Professional Documents
Culture Documents
No agglutination ~
compatible
Agglutination ~
incompatible
The procedure
can be done for
treatment or
transfusion
purposes.
Istilah
Autologous
derived from organisms of the self; same
individual; "autologous blood donation"
Heterologous
derived from organisms of a different but related
species; "a heterologous blood donation”
Apheresis
Greek work meaning “take out”
The process of removal of whole blood from a donor or
patient, separating out specific portions, and returning
the other portions to the donor/patient
Can be done for
Harvesting specific components for transfusion (plasma, platelet,
red cells)
Removal of specific pathologic substances
Cytapheresis
Toharvest specific cellular components such as
platelets, granulocytes or red cells.
Plasmapheresis
Toharvest plasma only and return back the cellular
components to the donor/patient
Blood Components
Prepared from Whole blood collection or apheresis
Whole blood is separated by differential centrifugation
Red Blood Cells (RBC’s)
Platelets
Plasma
Cryoprecipitate
Others
Closed System
Platelet-rich
RBC’s Plasma
Differential Centrifugation
Second Centrifugation
RBC’s Platelet-rich
Plasma
Second
Platelet Plasma
RBC’s Concentrate
Whole Blood
Storage
4° for up to 35 days
Indications
Massive Blood Loss/Trauma/Exchange Transfusion
Considerations
Use filter as platelets and coagulation factors will not
be active after 3-5 days
Donor and recipient must be ABO identical
RBC Concentrate (Packed red
cell/pRC)
Storage
4° for up to 42 days, can be frozen
Indications
Many indications—ie anemia, hypoxia, etc.
Considerations
Recipient must not have antibodies to donor RBC’s
(note: patients can develop antibodies over time)
Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl)
Usually transfuse over 2-4 hours (slower for chronic
anemia
Platelets
Storage
Up to 5 days at 20-24°
Indications
Thrombocytopenia, Plt <15,000
Bleeding and Plt <50,000
Invasive procedure and Plt <50,000
Considerations
Contain Leukocytes and cytokines
1 unit/10 kg of body weight increases Plt count by 50,000
Donor and Recipient must be ABO identical
Plasma and FFP
Contents—Coagulation Factors (1 unit/ml)
Storage
FFP--12 months at –18 degrees or colder
Indications
Coagulation Factor deficiency, fibrinogen replacement, DIC, liver
disease, exchange transfusion, massive transfusion
Considerations
Plasma should be recipient RBC ABO compatible
In children, should also be Rh compatible
Account for time to thaw
Usual dose is 20 cc/kg to raise coagulation factors approx 20%
Cryoprecipitate
Description
Precipitate formed/collected when FFP is thawed at 4°
Storage
After collection, refrozen and stored up to 1 year at -18°
Indication
Fibrinogen deficiency or dysfibrinogenemia
vonWillebrands Disease
Factor VIII or XIII deficiency
DIC (not used alone)
Considerations
ABO compatible preferred (but not limiting)
Usual dose is 1 unit/5-10 kg of recipient body weight
Granulocyte Transfusions
Prepared at the time for immediate transfusion
(no storage available)
Indications – severe neutropenia assoc with
infection that has failed antibiotic therapy, and
recovery of BM is expected
Donor is given G-CSF and steroids or Hetastarch
Complications
Severe allergic reactions
Can irradiate granulocytes for GVHD prevention
Leukocyte Reduction Filters
Used for prevention of transfusion reactions
Filter used with RBC’s, Platelets, FFP,
Cryoprecipitate
Other plasma proteins (albumin, colloid
expanders, factors, etc.) do not need filters—
NEVER use filters with stem cell/bone marrow
infusions
May reduce RBC’s by 5-10%
Does not prevent Graft Verses Host Disease
(GVHD)
RBC Transfusions
Preparations
Type
Typing of RBC’s for ABO and Rh are determined for
both donor and recipient
Screen
Screen RBC’s for atypical antibodies
Approx 1-2% of patients have antibodies
Crossmatch
Donor cells and recipient serum are mixed and
evaluated for agglutination
WHOLE BLOOD ABO AND
RH COMPATIBILITY
DONOR
RECIPIENT A B O AB Rh Rh
Positive Negative
A
B
O
AB
Rh Positive
Rh Negative
RBC Transfusions
Administration
Dose
Usual dose of 10 cc/kg infused over 2-4 hours
Maximum dose 15-20 cc/kg can be given to hemodynamically
stable patient
Procedure
May need Premedication (Tylenol and/or Benadryl)
Filter use—routinely leukodepleted
Monitoring—VS q 15 minutes, clinical status
Do NOT mix with medications
Complications
Rapid infusion may result in Pulmonary edema
Transfusion Reaction
PACKED RBC ABO AND RH
COMPATIBILITY
DONOR
RECIPIENT A B O AB Rh Rh
Positive Negative
A
B
O
AB
Rh Positive
Rh Negative
Platelet Transfusions
Preparations
ABO antigens are present on platelets
ABO compatible platelets are ideal
This is not limiting if Platelets indicated and type
specific not available
Rh antigens are not present on platelets
Note: a few RBC’s in Platelet unit may sensitize the
Rh- patient
Platelet Transfusions
Administration
Dose
May be given as single units or as apheresis units
1 apheresis unit contains 6-8 Plt units (packs) from a
single donor
Procedure
Should be administered over 20-40 minutes
Filter use
Premedicate if hx of Transfusion Reaction
Complications—Transfusion Reaction
Transfusion Complications
Acute Transfusion Reactions (ATR’s)
Chronic Transfusion Reactions
Transfusion related infections
Acute Transfusion Reactions
Hemolytic Reactions (AHTR)
Febrile Reactions (FNHTR)
Allergic Reactions
Over load
TRALI
Coagulopathy with Massive transfusions
Bacteremia
Febrile Nonhemolytic
Transfusion Reactions (FNHTR)
Definition--Rise in patient temperature
>1°C (associated with transfusion without
other fever precipitating factors)
Occurs with approx 1% of PRBC
transfusions and approx 20% of Plt
transfusions
FNHTR caused by alloantibodies directed
against HLA antigens
Need to evaluate for AHTR and infection
What to do?
If an FNHTR occurs
STOP TRANSFUSION
Use of Antipyretics—responds to Tylenol
Use of Corticosteroids for severe reactions
Use of Narcotics for shaking chills
Future considerations
May prevent reaction with leukocyte filter
Use single donor platelets
Use fresh platelets
Washed RBC’s or platelets
Allergic Nonhemolytic Transfusion
Reactions
Etiology
May be due to plasma proteins or blood
preservative/anticoagulant
Best characterized with IgA given to an IgA deficient
patients with anti-IgA antibodies
Presentswith urticaria and wheezing
Treatment
Mild reactions—Can be continued after Benadryl
Severe reactions—Must STOP transfusion and may
require steroids or epinephrine
Prevention—Premedication (Antihistamines)
Massive Transfusions
Coagulopathy may occur after transfusion
of massive amounts of blood
(trauma/surgery)
Coagulopathy is caused by failure to
replace plasma
See electrolyte abnormalities
Due to citrate binding of Calcium
Also due to breakdown of stored RBC’s
Acute Hemolytic Transfusion Reactions
(AHTR)
Occurs when incompatible RBC’s are transfused into a
recipient who has pre-formed antibodies (usually ABO or
Rh)
Antibodies activate the complement system, causing
intravascular hemolysis
Symptoms occur within minutes of starting the
transfusion
This hemolytic reaction can occur with as little as 1-2 cc
of RBC’s
Labeling error is most common problem
Can be fatal
Symptoms of AHTR
High fever/chills
Hypotension
Back/abdominal pain
Oliguria
Dyspnea
Dark urine
Pallor
What to do?
If an AHTR occurs
STOP TRANSFUSION
ABC’s
Maintain IV access and run IVF (NS or LR)
Monitor and maintain BP/pulse
Give diuretic
Obtain blood and urine for transfusion reaction
workup
Send remaining blood back to Blood Bank
Blood Bank Work-up of AHTR
Check paperwork to assure no errors
Check plasma for hemoglobin
DAT
Repeat crossmatch
Repeat Blood group typing
Blood culture
Labs found with AHTR
Hemoglobinemia
Hemoglobinuria
PositiveDAT
Hyperbilirubinemia
Abnormal DIC panel
Monitoring in AHTR
Monitor patient clinical status and vital
signs
Monitor renal status (BUN, creatinine)
Monitor coagulation status (DIC panel–
PT/PTT, fibrinogen, D-dimer/FDP, Plt,
Antithrombin-III)
Monitor for signs of hemolysis (LDH, bili,
haptoglobin)
Bacterial Contamination
More common and more severe with
platelet transfusion (platelets are stored
at room temperature)
Organisms
Platelets—Gram (+) organisms, ie
Staph/Strep
RBC’s—Yersinia, enterobacter
Risk increases as blood products age (use
fresh products for immunocompromised)
Transfusion Associated Infections
Hepatitis C
Hepatitis B
HIV
CMV
CMV can be diminished by leukoreduction,
which is indicated for immunocompromised
patients
Chronic Transfusion Reactions
Alloimmunization
Transfusion Associated Graft Verses Host
Disease (GVHD)
Iron Overload
Transfusion Transmitted Infection
Alloimmunization
Can occur with erythrocytes or platelets
Erythrocytes
Antigen disparity of minor antigens (Kell, Duffy, Kidd)
Minor antigens D, K, E seen in Sickle patients
Platelets
Usually due to HLA antigens
May reduce alloimmunization by leukoreduction (since
WBC’s present the HLA antigens)
Washed Blood Products
PRBC’s or platelets washed with saline
Removes all but traces of plasma (>98%)
Indicated to prevent recurrent or severe
reactions
Washed RBC’s must be used within 24 hours
RBC dose may be decreased by 10-20% by
washing
Does not prevent GVHD
TRALI
Transfusion Related Acute Lung Injury
Clinical syndrome similar to ARDS
Occurs 1-6 hours after receiving plasma-
containing blood products
Caused by WBC antibodies present in
donor blood that result in pulmonary
leukostasis
Treatment is supportive
High mortality
Transfusion Associated GVHD
Mainly seen in infants, BMT patients, SCID
Etiology—Results from engraftment of
donor lymphocytes of an
immunocompetent donor into an
immunocompromised host
Symptoms—Diarrhea, skin rash,
pancytopenia
Usually fatal—no treatment
Prevention—Irradiation of donor cells
Donor screening
2Donor Eligibility Criteria
Wt > 45 Kg
Who can donate?
• Age: 18 - 60 years
• Weight : > 45 kgs
• Hemoglobin level: >12 gms/dl for men
and 12.5 gms/dl for women
• In good health
3. Deferral Criteria
Who CANNOT donate?
Life long 1 year 6 Months
х Abnormal bleeding o Surgery o Tattooing or
disorder body piercing
х Heart, Kidney, Liver o Typhoid
Disorder o Dental
х Thyroid disorder o Dog bite extraction
х Epilepsy, Mental
disorders o Unexplained o Root canal
weight loss treatment
х Tuberculosis, Leprosy,
х Asthma o Continuous o Malaria
х Cancer low grade
fever o Vaccination
3. Deferral Criteria…
(Donor Consent Form)
be mentally prepared
PHYSICAL EXAMINATION
Temperature
Maximum 37.5 0C
Donor weight
Minimum 45 Kgs
Amount of blood to be drawn
(Donor wt. in Kg÷50) X 450
Venipuncture site
Inspection for scar marks
TYPE OF BLOOD DONATION
WHOLE BLOOD DONATION
APHERESIS DONATION
Health benefits:
Regular donation (2-3 times a year….)
Lowers cholesterol
Lowers lipid levels
Decreases incidence of heart attacks,
strokes
What can YOU do?
Make Blood Donation a HABIT
Donate regularly – every 3 months
to commemorate special days like
birthdays, anniversaries ….
Motivate others to donate
Refer your friends and relatives