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Perth Haematology :: Dr Steven Ward

Blood Products

IvIg     WDP Transfusion Manual   TX

The Australian Red Cross Blood Service (ARCBS) provides blood and blood products for use within Australia. It collects blood from volunteer donors, processes the blood to provide the blood products and sends plasma to CSL (Commonwealth Serum Labs) to make specialised plasma products. ARCBS is responsible for ensuring safe and continuing supply of blood.

A whole blood donation is always split into many different components.

                                                                             

 

 

 

 

 

 

 

 

 

Facts from ARCBS:

         

 

                    SUMMARY OF TRANSFUSION GUIDELINES

          NHRMC/ASBT Clinical Practice Guidelines on the use of Blood Components 2002

 

 

 

TRANSFUSION GUIDELINES

(Ref: NH&MRC / ASBT Clinical Practice Guidelines on the use of Blood Components 2002)

 

    The clinical and laboratory indications for transfusing a patient must be documented in clinical notes.

     As part of the informed consent process, a patient should be given a clear explanation of the potential risks and 
     benefits of blood component therapy in his or her situation.

 

RED BLOOD CELLS

The decision to transfuse should be based on the following:

Clinical assessment of the need for blood based on symptoms, signs of cardio-respiratory compromise, increased oxygen requirements, blood loss, arterial or aortic valve stenosis, ability to tolerate anaemia, availability of other specific therapy (iron, B12, folate).

Hb (g/L)

<70       Likely to need blood, although lower thresholds may be acceptable

70-100 Likely to be appropriate during surgery associated with major blood loss or impaired oxygen transport.  Also patients on chronic transfusion programs or during myelosuppressive therapy.

>100    Not likely to be appropriate.

  Risk of transfusion vs anaemia (infection, transfusion reactions, allo-immunisation, iron loading,)

PLATELETS

Transfuse platelets to prevent bleeding if:

  Count < 10 x 109/L

  Count <20 with risk-factors (eg fever, antibiotics, systemic haemostatic failure)

  Count <50 surgery and invasive procedures

  Count <100 surgery with serious bleeding complications (eg ocular or neurosurgery)

  Platelet function disorders depends on the clinical setting (count is not predictive of defect)

 

Transfuse platelet to control bleeding if:

  Bleeding when thrombocytopenia is a major contributor

  Massive haemorrhage ( and count <50)

 

Platelets are generally contra-indicated for:

ITP, TTP/HUS or asymptomatic thrombocytopenia

 

 

 

    FRESH FROZEN PLASMA (FFP) is appropriate for:

  Warfarin reversal during life-threatening bleeding. Consider also vitamin K and Prothrombinex

  Bleeding with coagulopathy due to  (a) acute DIC, (b) massive transfusion, (c) cardiac bypass, (d) liver disease

  Clotting factor deficiency where no specific factor concentrate is available.

 

CRYOPRECIPITATE is appropriate for:

Bleeding, trauma, surgery or invasive procedure with fibrinogen <1g/L, dysfibrinogenaemia or acute DIC

 

 

 

Reference is made to The National Health and Medical Research Council (NHMRC) clinical practice guidelines on Blood and Blood Products:

 

         Appropriate Use of Red Cells

         Appropriate Use of Platelets

         Appropriate Use of Fresh Frozen Plasma & Cryoprecipitate

 

Available @:

 www.nhmrc.gov.au/publications/subjects/blood.htm

 

 

 

 

 

 

 

Red Cells
FFP
Factor VIII
IVIg (Intragam)
Anti-D (Rh(D) Ig)

 

 

Platelets
Plasma Products

To treat anaemia

Increase Oxygen carrying capacity

Prevent bleeding and bruising