UPDATES ON OPTIMAL TRANSFUSION THERAPY

Abstract

Inmodernmedicaltreatments, patients may receive wholebloodorjustspecificcomponentsofthebloodneededtotreattheirparticularcondition.Manycomponentscanbederivedfromdonatedblood.Thisapproachtotreatment,referredtoasbloodcomponenttherapy,allowsseveralpatients to benefit from one unit ofdonatedwholeblood.Themaintransfusablebloodcomponentsinclude: • Wholeblood, containingredcells,whitecells,andplatelets(~45%ofvolume)suspendedinplasma(~55%ofvolume).Itisindicatedforredcellreplacementinacutebloodlosswithhypovolemiaandinexchangetransfusioninneonates. • Packedredcells(PRBCs),orerythrocytes,carryoxygenfromthelungstobody’stissueandtakecarbondioxidebacktolungstobeexhaledandusedindecompensatedanemia(toincreaseredcellmass)innormovolemicpatientsandpatientsatriskofvolumeoverloadandalsousedwithreplacementfluidsinacutebloodloss. • WashedPRBCs,usedforanemicpatientswith a historyofallergictransfusionreactions. • LeucodepletedPRBCs,giventoanemicpatientswith a historyoffebrilenonhemolytictransfusionreactions. • IrradiatedPRBCs,usedtoavoidtheriskofofGVHDinimmune-compromisedpatients. • Platelets,orthrombocytes,aresmall,colorlesscellfragmentsinthebloodwhosemainfunctionistointeractwithclottingproteinstostoporpreventbleeding. Platelets either single donor (SDPs)orrandomdonor(RDPs)areindicatedtostopbleedingcausedbythrombocytopeniaorplateletfunctiondefects.Theyarealsousedtopreventbleedinginsurgicalpatientswithseverepreoperativeplateletdeficiency.theyarecontraindicatedinITPandTTP. • Plasmaisafluid,composedofabout92%water,7%vitalproteinssuchasalbumin,gammaglobulin,anti-hemophilicfactor,andotherclottingfactors,and1%mineralsalts,sugars,fats,hormonesandvitamins.FFPisusedinreplacementofcoagulationfactorsasinliverdisease,warfarinoverdose,massivetransfusion,DIC,TTPandwhenPTorPTTisatleast1.5timesnormal. • Cryoprecipitate(Cryo)isaportionofplasmarichinclottingfactors,includingFactorVIIIandfibrinogen.Itispreparedbyfreezingandthenslowlythawingthefrozenplasma.ItisindicatedasanalternativetofactorVIIIconcentrateinhemophiliaAandvonWillebranddiseaseandalsousedasasourceoffibrinogeninDICandliverfailure. • Coagulationfactorconcentratesasprothrombincomplexconcentratesusedforrapidcorrectionofwarfarinoverdose,activatedfactorVIIusedtocompensateforlackoffactorsVIIIorIXtreatinghemophiliaandothercongenitalandacquiredcoagulopathies,factorVIII,factorIXandvWFconcentratesusedtotreathemophiliaandvonWillebranddiseaseandactivatedfactorXIIIusedforpatientswithcongenitalfactorXIIIdeficiencytoincreaseclotstrengthandresistancetoplasminproteolysis.