Professional Documents
Culture Documents
GENERAL COMMENTS:
Blood components should only be given when clearly indicated! I.e. when the expected
benefits to the patient are likely to outweigh the potential hazards!!!
Blood transfusion in Australia is very safe because we have a rigorous screening program
in place (incl. HIV, HBC, HCV and syphilis), although one can not exclude 100% rare
infections with Hep G or prion (Creutzfeld-Jacob disease, CJD).
Blood is usually given with reservations and in otherwise healthy patients not considered
unless Hb <80g/L
WHOLE BOOD:
The total blood volume of a 70 kg adult is approximately 75 ml/kg or 5 litres.
Whole blood has limited usefulness as a transfusion therapy. Although it can
provide both volume and oxygen-carrying capacity, this is often better achieved
using the individual blood components.
Disadvantages of whole blood, partially because of degradation during storage,
include low levels of clotting factors, frequently elevated levels of potassium,
hydrogen ion and ammonia, and the presence of a large number of antigens. It also
can cause circulatory overload!
A unit of whole blood contains about 500 ml of blood plus a preservativeanticoagulant:
i. Citrate - anticoagulant
ii. Phosphate - reduces haemolysis
iii. dextrose - energy source for RBC
iv. adenine. maintains ATP levels
PACKED RED BLOOD CELLS:
Red blood cell replacement is usually done with packed red blood cells , primarily
to increase oxygen-carrying capacity!!!
One unit of packed cells (about 300 mls) raises an adults haemoglobin by 1 g/dl
or the haematocrit by 3% and is usually transfused over 1 to 2 hours unless there is
haemodynamic instability.
ADVANTAGES OVER WHOLE BLOOD: longer life, less storage lesions /
citrate /Na / K, less antigens transferred
DISADVANTAGES: slower flow, smaller volume, higher viscosity
INDICATIONS:
o Hb level <7g/dl
o Hb level < 10 g/dl if significant symptomatic angina or CCF or syncope or
active bleeding!
o Hb should not be the sole deciding factor. Consider also patient factors,
signs and symptoms of hypoxia, ongoing blood loss and the risk to the
patient of anaemia.
PLATELETS:
INDICATIONS:
- bleeding and platelets < 50 or skin bleeding time >2x!
- born marrow failure with platelets <109/L
- platelet dysfunction