THE RATIONAL USE OF BLOOD AND BLOOD

PRODUCTS

• To discuss the following:

• The various components available from blood

• The rational use of blood and its components

• Problems faced

• Proposals for improved blood product usage

Blood is an amazing fluid

Keeps us warm

Provides nutrients for cells, tissues and organs

Removes waste products from various sites

Packed red blood cells(PRBC) Platelets ( PRP ) Fresh Frozen Plasma (FFP) Cryoprecipitate ( CP ) Cryo poor plasma ( CPP)

1 unit of blood theoretically gives 1 unit FFP 1 unit PRBC’s 1 random donor unit Platelet

Rational Use of BloodRational Use of Blood

RATIONALRATIONAL

• Right productRight product

• Right doseRight dose

• Right timeRight time

• Right reasonsRight reasons

LogicLogic(Rationale behind Rational use of blood)(Rationale behind Rational use of blood)

• EconomyEconomy - -Scarcity of resourceScarcity of resource1 in 4 get blood component1 in 4 get blood component

• Safety -Safety - Inherent risks involvedInherent risks involved

in transfusion therapyin transfusion therapy1 in 2 million gets HIV1 in 2 million gets HIV

• Scientifically appropriateScientifically appropriateHaematinic in nutritional anemiaHaematinic in nutritional anemia

Guidelines For Promoting Guidelines For Promoting Component TherapyComponent Therapy

• Definite indicationDefinite indication - - A blood transfusion A blood transfusion should never be ordered unless it is worth the should never be ordered unless it is worth the riskrisk

• Single unit transfusion Single unit transfusion – has no significant – has no significant therapeutic benefittherapeutic benefit

• Use of fresh blood Use of fresh blood - - should be avoided should be avoided because of increased risk of infections (TTI)because of increased risk of infections (TTI)

1. Give only what is needed1. Give only what is needed

Red cellsRed cells OO22 carrying carrying capacity capacity

(Anemia)(Anemia)

PlateletsPlatelets ThrombocytopeniaThrombocytopenia

FFPFFP Multiple clotting Multiple clotting factor deficiencyfactor deficiency

CRYOCRYO Hemophilia A Hemophilia A

2. Different Storage 2. Different Storage ConditionsConditions

CompComp.. Temp.Temp. Shelf life Shelf life

Red cellsRed cells 4-64-600 C C 35 days 35 days

FFP/CPP FFP/CPP - 40 - 40 00 C C 1 year 1 year

Platelets 22-24Platelets 22-2400 C on platelet agitator C on platelet agitator

5days5days

CRYOCRYO - 40- 4000 C C 1 Year 1 Year

3. Conservation of Scarce 3. Conservation of Scarce ResourceResource

•Separation of whole blood in Separation of whole blood in 3-4 components3-4 components

•Benefits more than one Benefits more than one patient at a time.patient at a time.

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Centrifugation

Principle

Sediment of blood cells depend on t heir size as well as the difference of the

ir density from that of the surrounding fl uid, viscosity of medium, flexibility of th

e cells which are temperature dependen t

Parameter Whole blood

Volume 350 – 450 mlIncrement in Hb 1 -1.5 gm/dlRed cell mass /ml Same as PRBCViable platelets NoLabile factors NoPlasma citrate ++++Allergic reactions ++++FNHTR ++++Risk of TTI ++++Waste of components Yes

Packed red cells

200 – 240 ml1 -1.5 gm/dlSame as WB

NoNo++++

No

Why whole blood not rationalWhy whole blood not rational• Maximize blood resourceMaximize blood resource

Whole bloodWhole blood one patientone patientComponent therapyComponent therapy four patientsfour patients

packed red cellspacked red cells thalassemia thalassemia plasmaplasma liver disease / burnsliver disease / burnsplateletsplatelets thrombocytopeniathrombocytopeniacryoprecipitatecryoprecipitate hemophiliahemophilia

Specific storage requirements of componentsSpecific storage requirements of components

Whole blood Whole blood + 4+ 400CCComponentsComponents

plateletsplatelets + 20 – 24 + 20 – 24 ooCC cryoprecipitate & FFPcryoprecipitate & FFP - 30 - 30ooCC red cellsred cells + 2 – 8 + 2 – 800CC

• Better patient managementBetter patient management• concentrated dose of required componentconcentrated dose of required component• avoid circulatory overloadavoid circulatory overload• minimize reactionsminimize reactions

eg. Requirement of platelets to raise count from 20 to 50,000/uleg. Requirement of platelets to raise count from 20 to 50,000/ulfresh whole bloodfresh whole blood 5 units5 units 1750 ml1750 mlrandom plateletsrandom platelets 5 units5 units 250 ml250 mlapheresis plateletsapheresis platelets 1 unit1 unit 200 ml200 ml

• Decreased cost of managementDecreased cost of managementexcept for the cost of bag, other expenses remain sameexcept for the cost of bag, other expenses remain same

Why whole blood not rationalWhy whole blood not rational

““Fresh blood” – a misconceptionFresh blood” – a misconception

What is “fresh blood”?What is “fresh blood”? unit kept at 4unit kept at 4ooC for 4 hours is no longer “fresh”C for 4 hours is no longer “fresh” storage lesions in different constituents duestorage lesions in different constituents due to storage tempto storage temp

Increased risk of disease transmissionIncreased risk of disease transmission intracellular pathogens (CMV, HTLV) intracellular pathogens (CMV, HTLV) survive in leukocyte in fresh bloodsurvive in leukocyte in fresh blood syphilis transmissionsyphilis transmission TreponemaTreponema can not survive > 96 hours in stored blood can not survive > 96 hours in stored blood

malaria transmissionmalaria transmission

malarial parasite can not survive > 72 hrs in stored malarial parasite can not survive > 72 hrs in stored bloodblood

Immunological complication due to WBCsImmunological complication due to WBCs in fresh bloodin fresh blood

TA-GvHD – 90% fatalityTA-GvHD – 90% fatalityTA-immunomodulationTA-immunomodulation alloimmunizationalloimmunization

LogisticsLogistics no time for component preparationno time for component preparation less time for infection screeningless time for infection screening increased chances of error increased chances of error

““Fresh blood” – a misconceptionFresh blood” – a misconception

The clinician should;The clinician should;1.1. complete all required details on complete all required details on

the blood request formthe blood request form2. accurately label blood sample 2. accurately label blood sample

tubestubes3. check the identity of the 3. check the identity of the

patient, the product and the patient, the product and the documentation at the patient’s documentation at the patient’s bedside before transfusionbedside before transfusion..

•No evidence that warming blood is beneficial to the patient when infusion is slow

SummarySummary

1.1. No place for Whole Blood in clinical medicineNo place for Whole Blood in clinical medicine2.2. Discourage single unit / fresh blood Discourage single unit / fresh blood 3.3. Component preparation and use is the demand of timeComponent preparation and use is the demand of time4.4. Promotion of judicious use of blood / componentsPromotion of judicious use of blood / components5.5. Promote autologous use of bloodPromote autologous use of blood

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