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Blood component therapy

  1. Packed cell-
    1. 1 unit pRBC’s raises Hgb 1 gm/dL and hematocrit 2-3%
    2. Patient hemoglobin levels down to 7 gm/dL are generally tolerated if intravascular volume is maintained.
    3. Mixed with saline: LR has Calcium which may cause clotting if mixed with pRBC’s.
    4. volume 300 ml
  2. Frozen RBC’s
    1. Expensive
    2. Decrease chances of reactions
    3. Decrease chances of disease transmission
  3. Platelet concentrate (50ml)
    1. Treatment of thrombocytopenia
    2. Intra-operatively used if platelet count drops below 50,000 cells-mm3 (lab analysis).
    3. 1 unit of platelets increases platelet count 5000-10000 cells-mm3.
    4. Risks:
      1. Sensitization due to HLA on platelets
      2. Viral transmission
    5. Stored at room temp. (survival 4-5 days) while at 4oC survival is 24-48 hrs.
  4. Fresh frozen plasma (volume 225 ml)
    1. Plasma from whole blood frozen within 6 hours of collection.
    2. Contains coagulation factors except platelets
    3. Used for treatment of isolated factor deficiencies, reversal of Coumadin effect, TTP, etc.
    4. Used when PT and PTT are >1.5 normal
    5. Risks:
      1. Viral transmission
      2. Allergy
  5. Cryoprecipitate (10 ml)
    80-145 units of factor VIII fibrinogen 250 mg
  6. Granulocytes
    Recent trends- Experimental oxygen-carrying solutions: developed to decrease dependence on human blood products
    1. Military battlefield usage initial goal
    2. Multiple approaches:
      1. Outdated human Hgb reconstituted in solution
      2. Genetically engineered/bovine Hgb in solution
      3. Liposome-encapsulated Hgb
      4. Perflurocarbons
    3. Potential Advantages:
      1. No cross-match requirements
      2. Long-term shelf storage
      3. No blood-borne transmission
      4. Rapid restoration of oxygen delivery in traumatized patients
      5. Easy access to product (available on ambulances, field hospitals, hospital ships)
    4. Potential Disadvantages:
      1. Undesirable hemodynamic effects:
      2. Mean arterial pressure and pulmonary artery pressure increases
      3. Short half-life in bloodstream (24 hrs)
      4. Still in clinical trials.

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