Blood components and plasma derivatives pt 2

Cryoprecipitate antihemophilic factor CRYO

Protein precipitate portion of FFP thawed at 1-6C

Volume 15 ml for single unit and 100ml (pool of 5)

Stored at -18C (Cannot be frozen)

Shelf life 1 year

CRYO contents

vWF 80-120 units

Fibrinogen >150mg

Factor VIII >80IU

Factor XIII 40-60IU

Fibronectin

CRYO vWF

80-120 units

CRYO fibrinogen

>150mg

CRYO Factor VIII

>80 IU

CRYO Factor XIII

40-60IU

CRYO prep

Thaw at 30-37C

Store 6 hours at 20-24C after that (4 hours) if pooled

Cannot be re-frozen

Transfuse within 4 - 6 hours

CRYO indications

Hypofibrinogenemia <200 mg/dL

Dysfibrinogenemia

Uremic bleeding not responsive to DDAVP

Factor XIII deficiency

vWF / Hemophilia 2nd line

CRYO contraindications

vWF conc are available

Hemophilia A conc available

Rh type irrelevant, but ABO compatibility preferred

CRYO dosing

Standard Dose: 10 units (=2 pooled units) repeat test for response

30 minutes to thaw and pool

Outdate after thawing; 4-6 hours, store at room temp

Platelets

Apheresis

1 single donor platelet = 6 pooled

5 days outdate at room temp, rotation/ agitation

Test for bacteria

ABO type specific

Plastic permeability

Random donor platelets

50-65 ml

Minimum 5.5 × 10^10 platelets per bag

Single unit should raise platelet count by 5,000-10,000/ul

If pooled must be given within 4 hours

Single donor platelets

Volume 180-250ml but can be reduced

6-10units of random donor platelets conc

1 ½ - 2 ½ hour apheresis time

3 ×10^11 platelets per unit

Raise platelet count by 30,000 - 50,000

Cold storage platelets

Same as single donor

14 days outdate

Store at 1-6C without agitation

Platelet indications

Thrombocytopenia or active platelet related bleeding

Bone marrow failure, chemo, cardiopulmonary bypass

Dysfunctional platelet disorders

Prophylaxis on anti-platelet meds

Platelet contraindications

TTP platelet destruction

Microangiopathic processes and PTP

Heparin induced thrombocytopenia

Platelet count >100k/ul without dysfunction

Cirrhosis / splenomegaly

Unrelated bleeding

Transfusion night before procedure

Factors affecting platelet transfusion effectiveness

Splenomegaly

Hyperthermia

Sepsis

Allo-platelet antibodies

Auto-platelet antibodies

Splenomegaly

platelet sequestration - decreased platelet increment

Hyperthermia / Spesis

decreased platelet survival

Allo-platelet antibodies

Anti HLA markedly decreased platelet increment; requires HLA matched platelets to get satisfactory platelet transfusion increment

Auto-platelet antibodies ITP

no platelet increment response

24 hour post-infusion count

if no incremental rise, then this signifies a problem

Could be accelerated usage as in DIC or could be another extenuating factor as seen above

1 hour post transfusion count

if no incremental rise, then the patient probably has platelet antibodies, splenomegaly, sepsis, or hyperthermia present

Platelet refractoriness

A repeat failure to achieve homeostasis or expected increment count

Associated with poor post transfusion platelet count on 2 separate occasions + DIC, MAHA, TTP, etc

Granulocytes

Mobilize the donor with corticosteroids ± G-CSF

Volume 250-300ml

> 1.0X10^10 granulocytes

20-50ml RBCs

3×10^11 platelets

Hematocrit 10%

Granulocytes pedigree

Pedigreed donors, emergency release before IDMs are preformed

Extend to 30 day testing

Granulocytes storage

Room temp 20-24 without agitation

Shelf life 24 hours

Granulocytes considerations

Must be irradiated, ABO compatible

Must NOT be leukocyte reduced

can cause severe transfusion RXN

Granulocytes indications

Culture proven infection G-ve

NOT responsive to antimicrobial therapy

Neutropenia

Expected bone marrow recovery

Transplant patients

Neonatal sepsis

Hereditary neutrophil defects

Granulocytes contraindications

Prophylaxis in non-infected patients

Whole blood

Operational setting, trauma, massive transfusion, military, autologous transfusion

Volume 450-500ml

Storage 1-6C

Shelf life 21-35 days

Whole blood components

200ml of RBCs

250ml plasma, WBCs, platelets, and anticoagulant

Whole blood cirumstances

ABO identical or low titer O positive whole blood LTOWB in trauma setting

Prothrombin Complex Concentrate

Assayed for Factors IX and II

Contains Factors II, VII, IX, and X - Vitamin K Dependent

Small volume highly concentrated

Used for factor IX deficiency (Hemophilia B) and Factor II deficiency