Transfusions - Transfusion Medicine Types Indications and...

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Transfusion Medicine: Types, Indications and Complications David Harford Hematology/Oncology
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History of Transfusions Blood transfused in humans since mid- 1600’s 1828 – First successful transfusion 1900 – Landsteiner described ABO groups 1916 – First use of blood storage 1939 – Levine described the Rh factor
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Transfusion Overview Integral part of medical treatment Most often used in Hematology/Oncology, but other specialties as well (surgery, ICU, etc) Objectives Blood components Indications for transfusion Safe delivery Complications
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Blood Components Prepared from Whole blood collection or apheresis Whole blood is separated by differential centrifugation Red Blood Cells (RBC’s) Platelets Plasma Cryoprecipitate Others Others include Plasma proteins—IVIg, Coagulation Factors, albumin, Anti-D, Growth Factors, Colloid volume expanders Apheresis may also used to collect blood components
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Differential Centrifugation First Centrifugation Whole Blood Main Bag Satellite Bag 1 Satellite Bag 2 RBC’s Platelet-rich Plasma First Closed System
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Differential Centrifugation Second Centrifugation Platelet-rich Plasma RBC’s Platelet Concentrate RBC’s Plasma Second
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Whole Blood Storage 4° for up to 35 days Indications Massive Blood Loss/Trauma/Exchange Transfusion Considerations Use filter as platelets and coagulation factors will not be active after 3-5 days Donor and recipient must be ABO identical
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RBC Concentrate Storage 4° for up to 42 days, can be frozen Indications Many indications—ie anemia, hypoxia, etc. Considerations Recipient must not have antibodies to donor RBC’s (note: patients can develop antibodies over time) Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl) Usually transfuse over 2-4 hours (slower for chronic anemia
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Platelets Storage Up to 5 days at 20-24° Indications Thrombocytopenia, Plt <15,000 Bleeding and Plt <50,000 Invasive procedure and Plt <50,000 Considerations Contain Leukocytes and cytokines 1 unit/10 kg of body weight increases Plt count by 50,000 Donor and Recipient must be ABO identical
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Plasma and FFP Contents—Coagulation Factors (1 unit/ml) Storage FFP--12 months at –18 degrees or colder Indications Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease, exchange transfusion, massive transfusion Considerations Plasma should be recipient RBC ABO compatible In children, should also be Rh compatible Account for time to thaw Usual dose is 20 cc/kg to raise coagulation factors approx 20%
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Cryoprecipitate Description Precipitate formed/collected when FFP is thawed at 4° Storage After collection, refrozen and stored up to 1 year at -18°
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Transfusions - Transfusion Medicine Types Indications and...

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