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Unformatted text preview: Lecture 13 – Transfusion Medicine Blood Groups: Type A Anti-B Type B Anti-A Type O Anti-A & B Type AB None *RBC composition: Mostly Type O>Type A>Type B> Type AB T ransfusion Medicine • multiple therapeutic agents in blood • rbc, plt, coag factors, Ig, etc • limited availability, from living donors • recombinant proteins • Artificial blood substitutes ? • limited viability on storage • variable stability • requirement for matching • preformed & immune antibodies • blood transfusion has significant risks • immune, infectious, physical Blood Component Therapy • I ncrease blood oxygen-car rying capacity • packed red blood cells • whole blood • integrated “closed” multi-bag component preparation system • make sure you’re treating signs and symptoms of ANEMIA not the lab values • Support hemostasis (± volume) • platelets • fresh frozen plasma • cryoprecipitate • clotting factor concentrates (VII I, IX, ATII I) • Support or modulate immune function • granulocytes • IgG fractions & hyperimmune IgG • IV IgG Blood Donor Selection 500mL of the 5L Consider both Patient & Donor safety • History and Physical - hi risk group status • ABO/Rh type (+/- special antigen typing) • Antibody tests on serum • Donor I nfectious Disease testing: • Syphilis • Hepatitis – B, C • HIV – 1/2 • HTLV-I/I I • West Nile Virus • Chaga’s disease (Trypanasomiasis) • (autologous donations may not be tested – donation for yourself in surgery) Creation of Blood components from whole blood Blood Components derived from whole blood- FFP (fresh frozen plasma)- PRBC (packed rBC)- PC (platelet concentrate)- Say an average person with HCt = 40% o 500cc 200 cc of RBC o In between is the buffy code which is 50cc- Whole Blood Unit o 450 ml blood + 60-100 ml anticoagulant/preservative citrate-phosphate-dextrose-adenine (CPDA1) o Rred blood cells - 250 ml @ 65-75% hct o plasma - 250-300 ml (VIII & V labile; have to be frozen within 8 hour) o platelets ( non-functional in whole blood or prbc) o leukocytes granulocytes ( non-functional ) lymphocytes ( may cause GvHD, not good ) monocytes (may cause alloimmunization to H LA)- Reb Blood Cell Component Characterist ics I ndications Whole Blood **not available** (by the time it is package two days old not always good) 500 mL, Hct=40% RBC (O2) and Volume Deficit Packed Red Cells (PRC) 250 mL, Hct= 75% RBC (O2) deficit (signs/symptoms of anemia) Leukyocyte- See PRC (<5 X10^6 Manage WBC Ab Prevent Feb Rxn reduced (PRC (bedside or prestorage filter, removed RBC) WBC – prevent febrile t ransfusion reactions) Prevent WBC Ab Prevent CMV Saline-washed (PRC) *processed and suspended in saline (similar PRC , but prevent allergic reactions) 180mL; like PRC <1% plasma prot (24 hour outdate) Prevent allergic Rxns F rozen –thawed (PRC) See washed PRC Prolonged storage of rare blood type- RBC survival after storage o For a store after 35 days refrigetator...
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- Spring '11
- red blood cells, Fresh frozen plasma