BLOOD & BLOOD COMPONENTS
Contents Indications Volume Shelf Life Effect of 1 unit Other
Whole RBC, platelets & plasma; O2 carrying capacity 500 mL 21-35 days inc Hb by 1g/dL O2 capacity & volume
Blood all platelets @ 1-6 C inc Hct by 3% must be ABO identical
& some CF not functional Risk of volume overload
Limited indications
Should supply only pt needs
RBC Hct of 55-65% O2 carrying capacity 300 mL 21- 42 days inc Hb by 1g/dL 10 to suppress abn Hb
must be ABO compatible
Platelets SDP - only platelets Thrombocytopenia 350 mL 5 days inc platelet 30 X 109 b/t 10 & 50,000, inc risk of bleeding w/ trauma or inv procedure
harvested from donor or Abnormal plt function room temp In prep for invasive procedure should be > 50,000
Concentrate = separated If stable: keep > 10,000 >prone to In prep for neuro procedure > 100,000
from hole bld donation If risk: > 20,000 bacteria
Fresh Physiologic concentrations Deficiency in many CFs 200 - 1 year standard dose 2 units need 30 min to thaw >> expired 24 hours after thaw @ 1-6 C
Frozen of all CFs Rapid reversal of 300 mL at > In emergency O type and Rh negative units w/ minimal plasma are issued
Majority of severe and hemolytic transfusion reactions are due to CLERICAL ERRORS!!
Transmissible disease:
Nucleic acid testing has significantly reduced the risk Mandatory testing for: HIV, HTLV, Hep B and C, Syphilis, bacteria (platelets only)
Many transmissible infx are not routinely tested for ( CMV, EBV, Herpes 6 & 8, Paro virus, Malaria, etc)
Transfusion Reactions
Acute Hemolytic Transfusion Reaction: Most dangerous>> fever, chills, pn, N/V, dyspnea, SHOCK, hypotension hemoglobinuria & oliguria (2° to renal failure), DIC
Due to ABO incompatible transfusion (mostly due to clerical error) Rx: Stop tx, give fluids, maintain renal perfusion, control DIC
Mild Allergic: >> hives, itching, local erythema Due to allergy to soluble substance in donor plasma
Rx: antihistamine
Anaphylaxis: >> laryngeal edema, bronchospasm, respiratory distress, shock & hypotension, N/V
Due most commonly to IgA deficient recipient with anti-IgA Abs Rx: Stop tx, epinephrine, fluids, protect airway
Febrile Non-hemolytic Tx Reaction: fairly common >> fever, shaking chills Due to anti-leukocyte Abs in recipient or cytokines in product
Rx: stop tx, antipyretics
Transfusion Related Acute Lung Injury:>> ARDS like sx w/i 3-6 hours of tx - cyanosis, cough, pulmonary with -out on chest x-ray
(TRIAL) Due to anti-granulocyte, anti-HLA Abs in plasma of donor
Protein-rich fluid goes from capillary >> alveoli >> white out on x-ray (Non-cardiogenic)
Rx: supportive resp care
Circulatory Overload: >> dyspnea, cough, cyanosis, HA, peripheral edema, CHF signs Due to volume overload or rapid tx
Rx: diuretics & O2, phlebotomy 1mL/Kg/hour is the rule
Septic Shock: may be due to RBC (rare) or platelets >> fever, shock, hemoglobin uria (renal failure), DIC, N/V, diarrhea, cramps
Due to growth of bacteria during product storage Rx: antibiotics, fluids, pressors for hypotension
Delayed Hemolytic Tx Reaction: (>24 hours after tx) >> unexplained jaundice or drop in Hb
Due to primary immunization or Memory abs response (Pt previously exposed to RBC Ag)
Rx: Monitor for hemolysis, tx w/ Ag (-) blood
Graft vs. Host: >> fever, skin rash, hepatitis, bone marrow suppression - occurring w/i 4-10 days after tx Rx: most w/o benefit >> 90% mortality
Due to lymphocytes w/i blood products attacking recipient Irradiate cellular products for at risk patients
Iron Overload: In those receiving> 50 RBC tx (each unit of RBC has 250 mg Fe) >> cardiomyopathy, arrhythmias, cirrhosis, diabetes
If fever occurs during tx >> STOP immediately (may be acute hemolytic rxn, bacterial contamination, TRALI, febrile non-hemolytic tx rxn)