Download Gamma irradiation: indication

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Transfusion
in children
Packed cell, platelet, FFP,
cryoprecipitate, WBC
Packed red cell
Transfusion
Packed red cells
• Average hematocrit of a unit is 65-75%
( concentrated)
• Estimated unit size : 250-350 cc
• Stored at 2-6 C
• Mixed with preservation ( shelf-life of 35 days)
• Infusion should take maximum 4 hours
General guidelines
• Oncology:
Hb,8gr/dl
increased O2 requirement
patient symptomatic
• Bone marrow failure:
Hb<7 gr/dl
increased O2 requirement
• Hemoglobinopathies:
clinical situation(thalassemia major or
intermediate, sickle cell
Contraindication:
• Anemia that can be corrected by
nontransfusion therapy( iron, recombinants
erythropoietin)
• Hypovolemia
Recommendation
• CMV seronegative, irradiated, leukopoor
preparation should be used per clinical
guidelines
Platelet transfusion
Descriptions:
• 1 random donor unit is concentrate of platelet
separated from a unite of whole blood
(5.5×1010 platelet in 40-70 cc plasma)
• A single donor unit is a unit collected by
apheresis that contain 4-8 time the number of
platelet in 1 random donor unit (3 × 1011
platelet in 100-500 cc plasma)
Platelet dosages
• Dose of random donor unit platelet is one unit
per 5-10kg, ( or 10cc/kg for small infant)
• Dose of single donor platelet is 10cc/kg per
infusion to maximum 1 unit apheresis(up to the
adult dose)
• Transfusion may proceed as quickly as tolerated:
10cc/ kg/hour
General guideline
• Hematology patients:
Platelet<10,000
Actively bleeding ( and platelet < 50,000)
Preparation for invasive procedure (IT , LP, liver biopsy….)
• Oncology patients:
Platelet<20,000
Actively bleeding ( and platelet < 50,000)
Preparation for invasive procedure
Contraindication:
• Thrombocytopenia and platelet distraction in
patient with autoimmune disorder(ITP) and no
active bleeding
• TTP : Platelet transfusions are contraindicated
unless there is life-threatening haemorrhage,
• Heparin-induced thrombocytopenia :HIT is
frequently associated with severe thrombosis
(acute arterial thrombosis !)
Recommendation:
• Infuse relatively quickly(10ccc/kg/hour) to
reduce clumping and adherence in bag and
tubing
• If concern over platelet response, obtain posttransfusion platelet count at 15 minute to 1
hour
Blood group and platelet transfusion
• Identical ABO group as the patient are the
components of choice and should be used as
far as is possible (but not always available).
• Administration of ABO non-identical platelets is
acceptable transfusion practice (but may result in
hemolysis)
• In general, ABO-matched is best, but mismatched can
be used when necessary
Blood group and platelet transfusion
• Group O platelets may be used for group A, B
and AB patients if they have been tested and
labelled as negative for high-titre anti-A and
anti-B
• RhD-negative platelet concentrates should be
given, where possible, to RhD-negative
patients,
Blood group and platelet transfusion
• If RhD-positive platelets are transfused to a
RhD-negative woman: a dose of 250 i.u. antiD cover five adult therapeutic doses of RhDpositive platelets (it should be given subcutaneously in
thrombocytopenic patients)
• It is not necessary for men or women without
childbearing potential
Fresh Frozen Plasma
Transfusion
Fresh Frozen Plasma(FFP)
• Contain coagulation factors in physiologically
amounts( each ml contain I IU of each
coagulation factor
• Contain anticoagulation's such as protein C
and S
• Contain albumin, immunoglobulins, and
complement proteins
Indications for FFP
• Patients who require replacement of multiple plasma
coagulation factors( e.g. liver disease, DIC ..)
• Massive transfusion ( have clinically significant
coagulation deficiencies)
• Patient taking warfarin who are bleeding or need to
undergo an invasive procedure before Vit. K could
reverse the warfarin effect
• Transfusion or plasma exchange in patient with TTP
• Management of patients with selected coagulation
factor deficiencies , for which no specific coagulation
concentrates are available
Contraindications FFP
• Don’t use when coagulopathy can be corrected
with specific therapy( Vit.K, cryoprecipitate,
coagulation factor concentrate)
• Don’t use when blood volume can be safely and
adequately replaced with other volume
expander
• Don’t use as a source of albumin
Dosing FFP
• Hemostasis can be achieved when the activity
of coagulation factors is at least 25-30% of
normal: Unless there is coagulation inhibitor( heparin,
etc.), hyperfibrinogenemia
• Plasma volume is approximately 40cc/kg
• 10-15cc/kg of FFP will replace coagulation
factors to 20-30%
FFP storage
• Frozen at -18 C for 1 year or at -65 for 7 years
• Once thawed should be infused within 4 hours
Cryoprecipitate
Cryoprecipitate
• Cold soluble remnant of FFE
• Concentrated preparation that contain :
Factor 8 (80-100 IU/bag),
Fibrinogen(200mg/bag),
Factor 13,
von Willwberand factor
Cryoprecipitate Indication:
• First line therapy for control of bleeding with :
fibrinogen deficiency,
factor 13 deficiency
• Second line therapy for :
von Willebrand disease
Factor 8 deficiency
Cryoprecipitate Contraindications:
• Don’t use unless result of laboratory studies
indicate a specific hemostasis defect for which
this product indicated
• Don’t use if virus inactivated factor 8
concentrates or recombinants factor preparation
are available for patient with v.W. disease or
hemophilia A
• Don’t use for DIC( dose not contain all necessary
factors(factor 5)
Cryoprecipitate dose
• Hyperfibrinogenemia: 0.2 bag /kg( increase
fibrinogen approximately 50-100 mg/dl)
• Factor 13 deficiency: 1 bag/10 kg once
• Bleeding in vWD : 1 bag/10kg every 6-12
hours
WBC transfusion
WBCs
• Administered as soon after collection as
possible
• If stored, maintain at room temperature(20-24
C) without agitation, for no more than 24
hours
• Donor preparation with G-CSF increased
harvest yield
WBCs : need to
• Be cross-matched with the recipient's serum
• Irradiated because of the large number of
lymphocytes present.
• Considered for patients with an absolute
neutrophil count <0.5 x 109/L and a good
chance of marrow recovery.
Indication :
• Documented sever bacterial of fungal
infections with an ANC<500 ,
• Functional granulocyte defect and
unresponsiveness to antimicrobial therapy
Contraindication:
• Irreversible BM failure
• Prophylaxis's in non infected patients
Pediatric dosage
• 1-2×109 cell/kg
• Once initiated, WBC therapy should continue
on daily basis until infection is cured, patient
defervesce, or ANC is>500
Processing
Leukodepletion, Gamma irradiation,
washing, CMV negative
Processing:
Leukodepletion
Processing: Leukodepletion
• Leukodepletion is a technical term for the
removal of leucocytes (white blood cells) from
blood components using special filters.
• Leukodepletion of blood components removes
≥ 99% of contaminating leucocytes
• Prestorage or bedside filter?
Processing: Leukodepletion
• Reduced risk of platelet refractoriness(HLA
alloimmunization)
• Reduced risk of febrile non-haemolytic transfusion
reactions
• Reduced risk of CMV transmission
• Possible reduced risk of transfusion-associated
GVHD (reduce risk but not prevent)
Processing:
Gamma irradiation
Processing: Gamma irradiation
• Gamma irradiation of blood product to stop
donor lymphocyte proliferation
• Prevent transfusion induced GVHD (100%
fatal)
Gamma irradiation: indication
• Intrauterine transfusion
• Neonates with a birth weight of ≤ 1,200 g
and/or gestational age ≤ 30 weeks.
• Congenital cellular immunodeficiency.
• Aplastic anaemia receiving ATG
Gamma irradiation: indication
Autologous BMT
• Bone marrow or peripheral blood stem cell
autologous transplantation (in the 7 days
before collection of bone marrow or PBSC and
up to 3 months after BMT, or 6 months for
patients undergoing TBI).
Gamma irradiation: indication
Allogeneic BMT
• All recipients of allogeneic haemopoietic stem cell
transplantation (SCT) must receive irradiated blood
components from the time of initiation of conditioning
chemoradiotherapy
• Irradiated components should be continued while the
patient continues to receive GVHD prophylaxis (until
the end of GVHD prophylaxis)
• Allogeneic blood transfused to bone marrow and
peripheral blood stem cell donors 7 days prior to or
during the harvest should also be irradiated.
Gamma irradiation: indication
chemotherapy
• Hodgkin’s lymphoma
• chemotherapy (should be decided on an
individual basis)
• It is not necessary to irradiate red cells or
platelets for adults or children with acute
leukaemia, except for HLA-selected platelets or
donations from first- or second-degree relatives
Gamma irradiation: indication
other indications
• All transfusions from first- or second-degree
relatives should be irradiated, even if the patient
is immunocompetent
• All HLA-selected platelets should be irradiated,
even if the patient is immunocompetent.
• All granulocytes should be irradiated before issue
and transfused with minimum delay
Gamma irradiation: not necessary
When none of the above conditions are present, it is not
necessary to irradiate blood components transfused to:
• HIV infection,
• Aplastic anaemia
• Solid organ transplantation,
• Chemotherapy for NHL, acute leukaemia and solid tumours
• It is not necessary to irradiate red cells for routine 'top-up'
transfusions of premature or term infants unless either
there has been a previous IUT, or the donation has come
from a first- or second-degree relative
Processing:
washing
Processing: washing
• Help to remove extra K from red cell
• Remove IgA form plasma
• Extra plasma containing antigens and
cytokine
• Should be used within 24 hr.
Processing: washing
Indication :
• Patients with IgA deficiency
• Prevention of allergic reactions
• Post-transfusion febrile reactions, present
even when leukodepleted RBCs are used
Processing:
CMV negative components
CMV negative components:
Are recommended for the following recipients
to reduce the risk of CMV transmission :
 CMV negative recipients of allogeneic stem cell and
bone marrow transplants CMV negative pregnant
women
 Intrauterine transfusions
 Infants weighing less than 1200 g at birth
CMV negative components :
May be recommended for CMV negative
individuals:
 HIV infection
Conditions likely to require an BMT or Solid
organ transplant recipients
Severe neutropenia