Difference between revisions of "Blood products"

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*[[Prothrombin complex concentrates]]
 
*[[Prothrombin complex concentrates]]
 
{{Transfusion risk}}
 
{{Transfusion risk}}
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===Leukocyte Irradiated/Depleted RBCs<ref>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</ref>===
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*Gamma or X-radiated blood components to prevent [[Transfusion-associated graft-versus-host disease]] for at risk patients
 +
*If tranfusion required for crashing patient, do not delay tranfusion of uncrossed blood to irradiate products beforehand
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*Requires minimum 25 Gy irradiation, not to exceed 50 Gy for all:
 +
**Packed red cells
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**Platelets
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**Granulocyte components, regardless of immunocompetency
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**First or second degree relatives, regardless of immunocompetency
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**HLA-selected components, regardless of immunocompetency
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*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
 +
====At Risk Patients Requiring Irradiated Products====
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*Congenital immunodeficiency syndromes (T-cell deficiencies)
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*Neonates, especially if premature
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*Exchange transfusions in pre-term and term infants
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*Intrauterine transfusions
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*Acquired immunodeficiencies to include:
 +
**Lymphoma
 +
**Leukemia
 +
**Aplastic anemia
 +
**Neutropenia
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*Patients receiving:
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*Stem cell transplants or harvesting
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**Purine analogue chemotherapies (fludarabine, cladribine, deoxycoformicin, bendamustine, clofarabine, etc.)
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**Certain biologic immunosuppresants (alemtuzumab)
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====Not Routinely Needing Irradiated Products====
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*HIV, AIDS
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*Concurrent, non-severe common viral infection
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*Rituximab treatment
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*Routine solid organ transplant
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*Routine infant cardiac surgery
  
 
==See Also==
 
==See Also==

Revision as of 01:44, 20 August 2016

Background

Types

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

Leukocyte Irradiated/Depleted RBCs[2]

  • Gamma or X-radiated blood components to prevent Transfusion-associated graft-versus-host disease for at risk patients
  • 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

At Risk Patients Requiring Irradiated Products

  • Congenital immunodeficiency syndromes (T-cell deficiencies)
  • Neonates, especially if premature
  • Exchange transfusions in pre-term and term infants
  • Intrauterine transfusions
  • Acquired immunodeficiencies to include:
    • Lymphoma
    • Leukemia
    • Aplastic anemia
    • Neutropenia
  • Patients receiving:
  • Stem cell transplants or harvesting
    • Purine analogue chemotherapies (fludarabine, cladribine, deoxycoformicin, bendamustine, clofarabine, etc.)
    • Certain biologic immunosuppresants (alemtuzumab)

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