• indication- provide oxygen carrying capacity
• volume- 0.5 L
• effect- one unit raises Hb by 1 g/dL or Hct by 3%
• contents- RBC, platelts, plasma from single donor
  • all platelets and some of the coagulation factors are not functional

• advantage- provide oxygen carrying capacity and volume
• must be ABO identical to intended recipient
• can also use RBC's and crystalloid solutions

• increase danger of volume overload due to increased volume transfused
• whole blood very limited indications and NOT available in most institutions
• blood routinely separated into compenents (more efficient)
  • transfuse needed component

1. whole blood collected from donor
2. centrifuge and separate RBC's from platelet, plasma fraction
3. place platelet, plasma into sepearate bag and further centrifuge
   1. prepare platelet concentrate or plasma prepared as fresh frozen plasma precipitate

• indication- provide oxygen carrying capaicity
• volume: 300 mL
  effect- one unit should increase in same value as whole blood
• shelf life: 21-42 days at 1-6 degrees C

• dependent on pts factors
• less than 6 g/dL Hb warents consideration
• most guidlines transfuse once 7 g/dL Hb

You mainly want to treat underying cause

Must be ABO compatible

• available as
  • platelet concentrate (platelets separated from whole blood donation
  • 6 pint concentration constitute dose in average adult
  • apheresis product (SDP)
• volume: 300 mL
• effect- apheresis unit or 6 platelet conc. should raise platelet count 30 x 10^9
• shelf life- 5 days at 20-24 C with gentle agitation

• indication- thrombocytopenia or abnormal platelet function
  • present with petechia, purpura, epitaxis
• setting of thrombocytopenia guidelines
  • if otherwise stable, not bleeding (ex: chemo pts), platelets should be transfused to keep platelet count at 10000
  • if mitigating factors like heparin therapy, platelet count should be kept at 20000
  • if about to undergo invasive procedure, platelets should be at 50000
  • if about to undergo neurosurgery, platelets should be at 100000
  • but remember there are other causes for bleeding than thrombocytopenia or platelet defect
    • if bleed after transfuse, consider anatomic defects or other defects

• volume: about 200-300 mL
• contents- physiologic concentrations of all coagulation factors
• standard dsoe- minimum 2 units followed by repetition of coagulation testing
• shelf life: 1 yr at less than -18 C
• time required for preparation: 30 minutes to thaw
  • outdate after thawing: 24 hrs in storage at   1-6 C

• clinically significant deficiency in multiple coagulation factors
• rapid reversal of coumadin when can't wait for vitamin K
• tx of single factor deficiency for which no coagulation factor concentrate is available

Don't use if there is a more specific therapy available (ex: factor VIII concentrates, ATIII concentrates)

• volume expansion
• nutritional supplement
• source of Ig
• substitute for vitamin K

• mechanism of formation- precipitate forming when FFP is thawed at 1-6 C
• contents- factor VIII, vWF, factor I, factor XIII
• volume: 10-15 mL
• shelf life: 1 yr at less than -18 C

• control of bleeding associated with fibrinogen deficiency or dysfunctional fibrinogen
• tx of factor XIII deficiency
• second line therapy
  • hemophilia A if factor VIII conc. not available
  • vW disease if factor VIII concentrate high in vWF not available
  • when these specific factor VIII concentrates are not available

• standard dose: 10 units followed by repitition of testing
• alternatively, total dose necessary to achieved desired levels of factor VIII or factor I can be calculated
• time for preperation: 30 minutes to thaw and pool
• outdate after thawing
  • 6 hrs: storage at room temperature
  • 4 hrs after pooling, storage at room temperature

• leukocyte reduction (remove WBC's)
• irridation (prevent proliferation of lymphocytes)
• washed protein (remove plasma proteins)

• prevention of:
  • alloimmunization to HLA Ag
  • infection with CMV
  • febrile non hemolytic transfusion rxns

pts at risk for these complications are those repeatedly tranfused (ex: hem/onc patients)

• indication- prevent transfusion associated GVHD
• pts at high risk include:
  • SCT recipients
  • recipients of donor units from their blood relatives
• time required for preparation: 5 minutes

• remove plasma proteins that could be harmful to intended recipients
  • ex: IgA in patient who is IgA deficient and anti-IgA with previous anaphylatic rxns to plasma in cellular blood components
• time needed for prep
  • 45 minutes for RBC's
  • 3 hrs for platelets
• outdated time after prep (its short, so you must administer quickly)
  • 24 hrs for RBC's
  • 4 hrs for platelet

• pts blood type must be determined
• screen for RC Ab's must be performed if RBC's are ordered

• specify number of red cell units needed should be ordered if transfusion definite/highly likely
• should not be orderd indiscriminately because blood supply is limited, ties up blood, and increases chance of outdating blood
  • less than half day supply of O type red cells

• type and screen
  • blood type
  • Ab screen
    • screen for red cell Ab due to previous exposure (ex: pregnancy, transfusion)
    • if screen positive: Ab ID
• type and crossmatch
  • detects "unexpected Ab's" in patient plasma

• ABO incompatibility
• plasma containing Ab infused into ABO incompatible recipient

• clinical service determines/indicates to transfusion service that pt cant wait for completion of pretransfusion testing and crossmatch
• fill out form
• O type red cell units which contain only a small amount of plasma are issued on an emergent basis prior to testing
• important to get pt sample as soon as possible for testing (will complete after emergency release, conserve O units)

• usually clerical errors at bedside
  • mislabeling specimens
  • transfusion of blood products to wrong patient

• transfusion rxns
  • hemolytic transfusion rxns
    • acute
    • delayed
  • febrile non hemolytic transfusion rxns
  • allergic rxns
  • transfusion related acute lung injury (TRALI)
• circulatory overload
• transmissible disease
• alloimmunization
• iron overload

• platelets for bacteria
• HIV
• HTLV
• hep B and C
• syphilis

• signs/symptoms
  • chest/back/flank/infusion site pain
  • dyspnea
  • hypotension
  • shock
  • tachyardia
  • hemoglobinuria
  • oliguria/anuria
  • DIC
  • bleeding
  • "feeling of impending doom"
• cause: ABO or non ABO incompatible transfusion
• most dangerous immunologic transfusion rxn

• tx
  • stop transfusion
  • treat hypotension with fluids
  • maintain renal perfusion
  • control DIC
• lab dx
  • clerical check
  • evaluate serum for evidence of hemolysis
  • repeat testing on pre and post transfusion specimens
  • urinalysis

• signs/symptoms
  • hives
  • itching
  • local erythema
• cause- allergy to soluble substance in donor plasma
• tx
  • stop transfusion
  • medicate with an antihistamine
  • restart only if symptoms resolve (check hospital policy)

• signs/symptoms
  • coughing
  • laryngeal edema
  • bronchospasm
  • respiratory distress
  • shock
  • hypotension
  • nausea
  • vomitting/cramps
• cause when IDed- most commonly IgA deficient recipient with anti-IgA Ab

• tx
  • stop tranfusion immediately
  • epinepherine, fluids, protect airway
• lab dx- assay to detect presence of anti-IgA Ab in recipient
• avoidance- may require washed cellular products or IgA deficient plasma for futre transfusions if IgA deficient with anti-IgA

• signs/symptoms
  • fever (greater than 1 C)
  • shaking chills/rigors
  • cold discomfort
• cause- anti leukocyte Ab in recipient or cytokines in production
• tx
  • stop transfusion
  • give antipyretics for fever, meperidine for severe rigors
  • product must not be restarted (fever may represent a more serious rxn)

• lab dx- must rule out hemolytic rxn
• avoidance- 15% of pts have recurrence
  • leukoreduced red cell and platelet products
  • pre medication with antipyretics (aspirin free)

• leading cause of transfusion related death
• signs/symptoms
  • ARDS like picture within 1-6 hrs of transfusions
  • dyspnea
  • hypoxemia
  • tachycardia
  • cyanosis
  • fever
  • hypotension
  • pulmonary whiteout on chest Xray with a normal cardiac silhoutte
• cause
  1. causative agent is:
     • Ab in transfused unit against HLA or granulocyte Ag present on recipient WBC's
     • bioactive lipid substances in product
  2. primes recipient neutrophils and trigger inflammatory response
  3. accumation of activated neutrophils in lung with microvascular occlusion and capillary leakage

• tx- supportive respiratory care usually resolves in 48-96 hrs
• lab dx
  • screen donor for HLA or granulocyte Ab
  • granulocyte crossmatch between recipient WBC's and donor cells
• avoidance- defer donor

• signs/symptoms: resemble CHF
  • dyspnea
  • cough
  • cyanosis
  • tachycardia
  • systolic HTN
  • pulmonary edema
  • JVD
  • peripheral edema headache
• cause- volume overload or rapid infusion
• tx
  • diuretics and oxygen
  • phlebotomy
• avoidance
  • slow rate of infusion
  • concentrate products or split units

• signs/symptoms
  • fevers
  • chills/rigors
  • hypotension/shock
  • NV
  • abdominal cramps
  • diarrhea
  • DIC
  • renal failure
• cause- growth of bacteria in products during storage
  • contamination from asymptomatic donor bacteremia
  • poor technique in product preparation

• tx- antibiotics, fluids, pressors
• dx
  • temperature increase (esp. if above 2 C)
  • culture pt
• lab investigaion- rule out hemolytic rxn and culture returned unit (more common in platelets)
• avoidance
  • proper storage of product
  • follow expiration date of product
  • examination of product
  • bacterial culture of platelets

• signs/symptoms
  • unexplained jaundice and/or drop in Hb
• causes
  • primary alloimmunization
  • memory Ab resonse
• tx
  • monitor signs and symptoms of hemolysis
  • supportive measures
  • transfuse w/Ag negative blood
• lab investigation
  • DAT
  • elution
  • Ab screen and ID
  • follow Hb and billirubin
• avoidance- history of transfusion and Ab, notify transfusion service

• signs/symptoms
  • fever
  • skin rash
  • hepatitis
  • diarrhea
  • marrow aplasia most often within 2 weeks after transfusion
• cause- lymphocytes in cellular blood products proliferate and attack recipient

• 90% mortality despite tx
• tx (in combo)
  • steroids
  • chemo
  • anti-CD3
  • anti-thymocyte globulin (ATG)
  • cyclosporin
• avoidance- irradiate cellular products given to at risk patients

• severe compromise of cell mediated immunity
  • SCT
  • cellular immunity deficiency
  • Hodgkin's
  • hematologic malignancy
  • receiving high dose chemo, radiation, and/or aggressive immunotherapy
  • pts on fludarabine, purine nucleoside analogs
  • neonates
  • intrauterine transfusions

• in patients receiving more than 50 red cell transfusions
• signs/symptoms
  • cardiomyopathy
  • arrhythmias
  • cirrhosis
  • DM
• cause- deposition of iron in organs
• lab dx- ferritin levels
• tx- iron chelation therapy
• avoidance- avoid unnecessary red cell transfusions, dietary restrictions of iron intake

• acute hemolytic transfusion rxns
• bacterial contamination
• TRALI
• febrile non hemolytic transfusion rxn
• underlying disease/condition

• always notify TS if rxn suspected
• implicated product should be sent to TS, urine sample
• always notify TS if patient gives a history of Ab or transfusion rxns