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Blood Transfusion
O2
carrying
capacity
Leukocyte
function
Improve
Blood
volume
Physiologic Guidelines
Acute anemia
o
The lower limit of human tolerance to
hypovolemia is not established but at Hgb
of 7mg/dl or higher, oxygen delivery is
believed to be adequate
o
In healthy individuals, tissue oxygenation is
maintained and anemia is tolerated at
hematocrit as low as 18-25 CV%
o
The heart does not produce lactic acid until
Hct reaches 15-20% CV% and heart failure
does not usually occur until Hct reaches 10
CV%.
Chronic anemia
o
Cardiac output does not change until Hgb
falls below 7gm/dl
Significant symptoms do not appear until
o
there is a 50% reduction in red cell mass.
Practice Guidelines for Component Therapy,
American Society of Anesthesiology, 1996
Hemostasis
average-sized adult
4.
Whole Blood
o
Platelets and granulocytes no longer viable
within 24 hours
o
Factor V >80% level for at least 5 days
o
Factor VIII >80% level for 1-2 days
o
Factor XI falls rapidly to 20% within 1 wee
Factor II, VII, IX, X, fibrinogen are wello
maintained
*
For the above contents, pRBC, FFP, and
platelet concentration are superior to
fresh whole blood
Indications for Whole Blood
Exchange transfusion
Autologous transfusion
Platelet Concentrate
Prepared in 2 ways:
Random donor platelet concentrate:
1.
Separated by centrifugation from whole
blood within 6 hours from extraction
2.
Platelet pheresis:
Blood drawn from donor passes through an
apheresis machine, which by centrifugation
separated the platelets and returns the
remainder of the blood to the donor
5.
6.
7.
8.
9.
Cryoprecipitate
*
Therapeutic dose: 1u/6kg BW or 8-10 units in an adult
Granulocyte Transfusions
o
Absolute neutrophil count <500
Fever
o
Identified responsible organism
o
No decrease in fever after 48 hours of
o
antibiotic therapy
*
Should not be initiated for at least 96 hours after
onset of clinical signs and symptoms of infection
Consider giving for at least 7 days
Problems:
o
Highly antigenic
Cost
o
Use of newer-generation antibiotics and colonystimulating factors have reduced its use
Washed pRBC
Cumbersome
Collection filters
Bedside filters
For PNH
Bethesda Handbook of Clinical Hematology, 2005