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Component therapy--still in its infancy: eight year experience at a tertiary hospital in Indore.

Introduction

Blood transfusion therapy has evolved remarkably over the years since its introduction into clinical practice. It has also become an indispensable life saving measure in patient care. The use of blood and blood components in clinical practice has, nonetheless, continued to face challenges demanding sustained efforts aimed at improvement in its use. [1]

Prominent among such challenges is the issue of transfusion transmitted diseases as well as the unavailability of a reliable safe donor pool particularly in developing nations. The goal of modern transfusion therapy is to provide appropriate replacement therapy with blood components (red cells, platelets, fresh frozen plasma, cryo-precipitate etc.) as opposed to the whole blood for patients with specific haematological deficiencies. [2]

Blood has been a scarce 'commodity' ever since, and because of that, many lives are lost which could have been saved. The main reason is that no artificial alternative is available till date. The only logical solution to this dilemma, at present, appears to use one unit of blood for more than one patient--Component Therapy. It is just like using a specific drug for a specific malady instead of a combination--in fact "Tailor Made" use of blood. This concept came to Madhya Pradesh in 2002 and gained momentum in 2003.

Materials and Methods

In the state of the art blood bank of M.Y. Hospital, Indore (MYH), components are being supplied to the patients as per their specific need. The data has been retrieved from the records of the blood bank.

Results

A total of 100,071 transfusion episodes were reviewed and analysed. The distribution of collection of blood year wise (table 1), Blood component (table 2), component status (Madhya Pradesh vs. MYH) (table 3), individual components (table 4) were noted.

Discussion

The data reveals that there is an increase in the demand and use of components over a period of 5 years. This increase is no doubt small, but a promising one. As compared to only 75 platelet concentrates in the year 2004, 314 in 2007 is definitely encouraging. Similarly, there is an increase over past years in other components also. In our institute, 10% components are prepared as compared to 38% in the state of Madhya Pradesh.

The present study may be a preliminary indicator that there may be a better awareness and appreciation of component transfusion by clinicians over the period. Unfortunately, the increased awareness of clinicians of the need to use component transfusion as against whole blood transfusion has not been met by a corresponding enhanced capacity of our blood banks towards the provision of blood components for clinical use.

The provision of a regular supply of safe blood components to hospital. In contemporary transfusion practice, there is little justification for whole blood transfusion. An area of current debate in the area of transfusion for trauma patients relates to the management of trauma patients with massive bleeding.

In developed transfusion centers where component therapy is the rule, it has been proposed that coagulopathic trauma patients be primarily resuscitated with FFP in a ratio of 1:1:1 to red blood cells and platelets, virtually receiving "reconstituted whole blood." Thus transfusion of fresh whole blood is justified in such circumstances. However none of the whole blood transfusions given peri-operatively in this audit could be justified and were thus adjudged inappropriate.

Red cell transfusion is the least inappropriately used blood component in this study, however the situation can still be improved upon. Anaemia (reduction in haematocrit for the age and sex in a patient) is described as mild if the packed cell value is greater than or equal to (>) 30% and physicians should be discouraged from routinely transfusing patients with mild anaemia.

The "optimal" haemoglobin concentration for pre and post-operative patients depends on the patient and the belief that a haemoglobin value <10 g/dl (haematocrit <30%) indicates a need for red cell transfusion has been challenged. [3-5] This is because cardiac output does not change significantly until the Hb decreases <7g/dl.

Tissue oxygenation is generally maintained at haematocrit levels as low as 30% as long as the blood volume remains normal. [6-8] Between the limits of haematocrit levels 18%-30%, (moderate anaemia), the decision to transfuse should be based on a consideration of the patient's age, cardiovascular and respiratory status, activity level, symptoms, underlying diagnosis and the state of the bone marrow activity. Many anaemic patients at or above haematocrit of 25% (Hb 8g/dl) do not need transfusion. However, the physiologic adjustments to chronic anaemia have a limit and particularly in the elderly patients with myocardial or vascular disease.

Conclusion

The data reveals that packed cells occupy the first place with FFP being a close second, with platelet concentrate, PRP and cryoprecipitate lagging far behind. A spurt in the use of PRP was seen in the year 2006 which can be attributed to the outbreak of Dengue and Chicken Guniya with their resultant side effects of thrombocytopenia. This slow growth is most probably due to lack of awareness amongst clinicians and needs urgent corrective measures in the form of awareness campaigns for increasing the rational use of blood components. We can add our recommendation to that of WHO stating that while encouraging the use of appropriate blood components care should be taken that irrational use is avoided to prevent unnecessary transfusions.

References

[1.] Blachman MA, Shepherd FA, Perrault RA. Clinical use of blood, blood components and products. Can Med Assoc J 1979;121:3342.

[2.] Simpson MB: Audit criteria for transfusion practices. In: Wallas CH, Muller UH, (eds). The Hospital Transfusion Committee. A Technical Workshop, American Association of Blood Banks, Anaheim, Calif, 1982. p. 21-60.

[3.] Sirchia G, Giovanetti AM, Mc Clelland B, Fracchia GN. Safe and Good Use of Blood in Surgery (SANGUIS): Use of Blood Productand Artificial Colloids in 43 European Hospitals. European Communities 1994.

[4.] Schoeder ML, Rayner HL. Transfusion of blood and blood components. In: Lee RG, Bitchel TC, Foerster JF, Athens JW, LucjensJN, (eds). Wintrobe's Clinical Haematology. 9th edi. Philadelphia, London: Lea & Febiger 1993. p. 651-700.

[5.] Tuckfield A, Haeusler MN, Grigg AP, Metz J. Reduction of inappropriate use of blood by prospective monitoring of transfusion requests. Med J Austr 1997;167: 473-6.

[6.] Ibegbulam OG. Five year audit of blood transfusion practice at the University of Ilorin Teaching Hospital. [Dissertation] African College of Physician, Ilorin Nigeria. West 1996.

[7.] Repine TB, Perkins JG, Kauvar DS, Blackbone L. The use of fresh whole blood in massive transfusion. J Trauma 2006;60:S59-69.

[8.] Holcomb JB, Jenkins D, Rhee P. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 2007;62:307-10.

Source of Support: Nil

Conflict of interest: None declared

Ashok Yadav, CV Kulkarni, NP Tiwari

Department of Pathology, MGM Medical College and MY Hospital, Indore, Madhya Pradesh, India

Correspondence to: NP Tiwari (narmadapdtiwari@gmail.com)

DOI: 10.5455/ijmsph.2014.030720141

Received Date: 13.05.2014

Accepted Date: 03.07.2014
Table-1: Whole blood year wise

Year    Units of whole blood

2003    10423
2004    11291
2005    11542
2006    12088
2007    12145
2008    13052
2009    14226
2010    15304

Table-2: Component year wise

Year    Component
2003    210
2004    1133
2005    950
2006    824
2007    1587
2008    2166
2009    6607
2010    6725

Table-3: Component status (Madhya Pradesh Vs. M. Y. H.)

Year               Components (M.Y.H.)   Components (M.P.)

2003               210                   509
2004               1133                  3379
2005               950                   12764
2006               824                   15577
2007-Sep' 2007     1026                  12889 (Aug)

Source: State AIDS Control Society - NACO supported blood bank i.e.
Indore, Bhopal, Gwalior, Jabalpur and BMHRC, Bhopal

Table-4: Individual component

Year    Packed   FFP    Platelet   PRP   Cryo.
        Cells           conc.            Ppt.

2003    200      10     --         --    --
2004    528      478    75         50    02
2005    461      320    11         145   13
2006    414      161    71         242   00
2007    737      338    70         436   00
2008    1185     469    200        312   00
2009    3405     1093   2109       00    00
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Article Details
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Title Annotation:RESEARCH ARTICLE
Author:Yadav, Ashok; Kulkarni, C.V.; Tiwari, N.P.
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:9INDI
Date:Oct 1, 2014
Words:1302
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