THE RATIONAL USE OF BLOOD AND BLOOD PRODUCTS
To discuss the following:
The various components available from blood The rational use of blood and its components Problems faced Proposals for improved blood product usage
Blood
is an amazing fluid us warm nutrients for cells, tissues and organs waste products from various sites
Keeps
Provides
Removes
Packed red blood cells(PRBC) Platelets ( PRP ) Fresh Frozen Plasma (FFP) Cryoprecipitate ( CP ) Cryo poor plasma ( CPP)
1 unit of blood theoretically gives
1 unit FFP 1 unit PRBCs 1 random donor unit Platelet
Rational Use of Blood
RATIONAL
Right product
Right dose Right time
Right reasons
(Rationale behind Rational use of blood)
Economy -Scarcity of resource
1 in 4 get blood component
Logic
Safety - Inherent risks involved
in transfusion therapy
1 in 2 million gets HIV
Scientifically appropriate
Haematinic in nutritional anemia
Guidelines For Promoting Component Therapy
Definite indication - A blood transfusion should
never be ordered unless it is worth the risk therapeutic benefit
Single unit transfusion has no significant
Use of fresh blood - should be avoided because of
increased risk of infections (TTI)
1. Give only what is needed
Red cells O2 carrying capacity (Anemia) Thrombocytopenia Multiple clotting factor deficiency Hemophilia A
Platelets FFP
CRYO
2. Different Storage Conditions
Comp. Red cells FFP/CPP Temp. 4-60 C - 40 0 C Shelf life 35 days 1 year
Platelets
CRYO
22-240 C on platelet agitator 5days
- 400 C 1 Year
3. Conservation of Scarce Resource
Separation of whole blood in 3-4 components Benefits more than one patient at a time.
Centrifugation
Principle
Sediment of blood cells depend on their size as well as the difference of their density from that of the surrounding fluid, viscosity of medium, flexibility of the cells which are temperature dependent
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Parameter
Volume Increment in Hb Red cell mass /ml Viable platelets Labile factors Plasma citrate Allergic reactions FNHTR Risk of TTI Waste of components
Whole blood 350 450 ml 1 -1.5 gm/dl Same as PRBC
Packed red cells 200 240 ml 1 -1.5 gm/dl Same as WB
No No ++++ ++++ ++++ ++++ Yes
No No + + + + No
Why whole blood not rational
Maximize blood resource
Whole blood Component therapy one patient four patients thalassemia liver disease / burns thrombocytopenia hemophilia
packed red cells plasma platelets cryoprecipitate
Specific storage requirements of components
Whole blood Components platelets cryoprecipitate & FFP red cells + 4 0C
+ 20 24 oC - 30oC + 2 80C
Why whole blood not rational
Better patient management concentrated dose of required component
avoid circulatory overload minimize reactions eg. Requirement of platelets to raise count from 20 to 50,000/ul fresh whole blood 5 units 1750 ml random platelets 5 units 250 ml apheresis platelets 1 unit 200 ml
Decreased cost of management
except for the cost of bag, other expenses remain same
Fresh blood a misconception
What is fresh blood?
unit kept at 4oC for 4 hours is no longer fresh storage lesions in different constituents due to storage temp
Increased risk of disease transmission
intracellular pathogens (CMV, HTLV)
survive in leukocyte in fresh blood syphilis transmission
Treponema can not survive > 96 hours in stored blood
malaria transmission
malarial parasite can not survive > 72 hrs in stored blood
Fresh blood a misconception
Immunological complication due to WBCs in fresh blood
TA-GvHD 90% fatality TA-immunomodulation alloimmunization
Logistics
no time for component preparation less time for infection screening increased chances of error
The clinician should; 1. complete all required details on the blood request form 2. accurately label blood sample tubes 3. check the identity of the patient, the product and the documentation at the patients bedside before transfusion.
No evidence that warming blood is beneficial to the patient when infusion is slow
Summary
1. 2. 3. 4. 5. No place for Whole Blood in clinical medicine Discourage single unit / fresh blood Component preparation and use is the demand of time Promotion of judicious use of blood / components Promote autologous use of blood
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