Introduction
Along with cardiothoracic operating departments, cardiothoracic intensive care units are some of the greatest consumers of blood products in the world; so for example UK cardiac surgical centres use approximately 10% of the national supply. Furthermore, use of blood products is currently on the increase due to a combination of factors, including advancing patient age, increasing burden of comorbidities, expanding use of antiplatelet therapy and greater surgical complexity. Importantly, transfusion of blood products is associated with increased morbidity and mortality thus it is imperative to employ strategies such as patient blood management (PBM) to avoid unnecessary transfusion and conserve precious resources.
Blood Products
More than 2 million donations are made each year in the UK to National Health Service Blood and Transfusion (NHSBT). From these donations, approximately 2,000,000 units of red cells, 300,000 units of platelets, 350,000 units of FFP and 126,000 units of cryoprecipitate are prepared. The current commonly prescribed blood products in the UK are listed in Table 13.1.
Table 13.1 Comparison of blood products and components currently in use in the UK
| Commercial product | Protein | Platelet | Fibrinogen | II | V | VII | VIII | vWF | IX | X | XI | XII | XIII | Protein C | Protein S | Antithrombin | Heparin | Red cell stroma | Blood group specific | White cell contaminant | Clinically important subtypes | Donor exposure | Pathogen inactivation or reduction | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Blood components | Packed red cells | Haemoglobin <40 g/l | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | No | Yes | Yes | <5106/unit | washed, CMV, negative, irradiated | 1 | Leukodepletion (UK) | ||
| Platelets | >240 × 109/l | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | trace | No | trace | Yes | <5106/unit** | pool, single donor apheresis, HLA matched | 1 to 6 | Leukodepletion (UK) | ||||
| FFP | >50 g/l | nil | 0.9 g/l | variable | variable | variable | >70 U | variable | variable | variable | variable | variable | variable * | variable * | variable * | variable * | No | trace** | Yes | <5106/unit** | 1 | Leukodepletion (UK) | ||||
| Cryoprecipitate | nil | >0.7 g/pool | variable | variable | variable | 350 U/pool | variable | variable | variable | variable | variable | variable | variable | variable | variable | No | trace** | Yes | <5106/unit** | 5 | Leukodepletion (UK) | |||||
| Methylene blue FFP | >50 g/l | nil | 0.7 g/l | variable | variable | variable | 50 U | variable | variable | variable | variable | variable | variable | variable | variable | variable | No | trace** | Yes | <5106/unit** | 1 | Methylene blue | ||||
| Methylene blue cryo | nil | 0.7 g/pool (80% of untreated) | variable | variable | variable | 350 U/pool (80% of untreated) | variable | variable | variable | variable | variable | variable | variable | variable | variable | No | trace** | Yes | <5106/unit** | Methylene blue | ||||||
| Blood products | Fibrinogen concentrate | Riastap ® | Albumin | nil | 20 g/l | No | nil | No | No | >20,000 | Pasteurisation | |||||||||||||||
| Prothrombin complex | Beriplex ® | 6–14 g/l | nil | NA | 20–60** | NA | 10–25** | NA | NA | 20–31*** | 22–60*** | NA | NA | 15–45 | 12–38 | Yes | Yes | nil | No | No | >20,000 | Filtration, pasteurisation | ||||
| Octaplex ® | 1.3–4.1 g/l | nil | NA | 20–76*** | NA | 18–48** | NA | NA | 50*** | 36–60*** | NA | 26–62** | 24–64** | NA | Yes | nil | No | No | >20,000 | Filtration, pasteurisation | ||||||
| SD FFP | 45–70 g/l | nil | NA | NA | 31 | NA | 28 | NA | NA | NA | NA | NA | NA | 50 | NA | No | nil | Yes | No | >20,000 | Solvent detergent |
* Assumed to be 100% activity but donors will vary 70–100%.
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