BLOOD PRODUCTS AND THEIR

INDICATIONS

Mr. Donald Brown

 BACKROUND
 SANBS was formed by the
amalgamation of 6 blood
transfusion services
 This is in keeping with WHO
recommendation for a single BTS
within a country
The South African National Blood
Service
SABTS

F State
NBTS
Medimatch

WPBTS BBTS
EPBTS
 MISSION

TO PROVIDE
 ALL PEOPLE RESIDENT IN RSA
WITH AN APPROPRIATE AND
COST- EFFECTIVE SERVICE
 AND A COMPREHENSIVE RANGE
OF LOW RISK AND
EFFICACIOUS BLOOD AND
BLOOD PRODUCTS
 MISSION
 FROM VOLUNTARY,
NON-REMUNERATED
BLOOD DONORS
 THEREFORE WE PROVIDE
SAFE BLOOD FROM THE
STARTING POINT
 DONOR PROCESSING

New Donor Haemoglobin

Medical Self Exclusion
presents estimation
Questionnaire Questionnaire
at clinic (Copper Sulphate)

Tested for Blood Pressure

HIV Antibody (102) Pulse
Donor Unit HIV P24 Antigen Weight
accepted for Hepatitis B Surface Antigen
patient use Hepatitis C Antibody
Syphilis
Blood Groups UNIT of BLOOD
Irregular Antibodies DONATED
 Granulocytes Platelets
Whole
Blood
FFP

Red Cells Cryoprecipitate

Plasma

Fractionation Immumoglobulins

Prothrombin Albumin
Cryoprecipitate Intrvenous Gammaglobulin
Complex
Hepatitis B IgG
(factors II,VII,IX & X)
Rabies IgG
Poly specific IgG
Factor VIII Tetanus IgG
Concentrate Anti D IgG
Anti Measles IgG
Anti Varicella Zoster IgG
 WHOLE BLOOD

 NOT COMMONLY INDICATED

 BEST IF TRANFUSED AS EARLY
AS POSSIBLE AFTER DONATION
i.e.within. hrs.
 COMPONENTS, EPECIALLY
PLATELETS AND CLOTTING
FACTORS DETERIORATE
WITHIN HOURS OF DONATION
 INDICATIONS
1. MASSIVE BLOOD LOSS WITH
HYPOVOLEMIA WITH A
POSSIBILITY OF RECURRENCE
2. EXCHANGE TRANSFUSION IN
NEONATES
3. RED CELL TRANSFUSION
WHERE NO RED CELLS ARE
AVAILABLE
 PRECAUTIONS

• MUST BE ABO & Rh

COMPATIBLE
• WARMING WITH A PROPER
WARMING DEVICE IS INDICATED
• NO MEDICATION OR DRUGS
MUST BE ADDED TO THE UNIT
• RISK OF VOLUME OVERLOAD
MUST ALWAYS BE BORNE IN
MIND
RED CELL CONCENTRATES

INDICATED TO IMPROVE TISSUE

OXYGENATION IMPAIRED BY
ANEMIA OR HYPOVOLEMIA
 NORMOVOLEMIC ANEMIA
 ONGOING ANEMIA WHERE
VOLUME HAS BEEN REPLACED
WITH CRYSTALLOIDS OR
COLLOIDS
 PRECAUTIONS
 ABO AND Rh COMPATIBLE
 USUALLY A SLOW
TRANSFUSION THUS NO REAL
NEED FOR WARMING
 NORMAL SALINE CAN BE GIVEN
VIA A “Y” TYPE INFUSION SET
 ONE UNIT OF RCC WILL RAISE
Hb BY +/- 1 mg/dl
 PLATELETS
 CAN BE AVAIABLE AS:
1. POOLED
2. APHERESIS / SINGLE DONOR
 STORED AT ROOM TEMP. ON A
SHAKER TO PREVENT
CLUMPING
 MUST BE TRANSFUSED AT
ONCE
 COMPLETE TRANSFUSION IN
20 min.
 INDICATIONS
BLEEDING DUE TO
THROMBOCYTOPENIA
SECONDARY TO:
 DEFECTIVE PRODUCTION
1. APLASTIC ANEMIA
2. LEUKEMIA
 DEFECTIVE PLATELET
FUNCTION
1. CONGENITAL PLATELET
DISORDERS
 INDICATIONS
 INCREASED PLATELET
CONSUMPTION
1. DISSEMINATED
INTRAVASCULAR
COAGULOPATHY
 DILUTIONAL
1. MASSIVE BLOOD
TRANSFUSION
 PRECAUTIONS

 GIVE PLATELETS THAT ARE ABO

COMPATIBLE WHERE POSSIBLE
 NOT INDICATED IN ITP AND TTP
 USE A SPECIAL PLATELET
INFUSION SET
 RISKS ARE AS FOR RCC AND
WB
FRESH FROZEN PLASMA
 SEPARATED WITHIN 18 hrs. OF
DONATION FROM
ANTICOAGULATED WHOLE
BLOOD AND FROZEN AT –18o C
 ALL CLOTTING FACTORS,
ALBUMIN AND
IMMUNOGLOBULINS ARE
CONTAINED AT NORMAL
PHYSIOLOGICAL LEVELS
FRESH FROZEN PLASMA
 FFP SHOULD BE THAWED IN
WATER AT 30-37o C BEFORE
INFUSION
 CAN BE STORED IN A FRIDGE AT
2-6o C, AFTER THAWING
 TRANSFUSION SHOULD OCCUR
AS SOON AS POSSIBLE AFTER
THAWING AND SHOULD BE
CEMPLETED IN 20 min.
 INDICATIONS
 REPLACEMENT OF MULTIPLE
COAGULATION FACTORS IN:
1. Hepatic disease
2. Warfarin overdose
3. Multiple transfusions
 D.I.C.
 T.T.P.
 VITAMIN K DEFICIENCY (with
active bleeding)
 PRECAUTONS

 ABO COMPATIBILITY IS
PREFERRABLE BUT GROUP AB
MAY BE USED UNIVERSALLY
 GIVE VIA A BLOOD ADMIN.
SET
 FFP IS HYPEROSMOLAR
DUE TO ADDITIVES IN
ORIGINAL BLOOD UNIT
 PRECAUTIONS

 HYPER-KALEMIA /NATREMIA
MAY OCCUR IF LARGE
VOLUMES ARE
TRANSFUSED
 FFP IS NOT INDICATED IN
HYPOVOLEMIA
 CRYOPRECIPITATE
 PREPARED FROM FFP BY
THAWING AT 4o C AND
RESUSPENSION
 CONTAINS ~ 50% OF FACTOR
VIII AND FIBRINOGEN FOUND
IN PLASMA
 STORED AT –25o C FOR UP TO 1
YEAR
 MUST BE INFUSED WITHIN 6 hrs.
OF THAWING VIA A BLOOD
ADMIN. SET
 INDICATIONS
 AS AN ALTERNATIVE FOR
FACTOR VIII IN :
1. von Willebrand’s disease
2. Hemophilia A
3. Inherited factor viii deficiencies
 AS A SOURCE OF FIBRINOGEN
IN ACQUIRED
COAGULOPATHIES (DIC)
 FACTOR VIII

 PREPARED FROM LARGE

POOLS OF VIRUS INACTIVATED
PLASMA
 STORED AT 2-6o C
 RECONSTITUTED WITH H2O
BEFORE INFUSION VIA A
BLOOD ADMIN. SET
 INDICATIONS
 HEMOPHILIA A

 Von WILLEBRAND’S DISEASE

 ALBUMIN
 PREPARED BY FRACTIONATION
OF LARGE POOLS OF PLASMA
 PROCESS OF FRACTIONATION
INACTIVATES VIRUSES eg.
HIV/HBV
 STORED AT ROOM
TEMPERATURE
 NO FILTER IS NEEDED WHEN
INFUSING
 N/S OR RINGER’S CAN BE
ADDED
 INDICATIONS
 BURNS
 SHOCK (ADD VOLUME
EXPANDERS)
 REPLACEMENT FLUID
FOLLOWING
PLASMAPHARESIS.
 DIURETIC RESISTANT EDEMA
IN:
1. Ascites
2. Nephrotic syndrome
UNJUSTIFIED INDICATIONS
 CIRRHOSIS

 CHRONIC RENAL FAILURE

 MALNUTRITION
 PRECAUTIONS

 ADMINISTRATION OF 20%
ALBUMIN MAY CAUSE
PULMONARY EDEMA
 CLOSE MONITORING IS
ESSENTIAL
 HYPERSENSITVITY
REACTIONS MAY OCCUR
 IMMUNOGLOBULINS
 CONCENTRATED Ab
CONTAINING COMPONENT OF
PLASMA (IgG)
 OBTAINED BY FRACTIONATION
OF PLASMA ( VIRUCIDAL )
 SPECIFIC HYPERIMMUNE Ig IS
PREPARED FROM DONORS
WITH HIGH TITRES OF A
SPECIFIC ANTIBODY
 PREPARATIONS AVAILABLE IN
BOTH IMI AND IVI FORMS
 INDICATIONS
 IMI IMMUNOGLOBULINS:
1. Anti-D for the prevention of HDN
in sensitized Rh. neg. mothers
2. Others to prevent / Rx tetanus,
rabies, hepatitis A&B
 IVI IMMUNOGLOBULINS:
1. Agammaglobulinemia
2. Immmunodeficiency states, including
HIV
3. Idiopathic thrombocytopenic purpura
(ITP)
 PRECAUTIONS

ANAPHYLACTIC REACTIONS CAN

OCCUR IF:
 IMI product is given IVI.
 The patient previously had a
reaction toward a human protein
product
 The patient suffers from IgA
deficiency
 CONCLUSION
 The use of blood and blood
products should form part of the
many available medical or surgical
interventions for the patient
 The scarcity of these make their
usage a matter of serious
consideration, bearing the side
effects in mind
 It is imperative that the appropriate
product is used for the appropriate
indication.