Difference between revisions of "Blood products"

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==Packed Red Blood Cells==
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==Background==
===Features===
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{{Transfusion risk}}
#Can give type O Rh-positive pRBCs to a man or woman no longer of child-bearing age
 
#Options:
 
###Leukocyte reduced
 
####Eliminates 70-85% of leukocytes
 
####Reduces nonhemolytic febrile reactions
 
####Prevents sensitization in pts who may require bone marrow transplant
 
####Minimizes risk of HIV and CMV infection
 
###Irradiated
 
####Eliminates capacity of T-cells to proliferate (prevents graft-versus-host disease)
 
####Consider in transplant pts, neonates and immunocompromised pts
 
###Washed
 
####Indicated for pts w/ hypersensitivity to plasma (such as IgA deficiency)
 
  
===Indications===
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==Products==
#Acute hemorrhage or chronic anemia with Hb <6
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===Types===
#Symptomatic anemia or cardiopulmonary disease AND Hb <10
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*[[Packed red blood cells]]
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*[[Platelet transfusion]]
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*[[Fresh frozen plasma]]
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*[[Cryoprecipitate transfusion]]
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*[[Humate-P]]
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*[[Prothrombin complex concentrates]]
  
===Dose===
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==Unit Conversions==
#One unit (250mL) raises hemoglobin by 1 g/dl
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{{Blood product unit conversions}}
##Usually transfuse at least 2 units at a time (15mL/kg in peds)
 
#Must transfuse no slower than 1 unit/4hr
 
##If require slower transfusion (e.g. risk for volume overload) the pRBC can be split
 
  
==Platelets==
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==Special Considerations==
===Features===
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{{Leukocyte Irradiated and Reduced (Depleted) Blood Products}}
#Transfusion should be type specific b/c platelets are bathed in plasma
 
##Non-type specific plts can be used but results in higher rate of complications
 
#Like pRBCs, plts can be leukocyte reduced or washed
 
 
 
===Indications===
 
#Plt count <10K in asymptomatic patients (unless due to ITP, TTP, or HIT)
 
#Plt count <15K with a coagulation disorder or minor bleeding
 
#Plt count <20K with major bleeding
 
#Plt count <50K with need for invasive procedure or surgery
 
#Plt count <100K with need for neurologic or cardiac surgery
 
 
 
===Dose===
 
#1 unit raises count by 50K
 
 
 
==Fresh Frozen Plasma==
 
===Features===
 
#Contains all coagulation factors and fibrinogen
 
##40 mL/kg raises any factor by 100% (each unit is ~200mL)
 
#May cause fluid overload
 
#ABO compatibilty a must but crossmatch before transfusing not
 
#INR of FFP is ~1.2
 
 
 
===Indications===
 
#Rapid reversal of warfarin over-anticoagulation
 
#Bleeding and multiple coagulation defects
 
#Correction of coagulation defects for which no specific factor is available
 
#Transfusion of more than one blood volume w/ evidence of active bleeding + coagulopathy
 
 
 
===Dose===
 
#Transfuse at least 15 mL/kg at a time (4 units in 70-kg adult)
 
 
 
==Cryoprecipitate==
 
===Features===
 
#Cold insoluble protein fraction of FFP
 
#Contains: fibrinogen, vWF, and factor VIII
 
#1 bag (10ml) has 50-500 units of factor 8 activity
 
 
 
===Indications===
 
#Bleeding with fibrinogen level of <100 milligrams/dL
 
#Dysfibrinogenemia
 
#Bleeding in vWD that is unresponsive to ddAVP and Factor VIII is unavailable
 
 
 
===Dose===
 
#1 unit/5kg (usually 10 units are given at a time)
 
##Will raise fibrinogen level by 75
 
  
 
==See Also==
 
==See Also==
*[[Transfusion Reactions]]
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*[[Acute transfusion reaction]]
*[[TXA]]
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*[[Massive transfusion]]
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*[[Coagulopathy (main)]]
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*[[Tranexamic acid]]
  
==Source==
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==References==
Tintinalli
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<references/>
  
[[Category:Drugs]]
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[[Category:Pharmacology]]
 
[[Category:Heme/Onc]]
 
[[Category:Heme/Onc]]

Latest revision as of 17:59, 23 September 2018

Background

Transfusion Risk Ratios[1]

Rate Complication
1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
1:100 Minor allergic reactions (urticaria)
1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
1:700 Transfusion-associated circulatory overload per transfusion episode
1:5,000 Transfusion-related acute lung injury (TRALI)
1:7,000 Delayed hemolytic transfusion reaction
1:10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
1:40,000 Death from bacterial sepsis per pool of 5 donor units of platelets
1:40,000 ABO-incompatible transfusion per RBC transfusion episode
1:40,000 Serious allergic reaction per unit of component
1:82,000 Transmission of hepatitis B virus per unit of component
1:100,000 Symptomatic bacterial sepsis per unit of RBC
1:500,000 Death from bacterial sepsis per unit of RBC
1:1,000,000 Transmission of West Nile Virus
1:3,000,000 Transmission of HTLV per unit of component
1:3,100,000 Transmission of hepatitis C virus per unit of component
1:4,700,000 Transmission of HIV per unit of component

Products

Types

Unit Conversions

Blood product unit conversions

Special Considerations

Leukocyte Irradiated and Reduced (Depleted) Blood Products[2]

  • Leukocyte reduced: Prevents sensitization in patients who may require bone marrow transplant
  • Irradiated: Eliminates capacity of T-cells to proliferate (prevents Transfusion-associated graft-versus-host disease)
  • If tranfusion required for crashing patient, do not delay tranfusion of uncrossed blood to irradiate products beforehand
  • Requires minimum 25 Gy irradiation, not to exceed 50 Gy for all:
    • Packed red cells
    • Platelets
    • Granulocyte components, regardless of immunocompetency
    • First or second degree relatives, regardless of immunocompetency
    • HLA-selected components, regardless of immunocompetency
  • Irradiated products should be administered shortly after irradiation
  • Those products not used for intended recipient may be returned safely to stock for others not requiring irradiated components, though with reduced shelf life
  • Not necessary to irradiate FFP, cryoprecipitate, fractioned plasma products
Generally Accepted Indications For Irradiated Blood Products[3][4]
  • Immunocompromised stem cell recipients
  • Organ transplant recipients
  • Patients undergoing marrow transplantation
  • Intrauterine transfusion
  • Neonatal exchange transfusions
  • Premature and low birthweight neonates
  • Hodgkin lymphoma
  • Congenital cell-mediated immunodeficiencies (DiGeorge, Wiskott-Aldrich, Leiner's, 5'-nucelotidase deficiency)
  • Acquired immunodeficiencies to include:
    • Leukemia, CLL
    • Aplastic anemia
    • Neutropenia
  • Patients receiving:
    • Purine analogue chemotherapies (fludarabine, cladribine, deoxycoformicin, bendamustine, clofarabine, etc.)
    • Certain biologic immunosuppresants (alemtuzumab)
  • Donations from biologic relatives
  • Donations from HLA-matched donors
  • Genetically homogenous populations
  • Probably indicated int:
    • Hematologic malignancies other than Hodgkin lymphoma
    • Solid tumors treated with cytotoxic agents
Indications For Leukoreduced Blood Products[5]
  • Chronically transfused
  • Cardiac surgery
  • Solid organ or stem cell transplant recipients, before and after
  • Previous febrile nonhemolytic transfusion reactions
  • CMV seronegative patients at risk

Not Routinely Needing Irradiated Products

  • HIV, AIDS
  • Concurrent, non-severe common viral infection
  • Rituximab treatment
  • Routine solid organ transplant
  • Routine infant cardiac surgery

See Also

References

  1. Wagner, L. Why Should Clinicians Be Concerned about Blood Conservation? ITACCS. 2005 PDF
  2. Treleaven J et al. Guidelines on the use of irradiated blood components: Prepared by the BCSH Blood Transfusion Task Force. British Society for Haematology. Jan 2013. http://www.bcshguidelines.com/documents/irrad_bcsh_072010.pdf
  3. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Treleaven J, Gennery A, Marsh J, Norfolk D, Page L, Parker A, Saran F, Thurston J, Webb D. Br J Haematol. 2011;152(1):35.
  4. 2.AABB Technical Manual, 17th ed, Roback JD, Grossman BJ, Harris T, et al, (Eds). American Association of Blood Banks Press, Bethesda 2011. p.755.
  5. The reintroduction of nonleukoreduced blood: would patients and clinicians agree? Rosenbaum L, Tomasulo P, Lipton KS, Ness P. Transfusion. 2011 Dec;51(12):2739-43. Epub 2011 May 26.