Hemotherapy

Hemotherapy is the replacement of a certain part of the blood. It is the transfer of biological material from the donor organism to the recipient organism.

Types of biological material
We distinguish blood derivatives and transfusion products. It is a biological material, which is served to the recipient directly (or sometimes after deleukotization and / or irradiation) after collection. Examples are erythrocyte concentrate (erythrocyte mass, "erymass"), platelet concentrate and fresh frozen plasma (fresh frozen plasma, FFP).
 * Transfusion products

It is a material made from the donor's biological material by various biochemical-physical processes. For example are IV immunoglobulins ("ivigy") or individual coagulation factors (except recombinant ones).
 * Blood derivates



Principles of expedient hemotherapy
The patient's benefit should outweigh the risk of possible complications of  hemotherapy (urticaria, febrile reactions, hemolysis, TRALI, iron overload…). Concurrently, it is important to find out the cause of the deficiency.

Indication
Hemotherapeutic substition is needed in cases of anemia, thrombocytopenia a coagulopathy.

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Anemia
The classic recommendation states that erythrocytes should be substituted when hemoglobin values are lower than 80 g / l, unless the patient is suffering from ischemia or severe infection. An exception is sideropenic anemia, for which it is more appropriate to substitute iron. For elderly patients with ischemia (ICHS, ICHDK etc.) or patients with sepsis is advisable to substitute earlier. The limits are chosen individually according to the condition, often when hemoglobin values are lower than 100 g / l.

Hypertransfusion is useful in case of paroxysmal nocturnal hemoglobinuria and sick cell disease.

For substitution is most often used erythrocyte mass. Whole blood is used only in war medicine (or in developing countries).

Trombocytopenia
It is pointless to substitute platelets (even et zero values) in case of immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura. Substituted platelets are rapidly destroyed and immune system is more sensitized. Substitution is necessary in case of vital indication for unstoppable bleeding. For other thrombocytopenias, the cut-off value is considered to be '''počet trombocytů 10. 109/l''', after which it is expedient to substitute platelets. If a patient with thrombocytopenia also has a fever or coagulopathy, it is advisable to substitute the platelets earlier.

The requested platelet values for invasive procedures are: (However, achieving these values is not always entirely realistic in hematology.)
 * at least 50×109/l for venous cannula insertion or lumbal punction,
 * at least 80×109/l before less complicated operations,,
 * at least 100×109/l before more complicated operations.

Platelet concentrates can be served either mixed (mixed from several donors to achieve sufficient amount) or from platelet spheroids, which are from one donor and therefore less sensitizing.

Coagulopathy
The need of fresh frozen plasma is indicated:
 * to substitute coagulation factors because of their deficiency (hemophilia, if individual factors are not available, etc.),,
 * for substitution in DIC,
 * in case of Warfarin intoxication, if it is desirable to reduce INR rapidly and prothrombin complex is not available,
 * for exchange plasmapheresis in TTP.

Related Articles

 * Blood transfusion
 * Hemotherapy (pediatrics)
 * Hemapheresis

Reference
Category:Internal medicine

Category:Hematology