Component therapy--still in its infancy: eight year experience at a tertiary hospital in Indore.
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. 
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. 
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.
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.
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.
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.
[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 (email@example.com)
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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|Title Annotation:||RESEARCH ARTICLE|
|Author:||Yadav, Ashok; Kulkarni, C.V.; Tiwari, N.P.|
|Publication:||International Journal of Medical Science and Public Health|
|Date:||Oct 1, 2014|
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