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BLOOD

COMPONENT
THERAPY II
Plasma Components and
Products

Consist of:
Fresh frozen plasma
Cryoprecipitate
Cryosupernatant
Fresh Frozen Plasma
Plasma which is separated from whole blood and
frozen within 6 hours of phlebotomy.
Content:
-plasma protein
-all coagulation factors ( include labile F V + F
VIII)
Storage and shelf life:
- storage at -18C
- deep freeze at -40C can be kept for 2 year



FFP
Properties:
-1 unit volume: 200 ml
-plasma apheresis : 600 ml
- paediatric : 50-100 ml
Administration :
- thawed in 37C water bath
- administer within half an hour after thawing
( activity of labile F V, V III is rapidly lost)
FFP
Definite indications:
1) Replacement for isolated factor deficiencies
(specific factor not available eg: F V)
2) Immediate reversal warfarin effect.
3) Replacement of coagulation factors in: DIVC.
4) Inherited def of inhibitors of coagulation eg: Anti
thrombin III, protein C, protein S.
6) Treatment of TTP
FFP
Conditional uses (FFP only indicated in the
presence of bleeding and disturbed coagulation):
- Massive transfusion
- Liver disease
- Cardiopulmonary bypass surgery
- Special paediatric indications eg: severe sepsis

FFP
Contraindication:
- estimated as many 73% are used without
justification
- 1) volume expander
- 2) nutritional source of protein + immunoglobulin
- 3) Urticaria + anaphylactoid reaction or previous
severe reaction to plasma

FFP
Dose + Administration:
- ABO compatible with recipient blood cell +
without regard to Rh type
- Cross matching not required
- Amount used depend on clinical situation
eg: DIVC case: 2 units for adult
paediatric: 10-20 mls /kg
- efficacy assessed with PT, aPTT
CRYOPRECIPITATE
Cold-insoluble precipitate recovered fr. controlled
thaw of FFP
Seen as white material that remain in the bag after
plasma portion is thawed (10% ice at 4C)
Separated from the thawed plasma and refrozen at
-40C

Cryoprecipitate
Properties:
-1 unit volume: 30 5 ml
- Content: 80 IU of F VIII
250 mg fibrinogen
20-30% F XIII in original unit
40-70% FVIII: vWF in original unit
Storage and shelf life :
-stable up to a year at -40C
Cryoprecipitate
Administer:
-thaw product at 37C
-transfused within 6 hours if used for f VIII activity
- ABO compatible with recipient blood type.
Hemolysis of recipient red cell observed following
transfusion of large amount of ABO-incompatible
cryoprecipitate.
-transfused without regard to Rh type
- crossmatching not required

Cryoprecipitate
Indications:
1) Bleeding a/w F VIII deficiency
2) von Willebrands disease
3) congenital / acqiured fibrinogen deficiency eg: DIC
4) F XIII deficiency
5) used in combination with thrombin as topical agent to stop
bleeding (fibrin glue)
-removal of urethral stones + stabilization of auditory
ossicles)
Cryosupernatant
Residual plasma fraction depleted of vWF,
fibrinogen, fibronectin, F XIII
Contain vit K dependent factors
Refer to illustration on cryopeparation
Volume: 100-170 ml
Storage: <30C
Life span: 6-12 months
Indication:
-liver failure/pathology - vit K def
-warfarin overdose -plasma exchange in TTP
Miscellaneous Blood Product
Albumin preparation
Factor VIII Concentrate
Factor IX Concentrate
Immune serum Globulin

1)Albumin Preparation
Protein solution containing predominantly
albumin prepared by fractionation of large
pools of plasma.
Properties:
1) Albumin solution
2) Plasma protein fraction
Albumin solution
Available in 5% and 25% solution.
Contain 96% albumin and 4% globulin + other
plasma protein.
Pooled plasma product and is heat treated to
inactivate viral activity.
5% solution: osmotically + oncotically equivalent
to plasma
25% solution; markedly hyperoncotic.
Shelf life: 5 years at 2-10C.


Plasma Protein Fraction
Prepared the same manner as albumin.
Differences: albumin content 80 to 85%
Stored at room temperature for 3 years or at
1-6C for 5 years.
Administration:
- albumin + PPF do not contain ABO antigen
or Ab compatibility not required

Albumin preparation
Indication (both):
Volume expansion and colloid replacement for
patients in hypovolemic shock, burn, undergoing
retroperitoneal surgery in which large volume of
protein-rich fliud may pool in the bowel.
Indication for PPF: paralel those for 5% albumin.
Albumin solution not indicated to correct
nutritional def (enteric, parenteral,
hyperalimentation > appropriate)



Albumin preparation
Dose:
1 gm/kg will raised serum albumin by 8 gm/l
Adult: initial : 60-80 gm
maintainance : according to clinical
response
Transfuse in 3 hrs.
Albumin Preparation
Contraindication:
1) Rapid infusion of PPF lead to hypotensive
episodes.
not indicated when rapid restoration of volume
is involved eg: hypovolemic shock)
2) Infusion of 25% albumin rapidly the oncotic
pressure by drawing large volume of H2O fr tissue
to vascular space risk of cardiac overload +/or
intestinal dehydration
Factor VIII Concentrate
FVIII concentrate or antihemophilic Factor
(AHF) specific treatment for F VIII def
(hemophilia A)
Prepared fr large donor pools of plasma
Pooled plasma is fractionated , lyophilized
+ stored at 1-6C
Heat treated to reduce risk of transfusion
transmitted disease.

F VIII Concentrate
1 vials contain 200, 500 i.u.
2 types:
1) Intermediate purity-15 i.u. of F VIII:C/ml
2) High purity 20-30 i.u. F VIII:C/ml
Indication:
1) Treatment or prevention of bleeding in
hemophilia A
2) Severe vWD (only intermediate purity should
be used)
3) F VIII:C antibodies patient (low level)



Factor IX Concentrate
2 heat treated , lyophilized concentrates of
F IX:
1) Factor IX complex
2) Pure Factor IX concentrate
F IX complex (Prothrombin complex)
Contain factor II, VII, IX and X
F IX concentrate: contain 20-30 % F IX,
trace amount of F II, VII, X.
Factor IX concentrate
Indication:
1) Hemophilia B
2) Haemophilia A with inhibitors
Contraindication:
-Fac IX complex a/w thromboses and episode of
DIC.( d/t activated factor)
- Adverse effect also seen in Haemophilia A
with inhibtors

Immune Serum Globulin
Prepared from pooled plasma by cold
ethanol fractionation
Concentration of plasma globulin
Passive immune protection to individual
exposed to certain disease eg: hepatitis B ,
herpes zoster
Liver disease
Factors contribute bleeding:
1) Deficient multiple coagulation factors (Fac I, II,
V, VII, IX, X) d/t liver synthesis
2) Chronic consumptive coagulopathy
3) Plt fx abn
Usually subclinical but if hemostatically
challenged , bleeding result.
No indication of FFP in pt with abn coagulation
profile who are not hemostatically stressed and
not actively bleeding.
DIVC
N coagulation response accentuated + normal
inhibitory mech overwhelmed.
Coagulation factors, plt consumed
Formation of fibrin thrombi through out
microcirculation
Common causes:
-obstetric complication -sepsis
-metastatic CA

DIVC regime:
6 unit cryoprecitate tranfused over hour followed by;
4 unit plt over 1 hour and
2 unit FFP
Response should be closely monitored by repeated lab test
(PT, aPTT) and clinical assessment.
Chronic DIVC or absence of haemorrhage : no indication
to give component therapy in attempt to normalize lab
result.

Reversal Coumadin Drugs
Warfarin sodium (eg: Coumadin) interfere with
hepatic synthesis of vit K-dependent coagulation
factors (Fac II, VII, IX, X)
Invitro abN aPTT
Reversed the effect : vit K admin (neutralizes the
effects within several hours to a day)
In emergency situation (active bleeding), FFP
administered to achieve rapid hemostasis.
Autologous Transfusion
Therapeutic benefit:
1) Safe (risk of TTD eliminated)
2) No alloimmunization
Conserves blood banks limited homologous
blood supply
Either be:
1) Perioperative Hemodilution
2) Intraoperative Salvage
3) Postoperative Blood Salvage
Perioperative Hemodilution
Eg: Cardiopulmonary bypass surgery
Withdraw 1/> units of blood preoperatively +
replace with crystalloid / colloid solution
normovolemic, hemodiluted state
Results in improved blood flow in pt circulation +
loss of < red cell
Labelled properly (pt name, RN,date/time
phlebotomy)
Reinfuse within 8 hr: reliable source of plt, coag
factors.


Intraoperative Salvage
Blood-containing fluid aspirated fr op site,
centrifuge or washed and reinfused through a filter
during op/post op.
Vascular procedure large amount of blood pool
in body cavities.
Collection device washes with 0.9% saline +
transfuse immediately or stored at room
temperature for 6 hrs or at 1-6C for 24 hrs.
Complication: hemolysis, DIVC, air embolism
Postoperative Blood Salvage
Within first 24-48 hrs after surgery in pt actively
bleeding in closed site (chest, joint cavity)
Contraindicated if evidence of infection or
malignant tumor cell at site
Blood collected into sterile container, labelled and
filtered.
Reinfuse within 6 hours, to minimize proliferation
of bacteria