Blood Products: Indications and Complications

BLOOD
PRODUCTS
INDICATIONS AND COMPLICATIONS
-AZIZAH ASMAR-
BLOOD PRODUCTS
 Any therapeutic substance prepared from
human blood
BLOOD PRODUCTS
Blood component Plasma derivative
Whole Blood Albumin

Red Blood Cells Coagulation factor concentrates
Platelets Immunoglobulins
Fresh Frozen Plasma
Cryoprecipitate
WHOLE BLOOD
 Unseparated blood collected into an approved
container containing an anticoagulant-
preservative solution i.e CPDA
 Citrate-phosphate-dextrose-adenine (CPDA)
solution
 The citrate chelates the calcium present in blood
and prevents coagulation
 A 1pint whole blood donation contains:
 Up to 510 ml total volume
 450 ml donor blood
 63 ml anticoagulant-preservative solution
 Haemoglobin approximately 12 g/ml
 Haematocrit 35%–45%
 No functional platelets
 No labile coagulation factors (V and VIII)
 Storage
 Between +2°C and +6°C in approved blood bank
refrigerator, fitted with a temperature chart and
alarm
 Transfusion should be started within 30 minutes of
removal from refrigerator
 Indications
 Red cell replacement in acute blood loss with
hypovolaemia
 Exchange transfusion
 Patients needing red cell transfusions where red
cell concentrates or suspensions are not available
PACKED RED CELLS
 Description
 150–200ml red cells from which most of the plasma
has been removed
 Haemoglobin approximately 20 g/100 ml (not less
than 45 g per unit)
 Haematocrit 55%–75%
 Storage
 Same as whole bloods
 Indications
 Replacement of red cells in anaemic patients
 Use with crystalloid replacement fluids or colloid
solution in acute blood loss
LEUCOCYTE-DEPLETED RED
CELLS
 Description
 A red cell suspension or concentrate containing <5
x 106 white cells per pack, prepared by filtration
through a leucocyte-depleting filter
 Haemoglobin concentration and haematocrit
depend on whether the product is whole blood, red
cell concentrate or red cell suspension
 Leucocyte depletion significantly reduces the risk
of transmission of cytomegalovirus (CMV)
 Indications
 Minimizes white cell immunization in patients
receiving repeated transfusions but, to achieve this,
all blood components given to the patient must be
leucocyte-depleted
 Reduces risk of CMV transmission
 Patients who have experienced two or more
previous febrile reactions to red cell transfusion
PLATELET
 Description
 Single donor unit in a volume of 50–60 ml of
plasmashould contain:
 At least 55 x 109 platelets
 <1.2 x 109 red cells
 <0.12 x 109 leucocytes
 Storage
 Up to 72hours at 20°C to 24°C (with agitation) unless
collected in specialized platelet packs validated for
longer storage periods; do not store at 2°C to 6°C
 Longer storage increases the risk of bacterial
proliferation and septicaemia in the recipient
 Indications
 Treatment of bleeding due to:
 Thrombocytopenia
 Platelet function defects
 Prevention of bleeding due to thrombocytopenia,
such as in bone marrow failure
FRESH FROZEN PLASMA
 Description
 Pack containing the plasma separated from one
whole blood donation within 6 hours of collection
and then rapidly frozen to –25°C or colder
 Contains normal plasma levels of stable clotting
factors, albumin and immunoglobulin
 Factor VIII level at least 70% of normal fresh
plasma level
 Storage
 At –25°C or colder for up to 1 year
 Before use, should be thawed in the blood bank in
water which is between 30°C to 37°C. Higher
temperatures will destroy clotting factors and
proteins
 Once thawed, should be stored in a refrigerator at
+2°C to +6°C
 Indications
 Replacement of multiple coagulation
factordeficiencies: e.g.
 Liver disease
 Warfarin (anticoagulant) overdose
 Depletion of coagulation factors in patients receiving
large volume transfusions
 Disseminated intravascular coagulation (DIC)
 Thrombotic thrombocytopenic purpura (TTP)
CRYOPRECIPITATE
 Description
 Prepared from fresh frozen plasma by collecting the
precipitate formed during controlled thawing at
+4°C and resuspending it in 10–20 ml plasma
 Concentrated source of factor VIII, factor XIII, vWF,
and fibrinogen
 Storage
 At –25°C or colder for up to 1 year
 Indications
 As an alternative to Factor VIII concentrate in the
treatment of inherited deficiencies of:
 von Willebrand Factor (von Willebrand’s disease)
 Factor VIII (haemophilia A)
 Factor XIII
 As a source of fibrinogen in acquired
coagulopathies: e.g. disseminated intravascular
coagulation (DIC)
HUMAN ALBUMIN SOLUTIONS
 Indications
 Replacement fluid in therapeutic plasma exchange:
use albumin 5%
 Treatment of diuretic-resistant oedema in
hypoproteinaemic patients: e.g. nephrotic syndrome
or ascites. Use albumin 20% with a diuretic
 Although 5% human albumin is currently licensed
for a wide range of indications (e.g. volume
replacement, burns and hypoalbuminaemia), there
is no evidence that it is superior to saline solution or
other crystalloid replacement fluids for acute plasma
volume replacement
COAGULATION FACTORS
Factor VIII concentrate
1. Treatment of haemophilia
A
2. Treatment of von
Willebrand’s disease: use
only preparations that
contain von Willebrand
Factor
Factor IX concentrate
•Factors II, IX and X 1. Treatment of haemophilia B
• Factor IX only (Christmas disease)
Prothrombin complex concentrate 2. Immediate correction of
(PCC) prolonged prothrombin time
•Factors II, IX and X
•Some preparations also contain
Factor VII
IMMUNOGLOBULINS
Immunoglobulin for • Hyperimmune or specific
intramuscular use immunoglobulin: from patients
with high levels of specific
antibodies to infectious agents:
e.g. hepatitis B, rabies, tetanus
• Prevention of specific
infections
• Treatment of immune
deficiency states
Anti-RhD immunoglobulin (Anti- •Prevention of haemolytic disease
D RhIG) of the newborn in RhD negative
mothers
Immunoglobulin for intravenous • Idiopathic autoimmune
use thrombocytopenic purpura and
some other immune disorders
• Treatment of immune deficiency
states
• Hypogammaglobulinaemia
• HIV-related disease
COMPLICATIONS
 Acute complications-within 24 hours
 Delayed complications
ACUTE INTRAVASCULAR
HAEMOLYSIS
 Caused by the infusion of incompatible red
cells.
 Antibodies in the patient’s plasma haemolyse the
incompatible transfused red cells.
 Even a small volume (10–50 ml) of incompatible
blood can cause a severe reaction and larger
volumes increase the risk.
 The most common cause is an ABO
incompatible transfusion.
BACTERIAL CONTAMINATION
AND SEPTIC SHOCK
 Bacterial contamination affects up to 0.4% of red cells and 1–2% of
platelet concentrates.
 Blood may become contaminated by:
 Bacteria from the donor’s skin during blood collection (usually skin
staphylococci)
 A bacteraemia present in the blood of a donor at the time the blood is
collected (e.g. Yersinia)
 Improper handling in blood processing
 Defects or damage to the plastic blood pack
 Thawing fresh frozen plasma or cryoprecipitate in a waterbath (often
contaminated).
 Some contaminants, particularly Pseudomonas species, grow at 2°C
to 6°C and so can survive or multiply in refrigerated red cell units.
 Staphylococci grow in warmer conditions and proliferate in platelet
concentrates at 20°C to 24°C.
FLUID OVERLOAD
 Fluid overload can result in heart failure and
pulmonary oedema.
 May occur when:
 Too much fluid is transfused
 The transfusion is too rapid
 Renal function is impaired.
 Fluid overload is particularly likely to happen in
patients with:
 Chronic severe anaemia
 Underlying cardiovascular disease.
ANAPHYLACTIC REACTION
 A rare complication of transfusion of blood
components or plasma derivatives.
 The risk is increased by rapid infusion
 Cytokines in the plasma may be one cause of
bronchoconstriction and vasoconstriction in
occasional recipients.
 Occurs within minutes characterized by:
 Cardiovascular collapse
 Respiratory distress
 No fever.
 Anaphylaxis is likely to be fatal if it is not managed
rapidly and aggressively.
TRANSFUSION-ASSOCIATED
ACUTE LUNG INJURY (TRALI)
 Usually caused by donor plasma that contains
antibodies against the patient’s leucocytes.
 Rapid failure of pulmonary function usually
presents within 1 to 4 hours of starting
transfusion, with diffuse opacity on the chest X-
ray(ie diffuse pulmonary infiltrate.
 No specific therapy. Intensive respiratory and
general support in an intensive care unit is
required.
MASSIVE TRANSFUSIONS
 ‘Massive transfusion’ is the replacement of blood loss
equivalent to or greater than the patient’s total blood
volume in less than 24 hours:
 70 ml/kg in adults
 80–90 ml/kg in children or infants.
 Morbidity and mortality high, not because of the large

volumes infused, but because of the initial trauma and
the tissue and organ damage secondary to haemorrhage
and hypovolaemia.
 However, administering large volumes of blood and
intravenous fluids may itself give rise to the following
complications.
 Acidosis
 Hyperkalaemia
 Citrate toxicity and hypocalcaemia
 Depletion of fibrinogen and coagulation factors
 Depletion of platelets
 Disseminated intravascular coagulation
 abnormal activation of the coagulation and
fibrinolytic systems, resulting in the consumption of
coagulation factors and platelets.
 Hypothermia
 Microaggregates
 SOURCE: WHO clinical blood handbook
 http://www.who.int/entity/bloodsafety/clinical_us
e/en/Handbook_EN.pdf
Thank You

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BLOOD

Blood component Plasma derivative

Whole Blood Albumin

 Morbidity and mortality high, not because of the large

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