Donor Screening and Blood Transfusion - Modern Blood Bank PDF

Chapter 11 **Donor Screening** The donor should register his information correctly including his name (first, middle and last), date and time of donation, address, contact number, gender, age and date of birth. He should complete the medical history questionnaire and he should undergo the physical...

Chapter 11 **Donor Screening** The donor should register his information correctly including his name (first, middle and last), date and time of donation, address, contact number, gender, age and date of birth. He should complete the medical history questionnaire and he should undergo the physical examination including the general appearance, weight, temperature, pulse (50-100 bpm), blood pressure (less than 180/100 mmHg), hemoglobin (12.5-15 g/dl) and skin lesion check. Donor Deferment Donors will be indefinitely deferred if they have a history of viral hepatitis, (+) HBsAg , reactive for Anti-HBc, past/present evidence of Hepatitis C infection, have been involved in post transfusion hepatitis, history of jaundice of unknown cause, past/present abuse of self-injected drugs, cancer, abnormal bleeding tendencies. (e.g. hemophilia A of B), cardiopulmonary diseases, leukemia, lymphoma, high risk sexual behavior, high risk occupation (e.g. prostitute), Chaga's disease, babesiosis, active pulmonary TB and donors taking Tegison for psoriasis because its potentially teratogenic. Those receiving human pituitary growth hormone (because of the risk of transmission of Creutzfeldt-Jakob disease, a prion disease similar to mad cow disease in cattle) will also be deferred permanently as well as those presenting symptoms of AIDS Related Complex (ARC), HIV/AIDS (these S/S includes persistent night sweats, fever for more than 10 days, significant weight loss, etc). Three Years Deferral will be given for those infected with malaria and visitors, immigrants or refugees from an area considered endemic for malaria/ residents of area endemic for malaria. 12-month deferral for donors with close contact to patient with hepatitis, who received blood or blood products, an organ or tissue transplant, with tattoo, ear and skin piercing, those who have received HBIg because it is given for exposure to possible infection and it may delay the onset of symptoms of disease, donors who have had or been treated for syphilis or gonorrhea, (+) serologic test for syphilis, donors who have traveled to areas considered endemic for malaria (don't defer a donor who started antimalarial therapy in preparation for travel to areas endemic for malaria), sexual contact with any person who has high risk of exposure to HIV, and surgical procedure (major/minor). Rabies vaccine (following the bite of a rabid animal) is also given a year deferral. Two months (8 weeks/ 56 days) for donors who had a recent whole blood donation. 6 weeks is given to pregnant women( deferred during pregnancy and 6 weeks following a third trimester delivery), 1^st^ and 2^nd^ trimester abortion or miscarriage need not to be a cause for deferral. Donors taking Accutane (isotetinoin for acne therapy is also a potent teratogen) should not be allowed to donate for one month (4 weeks) as wells as those who received vaccines for some diseases such as Rubella (German measles) and Varicella zoster (chicken pox). Those who have received attenuated virus vaccines for mumps, oral polio (Sabin), rubeola (measles), small pox, yellow fever and influenza (live virus) should be given a two-week deferral period. Those who have had a tooth extraction or dental work and patients taking aspirin within the last three days (If the donor is being evaluated for platelet pheresis procedure) should be deferred for three days. Donors participating in aphaeresis program can only donate after 48 hours. 24 hours is given to donors who have drunk alcoholic beverages. Donors who have active cold or flu symptoms must be deferred until the symptoms are gone. Donors who had vaccinations of the following killed viral, bacterial, rickettsial vaccines or toxoids such as diphtheria, tetanus, cholera, Hepa B vaccine, pertussis, typhoid, RMSF, Influenza (killed), injectable polio vaccine (Salk) need not be deferred. After blood collection, the unit should be checked for ABO/Rh, antibody screen, HBsAg, Anti-HBc, Anti-HCV and NAT, Anti-HIV 1/2 and NAT, WNV RNA, Anti-HTLV I/II and Syphilis. **Blood Grouping** Testing for donor ABO blood group must include both forward and reverse group and be cleared from any discrepancies. RhD negative should be confirmed by AHG phase. **Antibody Screening** Antibody screening should be performed by AHG. Donors with a positive antibody screen should be deferred. **HBsAg** The test procedure used must be approved by the FDA. The method approved are radioimmunoassay (RIA), enzyme linked immunosorbent assay (ELISA) and reverse positive hemagglutination (RPHA). **Anti-HBc** All HBsAg negative should be confirmed by Anti-HBc by approved methods. **Anti-HCV and NAT** The test procedure used must be approved by the FDA like enzyme immunoassay (EIA) parallel with NAT. Use the recombinant immunoblot assay (RIBA) or NAT to confirm the positive serological result. **Anti- HIV 1/2** The test procedure used must be approved by the FDA**.** Confirm all positive results by Western blot and NAT. **Important Points** - An allogeneic blood donor should weigh at least 110 lb (50 kg). - The pulse rate of a potential blood donor should be between 50 and 100 beats per minute. - The hemoglobin/hematocrit level of an allogeneic blood donor should be at least 12.5/38%. - A donor must be permanently deferred if he or she has had a confirmed positive test for HBsAg after the 11th birthday. - The deferral period for persons who have been treated for malaria is 3 years following therapy. - Persons who have had a blood transfusion are deferred for 12 months owing to risk of exposure to hepatitis, HIV, or other viral diseases. - A platelet pheresis donor should not have taken aspirin for 3 days before donation because it decreases platelet function. - The interval between whole blood donations is 8 weeks or 56 days. - A person with a history of hemophilia A or B, von Willebrand disease, or severe thrombocytopenia must be permanently deferred from donating blood. - Attenuated live viral vaccines such as smallpox, measles, mumps, yellow fever, and influenza (live virus) carry a 2-week deferral. - Attenuated live viral vaccines such as German measles (rubella) and chickenpox (varicella zoster) carry a 4-week deferral. - A blood donor who has a positive serologic test for syphilis must be deferred for 12 months. - Donors who have tested positive for the HIV antibody must be indefinitely deferred. - *Predeposit autologous donation* refers to blood for the donor-patient that is drawn before an anticipated transfusion (e.g., surgery) and stored until use. - An autologous donor must have a hemoglobin of at least 11 g/dL and a hematocrit level of at least 33%. - Intraoperative autologous transfusion occurs when blood is collected during a surgical procedure and is usually reinfused immediately. - Acute normovolemic hemodilution takes place in the operating room when 1 to 3 units of whole blood are collected and the patient's volume is replaced with colloid or crystalloid. The blood is reinfused during the surgical procedure. - Postoperative salvage is an autologous donation in which a drainage tube is placed in the surgical site and postoperative bleeding is salvaged, cleaned, and reinfused. - All whole blood units should be stored at 1°C to 6°C; those units destined for platelet production should be stored at 20°C to 24°C until platelets have been removed. - Donor units must be tested for the following viral markers: STS, anti-HIV-1/2, HIV-antigen, anti-HTIV I/II, HBsAg, anti-HBC, and anti-HCV. - RBCs must be prepared by a method that separates the RBCs from the plasma and results in a hematocrit level of less than or equal to 80%. - Irradiated RBCs must be given a radiation dose of at least 25 Gy to the midplane of the canister, after which the expiration date of the product changes to 28 days from the time of irradiation or maintains the original outdate, whichever comes first. - Leukocyte-reduced RBCs are products in which the absolute leukocyte count is less than 5 x 10\^6. - Random-donor platelets must contain at least 5.5 x 10\^{10} platelets; single-donor platelets must contain at least 3 x 10\^{11} platelets; each carries a shelf-life of 5 days. - FFP must be prepared within 8 hours of collection for CPD, CPDA-1, and CP2D; it is stored at --18°C for 12 months. - Cryoprecipitate is prepared from FFP and contains at least 80 units of antihemophilic factor and 150 to 250 mg of fibrinogen; this product is indicated for hemophilia A, factor XIII deficiency, and hypofibrinogenemia. - RhIg is a solution of concentrated anti-Rh\_0(D), which is manufactured from pooled hyperimmunized donor plasma. It is used to prevent Rh\_0(D) immunization of an unesensitized Rh-negative mother after an abortion, miscarriage, amniocentesis, or delivery of an Rh-positive or Rh-unknown infant. - One unit of random-donor platelets typically increases the platelet count in a 70-kg adult by 5,000 to 10,000/μL; 1 unit of apheresis platelets should increase the platelet count in a 70-kg adult by 30,000 to 60,000/μL. **Chapter 15** **Blood Transfusion Therapy and Transfusion in Transplantation** Blood and blood components are used as treatment and are considered drugs. Transfusion therapy is used primarily to treat the following conditions: inadequate oxygen-carrying capacity because of anemia or blood loss, insufficient coagulation proteins to provide adequate homeostasis, platelets to provide adequate homeostasis. **WHOLE BLOOD ( W. B.)** WB is composed of RBCs (Hct : 40 %), plasma, WBCs, platelet '' not function ", anti-coagulant (63 ml to 70 ml to 450 +- 45 ml or 500 + - 50 ml of whole blood). W.B. expires 21-35 days depending on the preservative used. Whole blood is used to replace the loss of both RBCs and plasma volume in rapidly bleeding , plasma deficient labile factors V and VIII after 8 Hrs of collection. One unit of W.B. can increase the Hct from 3-5% and the Hgb from 1-1.5 g\\dl during 48 for 72 hrs. Major use of W.B today is for autologous transfusion. Any unit less than 405 up 300 ml is considered as W.B. Additive solution (A.S.) added within 72 hrs , 450+ - 45 added 100 of A.S. **Packed Red Blood Cells (PRBCs)** PRBCs has approximately 75%(70-80%) Hct or approximately Hct 55-60% with A.S. Reduced plasma, WBC, platelets and anticoagulants. PRBCs volume is 300 ml + - 50 ml. PRBCs expiry is 21-35 depending on the preservative but with A.S. the expiry will be 42 days. PRBCs increase Hgb and Hct more quickly than unit of whole blood. PRBCs is indicated for conditions including pulse rate less than 100 beats \\min, respiratory rate 30 breaths \\min, surgical and leukemic patient with critical Hgb level less than 6 g/dl, OR with critical level 8 g/dl for patient with heart, lung or cerebral vascular disease, anemic patient with Hgb level less than 6 g/dl, critical level less than 8 g/dl for patient with heart, lung or cerebral vascular disease, healthy person can tolerate Hgb 5 g/dl by decrease activity and rest at bed, patient on renal dialysis could tolerate Hgb 6 g/dl by also decrease activity and rest on the bed. PRBCs transfusion is not recommended for that nutrition anemia , such as iron deficiency or pernicious anemia un less the patient shows "Decompensation". And also not recommended to promote wound healing, prevent infection , expand volume or prevent future anemia. The advantages of using RBCs rather than whole blood includes, equal O2 capacity in half volume, reduce level of significant antibody ( anti-A & anti-B ) reduce risk of transfusing O group to non O group, reduce level of acid ,citrate and potassium in unit where the acid level and citrate level lead to toxicity and Potassium load in patient lead to cardiac, renal, liver disease and the Centrifuged bag remove most of anticoagulant with plasma. **Washed Red Blood Cells and Frozen Deglycerolized** Washed RBCs is free of plasma protein components. It is indicated for patients who have severe allergic (anaphylactic) transfusion reaction, washed RBC one of used, for rare patient with IgA deficiency and patient with anti- IgA antibodies. Freezing RBCs allows the storage of rare blood group, autologous and special purposes Washed or deglycerolized RBCs should be infused in the same manner as that of PRBCs. Washed RBCs and deglycerolized RBCs has an expiry of 24 hours. **Leukocyte --reduced RBCs** Leukocyte-reduced RBCs contain RBCs and few platelets less, WBCs between 5 X 10^6^ to 5 X 10^8^ (USA standard should be less than 5 X 10^6^ , Europe standard should be less than 1 X 10^6^). It is indicated to reduce the risk of febrile non hemolytic transfusion reaction, Human leukocyte antigen alloimmunization, Transfusion --related acute lung injury (TRALI) and Transfusion -associated graft versus --host disease (TA-GVHD). Also it reduces the risk of transfusion of cytomegalovirus (CMV), Epstein -- Barr virus (EBV), HIV,HTLV. The WBCs should be less than 5 X 10^8^ to prevent (FNHTR). WBCs less than 5 X 10^6^ prevent and reduce other complications. **FFP Transfusion Therapy** **Coagulation disorders** 1. Haemophilia A. - Deficiency of F VIII. - Prolonged APPT. and F VIII COAG assay low. - Treatment by F VIII concentrate - Spontaneous bleeding can be controlled if F VIII\>20%. - Major surgery, post-traumatic bleeding and hemorrhage occur in dangerous sit F VIII should be \>100% and then maintained \>60%. 2. Haemophilia B. - Deficiency of F IX. - Prolonged APTT and F IX assay low. - Treatment with F IX concentrate. 3. Von willebrands disease (VWD). - Abnormal platelets adhesion. - Low F VIII activity. - Prolonged bleeding time. - Factor VIII assay low. - Factor VWF assay low. - Treated by FVIII with vWF. 4. Acquired coagulation disorder - Vitamin K deficiency. - Vitamin K is fat-soluble. - Present in green vegetables. - Bacterial synthesis in the gut. - Causes of deficiency table 18.3 p341. - Warfarin act as V K antagonists lead to decrease functional activity of F II, VII, IX, X, proteins C and S. - PT and APTT prolong. And low level of F II, VII, IX, and X in plasma. - Treatment by Prophylaxis vitamin K. - FFP if there hemorrhage is sever. - Liver disease. - Disseminated intravascular coagulation. - Causes of DIC. - Low platelet count. - Low level of fibrinogen. - TT prolongs. - Increase level of fibrinogen degradation products in serum and urine. - Treatment of underlying cause is most important. And supportive therapy with FFP. **Haemostatic function** 1. Blood count and blood film examination. - Blood count. - Platelets count. - Blood film examination. 2. Bleeding time: - To detects abnormal platelet function (normal rang 3-8 min. with platelets count \>75X10^9^ /L). 3. Screening tests of blood coagulation: a. (PT) the prothrombin time. Screening for [F VII], X, V, prothrombin, fibrinogen.(normal rang 10-14sec.). b. (APTT) the activated partial thromboplastin time. Screening for [F VIII, IX, XI, and XII] plus (X, V, prothrombin and fibrinogen).(normal rang 30-40sec.) c. (TT) the thrombin clotting time detect if there is deficiency of fibrinogen or inhibition of thrombin. (normal rang 14-16sec.) fig  fig  fig **Plasma** FFP (Fresh Frozen Plasma) is plasma prepared from whole blood (which has target collection time of 4-10 min. up to 15 min. with minimal trauma to tissue during venipuncture to prevent activation of coagulation system ) or an aphaeresis collection and frozen within 8 Hrs of collection at-18^o^C or colder used up to 1 year or at --65^o^C and used up to 7 year. FFP contains water, carbohydrates, fats, minerals, proteins "which include all labile & stable clotting factors" , 1mL of FFP contain 1unit of coagulation activity , \[ (1 IU/ml) labile and non-labile clotting factors. ~BBTM~\] A [coagulation factor unit] is defined, as the activity in 1ml of pooled normal plasma i.e. 100% activity is 1 unit/ml or 100 units/dl. FFP volume is 200 -225 ml. FREEZING METHOD Placing as soon as possible frozen by: 1. Placing the bag in a dry ice-ethanol or dry ice-anti-freeze bath. 2. Placing the bag in between layers of dry ice. 3. Placing the bag in a blast freezer. 4. Placing the bag in a mechanical freezer maintained at --65^o^C. Thawed FFP in 37^o^C for 30 min. should be transfused during 24 Hrs. after that can be stored in fridge at 1-6^o^C for up to 5 days and used as THAWED PLASMA. **THAWED PLASMA** is plasma containing all stable proteins factors. **PLASMA FROZEN WITH 24 Hrs OF COLLECTION (8-24 Hrs)** contains all the stable proteins, should be transfused immediately after that can be stored in fridge at 1-6^o^C up to 5 days and used as THAWED PLASM. **PLASM AND LIQUID PLASMA** is plasma containing all plasma content and lack of labile factors. Plasma prepared from whole blood and stored at-18^o^C used up to 5 years but if kept in 1-6^o^C used up to 5 days of collection of WB. ~AABB,\ ch.8~ **PLASMA CRYOPRECPITATE REDUCED** is plasma containing all plasma content and lack of labile factors V, VIII, vWF, fibrinogen, cryoglobulin and fibronectin. This product is used exclusively in the treatment of TTP. **SOLVENT/ DETERGENT TREATED POOLED PLASMA**. Methods: 1. Pooled no more than 2500 units of ABO type specific plasma. 2. Frozen to preserve labile coagulation factors. 3. Thawed and treated with the solvent tri-n-butyl phosphate and the detergent triton X-100 for 4Hrs at 31^o^C to inactivate lipid-enveloped viruses. 4. Remove S/D by extraction and column chromatography process. 5. Remaining plasma is sterile-filtered into standardized 200mL volume 6. Refrozen. Plasma contain labile and stable coagulation factors in same amount to FFP (\>0.7 IU/mL of factors V, VIII, X, XI and XIII) and (1.8 mg/mL of fibrinogen thawing and stored at 1-6^o^C for 24 Hrs. Protein C, S,α2-antiplasmin and α1-anti-trypsin are decreased and lack of vWF. S/D plasma in place of FFP and reduced low risk of disease transmission (HIV, HTLV, HBV, HCV and other lipid-enveloped viruses). S/D not used for pregnant women.  **FFP Indications:** - Massive transfusion and Bleeding. ~BBTM~ ~&\ modern~ - Replacement of coagulation factors."Factors: V, VIII, IX where 10%-15% of factor V levels are needed to maintain homeostasis". ~BBTM~ - Management of multiple factors deficiency."Liver disease". ~BBTM~ Treatment of antithrombin deficiency and TTP." Antithrombin heparin cofactors is serine protease inhibitor, normal range 84%-116%. Reverse the affect of sodium warfarin (coumadin) and warfarin over dosage. Treated multiple coagulation deficiencies occurring in patient with DIC. Patient with vitamin K deficiency. Before surgery if patient is on warfarin where INR should be less than 1.2 and for eye surgery where INR is less than 1.0. Factor XI deficiency "long half life". Replacement fluid during plasma exchange. Thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, syndrome of hemolysis elevated liver enzymes and low platelets (HELLP), for these cases FFP can provides unknown substance that lead to reversing the symptoms. Plasma is not used as a volume expander "crystalloid- colloid solution" and as a nutritional source. It should not be given if there is more effective treatment for coagulopathy." Factors VIII, IX or others". **Platelet Transfusion Therapy** Platelets are essential to the formation of the primary haemostatic plug and provide the haemostatic surface upon which fibrin formations occur. Platelets are produced in the bone marrow by fragmentation of the cytoplasm of megakaryocytes. Each megakaryocyte is responsible for the production of about 4000 platelets. Life span of PLT is 7-10.5 days PLT plug formation result from the combined processes of adhesion activation, release, aggregation and procoagulant activity. **Adhesion**: PLT Adhesion to damaged endothelium by the von willebran factor (VWF), VWF bind to glucoprotein receptor on the PLT (GPIb) lead to change PLT shape where changing the binding properties of membrane activation proteins. **Releasing**: of internal granule contents and activation of several metabolic pathways. **Aggregation**: recruitment of additional platelets by fibrin binding to IIb /IIIa. **Platelet procoagulant activity**: after releasing and aggregation, forming coagulation protein complex then forming fibrin. The normal platelet count is 150-400 X10^9^/L and the mean platelet diameter is 1-2um. Assessing PLT function is by medical history, physical examination, PLT count, bleeding time. These are poor predictors of surgical bleeding and are not reliable indicators of the need for PLT transfusion therapy. **Thrombocytopenia** When platelets count becomes \< 150.000 /uL and / or dysfunctional it is called thrombocytopenia. Patient with severe thrombocytopenia may have petechiae, easy bruising, and ecchymoses, mucosal or spontaneous hemorrhage. The main causes of thrombocytopenia are failure of platelets production, disorder of platelets function (Hereditary or Acquired) and increase destruction of platelets due to: 1. Chronic autoimmune thrombocytopenic purpura (ITP). 2. Acute immune thrombocytopenia. 3. Infection by virus or protozoa, e.g.: malaria. 4. Post-transfusion purpura, develop of anti- PL^A1^. 5. Drug-induced immune thrombocytopenia. 6. Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). 7. Disseminated intravascular coagulation (DIC). 8. Increased spleenic pooling (splenomegaly). 9. Massive transfusion syndrome. **Platelet transfusion** Significant bleeding due to thrombocytopenic or abnormal platelet function is an indication for therapeutic platelet transfusion, Many stable thrombocytopenic patient can tolerate platelet count as low as 5000/uL. **Indication :** 1. Severe thrombocytopenia \ 10.000/uL/m^2^. Absolute platelet increment = post transfusion -- pre transfusion platelet count. BSA = kg^(0.5378)^cm^(0.3964)^ **Platelet Selection** ABO antigens are present on the platelet surface. Incompatible ABO groups is not clinically significant and hemolysis rarely occurs. The D antigen is not present on the platelet but 0.5 mL of Rh D positive RBCs can immunize a recipient who is Rh D negative, therefore, one should select Rh D negative for a recipient who is Rh D negative. If there is no Rh D negative platelet, prophylactic anti-D (10ug for one Rh D positive unit) should be given to the recipient within 72hrs especially if the patient is a girl and a woman of childbearing age. For neonatal and pediatric transfusion, select group-specific if possible, or resuspend the unit in saline or albumin or AB plasma or group-specific plasma. **Refractoriness to platelet transfusion** HLA matched platelets should be irradiated. Washing platelet components removes some plasma protein for patients suffering from allergies. BSA = (W ^0.425^ x H ^0.725^) x 0.007184 Platelet refractoriness is defined as poor increment following a dose of platelets, due to auto/allo- anti-platelets or anti-HLA, infection, splenomegaly, drugs or accelerated platelet consumption. **Platelet aphaeresis** Platelet aphaeresis is indicated for alloimmunized recipient who are refractory to platelet transfusion, the transfusion of single unit that is HLA-matched or cross match compatible may improve the clinical response. **Quality Control of the Platelet Unit** The platelet count should be more than 5.5 X10^10^/ unit and the volume of plasma suspended must be 60-50mL. The pH at end of the day expiration should be more than 6.2. The platelet should be stored in the agitator at 20-24C. The expire date is after 5 days of collection. Platelet leukocytes reduced must contain less than 8.3 X 10^5^ WBCS /unit. Platelet aphaeresis leukocytes reduced must contain \ 25% total blood volume or | | | actively bleeding and received 4 | | | units RBCs | +-----------------------------------+-----------------------------------+ | Outcome | H/H ˂ 24 hours after transfusion, | | | Surgical procedure :post | | | operation hemoglobin ˂ | | | preoperative hemoglobin | +-----------------------------------+-----------------------------------+ | RBCs | | +-----------------------------------+-----------------------------------+ | Indications: | Decreased oxygen-carrying | | | capacity | | | | | | Acute loss of ˃ 15% blood volume; | | | hemoglobin ˂ 6 g/dL or hematocrit | | | ˂18% or symptoms related to | | | anemia | +-----------------------------------+-----------------------------------+ | Exceptions: | Patient with hemoglobin ˃ 7 g/dL | | | and coronary artery disease, | | | chronic pulmonary disease or | | | cerebral vascular disease | +-----------------------------------+-----------------------------------+ | Outcome: | H/H ˂ 24 hours after transfusion; | | | Surgical procedure :post | | | operation hemoglobin ˂ | | | preoperative hemoglobin | +-----------------------------------+-----------------------------------+ | Platelets | | +-----------------------------------+-----------------------------------+ | Indications: | Platelet count [˂]{.math.inline} | | | 5000-10000/μL without hemorrhage | | | or hemorrhage and platelet count | | | \< 50000 /μL or operative | | | procedure \ 60 sec or INR \> | | | 1.8 or documented coagulation | | | factors deficiency | +-----------------------------------+-----------------------------------+ | Outcome: | Correction of PTT, PT or | | | coagulation factors assay | | | immediately before and fewer than | | | 4 hours after transfusion | +-----------------------------------+-----------------------------------+ | Cryoprecipitate | | +-----------------------------------+-----------------------------------+ | Indications: | Fibrinogen deficiency or factors | | | XIII deficiency | +-----------------------------------+-----------------------------------+ | Outcome: | Fibrinogen, factors XIII | | | determination after transfusion | +-----------------------------------+-----------------------------------+ | H/H hemoglobin hematocrit | | +-----------------------------------+-----------------------------------+ **Important Points** - Transfusion therapy is used primarily to treat two conditions; inadequate oxygen-carrying capacity because of anemia or blood loss insufficient coagulation proteins to provide adequate hemostasis. - A unit of whole blood or packed RBCs in an adult should increase the hematocrit level 3 percent or haemoglobin level 1.0-1.5 g/dL. - RBCs are indicated for increasing the RBC mass in patients who require increased oxygen-carrying capacity. - Platelet transfusions are indicated for patients who are bleeding because of thrombocytopenia. In addition, platelets are indicated prophylactically for patients who have platelet counts under 5000-10,000/uL. - Each unit of platelets should increase the platelet count 5000-10,000/uL in the typical 70-kg human; each should contain at least 5.5 x 10^10^ platelets. - A plateletpheresis product is prepared from one donor and must contain a minimum of 3 x 10^11^ platelets. - FFP contains all coagulation factors and is indicated for patients with multiple coagulation deficiencies that occur in liver failure, DIC vitamin K deficiency, warfarin overdose, and massive transfusion. - Cryoprecipitate contains at least 80 units of factor VIII and 150 mg of fibrinogen, as well as vWF, and factor XIII. - Factor IX is used in the treatment of persons with haemophilia B. - Immunoglobulin (Ig) is used in the treatment of congenital hypogammaglobulinemia and patients exposed to hepatitis A or measles. - Massive transfusion is defined as the replacement of one or more blood volume (s) within 24 hours, or about 10 units of blood in an adult. - Emergency transfusion warrants group O RBCs when patient type is not yet known.