfusion history & transfusion reaction, blood component & quantity) Right blood donor ( Volunteer blood donor & autologous) Right laboratory tests (Blood group, cross match, antibodies screening, TTIs screening) Right blood component Right Report Right Patient 10 BLOOD TRANSFUSION

10. Steps & requirements in blood administration Recipient/patient consent Patient education and history Medical Order/Consultant advised Laboratory test reports Availability of emergency medicines & equipment's 11 BLOOD TRANSFUSION

11. Recipient/patient consent Recipient consent for the transfusion must be obtained from patients The recipient consent document should contain indications, risks, possible side effects The patient has the right to accept or reject a transfusion If the patient is unable to give consent, a legally authorized representative or surrogate may provide consent 12 BLOOD TRANSFUSION

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13. Patient education and history The patient should have the opportunity to ask questions It is important to take a history from the patient before the component is ordered so that it can be determined if the patient had reactions to components in the past Patient must be educated regarding transfusion reactions occurrence and initial inset appearance 14 BLOOD TRANSFUSION

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15. Medical Order/Consultant advised There must be an order from a licensed care provider and will clearly mentioned required blood component types (RCC, Platelets or FFPs ) and number of unites In order sheet patient, name, age, date of birth and medical history Any special processing required of the component (e.g. washing, irradiation, or filtration or apheresis) The date and time of transfusion 16 BLOOD TRANSFUSION

16. Laboratory reports After receiving an order from a licensed provider, the transfusion service initiates a series of steps to ensure the provision of a compatible component This includes ABO and Rh typing of the patient Cross match report: D onor blood must be matched with recipient Antibody screening report Transfusion transmitted infections screening report (HCV, HBV, HIV, Syphilis and malarial parasite) 17 BLOOD TRANSFUSION

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19. Whole Blood Red blood cell concentrate (RCC) Platelets and Platelets apheresis Fresh frozen plasma Cryoprecipitate and cryo -supernatant Apheresis granulocytes 20 WHOLE BLOOD & BLOOD PRODUCTS

20. Whole Blood When no blood components are removed is called whole blood 16 to 24 hours old blood does not contain functional platelets and important coagulation factors like factor V and VIII and must be blood group specific Storage Temperature: 2 to 6 C Shelf Life: 35 days 21 WHOLE BLOOD & BLOOD PRODUCTS

21. Whole Blood One point raises: 1-1.5 mg/dl or 3-5% HCT in adult Albumin content: 10-12 grams Transfusion Time: Should end 3 to 6 hours after issuance Indications for whole blood transfusion: Symptomatic anemia with large-volume deficit (>30-40% blood loss) and exchange blood transfusion 22 WHOLE BLOOD & BLOOD PRODUCTS

22. Whole Blood disadvantages Delayed increase in hemoglobin level Volume overload Electrolyte over load Anticoagulant toxicity Transfusion reactions to plasma proteins Cannot save three lives 23 WHOLE BLOOD & BLOOD PRODUCTS

23. Red Cells Concentrate or packed red blood cells When 80% plasma is removed from whole blood the remaining component is called packed red cells/RCC 70% patients needs RCC Storage Temperature: 2 to 6 C Shelf Life: 35 days Indication: To treat all types of anemia Hb raised: 1-1.5 gm./dl in adults 24 WHOLE BLOOD & BLOOD PRODUCTS

24. Advantages of RCC Hemoglobin is raised more quickly (2 hours) because adjustment in blood volume is less as compared to whole blood Circulatory overload is minimize Volume of anticoagulant & electrolytes is reduced Transfusion reactions to plasma proteins is reduced One blood donation can save three lives 25 WHOLE BLOOD & BLOOD PRODUCTS

25. Leuko -depleted RCC Average unit of RCC contain 2 x 10^9/L WBCs It is achieved by washing method, filtration and irradiation WBCs can causes Allo -immunization Graft versus host disease TRALI Febrile non hemolytic transfusion reaction 26 WHOLE BLOOD & BLOOD PRODUCTS

26. Leuko -depleted RCC indication Severe allergic reactions Beta thalassemia major patients Anaphylactic reactions due to anti IgA Allo -immunization to WBCs which make causes graft verses host disease 27 WHOLE BLOOD & BLOOD PRODUCTS

27. Fresh Frozen Plasma (FFPs) Liquid portion from whole blood is separated and frozen immediately known as FFPs Volume: 150-225 ml Storage Temperature: -40 or -80 C Shelf life: up to 1 years Adult dose: 4-6 unites (12-15ml/kg for paeds ) Duration of transfusion: with in two hours Factor VIII level: 80 IU 28 WHOLE BLOOD & BLOOD PRODUCTS

28. Fresh Frozen Plasma (FFPs) Indications of FFPs Snike bite DIC Vitamin K deficiency Hemophilia Contra indication: Volume expansion / protein replacement 29 WHOLE BLOOD & BLOOD PRODUCTS

29. Cryo -Precipitate and cryo -supernatant When FFPs is partially thawed the supernatant liquid is called cryo -supernatant while crystal sediments is called cryoprecipitate Cryoprecipitate Plasma volume: 10-20 mL Shelf Life: 8-12 hours Storage: -80 C for 12 months Factor VIII level: 80 IU, Fibrinogen level: 150-250 mg 30 WHOLE BLOOD & BLOOD PRODUCTS

30. Cryo -Precipitate and cryo -supernatant Cryoprecipitate: Indications Hemophilia A Von Willibrand disease Acquired FVIII deficiency Fibrinogen deficiency Cryo -supernatant is indicated for Hemophilia B, and Albumen replacement 31 WHOLE BLOOD & BLOOD PRODUCTS

31. Platelets concentrate Platelets concentrate is a important blood product and each random bag should contain 0.55 x 10^11 Platelets concentrate volume: 50-60 mL Shelf Life: 3-5 days Storages temperature: 22 C on agitator Adult dose: 4-6 unites Count raised: 5000-10000 in adults Group Specific 32 WHOLE BLOOD & BLOOD PRODUCTS

32. Guideline for therapeutic Platelets Active bleeding with platelets count: <50 x 10^9/L Active bleeding with platelets function defect Micro-vascular bleeding and platelets count <100 x 10^9/L in CABG surgery Bleeding after massive transfusion 33 WHOLE BLOOD & BLOOD PRODUCTS

33. T herapeutic Platelets contraindication Thrombotic thrombocytopenic purpura Post transfusion purpura Idiopathic thrombocytopenic purpura Heparin induced thrombocytopenic purpura 34 WHOLE BLOOD & BLOOD PRODUCTS

34. 35 Thank You Any Question.?