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Cryoprecipitate Transfusion Guidelines:

Posted by sammy on February 5, 2013 at 4:35 PM

Major Products Available:

 

Cryoprecipitated AHF (Cryoprecipitate)

Cryoprecipitated AHF, Pooled

 

Description/Contents:

 

The cold insoluble portion of plasma that

precipitates when fresh frozen plasma is thawed at

1-6oC. The supernatant (cryo-poor plasma) is

removed and the residual volume of cryoprecipitate

(approximately 15 ml) is refrozen and stored at -18

oC. Cryoprecipitate provides therapeutic amounts of

Factor VIII:C, Factor XIII, von Willebrand factor,

and fibrinogen. Each bag of cryoprecipitate contains

80-100 units of Factor VIII:C and 150-200 mg of

fibrinogen (Factor I).

In addition, significant amounts of Factor XIII

(fibrin-stabilizing factor) and von Willebrand factor

(vWF), including the high molecular weight

multimers of vWF, are also present.

 

Indications:

 

1.

Fibrinogen levels less than 115 mg/dl

2.

Cases of disseminated intravascular coagulation

where both fibrinogen and Factor VIII may be

depleted.

3.

Platelet count greater than 100,000 with

evidence of platelet dysfuntion and no response

to DDAVP

4.

Prophylaxis or treatment of significant Factor

XIII deficiency.

Historically, patients with von Willebrand’s disease

(vWD) and Hemophilia A are treated with

Cryoprecipitate.

 

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7. Guidelines for appropriate use of blood

Cryoprecipitate should not be used in the treatment

of Hemophilia B (Factor IX deficiency, Christmas

disease).

 

Cryoprecipitate has also been used in the

production of “fibrin glue” with the addition of

thrombin to form an insoluble clot for application to

surgical margins and other surgical applications.

Such use is not Food and Drug Administration FDA-

approved, although widespread. The safety of this

procedure, including the risk of the thrombin

source, has not been established.

 

Dosage and Administration:

 

For fibrinogen replacement, ten bags of

cryoprecipitate will increase the fibrinogen level of a

70-kilogram recipient approximately 70 mg/dl.

Cryoprecipitate is administered after pooling.

Compatibility testing is not necessary, but the

product should be ABO plasma compatible. Rh type

is not important.

 

Alternative Therapy:

 

Factor VIII concentrates that are made with

recombinant DNA technology or have been

pasteurized are safer and are the treatment of

choice for patients with hemophilia A and von

Willebrand’s disease. DDAVP (desmopressin) causes

the release of Factor VIII and vWF in most patients

with mild-moderate Hemophilia A and vWD.

Therefore, DDAVP may be used instead of

cryoprecipitate or factor concentrates in these

patients.

 

Autologous blood transfusion

 

Autologous blood transfusion is the collection and

re-infusion of the patient’s own blood or blood

components. Autologous blood transfusion allows

you to donate blood for own use. After collection,

blood is clearly marked with your name and

 

UCG 2010 168

 

 

 

7. Guidelines for appropriate use of blood

reserved for your use only. Documentation carefully

monitored. Autologous blood donation is possible by

the following:

 

Those who are not anaemic (starting

haemoglobin must be at least 11 g/dl, slightly

lower than required of a regular blood donor i.e.

12 g/dl)

Those who have no medical condition that could

cause problems during or after the blood donation

process

Those who are having planned surgery that

routinely requires a blood transfusion (except in

cases where long term storage is desired)

For planned surgery Autologous blood must be

tested for transfusion transmissible infections,

even if it is going to be transfused to the same

patient.

Five categories of autologous transfusions

recognized:

1.Preoperative autologous blood donation,

 

 

transfusion and storage: units of blood are drawn

from a patient usually starting (in short term

case) 3-5 weeks before elective surgical

procedure and stored for transfusion at the time

of the surgery

 

2.Intra-operative heamodilution: blood is collected

at the start of surgery and the fluid volume lost is

replaced with appropriate IV solutions, then

finally stored blood is re-infused after surgery

 

3.Intra-operative blood salvage: blood is salvage

from the surgical area during the operation for re-

infusion during or after the surgical procedure

 

4.Postoperative blood salvage: blood is collected

after surgical procedure is complete by drainage

of the operative area and re-infused

 

5.Autologous self stored blood (blood banking):

your own blood is preserved in a frozen state for

 

UCG 2010

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7. Guidelines for appropriate use of blood

use by you in case your need of a blood

transfusion arises. The safest blood you can

receive is your own! This process eliminates

donor-transmitted diseases. If you have a rare

blood type or if your blood contains rare

components, this process my mean the difference

between life and death. Autologous blood is

always a perfect match. It will be there when you

need it regardless of the general blood shortage.

 

Adverse reactions to transfusion

 

Key points

 

1.

Report all suspected acute transfusion reactions

immediately to the hospital blood bank

laboratory that handles with the clinician after

getting pre-transfusion sample, post –

transfusion sample, patients urine and the

transfused unit. Attention is made to the blood

bank when suspected contamination by bacteria

or heamolysis is from the blood bank.

Regrouping and testing are done on both

patient and transfused samples.

2.

Acute reactions may occur in 1-2% of patients

Rapid recognition and management of these

may save the patient’s life.

3.

Errors and failure to follow correct procedures

are the commonest cause of life threatening

acute haemolytic reactions.

4.

Bacterial contamination of red cells or platelet

concentrates is an under-recognized cause of

acute haemolytic transfusion reactions.

5.

Patients who receive regular transfusions are at

particular risk of acute febrile reactions. With

experience, these can be recognized so that

transfusions are not delayed or stopped

unnecessarily.

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7. Guidelines for appropriate use of blood

6.

Transfusion-transmitted infections are the most

serious delayed complications of transfusions.

Since these may occur long after the infusion,

the association with them may be missed.

Therefore record all transfusions accurately in

the patient’s case notes and consider

transfusion in the differential diagnosis.

7.

Infusion of large volumes of blood and IV fluids

may cause haemostatic defects or metabolic

disturbances.

Recommendations:

 

1.

The blood used for the compatibility testing

must be stored for 7 days at 2-8 oC for possible

investigation on transfusion reactions.

2.

A nurse should observe the patient during the

first 5-10 minutes after starting of each unit. At

the end of the period, the vital functions must

be registered. It should be documented which

parameter and at what frequency (pulse,

temperature, BP).

3.

The clinician handling the patient must be

involved in the differential diagnosis of

transfusion reactions. Also a quick and clear

investigation should be started in the hospital

blood bank laboratory.

4.

Prior to disconnecting, the unit must be closed

to avoid reflux of patient blood into the donor

blood.

5.

Systematic teaching and training of nursing

staff to prevent recognize and treatment of

transfusion reactions is indicated.

UCG 2010

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7. Guidelines for appropriate use of blood

Recognition and management of acute

 

transfusion reactions (occurring within 24

 

hours of transfusion)

 

Category 1: mild reactions

 

Signs and symptoms:

 

Localized cutaneous reactions, e.g. urticaria,

rash

Pruritis

Management:

 

X

Slow the transfusion

 

X

Give antihistamine, e.g. promethazine

hydrochloride 25-50 mg by deep IM or slow IV

-

give <25 mg/min as a diluted solution

 

containing 2.5 mg/ml in water for

injections(max: 100mg)

child: 1-5 yrs: 5 mg by deep IM

5-10 yrs: 6.25-12.5 mg by deep IM

 

If no clinical improvement within 30 minutes or if

condition worsens:

 

X

Treat as category 2

 

Category 2: moderately severe reactions

Sign and symptoms:

 

Flushing

Urticaria, pruritis

Rigors

Fever

Restlessness, palpitations

Tachycardia

Mild dyspnoea

Headache

Management:

 

X

Stop the transfusion

X

Replace the infusion set and keep the IV line

open with sodium chloride 0.9 % infusion

 

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7. Guidelines for appropriate use of blood

X

Notify the medical officer in charge and the

blood bank immediately

 

X

Send blood unit with infusion set, freshly

collected urine and new blood samples (one

clotted and one anticoagulated) from the vein

opposite the infusion site together with the

appropriate request form to the blood bank for

laboratory investigations.

 

X

Give antihistamine IM (see category 1 above)

 

X

Give antipyretic: paracetamol 15 mg/kg (adult:

1g)

 

X

If there are anaphylactic features (e.g.

bronchospasm, stridor): give hydrocortisone 4

mg/kg IV and aminophylline 6 mg/kg IV

 

X

Collect urine for the next 24 hours for volume

output and evidence of haemolysis and send to

the hospital laboratoryif there is clinical

improvement.

 

X

Restart transfusion slowly with a new blood unit

and observe carefully if no clinical improvement

within 15 mins of restarting or condition

worsens.

 

X

Treat as category 3

 

Category 3: life-threatening reactions

Signs and symptoms:

 

Rigors

Fever

Anxiety, restlessness

Hypotension (fall of >20% in systolic BP)

Tachycardia (rise of >20% in heart rate)

Haemoglobinuria

Unexplained bleeding (DIC)

Pain in chest, or near infusion site, or in

loin/back, headache

Respiratory distress, shortness of breath,

dyspoea

UCG 2010

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7. Guidelines for appropriate use of blood

Management:

 

X

Stop the transfusion

 

X

Give sodium chloride 0.9% IV infusion 20-30

ml/kg over 5 minutes to maintain systolic BP

 

X

Raise patient’s legs

 

X

Maintain airway and give high flow oxygen by

mask

 

X

Give adrenaline (epinephrine) injection 1 mg/ml

 

0.01 mg/kg slow IM

X

If there are anaphylactic features (e.g.

bronchospasm, stridor): give hydrocortisone 4

mg/kg IV and aminophylline 6 mg/kg IV.

 

X

Give diuretic: furosemide 1 mg/kg IV

 

X

Notify the medical officer in charge and blood

bank immediately

 

X

Send blood unit with infusion set, freshly

collected urine and new blood samples (one

clotted and one anticoagulated) from the vein

opposite infusion site with appropriate request

form to blood bank laboratory investigations.

 

X

Check fresh urine specimen for haemoglobinuria

 

X

Start a 24 –hour urine collection and fluid

 

balance chart and record all intake and output

X

Maintain fluid balance

X

Refer for further management where necessary

 

Notes:

 

If an acute transfusion reaction occurs, stop the

transfusion immediately and remove the giving

set. Check the blood pack labels and patient’s

identity. If there is a discrepancy consult the

blood bank.

In an unconscious or anaesthetized patient,

hypotension and uncontrolled bleeding may be

the only signs of transfusion problem.

In a conscious patient with a severe haemolytic

transfusion reaction, signs/symptoms may

UCG 2010

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7. Guidelines for appropriate use of blood

appear within minutes of infusing only 5-10 ml

of blood

-

close observation at the start of infusion of

 

each unit is therefore vital

 

For all category 2 & 3 reactions, record the

following in the patient’s notes:

-

type of reaction

-

time from start of transfusion that reaction

occurred

-

volume, type and pack numbers of blood

products transfused

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