Download INDICATIONS FOR EMERGENT TRANSFUSIONS

INDICATIONS FOR EMERGENT TRANSFUSIONS
Manjushree Matadial DO
Saint Joseph Hospital and Medical Center, April
27,2009
Red Blood Cells
• Indications
• Hemoglobin less than 7.0 g/dl in the absence of
coronary disease or ischemia
• Hemoglobin less than 7.0 g/dl during surgery
associated with major blood loss or impaired
oxygen transport
• Hemoglobin less than 8.0 g/dl in patients with
chronic transfusion regimen or during marrow
suppressive therapy
Red Blood Cells
• Hemoglobin less than 10.0 g/dl in select
populations ie. Neonates, coronary disease
or cerebrovascular disease
• Age less than 40 with Hct = 24
• Age 40 – 60 with Hct = 27
• Age 60 – 70 with Hct = 30
Pathophysiology
• Consequences of Anemia
• Increased cardiac output when Hgb < 7.0 g/dl
in acute situations
• Not the case in chronic anemia has been
compensated
• Increased oxygen extraction systematically at
the capillary level
Pathophysiology
• Decreased hemoglobin decreases the
oxygen delivery and the oxygen extraction
ratio increases which maintains a constant
oxygen uptake into the tissues
• A hemoglobin below 3.0 g/dl increases the
lactic acidosis
Blood Products
• Type and Screen
• Determines the ABO and Rh status and the
presence of antibodies
• Takes anywhere from 5 mins – 30 mins
• Risk of adverse reaction is 1: 1000
• Type O red cells are mixed with the patient’s
serum
Blood Products
• Type and Cross
• Determines ABO and Rh status as wells as
adverse reactions to low incidence antigens—
risk of reaction is 1 : 10,000
• Takes 60 mins
• Type O red cells are mixed with the patient’s
serum and the donor red cells are then mixed
with the patient’s serum to determine
incompatibility
Transfusions
• Type specific crossmatch
• Type specific uncrossmatch
• Type O Rh(-) used emergently
Transfusions
• Donor
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O
A
B
AB
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Recipient
O, A, B, AB
A, AB
B, AB
AB
Blood Products
• Whole blood
• Contains 510 ml
• PRBC’s
• Prepared by centrifuging whole blood and removing
250 ml of plasma supernatant
• Each unit of PRBC contains 200 ml of erythrocytes and
50 – 100 ml of plasma and CPD solution
• The concentration of hemoglobin is 23-27 g/dl
• 10 ml/kg will increase HCT by 10%
Blood Products
• Leukocyte-Poor Red Cells
• Used in transfusing patients that are febrile
• Patients with a history of non-hemolytic
transfusion reactions (caused by antibodies to
leukocytes in donor blood)
• Transplant recipients or candidates
• Patients requiring CMV (-) transfusions
Blood Products
• Washed Red Cells
• These are packed cells washed with isotonic
saline to remove leukocytes and residual
plasma
• The removal of plasma prevents allergic
reactions caused by prior sensitization to
plasma proteins in donor blood
• Is to be used in patients with hypersensitivity
reactions
Blood Products
• CMV (-) Blood
• CMV infects many tissues ie. Blood, kidney,
lung , liver and brain
• Following patients are susceptible to
transfusion-transmitted CMV primary
infections and disease therfore they should
receive CMV (-) blood
Blood Products
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CMV (-) Blood
Low birth weight neonates < 1200 grams
CMV seronegative pregnant women
CMV seronegative recipients of , or
candidates for bone marrow or peripheral
blood cell transplants
• CMV seronegative HIV (+) patients
Blood Products
• CMV seronegative recipients of, or
candidates for solid organ transplants
• CMV PCR screening tool
• A large portion of CMV seronegative
donors are CMV PCR positive
Blood Products
• Irradiated
• Prevents graft versus host disease in the
immune compromised patients
• Gamma irradiation eliminates the ability of
lymphocytes to proliferate and preventing them
from mounting and immune response to the
host tissue
Blood Products
• Bone marrow and stem cell transplant
recipients
• Congenital T cell immunodeficiency
syndromes: SCIDS, Wiskott-Aldrich,
DiGeorge
• Intrauterine transfusion
• Neonatal exchannge transfusion
Blood Products
• Irradiated Cells
• Premature neonates < 1200 grams
• Transfusions from blood relatives
• Patients with hematologic malignancies:
ie.Hodgkin’s, Non-Hodgkin’s and acute
leukemia and neuroblastoma
Platelet Therapy
• Indications for transfusions
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Platelets < 10, 000 with no risk factor
Active bleeding
Bone marrow failure
Platelets < 20, 000 with the following risk
factors: febrile, bleeding, ICH, antibiotic
therapy
Platelet Therapy
• Indications
• Surgery with a high risk of bleeding or an
invasive procedure
• Endoscopy with biopsy
• Lumbar puncture
• Surgical intervention
Platelet Therapy
• Indications
• Platelet function defects ie CABG (maintain
the platelets > 50, 000)
• Bleeding/ massive transfusion (maintain the
platelets > 100, 000 )
• Ie. DIC or CNS trauma
Platelet Transfusion
• Prepared by centrifuging fresh whole blood
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and suspending the supernatant pellet in a
small volume
1 unit of whole blood has 50 – 100 billion
platelets in 50 ml of plasma
Stored up to 7 days
Effectiveness declines after 3 days
Transfused in (6-10 ) units at a time
Cyropprecipitate Useage
• Replaced in the following manner (5-10
ml/kg)
• Replaces VIII (Hemophilia A), factor XIII,
fibrinogen, fibronectin, and vWF
• Used also in DIC and Trauma
Fresh Frozen Plasma
• Indications
• Used in life threatening bleeding in patients on
coumadin
• Liver disease if bleeding with abnormal
coagulation profile
• Acute DIC
• Following massive transfusions or CABG