transfusion products

Whole blood

pRBC

  • content:
    • packed RBC with small amount of plasma
    • HCT level of 55-65%

Plasma

  • content: coagulation factors, albumin, Igs, plasma proteins
  • indication: restore multiple coagulation factors (DIC)
  • FFP: frozen within 6 hours of collection, shelf life 1 year frozen, 24 hours after thawed, then has 5 days of storage
  • FFP: all soluble plasma proteins + clotting factors. Poor source of fibrinogen

Cryoprecipitate

  • content:
    • when FFP thawed, small amount of plasma that precipitates
    • fibrinogen, factor 8, factor 13, vWF
  • indication:
    • mostly hypofibrinogenemia, such as DIC. Fibrinogen < 100 mg/d
    • uremic bleeding
  • dosing: 5-10 units (from multiple donors pooled together)

Platelets

  • content:
    • platelet in plasma
    • half life 5 days
  • dosing:
    • platelet concentration: from whole blood donation
    • platelets collected from aphresis: dosing equals 4-6u platelet concentrates, raises plt by 20-25k

Plasma Derivatives

  • plasma pooled from thousands of donors and fractionated into different derivatives:
    • albumin
    • Ig
    • Rh Ig
    • coagulation factor concentrates: factor 8
  • recombinant factor concentrates: not containing any donor plasma. Used for younger patients with hemophilia (factor 8 and 9)
  • Prothrombin complex concentrates (PCC):
    • factor 2, 7, 9, 10
    • preferred product for bleed while on warfarin
    • only use for life threatening bleed because risk of thrombosis, do not just give for elevated INR
    • carries residual heparin, CI in HIT
  • 3 factor PCC: factor 2, 9, 10
  • 4 factor PCC: 2, 7, 9, 10
  • Activated PCC (Feiba): factor 2, 7a, 9, 10

Tranexamic acid and aminocaproid acid

  • tranexamic acid (Lysteda): inhibits fibrinolysis by forming complex that displaces plasminogen from fibrin. Inhibits plasmin
  • aminocaproic acid (Amicar): binds competitively to plasminogen and blocks binding to fibrin