Practical Blood Transfusion

Ampaiwan Chuansumrit, M.D.

Department of Pediatrics Faculty of Medicine Ramathibodi Hospital,

Mahidol University, Bangkok, Thailand

Packed Red Cells (PRC)

การแยกจากเลือดบรรจุในถุง การแยกจากเลือดบรรจุในขวด โดยใช้ syringe

Suction pump ใช้ดพูลาสมาหรือเกล็ดเลือดที่บรรจุขวด

ภทัรพร อิศรางกูร ณ อยุธยา. โลหติวิทยาในเดก็. 2538:199.

Residual Leucocyte • Convention packed red cells (PRC-C)

1.87x109 cells/unit

• Leucocyte poor by inverted centrifugation (LP-I)

4x108 cells/unit

• Leucocyte depleted PRC by filtration(LD-F)

0.75x106 cells/unit

Response to Different Red Cell Preparation

Type of PRC HLA antibodies (%)

Transfusion reaction (%)

1. PRC-C 65 13.4

Chuansumrit A, et al. Southeast Asian J Trop Med Public Health 2001;32:419-424.

2. LP-I 24 0.4 3. LD-F 0 0

4. LP-I 0.9 LD-F 20 0.9 3. PRC-C 5.8 LP-I 1.4 LD-I 50 0.8

Benefit of Removal of Leucocyte

• Transfusion reaction

• HLA alloimmunization

• CMV infection

Recommendation • Pre-storage filtration for leucocyte reduced

with WBC <105 to 106 cells/unit

• Red cell antigen typing in patients requiring

regular transfusion such as transfusion-

dependent thalassemia (TDT). TIF suggest pre-

transfusion Hb at 9.0-10.5 g/dL

• Red cell antigen typing in regular blood donors

Platelet Concentrate • Random donor PC: ≥ 5.5 x 1010 platelets • Pool PC • Platelet pheresis: ≥ 3 x 1011 platelets

• Dose - 1 unit/10 kg

• Response - prevention/control bleeding - platelet increment at 1 hour - 0.2-0.4 u/kg raise 40,000-80,000/µL

Platelet Refractoriness

• Underling conditions: fever, infection, DIC

• HLA antibody

• Antibody to humann platelet antigen (HPA)

Corrected counted increment (CCI)

= Body surface area (m2) x platelet count increment x 1011

Number of platelet transfusion > 5,000 m2/uL

Post transfusion platelet recovery (PPR)

= Estimated total body volume (ml/kg) x platelet count increment

Number of platelet transfusion > 20%

Early Diagnosis of Massive Bleeding

• Rate and volume of blood loss

• Bleeding of 1.5 mL/kg/min in >20 min or 150 mL/min

• Replacement with 50% blood volume in <3 h

Request of Blood from Blood Bank

• Immediate request: blood group O

• 10 min: ABO grouping

• 20 min: ABO & Rh grouping and

crossmatch at room temperature

Controlling Bleeding in Patients with Massive Bleeding

• Conventional blood component therapy

FFP 10-20 mL/kg

Platelet 0.2-0.4 unit/kg (10 units)

Cryoprecipitate 0.2 unit/kg

• rFVIIa 100 µg/kg at 15-30 min interval if the bleeding is not significant reduced (1-2 doses are usually used) followed by 100 µg/kg at 1-4 h interval (1-3 doses are usually used)

Algorithm for Use of rFVIIa in Controlling Bleeding Persistent massive

bleeding

First dose of rFVIIa 100 µg/kg

Bleeding markedly decreased

Subsequent dose at 1-4 h interval (1-3 doses are usually used)

Bleeding Slowed down

Bleeding stopped

Second dose of 30 min interval

Attempt to correct Hct >24%, plt >50,000-100,000/µL Fibrinogen 100-200 mg/dL T 37oC, pH > 7.2