Handbook of Blood and Blood Products

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An attachment to the analysis — prepared for educational purposes only — depicts amended sections of Title 21 of the Code of Federal Regulations CFR. The final rule, reflected in updated sections of the CFR, becomes effective on May 23, You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Log In. Page Content. Overview Blood, a living tissue circulating throughout the human body, is comprised of red blood cells, white blood cells, platelets and plasma.

Association Bulletins. White Paper on Quarantine Release Errors. External Resources. The majority of transfusion recipients in Australia are aged over 65 years. Comprehensive regulations covering all aspects of blood donation and processing of blood products mean Australian blood supplies are among the safest in the world. Governance for prescribing and clinical use have been formalised in the National Safety and Quality Health Service Standards.

As with any biologically derived product, blood components have an inherent degree of variability.


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Although infectious risks have decreased, the noninfectious risks have remained relatively unchanged. When deciding whether to transfuse, the risks associated with transfusion must be weighed against the expected benefits to the patient, including the risks of not transfusing. Previously under-recognised adverse effects of transfusion are being increasingly reported. These include the increased incidence of postoperative infection, increased length of hospital stay and increased morbidity and mortality in certain circumstances.

Blood products comprise three broad categories: fresh blood products, plasma products and recombinant products see Fig. Red cells are used to improve the oxygen-carrying capacity of blood in cases of clinically significant, symptomatic anaemia. A third of red cell transfusions in Australia are used in support of surgery elective and emergency , a third in haematology and oncology patients, and a third in medical and other contexts. Faced with the situation whereby both anaemia and its treatment with transfusion are associated with unfavourable outcomes, early and adequate investigation for anaemia is important to identify the underlying cause and consider alternatives to transfusion.

This is particularly the case in patients who need elective surgery, as timely identification and treatment of anaemia could obviate the need for transfusion in the perioperative period. Therapy could include iron supplementation oral or intravenous in the case of iron deficiency anaemia. Reticulocyte counts improve in as little as three days and haemoglobin should increase appreciably within two to three weeks. Correction of anaemia and repletion of iron stores can take 3—6 months with oral iron supplements, but can occur more rapidly with intravenous preparations.

Erythropoiesis-stimulating drugs increase haemoglobin concentration in many anaemic patients, but supraphysiological doses are required outside the context of renal failure. However, there is an increase in the risk of thromboembolic disease in the short 15 , 16 and long term 17 and these drugs have a trophic effect on some cancers.

If transfusion therapy is necessary for anaemia, the aim of red cell transfusion is not to normalise the haemoglobin concentration, but to improve the oxygen-carrying capacity of the blood to tissues. As tissue hypoxia cannot be directly measured, clinical assessment of the patient and evaluation of the pre-transfusion haemoglobin concentration are the primary considerations in the transfusion decision.

When prescribing red cells for transfusion in the patient without active bleeding, a single unit is recommended with clinical reassessment. If necessary, assessment of the haemoglobin increment should guide the need for further transfusion. This single unit policy is not appropriate in actively bleeding patients, those with severe anaemia, or in chronically transfused patients who need ongoing transfusion. Platelets are also used in cases of massive transfusion.

Clinical Guide to Transfusion

It is crucial to identify the cause of thrombocytopenia, as platelet transfusion is ineffective in immune-mediated platelet destruction, and may be contraindicated in some thrombocytopenic conditions. The risk of bleeding is also influenced by factors other than platelet count, including infection, concomitant medicines, vascular injury and coagulopathy.

Fresh frozen plasma comprises the acellular component of blood and contains all of the coagulation factors. It is used in patients with coagulopathy who are bleeding, or at risk of bleeding, when more specific therapy is not appropriate or available. Fresh frozen plasma is most commonly used in massive transfusion, cardiac bypass, liver disease or acute disseminated intravascular coagulopathy.

Abnormalities in coagulation tests such as prothrombin time or activated partial thromboplastin time are poorly predictive of bleeding, and prophylactic use to correct laboratory abnormalities is not recommended. Cryoprecipitate and cryodepleted plasma are derived from fresh frozen plasma. Cryodepleted plasma contains all the other coagulation factors. These products have limited indications.

Cryoprecipitate is used for hypofibrinogenaemia, and cryodepleted plasma is used in plasma exchange for thrombotic thrombocytopenic purpura. These are fractionated from plasma and are classified into three groups: immunoglobulins, coagulation factor concentrates and albumin preparations. The main indication for these products is to replace reduced or dysfunctional plasma proteins. Immunoglobulin preparations and RhD immunoglobulin are used to elicit an immunomodulatory response. Immunoglobulins can be divided into two groups — normal immunoglobulin and hyperimmune immunoglobulin.

Definitions

This is prepared from normal donors and contains normal concentrations of antibodies against prevalent infections. It is available in intramuscular, intravenous and subcutaneous formulations. These immunoglobulins are used in inherited and acquired immunodeficiency syndromes to replace deficient immunoglobulins. They are also used as an immunomodulator in a range of haematological, neurological, dermatological and inflammatory conditions. Approved indications are detailed in the 'Criteria for the clinical use of intravenous immunoglobulin in Australia'.


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  • Intramuscular preparations are used for passive immunisation of susceptible contacts of patients with infections such as measles, rubella, poliomyelitis and hepatitis A to provide immediate protection against infection. Guidance in specific situations is provided in the Australian Immunisation Handbook. This is prepared from donors who have responded to a specific infection or immunisation and contains high concentrations of specific antibody.

    These products can be used in the management of exposure to specific infections in susceptible patients. Exposure to rabies and the Australian bat lyssavirus are treated with rabies hyperimmune globulin. Individuals at high risk of these infections should be actively vaccinated.

    Rabies immunoglobulin is in short supply and is only available from public health units. RhD immunoglobulin anti-D is used to prevent immunisation of RhD negative women to the RhD antigen and consequently RhD haemolytic disease of the newborn. Current recommendations include a routine antenatal schedule for RhD negative mothers after potentially sensitising events such as miscarriage or the birth of an RhD positive baby.

    Guidelines on the prophylactic use of RhD immunoglobulin are available from the National Blood Authority. These are indicated for patients with specific factor deficiencies and a haematologist would normally be involved. The main exception is warfarin reversal with prothrombin complex concentrate in patients who are bleeding and have an elevated INR.

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    Blood Components | Professional Education

    Consensus guidelines for warfarin reversal have recently been updated. Recombinant products are manufactured from genetically engineered cell lines and are not purified from blood. They are generally coagulation proteins used for inherited bleeding disorders in which there is a deficiency of a specific protein in the coagulation cascade, for example, recombinant factor VIII for haemophilia A and recombinant factor IX for haemophilia B.

    They may also be used for patients with bleeding disorders who have developed antibodies that interfere with usual therapy. The costs associated with these products are significant, but they are the safest option and are used whenever possible. Patient blood management refers to the management and preservation of the patient's own blood with the aim of reducing or avoiding the requirement for the transfusion of blood components.

    The three 'pillars' of patient blood management include: 30 , The shift from component-based guidelines emphasises the importance of correlation with the clinical scenario to achieve the best patient outcomes using evidence-based transfusion practice.

    Transfusion of Blood and Blood Products: Indications and Complications

    The National Blood Authority is developing six evidence-based patient blood management guidelines, each focusing on a patient-based clinical approach. The increasingly evidence-based application of therapeutic decision making in transfusion medicine has the potential to improve patient outcomes, reduce healthcare costs, and slow the inevitable deficit in supply. In the alignment of economic and therapeutic considerations, there is the opportunity for widespread adoption of patient blood management principles.