Transcript BLOOD TWILIGHT SEMINAR

WHERE DO OUR BLOOD AND BLOOD
PRODUCTS COME FROM?

Australian Red Cross Blood Service collects
>900,000 units of whole blood from
volunteer donors every year
 Only2.5% of Aussies are blood donors!!!
 Australia is self sufficient in blood and
blood products with the exception of some
manufactured plasma products – IVIgG, Rh
anti D, some Factor 8 and Factor 9 products
What happens to a blood
donation?
• Processed or ‘fractionated’ into -
1 unit of concentrated (packed) red cells (PC)
1 unit of fresh frozen plasma (FFP)
1 (of a pool of 4) units of platelets
(1 unit of pooled platelets is from 4 donors)
A special process is used to leucoreduce red
cells and platelets which reduces febrile
nonhaemolytic reactions to transfusion
•
How much do we use in
HNEAHS?

Every year ~ 23,000 units of red cells
3,500 units pooled platelets
3,500 units fresh frozen plasma
210 paediatric ‘quad’ packs
4,500 bottles Albumex 4
2,300 bottles Intragam 3gm
4,500 bottles Intragam 12gm
4,000 vials Rh anti D Ig
What does it cost?

The cost of products alone is ~ $7million
 1 unit PC - $242
 1 unit pooled platelets - $430
 1 unit FFP - $50
 1 bottle Albumex 4 - $80
 1 bottle Intrgam 3gm - $250
 1 bottle Intragam 12gm - $1015
 1 vial Rh anti D - $115
Every donation undergoes extensive
testing
• ABO and Rh D typing
• Extended blood group typing of some units to
provide compatible blood for patients with red cell
antibodies stimulated by pregnancy or previous
transfusion
• Plasma is tested for antibodies against red cell
antigens
Transfusion transmitted disease
testing
• Syphilis
• HIV 1 and 2
• Hepatitis B
• Hepatitis C
• HTLV 1 and 2
• CMV – not all donations (60% donors +ve)
Diseases screened by donor
questionnaire (no test available)
• Malaria – can be transmitted in red cells only –
•
•
•
exclusion for 1 year after travel to endemic areas
(test coming)
Creuztfeldt-Jakob disease (CJD) – causes ‘mad
cow ‘ disease – never reported in Australia - 4
possible cases world wide – donors excluded who
have spent 6 months in the UK between 1 Jan
1980 and 31 Dec 1996 or had a transfusion in UK
Dengue fever – sporadic - far Nth Qld
West Nile virus – sporadic - USA
Indication for transfusion
• Red cells are the oxygen transport system of the body
- essential for life
- the only indication for red cell transfusion is to supply
oxygen to vital organs
- causes of reduced oxygen transport
blood loss
bone marrow failure – chemotherapy
- haematological malignancy
- comorbidities can increase the need for red cells
- lung disease
cardiac disease
• A normal red cell has a life span of ~ 120
days
• A unit of packed cells has an expiry of 42
days after collection – this is calculated so
that 75% of transfused red cells are viable
at the time of expiry of the unit
• Normal Hb – adult female 115 – 165 g/L
adult male 130 - 180 g/L
• Platelets – normal function is to initiate the
clotting process
• 150 – 400 x 10~9/L
• Normal life span 9 days / expiry 5 days after
collection
• For prevention of surgical bleeding need platelet
count > 80 x 10~9/L
• Haemato-oncology patients with bone marrow
•
failure – stable , not bleeding, not febrile –
prophylactic transfusion if platelet count <10 x
10~9/L
Aspirin and NSAID’s interfere with normal
function – cease 7 days preop
Decision to transfuse
 In
all cases transfusion must be a
balance of the benefits versus the
risks
 Transfusion is never completely
risk free
Risk >
Benefit
Benefit >
Risk
Hb Thresholds
Haemoglobin
g/L
4
0
5
0
6
0
Reversible in
short-term
7
0
8
0
9
0
10
0
11
0
Additional factors in
compromise of oxygen
transport
Within this region
individual patient factors
determine transfusion
threshold
12
0
13
0
14
0
Clinical Responsibilities Transfusion Reaction

Notify Medical Officer (MET/ Medical Response
call)
 Patients observations to be attended
 All clerical and identity checks to be repeated
 Provide supportive therapy.
 Change giving set – keep line open with N/ Saline
as ordered.
Contact Blood bank/ Pathology immediately
 Return used pack
 Send patient blood/ urine specimens with form as
directed by your Laboratory