بنام خدا Transfusion - PowerPoint Presentation

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بنام خدا

Slide2

Transfusion

in children

Packed cell, platelet, FFP, cryoprecipitate, WBC

Slide3

Packed red cell

Transfusion

Slide4

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

Slide5

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

Slide6

Contraindication:

Anemia that can be corrected by nontransfusion

therapy( iron, recombinants erythropoietin)

Hypovolemia

Slide7

Recommendation

CMV seronegative, irradiated,

leukopoor

preparation should be

used

per clinical guidelines

Slide8

Platelet transfusion

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Descriptions:

1 random donor unit is concentrate of platelet separated from a unite of whole

blood (5.5×10

10

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

×

10

11

platelet in 100-500 cc plasma)

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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

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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

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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

!)

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Recommendation

:Infuse relatively quickly(10ccc/kg/hour)

to reduce clumping and

adherence

in bag and

tubing

If concern over platelet response, obtain post-transfusion platelet count at 15 minute to 1

hour

Slide14

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

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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-BRhD

-negative platelet concentrates should be given, where possible, to

RhD

-negative patients,

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Blood group and platelet transfusion

If RhD-positive platelets are transfused to a RhD-negative

woman:

a

dose of 250

i.u

. anti-D

cover

five adult therapeutic doses of

RhD

-positive platelets

(it

should be

given subcutaneously

in thrombocytopenic

patients)

It is not necessary

for men

or women without childbearing potential

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Fresh Frozen Plasma

Transfusion

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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

complemen

t proteins

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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

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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

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Dosing

FFPHemostasis

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%

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FFP storage

Frozen at -18 C for 1 year or at -65 for 7 years

Once thawed should be infused within 4 hours

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Cryoprecipitate

Slide24

Cryoprecipitate

Cold soluble remnant of FFE

Concentrated

preparation that contain

:

Factor

8 (80-100 IU/bag),

Fibrinogen(200mg/bag

),

Factor

13

,

von

Willwberand

factor

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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

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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)

Slide27

Cryoprecipitate

doseHyperfibrinogenemia

: 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

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WBC transfusion

Slide29

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

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WBCs :

need toBe cross-matched with the recipient's serumIrradiated because of the large number of lymphocytes present.

Considered for patients with an absolute neutrophil count

<0.5 x 10

9

/L and a good chance of marrow recovery.

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Indication

:Documented

sever bacterial of fungal infections with an ANC<500

,

Functional

granulocyte defect and unresponsiveness to antimicrobial

therapy

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Contraindication

:Irreversible

BM

failure

Prophylaxis's in non infected patients

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Pediatric

dosage1-2×10

9

cell/kg

Once initiated, WBC therapy should continue on daily basis until infection is cured, patient defervesce, or ANC is>500

Slide34

Processing

Leukodepletion,

Gamma

irradiation, washing, CMV negative

Slide35

Processing

: Leukodepletion

Slide36

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?

Slide37

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)

Slide38

Processing:

Gamma

irradiation

Slide39

Processing: Gamma irradiation

Gamma irradiation of blood product to stop donor lymphocyte proliferation

Prevent transfusion induced GVHD (100% fatal)

Slide40

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

Slide41

Gamma irradiation:

indicationAutologous 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).

Slide42

Gamma irradiation:

indicationAllogeneic 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

.

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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

Slide44

Gamma irradiation:

indicationother 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

Slide45

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

Slide46

Processing:

washing

Slide47

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.

Slide48

Processing: washing

Indication

 

:

Patients

with IgA deficiency 

Prevention

of allergic

reactions

Post-transfusion

febrile reactions, present even when

leukodepleted

RBCs are used

Slide49

Processing

:

CMV

negative components

Slide50

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

Slide51

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

Slide52