Treponema pallidum loses its vitality in blood stored at (4±2°C) for 3 to 6 days

Plasmodium can be partially inactivated if stored at 4±2°C for 2 weeks

Whole blood stored within 3 days in ACD and within 7 days in CPD or CPDA is regarded as fresh blood.

Supplement coagulation factors, and the whole blood of the day is regarded as fresh blood

Replenish platelets, whole blood within 12 hours is considered fresh blood

To replenish granulocytes, whole blood within 8 hours is regarded as fresh blood.

Febrile non-hemolytic transfusion reaction (FNHTR)

Platelet transfusion refractory (PTR)

Transfusion-associated graft-versus-host disease (TA-GVHD)

Postpartum hemorrhage

major surgery

severe trauma

High-concentration red blood cells made by removing as much plasma as possible and adding additives at the same time

Intravenous infusion is smooth, different additives have different shelf lives, and are the most widely used in clinical applications.

Those who require blood transfusion due to acute blood loss caused by trauma or surgery

People with heart, kidney, and liver dysfunction who need blood transfusions

Chronic anemia with normal blood volume requiring blood transfusion

chronic anemia in children

Removes most of the plasma and has the same oxygen-carrying capacity as whole blood, but only half the capacity

For patients with heart, kidney, and liver dysfunction who require blood transfusion, it can reduce the patient's metabolic burden.

Too viscous, difficult to infuse, and less clinical application

The white blood cell clearance rate and red blood cell recovery rate are very high, with few adverse reactions to blood transfusion, and it gradually replaces suspended red blood cells.

Patients with aplastic anemia, globin production disorder anemia, and leukemia who require repeated blood transfusions

Patients preparing for organ transplantation

Patients with non-hemolytic febrile reactions caused by repeated blood transfusions that have produced white blood cell or platelet antibodies

Can significantly reduce the incidence of adverse blood transfusion reactions

Patients who develop allergic reactions after transfusion of whole blood or plasma

Patients with autoimmune hemolytic anemia

Patients with hyperkalemia and liver and kidney dysfunction requiring blood transfusion

Use high-concentration glycerol as a cryoprotectant for red blood cells, store it below -80°C, and then thaw and wash the glycerol-free red blood cell preparations before use.

Blood transfusion for patients with rare blood types

Blood transfusion in patients with immunodeficiency or immunosuppression

neonatal blood transfusion

intrauterine blood transfusion

Select blood transfusion from close relative donors

For patients with long-term repeated blood transfusions, the interval between blood transfusions is prolonged, which can reduce or delay the occurrence of hemochromatosis.

For adult patients without bleeding or hemolysis, 1 unit of red blood cell preparation can increase Hb5g/L

There is no need to increase it to normal levels, as long as it can improve and meet the oxygen supply of tissues and organs (increase to 80~100g/L)

The infusion speed should be slow and not too fast. For adults, 1 unit of red blood cell preparation should not be infused for more than 4 hours.

For patients with heart, kidney, and liver dysfunction, the elderly and infirm, newborns, and children, the infusion should be slower to avoid transfusion-associated circulatory overload (TACO).

Patients with acute massive blood loss should speed up blood transfusion

When transfusing red blood cell preparations, no drugs are allowed to be added except physiological saline when necessary.

Number of platelets in 1 unit³2.0x1010

Store under shaking conditions at 22±2°C and infuse within 6 hours

Number of platelets in 1 unit³2.5x1011

Store under shaking conditions at 22±2°C for 5 days

It can significantly reduce the probability and degree of bleeding, especially the risk of intracranial hemorrhage and visceral hemorrhage.

Low platelets are accompanied by factors such as increased destruction or consumption, such as infection, fever, sepsis, anticoagulant treatment, coagulation disorders (such as DIC), liver failure, etc., and the risk of bleeding is higher.

Various chronic diseases with poor platelet production, such as aplastic anemia, leukemia, thrombocytopenia after high-dose chemotherapy, and hematopoietic stem cell transplantation

Platelet count £50x109/L, prophylactic platelet transfusion required

The platelet count is £5x109/L. Platelets should be transfused promptly regardless of obvious bleeding.

Brain or eye surgery requires an increase in the patient's platelet count >100x109/L

Bleeding caused by reduced platelet production

Thrombocytopenia due to massive blood transfusion, platelet count £50x109/L

Infections and DIC

Idiopathic thrombocytopenic purpura (ITP)

Severe bleeding caused by abnormal platelet function

HIT is drug-induced immune thrombocytopenia, which often causes severe thrombosis and should not be transfused with platelets.

The platelet count of patients with TTP is extremely low, which may be caused by thrombosis that consumes a large number of platelets. Platelet transfusion will aggravate TTP.

Suitable for children who cannot tolerate too much fluid, patients with cardiac insufficiency and plasma protein allergy

Washing apheresis platelets to remove plasma proteins and other components, suitable for people allergic to plasma proteins

Filter out leukocytes during platelet apheresis, before platelet storage, or during transfusion

prevention

g-ray irradiation before infusion to inactivate immunologically active lymphocytes

Corrected Platelet Count Increment (CCI)

Platelet recovery rate (PPR)

If a single coagulation factor is deficient, such as hemophilia, FFP can be infused when there is no corresponding concentrated preparation.

Acquired coagulopathy in patients with liver disease

Coagulation disorders associated with massive blood transfusions

Bleeding due to oral anticoagulant overdose

Thrombotic thrombocytopenic purpura

immunodeficiency syndrome

Antithrombin III deficiency

DIC

Patients with plasma protein allergy after blood transfusion

Elderly and frail patients with normal blood volume

Severely ill infants and young children

Patients with severe anemia or cardiac insufficiency

Adult first time 200~400ml

Melt in 37°C water bath and infuse with blood transfusion device within 24 hours

Precautions

a. Plasma separated from whole blood more than 6 to 8 hours old

b. Plasma separated from whole blood within the validity period

c. FFP with a shelf life of 1 year

Below -20°C, 4 years

One of the most effective preparations besides FVIII concentrated preparations

It can significantly improve the prognosis of fibrinogen deficiency caused by severe trauma, burns, leukemia and liver failure.

Rich in FXIII

There is a deficiency or defect in vWF in the blood of patients with vWD, and cryoprecipitate contains higher levels of FVIII and vWF, which is one of the ideal preparations.

Fibronectin is a major opsonic protein used in severe trauma, burns, severe infections, hemophilia, skin ulcers and liver failure.

1~1.5U/10kg body weight

If the initial treatment effect is poor, increase the dose and repeat the treatment for better effects.

Completely melts in 37°C water bath, infusion must be completed within 4 hours

Intravenous infusion using standard blood transfusion set

Choose ABO same type or compatible infusion

Does not contain V factor and is generally not used alone to treat DIC.

After melting, place at room temperature to inactivate VIII and infuse as soon as possible; the melting temperature should not exceed 37°C to avoid inactivation of FVIII

If it still does not melt when heated to 37°C, it indicates that fibrinogen has been converted into fibrin and cannot be used.

Cryoprecipitate has not been inactivated by the virus. Hemophilia A patients require lifelong treatment and are susceptible to viral infection.

Patients with hemophilia A prefer FVIII concentrated preparations, and those with fibrin deficiency prefer fibrinogen products. These products have been treated with virus inactivation and are safe and reliable.

Once a day for 4 to 5 consecutive days, the daily dose is greater than 1.0x1010 granulocytes

Discontinue if there are pulmonary complications or infusion failure

Infuse as soon as possible after preparation, at room temperature no longer than 24 hours

The preparation contains a large amount of red blood cells and plasma, ABO and RhD are of the same type for infusion, and a cross-match test is done before infusion.

To prevent the occurrence of TA-GVHD, irradiate before infusion

It is not advisable to use leukocyte filters to filter concentrated granulocytes to prevent the spread of CMV. CMV antibody-negative donors should be selected

hypoalbuminemia

Expand blood volume

extracorporeal circulation

plasma exchange

hemolytic disease of newborn

Use with caution in patients with allergic reactions to albumin products, patients with heart disease, and patients with normal or high plasma albumin levels.

Intravenous infusion alone, or infusion with normal saline

Also known as normal human immunoglobulin, it is purified from the mixed plasma of thousands of people. It is mainly IgG, with very small amounts of IgA and IgM.

Contains anti-viral, anti-bacterial and anti-toxin antibodies and can only be injected intramuscularly, intravenous injection is prohibited

Immune globulin suitable for intravenous injection is prepared by gastric enzymatic digestion, chemical modification, ion exchange chromatography, etc., and is mostly freeze-dried powder. It can be configured with 5% or 10% solution for intravenous injection.

For immunodeficiency diseases, viral and bacterial infections

After immunization with the corresponding antigen, purification from plasma containing high-titer specific antibodies

Indications

Congenital absence or hypofibrinogen

Acquired fibrinogen deficiency, such as liver disease

DIC

primary fibrinolysis

Airtight, liquid impermeable, biodegradable, promotes blood vessel growth and formation, local tissue growth and repair

Patients with congenital and acquired AT deficiency, such as hereditary AT deficiency or functional deficiency disorders

Surgery to prevent deep vein and arterial thrombosis, cirrhosis and severe hepatitis, hemodialysis, nephrotic syndrome, DIC, bone marrow transplantation and secondary AT deficiency caused by chemotherapy, etc.

Serious infections in adults at high risk of death

DIC

Thrombotic disease

Bleeding in hemophilia A and B with antibodies

surgical hemostasis

Liver Transplantation

cardiac surgery

prostate surgery

cerebral hemorrhage

Traumatic bleeding

upper gastrointestinal bleeding

Others include thrombocytopenia, overdose of anticoagulants, postpartum hemorrhage, etc.

Calculated based on a 24-hour cycle, the blood volume transfused reaches more than the patient's own total blood volume.

The amount of blood transfused reaches more than 50% of the patient's total blood volume within 3 hours

Transfusion of more than 4 units of red blood cell preparation within 1 hour

Blood loss rate>150ml/min

Blood loss 1.5ml/(kg.min) for more than 20 minutes

Replenish blood volume to maintain tissue perfusion and oxygenation

Treat the cause of blood loss, use appropriate blood products to correct coagulation disorders, and control bleeding

red blood cell transfusion

platelet transfusion

Fresh frozen plasma transfusion

cryoprecipitate infusion

Other blood product transfusions

triad of death from massive blood transfusion

Prepare the patient's total blood volume of 3 to 5 or more

ABO homologous liver transplantation, even if there is a shortage of donors, ABO incompatible liver transplantation can be performed

Fresh frozen plasma transfusion

Apheresis platelet transfusion

red blood cell transfusion

cryoprecipitate infusion

Infusion of other plasma protein products

Regular monitoring of laboratory indicators during the perioperative period of liver transplantation

During liver transplantation, attention should be paid to body temperature, acid-base balance and electrolyte imbalance

Appropriate calcium supplementation is required during liver transplantation

Use autologous blood transfusion

immune hemolysis

The relationship between liver transplant survival rate and blood transfusion

a. Hypercoagulable period

b. Consumptive hypocoagulation period

c. Secondary hyperfibrinolysis stage

Clinical manifestations of extensive bleeding, microcirculation disorders, multiple embolisms, microangiopathic hemolytic anemia and primary disease

Red blood cell transfusion: When blood loss exceeds autologous blood volume by 20% to 30%, Hb is less than 80g/L, and accompanied by anemia symptoms or active bleeding, red blood cells can be transfused regardless of whether the pathological process of DIC is controlled or not.

Platelet transfusion: When platelets are less than 50x109/L, platelet transfusion should be done on the basis of heparin anticoagulation.

Fresh frozen plasma and cryoprecipitate transfusion: The consumptive hypocoagulation period is the best period to replenish fresh frozen plasma or cryoprecipitate.

Antithrombin concentrate infusion: When the antithrombin level is lower than 50% of the normal value, antithrombin concentrate should be supplemented

Infusion of other plasma protein preparations: Prothrombin complex concentrate (PCC) is extremely effective, along with activated protein C products

Newborn blood transfusion is small

Red blood cell preparations should be selected with short storage time, white blood cell removal, and washing and irradiation treatment if necessary.

Choose a blood transfusion set that can filter out microaggregates

Choose apheresis platelets with the same ABO and Rh blood types

If RhD-negative platelets are not available, RhD-negative children should receive an intramuscular injection of anti-RhD immunoglobulin at the same time as RhD-positive platelets are transfused.

Platelet apheresis is preferred: the residual amount of white blood cells and red blood cells in platelets is low and the purity is high, which can avoid transfusion reactions caused by HLA incompatibility

Use stock blood as little as possible and use fresh blood or recent blood instead.

If you can not lose, don’t lose. If you can lose less, don’t lose too much. If you can lose multiple times, don’t lose once. The principle is to use small amounts many times.