Longnecker's Anesthesiology > Part 7. Special Considerations in Anesthesia Care >

Chapter 85. Blood and Blood Component Therapy

Ian J. Welsby, BSc, MBBS, FRCA, and Steven J. Bredehoeft, MD

Clinically Available Blood Products

Topics Discussed:

activated partial thromboplastin time prolonged; acute hemorrhage; afibrinogenemia; allergic transfusion reaction; alloimmunization; anemia; antithymoglobulin; arthropathy; blood coagulation factor; blood component transfusion; blood group incompatibility; blood platelets; blood products; blood transfusion; coagulation factor deficiency, hereditary; cryoprecipitate; cytomegalovirus; cytomegalovirus infection; cytotect; delayed hemolytic transfusion reaction; desmopressin; disseminated intravascular coagulation; drotrecogin alfa; dysfibrinogenemia; factor ix; factor ix concentrates; factor viii; fibrin tissue adhesive; filtration; fresh-frozen plasma; hellp syndrome; hemoglobin measurement; hemolytic transfusion reaction; hemolytic transfusion reaction, acute; hemolytic-uremic syndrome; hemophilia a; hemophilia b; hepatic disease; human leukocyte antigens; immunoglobulin; immunoglobulins, intravenous; infant, premature; leukocyte reduced red blood cells, human; liver transplantation; massive transfusion; packed blood cell transfusion; plasma; plasma fractionation; platelet transfusion; posttransfusion purpura; prothrombin time increased; red cell product; thrombotic thrombocytopenic purpura; transfusion reaction; transfusion reaction, febrile; uremia; vitamin k antagonist; von willebrand disease; von willebrand disease, acquired; von willebrand factor; whole blood.

Sections:

Whole Blood, Red Cell Concentrates, Leukocyte-Reduced Red Cells, Washed Red Cells, Frozen Red Cells, Indications for RBC Transfusion, Chronic Anemia, Perioperative Period, Safety of Blood Transfusion, Red Blood Cell Compatibility, Alloimmunization, HLA Alloimmunization, Hemolytic Transfusion Reactions, Acute HTRs, Delayed HTRs, Pseudo HTRs, Plasma Component Derivatives, Fresh-Frozen Plasma, Indications for FFP, Liver Disease and Transplantations, Massive Transfusion, Rapid Reversal of Vitamin K Antagonists , Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome , Dosage, Compatibility and Side Effects, Immunoglobulin Preparations, Cryoprecipitate, Indications: Fibrinogen Deficiency, von Willebrand Disease, Fibrin Glue, Uremic Bleeding, Dosage, Compatibility and Side Effects, Factor Concentrates, Treatment Regimens, Factor IX Concentrates, Hemophilia with Circulating Inhibitors, von Willebrand Disease, Plasma-Protein Based Therapy: Factor VIII Concentrates, von Willebrand Factor Concentrates (Plasma-Derived and Recombinant), Acquired Disease, Other Factor Deficiencies, Anticoagulant Proteins, Platelets, Preparations, Transfusion Triggers, Refractoriness to Platelet Transfusion

Excerpt:

"Despite some clinicians' desires for fresh whole blood, especially for use in pediatric cardiac anesthesiology, the optimal use for a limited resource demands the use of red cells for oxygen-carrying capacity, plasma for coagulation proteins, and platelets for thrombocytopenia or platelet dysfunction. The component therapy approach maximizes the number of recipients benefiting from transfusion and optimally preserves the function of essential blood elements. Colloid replacement can be provided by synthetic colloids, such as gelatins and starches, or albumin products fractionated from plasma. The time required to perform federally mandated testing makes fresh whole blood practically unavailable to most clinicians; consequently, discussion is primarily focused on blood components.Red cell concentrates, or packed red blood cells (PRBCs), are obtained from CPDA-1-anticoagulated whole blood after centrifugation of most of the plasma and platelets. At most blood centers, the red cells are then mixed with 100 mL of an additive nutrient containing an additional dextrose and adenine (NutriCell or AS-3) or dextrose, adenine, and mannitol (Adsol or AS-1) solution that extends the storage period to 42 days³ and results in flow properties similar to those of whole blood. PRBCs from CPDA-1-anticoagulated blood are stored for up to 35 days. Loss of viability during storage is caused by cellular adenosine triphosphate (ATP) depletion, which leads to loss of membrane phospholipids, increased rigidity, and reduced life span, with current standards..."

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