Blood Products

Thoroughbred ensures better O2 transport capacity, volume expansion and a better replacement of clotting factor and was therefore previously recommended for rapid massive blood loss. However, since the therapy with blood components is just as effective and makes more efficient use of donor blood, is now in the US is no longer anywhere thoroughbred available. Erythrocytes to increase Hb are usually packed red blood cells, the blood component of choice. The indications are, respectively, depending on the patient. The O2 transport capacity may be sufficient to Hb values ??of 7 g / dL in healthy patients, but may be indicated already at higher hemoglobin concentrations in patients with decreased cardiopulmonary reserve or prolonged bleeding transfusions. One unit of packed red blood cells increases the Hb in the average adult to about 1 g / dl, and the hematocrit by about 3% of the value before transfusion. If only one volume expansion is necessary, other liquids can be used simultaneously or exclusively. For patients with multiple blood group antibodies or antibodies against very common antigens cryopreserved erythrocyte concentrates are used. Washed packed red blood cells are almost completely free of plasma constituents, especially leukocytes and platelets. They are given to patients showing severe reactions to plasma components (eg. As severe allergies, IgA immunization). In IgA-immunized patients transfusions from donors with IgA deficiency can be useful. Leukocyte depleted packed red blood cells are recovered by special filter systems that remove ? 99.99% of leukocytes. These are indicated in patients who have already had a non-hemolytic febrile transfusion reaction or require the cytomegalovirus-negative blood products, but these are not available. They are also used for exchange transfusions and to prevent the possibility of HLA alloimmunization prevention to (our inability to achieve the desired levels of platelets in the blood after platelet transfusion) a refractory response to platelet transfusion. In Germany, all packed red blood cells are leucocyte-depleted. Fresh frozen plasma fresh frozen plasma (FFP) contains all the clotting factors in unconcentrated form, but no platelets. It is used to treat bleeding due to a coagulation factors defect for which there is no possibility of a single factor substitution, used. Moreover, it is in a shortage of several factors such. Example by massive transfusions, disseminated intravascular coagulation (DIC), liver failure and used for rapid antagonizing an warfarin, although the prothrombin complex concentrate (PCC) is the first choice if it is available. FFP may be given in addition to red blood cell concentrates, if available for exchange transfusion not whole blood. FFP should not be used for a simple volume expansion. Cryoprecipitate Cryoprecipitates are concentrates obtained from FFP. Each concentrate contains about 80 units of Factor VIII and von Willebrand factor as well as 250 mg of fibrinogen. It also contains ADAMTS13 (an enzyme for in congenital thrombotic thrombocytopenic purpura is a lack), fibronectin and factor XIII. Cryoprecipitates were originally used to treat hemophilia and von Willebrand’s disease. Today, however, they are used mainly for Fibrinogenersatz in acute disseminated intravascular coagulation with bleeding, to treat a uremic bleeding in cardiothoracic surgery (fibrin glue) and gynecological emergencies such as placental abruption and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count ) and the rare factor XIII deficiency, unless there is human coagulation factor XIII concentrate is available. In general, they should not be used for other indications. Granulocytes granulocytes in a patient with sepsis and severe persistent neutropenia (ANC <500 / ul), which does not respond to antibiotics, be transfused (neutropenia). However, they must be administered within 24 hours after they were obtained. Therefore, the test results for HIV, hepatitis, human T-cell lymphotropic virus, and syphilis at the time of infusion may not yet available. Due to the improved antibiotic therapies and the use of drugs that stimulate the Granulozytenproduktion during chemotherapy, granulocyte transfusions are now rarely used. Immunoglobulins Rh immunoglobulin (RhIG; Anti-D) is administered intramuscularly or intravenously, and prevents the development of maternal Rh antibodies, which can be caused by a fetomaternal transfusion. The standard dose of i.m. RhIG is 300 micrograms and must be administered unless the child Rh0 (D) of an Rh-negative mother immediately after abortion or birth (live or stillbirth) - and you negative or if the mother already Rh0 (D) antibody has. In a fetomaternal transfusion of> 30 ml larger doses RhIG are necessary. There is a suspicion of a circulation of this quantity, a rosette test is performed to determine the volume of the fetomaternal transfusion initially, which – is a quantitative test (eg Kleihauer-Betke test.) Added – if it is positive. For the treatment of idiopathic thrombocytopenic purpura (ITP) is RhIG (anti-D) i.v. given. Other immunoglobulins are available for post-exposure prophylaxis in patients available that were exposed to some infectious diseases, including cytomegalovirus, hepatitis A and B, measles, rabies, respiratory syncytial virus [RSV], rubella, tetanus, smallpox and chickenpox (for application s . under the corresponding diseases). Platelet platelet concentrates are used to prevent bleeding in asymptomatic severe thrombocytopenia (platelet count <10,000 / ul) In bleeding patients with less severe thrombocytopenia (platelet count <50,000 / ul) In bleeding patients with platelet dysfunction due to platelet aggregation inhibitors, but with normal platelet count in patients get a massive transfusion that causes dilutionale thrombocytopenia platelet concentrates are sometimes used before invasive procedures, especially with extracorporeal circulation for> 2 hours (makes platelets often inoperable). One unit of a platelet concentrate increases the platelet count to about 10,000 / ul. Adequate hemostasis is achieved if platelet counts of 10,000 / ul in patients without complications and about 50,000 / ul in patients with surgical procedures. Therefore, adults are generally transfused 4-6 units of platelet concentrates. Platelet concentrates are increasingly being manufactured by automated processes that platelets (or other cells) collect and return the unnecessary components (eg., Erythrocytes, plasma) the dispenser. This method is referred to as cytapheresis. It allows to obtain a sufficient platelet count from a single donation (equivalent to 4-6 platelet concentrates) for the transfusion of an adult. Because it minimizes risks relating to infection and immunological reactions, it is compared with the transfusion of concentrates from different donors preferred under certain conditions. In some patients, it comes after a platelet transfusion does not to a sufficient increase in platelets (which is called refractoriness), which (by sequestration of platelets in the spleen or platelet consumption due to DIC or destruction by HLA or platelet specific antibodies and immune-mediated destruction) may be caused. If patients do not respond to the transfusion, they will, if possible, tested for alloimmunization. Patients with immune-mediated destruction can benefit from the administration of platelet different, randomly selected donors, since a greater likelihood with this is that some of the products are HLA-compatible. In addition, platelets from family members and AB0 or ??HLA-matched platelets can be used. The risk of alloimmunization can be reduced through the use of leukocyte-depleted red blood cell and platelet concentrates. Other blood products Irradiated blood products are used to protect high-risk patients before the development of graft-versus-host disease (GVHD) (transfusion complications: graft-versus-host disease (GVHD)). Many attempts have been made to develop blood substitutes containing inert chemical substances (eg. as perfluorocarbons) or hemoglobin solutions to transport O2 and deliver them to the tissue. Although these hemoglobin substitutes showed promising skills in O2 transport to tissues during an emergency, several clinical trials were discontinued because of increased mortality and serious adverse cardiovascular toxicity (z. B. hypotension). Currently, attempts to generate platelets and red blood cells from different stem cell sources. Hematopoietic progenitor cells (stem cells) from autologous or allogeneic donors can be transfused to the hematopoietic function in patients undergoing myeloablative or myelotoxic therapy (especially the immune function) restore (hematopoietic stem cell transplantation).

Health Life Media Team

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