Download FRESH FROZEN PLASMA

Whole Blood
Processed within
8 hours )
Packed red blood cells
Fresh frozen plasma
Platelets
Component preparation
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Principle - Differential
centrifugation
Red cells
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Bank plasma
Fresh frozen
Cryo supernate
Platelets
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Packed cells
Red cells + additive
Plasma
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Plasma +
Platelets
Platelet rich concentrate
Platelet rich plasma
Cryoprecipitate
Whole
blood
RBC
Buffy
DEFINITIONS
BLOOD PRODUCT = Any therapeutic substance prepared
from human blood
WHOLE BLOOD = Unseparated blood collected into an
approved container containing an anticoagulant preservative
solution
BLOOD COMPONENT = 1. A constituent of blood , separated
from whole blood such as
•
Red cell concentrate
•
Plasma
•
Platelet concentrates
2. Plasma or platelets collected by apheresis
3. Cryoprecipitate prepared from fresh frozen plasma
Blood Components
THE PRBC
M
e
m
Storage
-2–6OC
Unit of issue
- 1 donation ( unit or pack )
Administration
- ABO & Rh compatible
- Never add medication to a unit
- Complete transfusion within 4 hrs of
commencement
1
Dosage & Administration
Dosage - 1 unit/10 kg body wt
Adult dose is 4-8 units
Administration - Preferably ABO
& Rh group specific but not
essential
Other groups can be used
PLATELETS
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Platelet units can be either
Random donor units
 Apheresis units
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1 random donor unit contains 55 x109 platelets
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1 apheresis unit contains 240x109
Guidelines for Platelet Tx.
Mild - 50,000-1,00,000/µl
Tx - usually not required
Moderate - 20,000-50,000/µl
Tx-if symptomatic or has to
undergo surgery/trauma
Severe - < 20,000/µl
Risk of bleeding - high
Prophylactic Tx
Indications for platelet transfusion
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BLEEDING due to thrombocytopaenia
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Due to platelet dysfunction
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Prevention of spontaneous bleeding with counts
< 20,000
IMPORTANT PRECAUTIONS
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Stored at 20-24 Degree celcius.
Constantly agitated
Only last for 5 days
Infused in 30 mins
Fresh Frozen plasma
Fresh frozen plasma – labile & nonlabile
clotting factors, albumin and
immunoglobulin. Factor VIII ( 8 ) level at
least 70 % of normal fresh plasma level
Storage
- 20 C for 1 yr, - 65 C for 7 yrs.
Before use thawed at 37 o C
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Fresh frozen plasma
Indications
- Replacement of multiple coagulation factor
deficiencies eg
•
Liver disease
•
Anticoagulant overdose
•
Depletion of coagulation factors in pts receiving
large volume transfusions
DIC (disseminated intravascular coagulation)
FRESH FROZEN PLASMA
Indication
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Clinically significant deficiency of Factors II, V, X, XI
Replacement of multiple coagulation
factor deficiencies :liver disease , warfarin treatment,
dilutional and consumption coagulopathy
Contraindication
Volume expansion
Immunoglobulin replacement
Nutritional support
Wound healing
12
FRESH FROZEN PLASMA
Precaution
Acute allergic reaction are common
Anaphylactic reaction may occur
Hypovolemia alone is not an indication for
use
Dosage - Initial dose of 15 - 20 ml / kg
Administration
Must be ABO compatible, Rh not required
Infuse as soon as possible after thawing
( within 6 hrs )
using standard blood administration set
30/11/49
13
MD-3-49
FFP
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Fresh Frozen Plasma
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Plasma collected from single donor units or by
apheresis
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Frozen within 8 hours of collection
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-40o C
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Can last for a year
Dosage & Administration for
FFP
Dosage - 10-15 ml/Kg(Approx
2-3 bags for an adult)
Administration - Thawed at
+37o C before transfusion
ABO compatible
Group AB plasma can be used
for all patient
Do`s and Dont`s
In Blood and Blood
Components
Risk Benefit Analysis
benefit > risk
risk > benefit
Hb gm/dl 4 5 6 7 8 9 10 11 12 13 14
why not
transfuse
individual patient factors
decide transfusion trigger
why
transfuse
Time Limits for Infusion
Blood/
blood product
Whole blood/
red cells
Start infusion
Complete infusion
within 30 min. of within 4 hour
removing pack
(less in high
from
ambient temperature)
refrigerator
Platelet
concentrates
immediately
within 20 min
FFP
within 30 min
within 20 min
18
TRANSFUSION REACTIONS
@RBC’s !
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Nonhemolytic 1-5 % transfusions
Causes
-Physical or chemical destruction of
blood: freezing, heating, hemolytic drug
-solution added to blood
-Bacterial contamination
: fever, chills, urticaria
 Slow transfusion, diphenhydramine , antipyretic for fever
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Hemolytic
 Immediate: ABO incompatibility (1/ 12-33,000) with fatality (1/ 500800,000)
Majority are group O patients receiving type A, B or AB blood
Complement activation, RBC lysis, free Hb (+ direct Coombs Ab test)
Signs and Symptoms of AHTR
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Chills , fever
Facial flushing
Hypotension
Renal failure
DIC
Chest pain
Dyspnea
Generalized bleeding
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Hemoglobinemia
Hemoglobinuria
Shock
Nausea
Vomitting
Back pain
Pain along infusion vein
Anesthesia: hypotension, urticaria, abnormal bleeding
 Stop infusion, blood and urine to blood bank,
coagulation screen (urine/plasma Hb, haptoglobin)
 Fluid therapy and osmotic diuresis
 Alkalinization of urine (increase solubility of Hb
degradation products)
 Correct bleeding, Rx. DIC
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@WBC’s!
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Europe: All products leukodepleted
USA: Initial FDA recommendation now reversed pending objective
data (NOT  length of stay for  expense)
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Febrile reactions
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Recipient Ab reacts with donor Ag, stimulates
pyrogens (1-2 % transfusions)
20 - 30% of platelet transfusions
Slow transfusion, antipyretic, meperidine for
shivering
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TRALI (Transfusion related acute lung injury)
Donor Ab reacts with recipient Ag (1/ 10,000)
 noncardiogenic pulmonary edema
 Supportive therapy
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Transfusion-related Acute Lung Injury
(TRALI)
Acute and severe type of transfusion reaction
Symptoms and signs
 Fever
 Hypotension
 Tachypnea
 Dyspnea
 Diffuse pulmonary infiltration on X-rays
 Clinical of noncardiogenic pumonary edema
Transfusion-related Acute Lung Injury
(TRALI)
Therapy and Prevention
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Adequate respiratory and hemodynamic supportive
treatment
If TRALI is caused by pt. Ab  use LPB
If TRALI is caused by donor Ab no special blood
components
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Transfusion-associated Graft-versus-Host
Disease ( TA-GVHD)
Rare: immunocompromised patients
 Suggestion that more common with designated
donors
 BMT, LBW neonates, Hodgkin's disease, exchange
Tx in neonates
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Graft-versus-Host Reaction
Signs & Symptoms
 Onset ~ 3 to 30 days after transfusion
 Clinical significant – pancytopenia
 Other effects include fever, liver enzyme,
copious watery diarrhea,
erythematous skin
erythroderma
and desquamation
@Platelets!
Alloimmunization
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50 % of repeated platelet transfusions
Ab-dependent elimination of platelets with lack of response
Use single donor apheresis
Signs & Symptoms
 mild  slight fever and Hb
 severe  platelet refractoriness with bleeding
Post-transfusion purpura
 Recipient Ab leads to sudden destruction of platelets 1-2
weeks after transfusion (sudden onset)
 Rare complication
INFECTIOUS COMPLICATIONS
I. Viral (Hepatitis 88% of per unit viral risk)
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Hepatitis B
Risk 1/ 200,000 due to HBsAg, antiHBc screening (717 % of PTH)
Per unit risk 1/63-66,000
0.002% residual HBV remains in ‘negative’ donors
(window 2-16 weeks)
Anti-HBc testing retained as surrogate marker for
HIV
NANB and Hepatitis C
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Risk now 1/ 103,000 (NEJM 96) with 2nd/ 1/
125,000 with 3rd generation HCV Ab/ HVC RNA
tests
Window 4 weeks
70 % patients become chronic carriers, 10-20 %
develop cirrhosis
HIV
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Current risk 1/ 450- 660,000 (95)
With current screening (Abs to HIV I,
II and p24 Ag), window 6-8 weeks
(third generation ELISA tests in
Europe)
 sero -ve window to < 16 days
HTLV I, II
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Only in cellular components (not FFP, cryo)
Risk 1/ 641,000 (window period unknown)
Screening for antibody I may not pick up II
CJD (and variant CJD)
II. Bacterial
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Contamination unlikely in products stored for > 72 hours at
1-6 0 C
gram –ve, gram +ve bacteria
most frequent – Yersinia enterocolitica
Produced endotoxin
Platelets stored at room temperature for 5 days, with infection
rate of 0.25%
III. Protozoal
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Trypanosoma cruzi (Chaga’s disease)
Malaria
Toxoplasmosis
Leishmaniasis
Serological Testing
for Infectious markers
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HIV – Ag
Anti – HIV
HBsAg
Anti – HCV
Test for syphilis
METABOLIC COMPLICATIONS
Citrate toxicity
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Citrate (3G/ unit WB) binds Ca2+ / Mg+
Metabolized liver, mobilization bone stores
Hypocalcemia ONLY if > 1 unit/ 5 min or hepatic
dysfunction
Hypotension more likely due to  cardiac output/
perfusion than  calcium (except neonates)
Worse with hypothermia/ hepatic dysfunction