Transfusion Medicine PDF

CHAPTER TRANSFUSION MEDICINE Matt...

CHAPTER TRANSFUSION MEDICINE Matthew B. Elkins, Robertson D. Davenport, Paul D. Mintz 37 BACKGROUND, 771 SELECTION OF BLOOD COMPO- Reactions, 781 NENTS, 775 Acute Hemolytic Reactions, 782 BLOOD COLLECTION, 771 Red Blood Cells, 775 Delayed Hemolytic Reactions, 782 BLOOD COMPONENT MANUFAC- Platelets, 776 Bacterial Contamination of Blood TURE, 773 Components, 782 Red Blood Cells, 773 PRETRANSFUSION TESTING, 776 Transfusion-­Related Acute Lung Plasma, 774 TRANSFUSION ADMINISTRATION, Injury, 783 Cryoprecipitated Antihemophilic 777 Transfusion-Associated Circulatory Factor, 774 Blood Component Therapy, 777 Overload, 183 Platelet Concentrates, 774 Massive Transfusion, 779 Graft-­Versus-­Host Disease, 783 Leukocyte Components, 774 Neonatal and Pediatric Transfusion, Hypotensive Reactions, 784 Leukocyte-­Reduced Blood 780 Nonimmune Hemolysis, 784 Components, 774 TRANSFUSION REACTIONS, 781 Transfusion-­Transmitted Disease, 785 Special Components, 774 Febrile Nonhemolytic Reactions, 781 Pathogen Reduction, 775 CONCLUSION, 786 Allergic Reactions, 781 Severe Allergic (Anaphylactic) SELECTED REFERENCES, 786 KEY POINTS BACKGROUND  riteria for blood donor eligibility are established by the U.S. Food and C Transfusion medicine is a multidisciplinary specialty encompassing all Drug Administration (FDA) to minimize risks to both the donor and aspects of blood donation, blood component preparation, blood cell serol- the transfusion recipient. ogy, and blood transfusion therapy. The term blood banking has largely  lood components (red blood cells, platelet concentrates, fresh frozen B been superseded by transfusion medicine to emphasize the importance of plasma, cryoprecipitate) are manufactured and stored in a manner to patient care and clinical outcomes. minimize functional loss of desired constituents. Operationally, transfusion medicine is divided between blood centers and transfusion services. Blood centers recruit and collect blood from L eukocyte reduction of blood components reduces alloimmuniza- donors and manufacture and distribute blood components. Transfusion tion to human leukocyte antigens, cytomegalovirus transmission, and services perform pretransfusion compatibility testing, select and issue febrile reactions. Irradiation of blood components can prevent graft-­ blood components for patients, and provide medical support for blood versus-­host disease. Pathogen reduction can significantly reduce risks transfusion. Most hospital transfusion services do not collect their own of transfusion-­transmitted infections. blood, but rather rely on regional blood centers.  ccurate identification of the pretransfusion blood sample and the A Blood centers and transfusion services (collectively known as blood estab- intended recipient is the most important step in preventing acute lishments) are regulated by the U.S. Food and Drug Administration (FDA). hemolytic transfusion reactions. All blood establishments must be registered with the FDA, and blood cen-  estrictive red cell transfusion (hemoglobin target 7–8 g/dL) is associ- R ters that manufacture blood components must be licensed for distribution ated with improved outcomes in some patient populations. in interstate commerce. Criteria for the acceptability of blood donors, performance of pretransfusion testing, manufacture of blood components,  latelet transfusion is generally indicated for microvascular bleeding, P donor infectious disease testing, and evaluation and reporting of adverse platelet count 15% of estimated blood volume components. Optimally, venous access should be established before a Hb