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Blood Transfusion (Ref. Hari. 18th ed., Pg- 951)

Important Points:

Fresh-Frozen Plasma

  1. FFP contains stable coagulation factors and plasma proteins: fibrinogen, antithrombin, albumin, as well as proteins C and S.
  2. Indications for FFP include correction of coagulopathies, including the rapid reversal of warfarin; supplying deficient plasma proteins; and treatment of thrombotic thrombocytopenic purpura.
  3. FFP should not be routinely used to expand blood volume.
  4. FFP is an acellular component and does not transmit intracellular infections, e.g., CMV.
  5. Patients who are IgA-deficient and require plasma support should receive FFP from IgA-deficient donors to prevent anaphylaxis.

Plasma Derivatives

  1. Plasma from thousands of donors may be pooled to derive specific protein concentrates, including albumin, intravenous immunoglobulin, antithrombin, and coagulation factors.
  2. In addition, donors who have high-titer antibodies to specific agents or antigens provide hyperimmune globulins, such as anti-D (RhoGAM, WinRho), and antisera to hepatitis B virus (HBV), varicella-zoster virus, CMV, and other infectious agents.

Fluorocarbon synthetic chemical have shown promise, no blood substitute.

  1. Cryoprecipitate is a source of fibrinogen, factor VIII, and von Willebrand factor (vWF).
  2. It is ideal for supplying fibrinogen to the volume-sensitive patient.
  3. When factor VIII concentrates are not available, cryoprecipitate may be used since each unit contains approximately 80 units of factor VIII.
  4. Cryoprecipitate may also supply vWF to patients with dysfunctional (type II) or absent (type III) von Willebrand disease.
Cryoprecipitate is not a source for factor IX

Cryoprecipitate is a source for
  1. Fibrinogen
  2. Factor VIII
  3. VWF
Heparin Excess in blood Gas Syringe
Effects due to dilution of sample Effects due to acidic nature of heparin
Decreased PaCO2
Decreased HCO3
Decreased pH
  1. The most frequent reaction associated with the transfusion of cellular blood components is a febrile nonhemolytic transfusion reaction (FNHTR).
  2. These reactions are characterized by chills and rigors and a =1°C rise in temperature.
  3. FNHTR is diagnosed when other causes of fever in the transfused patient are ruled out.
  4. Antibodies directed against donor leukocyte and HLA antigens may mediate these reactions; thus, multiply transfused patients and multiparous women are felt to be at increased risk.
Important Points

Anti –D is not a naturally occurring antibody


Cryoprecipitate does not contain all coagulation factors.


Risks of Transfusion Complications
  1. Reactions
    1. Febrile (FNHTR)
    2. Allergic
    3. Delayed hemolytic
    4. TRALI
    5. Acute hemolytic
    6. Fatal hemolytic
    7. Anaphylactic
  2. Infections
    1. Hepatitis B
    2. Hepatitis C
    3. Hepatitis G virus
    4. HIV
    5. Malaria
    6. Cytomegalovirus
    7. Parvovirus B-19
  3. Other complications
    1. RBC allosensitization
    2. HLA allosensitization
    3. Graft-versus-host disease
Major complications of massive transfusion
  1. Coagulopathy
  2. Metabolic
    1. General
      1. Fluid over load
      2. Hypothermia
    2. Electrolyte
      1. Hyperkalemia
      2. Hypocalcemia
      3. Hypomagnesemia
      4. Acidosis
Nonimmunologic reactions
  1. Fluid Overload
  2. Hypothermia
  3. Electrolyte Toxicity
  4. Iron overload
    Impaired oxygen capacity of hemoglobin (↓ 2, 3 DPG)
  5. Hypotensive reactions.
  6. Immunomodulation

Extra Edge: (Ref. Hari. 18th ed., Pg- 886)


Blood substitute: Two main paths have been pursued:

  1. Fluorocarbon synthetic chemicals that bind oxygen reversibly,
  2. Artificially modified hemoglobins, known as hemoglobin-based oxygen carriers (HBOC).

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