1. بنام خدا

2. Transfusion in children
Packed cell, platelet, FFP, cryoprecipitate, WBC

3. Packed red cell Transfusion

4. Packed red cells Average hematocrit of a unit is 65-75%
( concentrated)
Estimated unit size : cc
Stored at 2-6 C
Mixed with preservation ( shelf-life of 35 days)
Infusion should take maximum 4 hours

5. General guidelines Oncology: Hb,8gr/dl increased O2 requirement
patient symptomatic
Bone marrow failure:
Hb<7 gr/dl
Hemoglobinopathies:
clinical situation(thalassemia major or
intermediate, sickle cell

6. Contraindication:
Anemia that can be corrected by nontransfusion therapy( iron, recombinants erythropoietin)
Hypovolemia

7. Recommendation
CMV seronegative, irradiated, leukopoor preparation should be used per clinical guidelines

8. Platelet transfusion

9. Descriptions:
1 random donor unit is concentrate of platelet separated from a unite of whole blood (5.5×1010 platelet in cc plasma)
A single donor unit is a unit collected by apheresis that contain 4-8 time the number of platelet in 1 random donor unit (3 × 1011 platelet in cc plasma)

10. Platelet dosages
Dose of random donor unit platelet is one unit per 5-10kg, ( or 10cc/kg for small infant)
Dose of single donor platelet is 10cc/kg per infusion to maximum 1 unit apheresis(up to the adult dose)
Transfusion may proceed as quickly as tolerated:
10cc/ kg/hour

11. General guideline Hematology patients: Platelet<10,000
Actively bleeding ( and platelet < 50,000)
Preparation for invasive procedure (IT , LP, liver biopsy….)
Oncology patients:
Platelet<20,000
Preparation for invasive procedure

12. Contraindication:
Thrombocytopenia and platelet distraction in patient with autoimmune disorder(ITP) and no active bleeding
TTP : Platelet transfusions are contraindicated unless there is life-threatening haemorrhage,
Heparin-induced thrombocytopenia :HIT is frequently associated with severe thrombosis (acute arterial thrombosis !)

13. Recommendation:
Infuse relatively quickly(10ccc/kg/hour) to reduce clumping and adherence in bag and tubing
If concern over platelet response, obtain post-transfusion platelet count at 15 minute to 1 hour

14. Blood group and platelet transfusion
Identical ABO group as the patient are the components of choice and should be used as far as is possible (but not always available).
Administration of ABO non-identical platelets is acceptable transfusion practice (but may result in hemolysis)
In general, ABO-matched is best, but mismatched can be used when necessary

15. Blood group and platelet transfusion
Group O platelets may be used for group A, B and AB patients if they have been tested and labelled as negative for high-titre anti-A and anti-B
RhD-negative platelet concentrates should be given, where possible, to RhD-negative patients,

16. Blood group and platelet transfusion
If RhD-positive platelets are transfused to a RhD-negative woman: a dose of 250 i.u. anti-D cover five adult therapeutic doses of RhD-positive platelets (it should be given subcutaneously in thrombocytopenic patients)
It is not necessary for men or women without childbearing potential

17. Fresh Frozen Plasma Transfusion

18. Fresh Frozen Plasma(FFP)
Contain coagulation factors in physiologically amounts( each ml contain I IU of each coagulation factor
Contain anticoagulation's such as protein C and S
Contain albumin, immunoglobulins, and complement proteins

19. Indications for FFP
Patients who require replacement of multiple plasma coagulation factors( e.g. liver disease, DIC ..)
Massive transfusion ( have clinically significant coagulation deficiencies)
Patient taking warfarin who are bleeding or need to undergo an invasive procedure before Vit. K could reverse the warfarin effect
Transfusion or plasma exchange in patient with TTP
Management of patients with selected coagulation factor deficiencies , for which no specific coagulation concentrates are available

20. Contraindications FFP
Don’t use when coagulopathy can be corrected with specific therapy( Vit.K, cryoprecipitate, coagulation factor concentrate)
Don’t use when blood volume can be safely and adequately replaced with other volume expander
Don’t use as a source of albumin

21. Dosing FFP
Hemostasis can be achieved when the activity of coagulation factors is at least 25-30% of normal: Unless there is coagulation inhibitor( heparin, etc.), hyperfibrinogenemia
Plasma volume is approximately 40cc/kg
10-15cc/kg of FFP will replace coagulation factors to 20-30%

22. FFP storage Frozen at -18 C for 1 year or at -65 for 7 years
Once thawed should be infused within 4 hours

23. Cryoprecipitate

24. Cryoprecipitate Cold soluble remnant of FFE
Concentrated preparation that contain :
Factor 8 ( IU/bag),
Fibrinogen(200mg/bag),
Factor 13,
von Willwberand factor

25. Cryoprecipitate Indication:
First line therapy for control of bleeding with : fibrinogen deficiency,
factor 13 deficiency
Second line therapy for :
von Willebrand disease
Factor 8 deficiency

26. Cryoprecipitate Contraindications:
Don’t use unless result of laboratory studies indicate a specific hemostasis defect for which this product indicated
Don’t use if virus inactivated factor 8 concentrates or recombinants factor preparation are available for patient with v.W. disease or hemophilia A
Don’t use for DIC( dose not contain all necessary factors(factor 5)

27. Cryoprecipitate dose
Hyperfibrinogenemia: 0.2 bag /kg( increase fibrinogen approximately mg/dl)
Factor 13 deficiency: 1 bag/10 kg once
Bleeding in vWD : 1 bag/10kg every 6-12 hours

28. WBC transfusion

29. WBCs Administered as soon after collection as possible
If stored, maintain at room temperature(20-24 C) without agitation, for no more than 24 hours
Donor preparation with G-CSF increased harvest yield

30. WBCs : need to Be cross-matched with the recipient's serum
Irradiated because of the large number of lymphocytes present.
Considered for patients with an absolute neutrophil count <0.5 x 109/L and a good chance of marrow recovery.

31. Indication :
Documented sever bacterial of fungal infections with an ANC<500 ,
Functional granulocyte defect and unresponsiveness to antimicrobial therapy

32. Contraindication: Irreversible BM failure
Prophylaxis's in non infected patients

33. Pediatric dosage 1-2×109 cell/kg
Once initiated, WBC therapy should continue on daily basis until infection is cured, patient defervesce, or ANC is>500

34. Processing
Leukodepletion, Gamma irradiation, washing, CMV negative

35. Processing: Leukodepletion

36. Processing: Leukodepletion
Leukodepletion is a technical term for the removal of leucocytes (white blood cells) from blood components using special filters.
Leukodepletion of blood components removes ≥ 99% of contaminating leucocytes
Prestorage or bedside filter?

37. Processing: Leukodepletion
Reduced risk of platelet refractoriness(HLA alloimmunization)
Reduced risk of febrile non-haemolytic transfusion reactions
Reduced risk of CMV transmission
Possible reduced risk of transfusion-associated GVHD (reduce risk but not prevent)

38. Processing: Gamma irradiation

39. Processing: Gamma irradiation
Gamma irradiation of blood product to stop donor lymphocyte proliferation
Prevent transfusion induced GVHD (100% fatal)

40. Gamma irradiation: indication
Intrauterine transfusion
Neonates with a birth weight of ≤ 1,200 g and/or gestational age ≤ 30 weeks.
Congenital cellular immunodeficiency.
Aplastic anaemia receiving ATG

41. Gamma irradiation: indication Autologous BMT
Bone marrow or peripheral blood stem cell autologous transplantation (in the 7 days before collection of bone marrow or PBSC and up to 3 months after BMT, or 6 months for patients undergoing TBI).

42. Gamma irradiation: indication Allogeneic BMT
All recipients of allogeneic haemopoietic stem cell transplantation (SCT) must receive irradiated blood components from the time of initiation of conditioning chemoradiotherapy
Irradiated components should be continued while the patient continues to receive GVHD prophylaxis (until the end of GVHD prophylaxis)
Allogeneic blood transfused to bone marrow and peripheral blood stem cell donors 7 days prior to or during the harvest should also be irradiated.

43. Gamma irradiation: indication chemotherapy
Hodgkin’s lymphoma
chemotherapy (should be decided on an individual basis)
It is not necessary to irradiate red cells or platelets for adults or children with acute leukaemia, except for HLA-selected platelets or donations from first- or second-degree relatives

44. Gamma irradiation: indication other indications
All transfusions from first- or second-degree relatives should be irradiated, even if the patient is immunocompetent
All HLA-selected platelets should be irradiated, even if the patient is immunocompetent.
All granulocytes should be irradiated before issue and transfused with minimum delay

45. Gamma irradiation: not necessary
When none of the above conditions are present, it is not necessary to irradiate blood components transfused to:
HIV infection,
Aplastic anaemia
Solid organ transplantation,
Chemotherapy for NHL, acute leukaemia and solid tumours
It is not necessary to irradiate red cells for routine 'top-up' transfusions of premature or term infants unless either there has been a previous IUT, or the donation has come from a first- or second-degree relative

46. Processing: washing

47. Processing: washing Help to remove extra K from red cell
Remove IgA form plasma
Extra plasma containing antigens and cytokine
Should be used within 24 hr.

48. Processing: washing Indication : Patients with IgA deficiency
Prevention of allergic reactions
Post-transfusion febrile reactions, present even when leukodepleted RBCs are used

49. Processing: CMV negative components

50. CMV negative components:
Are recommended for the following recipients to reduce the risk of CMV transmission :
CMV negative recipients of allogeneic stem cell and bone marrow transplants CMV negative pregnant women
Intrauterine transfusions
Infants weighing less than 1200 g at birth

51. CMV negative components :
May be recommended for CMV negative individuals:
HIV infection
Conditions likely to require an BMT or Solid organ transplant recipients
Severe neutropenia