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Cover Stories

Blood and Blood Product Utilization

The utilization of blood and blood products is an essential part of a patient’s treatment plan.
Patient populations where transfusion with blood or blood products is indicated include those
with anemia, cancer, sickle cell disease, trauma, surgery and bleeding disorders. Blood and
blood products are supplied to transfusion services by regional blood centers. Blood centers that
service Kentucky include Hoxworth Blood Center, the American Red Cross and the Kentucky
Blood Center. Routine products supplied include leukocyte reduced red blood cells (LRBCs),
platelets (PLTs) and fresh frozen plasma (FFP). Red blood cells and fresh frozen plasma are
appropriated to laboratory blood banks based on preset inventory levels. These levels are
monitored and adjusted through blood utilization reviews. Products can be delivered stat to
hospitals, but turn around time is related to the distance of the hospital from the blood center.

The most commonly transfused component is leukocyte reduced red blood cells (LRBC). Red
blood cells restore and maintain the body’s oxygen carrying capacity to the tissues. This is
typically monitored by testing a patient’s hemoglobin and hematocrit. Other important factors to
consider are cardiac performance, age, disease state and whether the patient is actively bleeding.
In most cases, a hemoglobin of 8 g/dL is capable of meeting the body’s oxygen carrying needs.
It is important in all patients to consider whether they are symptomatic. The goal is to not
transfuse unnecessarily, but a symptomatic chronic anemia patient with a hemoglobin of 8.5 g/
dL may need transfused. The American Society of Anesthesiologists states that perioperatively,
if a patient’s hemoglobin drops below 6 g/dL they almost always transfuse, if the hemoglobin is
above 10 g/dL they rarely transfuse and if the hemoglobin falls between 6-10 g/dL they also take
into consideration cardiac output, blood pressure and pO2.

Platelets are the second most commonly transfused blood component. Today, platelets are
usually collect by apheresis. The advantages of collecting platelets this way are that it only
exposes the patient to one donor and it allows for HLA typing or crossmatching. Platelets
can drop due to drugs, chemotherapy, liver or kidney disease, sepsis, increased FDPs,
cardiopulmonary bypass and marrow disorders. Platelet levels are evaluated with platelet
count and clinical symptoms. A platelet count should be drawn one hour post transfusion to
evaluate the increase in platelet count. If a patient has two consecutive poor responses to platelet
transfusion it could indicate refractoriness. If a patient becomes refractory, HLA matched or
crossmatched platelets should be considered. Patients in which platelets are contraindicated
include stable ITP patients, TTP patients and heparin induced thrombocytopenia unless there is a
life threatening hemorrhage.

Fresh frozen plasma (FFP) is the third most common blood component. FFP contains all clotting
factors and is the only approved component for Factors II, V, X and XI deficiencies. The
volume of FFP infused should be closely monitored to avoid hypervolemia. FFP should not be
used as a nutritional source, to enhance wound healing or as a volume expander.

For complicated transfusion cases, the blood center has a large inventory of rare frozen red
blood cells for patients with rare or multiple alloantibodies. A reference lab is also on site
to assist hospitals with complex cases. Their services include single and multiple antibody
identifications, including warm and cold autoantibodies, crossmatches, antigen typing and HLA
platelet matching. The blood center in cooperation with the hospital blood bank endeavors to
provide the physician with all the tools they need to successfully treat patients in need of blood
and blood products.

Bibliography
American Association of Blood Banks. American Association of Blood Banks Technoical
Manual, 14th Edition. AABB, 2002.Klein, Harvey MD and David Antsiee, PhD.
Mollison’s Blood Transfusion in Clinical Medicine, 11th Edition. Blackwell Publishing,
2005.

By Julie Brokamp, MT(ASCP), MS

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