WHERE DO OUR BLOOD AND BLOOD PRODUCTS COME FROM? Australian Red Cross Blood Service collects >900,000 units of whole blood from volunteer donors every year Only2.5% of Aussies are blood donors!!! Australia is self sufficient in blood and blood products with the exception of some manufactured plasma products – IVIgG, Rh anti D, some Factor 8 and Factor 9 products What happens to a blood donation? • Processed or ‘fractionated’ into - 1 unit of concentrated (packed) red cells (PC) 1 unit of fresh frozen plasma (FFP) 1 (of a pool of 4) units of platelets (1 unit of pooled platelets is from 4 donors) A special process is used to leucoreduce red cells and platelets which reduces febrile nonhaemolytic reactions to transfusion • How much do we use in HNEAHS? Every year ~ 23,000 units of red cells 3,500 units pooled platelets 3,500 units fresh frozen plasma 210 paediatric ‘quad’ packs 4,500 bottles Albumex 4 2,300 bottles Intragam 3gm 4,500 bottles Intragam 12gm 4,000 vials Rh anti D Ig What does it cost? The cost of products alone is ~ $7million 1 unit PC - $242 1 unit pooled platelets - $430 1 unit FFP - $50 1 bottle Albumex 4 - $80 1 bottle Intrgam 3gm - $250 1 bottle Intragam 12gm - $1015 1 vial Rh anti D - $115 Every donation undergoes extensive testing • ABO and Rh D typing • Extended blood group typing of some units to provide compatible blood for patients with red cell antibodies stimulated by pregnancy or previous transfusion • Plasma is tested for antibodies against red cell antigens Transfusion transmitted disease testing • Syphilis • HIV 1 and 2 • Hepatitis B • Hepatitis C • HTLV 1 and 2 • CMV – not all donations (60% donors +ve) Diseases screened by donor questionnaire (no test available) • Malaria – can be transmitted in red cells only – • • • exclusion for 1 year after travel to endemic areas (test coming) Creuztfeldt-Jakob disease (CJD) – causes ‘mad cow ‘ disease – never reported in Australia - 4 possible cases world wide – donors excluded who have spent 6 months in the UK between 1 Jan 1980 and 31 Dec 1996 or had a transfusion in UK Dengue fever – sporadic - far Nth Qld West Nile virus – sporadic - USA Indication for transfusion • Red cells are the oxygen transport system of the body - essential for life - the only indication for red cell transfusion is to supply oxygen to vital organs - causes of reduced oxygen transport blood loss bone marrow failure – chemotherapy - haematological malignancy - comorbidities can increase the need for red cells - lung disease cardiac disease • A normal red cell has a life span of ~ 120 days • A unit of packed cells has an expiry of 42 days after collection – this is calculated so that 75% of transfused red cells are viable at the time of expiry of the unit • Normal Hb – adult female 115 – 165 g/L adult male 130 - 180 g/L • Platelets – normal function is to initiate the clotting process • 150 – 400 x 10~9/L • Normal life span 9 days / expiry 5 days after collection • For prevention of surgical bleeding need platelet count > 80 x 10~9/L • Haemato-oncology patients with bone marrow • failure – stable , not bleeding, not febrile – prophylactic transfusion if platelet count <10 x 10~9/L Aspirin and NSAID’s interfere with normal function – cease 7 days preop Decision to transfuse In all cases transfusion must be a balance of the benefits versus the risks Transfusion is never completely risk free Risk > Benefit Benefit > Risk Hb Thresholds Haemoglobin g/L 4 0 5 0 6 0 Reversible in short-term 7 0 8 0 9 0 10 0 11 0 Additional factors in compromise of oxygen transport Within this region individual patient factors determine transfusion threshold 12 0 13 0 14 0 Clinical Responsibilities Transfusion Reaction Notify Medical Officer (MET/ Medical Response call) Patients observations to be attended All clerical and identity checks to be repeated Provide supportive therapy. Change giving set – keep line open with N/ Saline as ordered. Contact Blood bank/ Pathology immediately Return used pack Send patient blood/ urine specimens with form as directed by your Laboratory