II. Definitions

  1. Blood Product
    1. Native blood component acquired from a donor, that is processed for transfusion into a recipient
    2. Includes Packed Red Blood Cells (pRBC), Fresh Frozen Plasma (FFP), Platelets and Cryoprecipitate

III. Epidemiology

  1. Prevalence in U.S.
    1. More than 16 million units of Blood Product are transfused every year in the United States

IV. Types: Blood Product Modifications

  1. Background
    1. Modifications to Blood Products reduce complications, esp. in those patients at risk
  2. CMV Risk Reduction
    1. Indicated in pregnancy and severe Immunocompromised states
    2. Limits donors to CMV negative or supplies Leukocyte reduced blood
  3. Hemoglobin-S Negative Blood Products
    1. Indicated in Sickle Cell Anemia patients
    2. Limits donors to non-sickling Hemoglobin
  4. Irradiation
    1. Indicated in severe Immunocompromised states
      1. Indicated in Hematologic Malignancy, Bone Marrow Transplant, inherited cellular immune deficiency
      2. NOT indicated in HIV, Sepsis, Solid Organ Transplant or solid metastatic cancer
    2. Prevents T Lymphocytes from replicating
    3. Prevents Transfusion Associated Graft Versus Host Disease (TAGVHD)
  5. Leukocyte Reduction (Leukoreduction)
    1. Reduces Leukocyte concentration in Blood Products (pRBC, Platelet Transfusion)
    2. Typically standard for Red Blood Cell Transfusions to be Leukocyte reduced
    3. Decreases risk of Febrile Nonhemolytic Transfusion Reaction (FNHTR)
    4. Decreases risk of CMV Infection
  6. Pathogen Inactivation
    1. UV-Light mediated destruction of pathogens with Nucleic Acids (does not replace other donor screening methods)
    2. Similar results to Irradiation
    3. Pathogen Inactivation is only available for Plasma Transfusion and Platelet Transfusion
  7. Volume Reduction
    1. Acellular fluid reduced (concentrating Blood Product)
    2. Decreased risk of several Transfusion Complications
      1. Transfusion Associated Circulatory Overload (TACO)
      2. Febrile Nonhemolytic Transfusion Reaction (FNHTR)
      3. Allergic Transfusion Reaction
      4. Hemolytic Transfusion Reaction
      5. Hyperkalemia
    3. However, volume reduction has downsides (similar to washing)
      1. Decreases Blood Product shelf-life
      2. Requires increased blood bank staff time for processing
  8. Washing
    1. Replaces non-cellular fluid in cellular Blood Products
    2. Indicated in history of severe Allergic Transfusion Reaction or IgA deficiency
    3. Also indicated to sensitivity to extracellular Hemoglobin or Potassium
    4. Decreased risk of several Transfusion Complications
      1. Febrile Nonhemolytic Transfusion Reaction (FNHTR)
      2. Allergic Transfusion Reaction
      3. Hyperkalemia
    5. However, washing has significant downsides
      1. Decreases Blood Product shelf-life (activates Platelets, hemolyzes Red Blood Cells)
      2. Requires increased blood bank staff time for processing

V. Types: Packed Red Blood Cells (pRBC)

  1. See Blood Transfusion (pRBC, Packed Red Blood Cells)
  2. Contains 200-250 ml per unit pRBC
  3. Increases Hematocrit 3% per unit pRBC
  4. Increases Hemoglobin 1 gram/dl per unit pRBC
  5. Indication
    1. Hemorrhagic Shock
    2. Hypovolemic Shock despite 40 ml/kg crystalloid
    3. Hemoglobin <7 to 8 g/dl
    4. Coagulopathy

VI. Types: Fresh Frozen Plasma (FFP)

  1. See Plasma Transfusion (Fresh Frozen Plasma, FFP)
  2. Contains 200-250 ml per unit
    1. Contains all Clotting Factors
    2. Does not contain Platelets
  3. Dosing: 10-20 ml/kg
  4. Increases Fibrinogen 7-10 mg/dl per unit
  5. Prothrombin Complex Concentrate (PCC4) has largely replaced FFP for Warfarin Emergent Reversal of Anticoagulation
  6. Indications
    1. INR >1.5 to 1.6 AND
    2. Active bleeding or high risk of bleeding

VII. Types: Cryoprecipitate

  1. See Cryoprecipitate
  2. See Prothrombin Complex Concentrate (PCC4)
  3. Contains 50 ml/unit
    1. Contains Fibrinogen
    2. Contains Factors V, VIII, XIII, vWF
  4. Increases Fibrinogen up to 100 mg/dl per unit dose (15-20 ml per 5-7 kg body weight)
  5. Indications
    1. Hypofibrinogenemia (Fibrinogen <100-150 mg/dl)

VIII. Types: Platelets

  1. See Platelet Transfusion
  2. Contains 50 ml/unit
  3. Increases Platelets 30,000/ul to 50,000/ul per 2.0 m2 BSA per 6 pack (one Platelet Apheresis Unit)
  4. Indications
    1. Platelet Count <50,000 AND Surgery or childbirth (other cut-offs vary between 10-20,000) OR
    2. Massive Transfusion Protocol

IX. Adverse Reactions

  1. See Transfusion Complication
  2. Hypothermia (warm Blood Products before infusion)
  3. Hypocalcemia
  4. Transfusion Reactions

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