Post on 07-May-2015
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BLOOD TRANSFUSIONBLOOD TRANSFUSION
Dr. Syed Alam ZebSurgical B,Kth Peshawar
THE DISCOVERY OF BLOOD THE DISCOVERY OF BLOOD GROUPSGROUPS
In 1901 Sir Austrian Karl Landsteiner discovered blood groups.
He was awarded nobel prize for this discovery in 1930.
WHAT IS BLOOD MADE OF?WHAT IS BLOOD MADE OF?
RBCs WBCs PLATELTS PLASMA
BLOOD GROUPINGBLOOD GROUPING
ABO & Rh System. ABO group depends
which antigen is on the RBC & what antibody is in plasma.
ABO BLOOD GROUPSABO BLOOD GROUPS
Blood group A: They have A antigen on cell surface and B antibody in plasma.
ABO BLOOD GROUPSABO BLOOD GROUPS
Blood group B: They have B antigens on cell & A antibody in plasma.
ABO BLOOD GROUPSABO BLOOD GROUPS
Blood group AB: They have both the A & B antigens on cell surface and no anti-body in plasma.
ABO BLOOD GROUPSABO BLOOD GROUPS
Blood group O: They have no antigen on cell surface but have both A & B antibodies in plasma.
RH factor grouping:RH factor grouping:
Rh+ : n They have Rh antigen on RBC surface but don’t have Rh antibody.
RH factor groupingRH factor grouping
Rh-ve: They don’t have Rh antigens on cells & normally don’t have Rh antibodies BUT they develop Rh antibodies if trasfused with RH +ve blood.
RH factor groupingRH factor grouping
Rh-ve cant receive blood from Rh+ve.
Rh+ve can receive blood from Rh-ve.
BLOOD GROUP NOTATIONBLOOD GROUP NOTATION
A Rh +ve B Rh +ve AB Rh +ve O Rh +ve
A Rh -ve B Rh -ve AB Rh -ve O Rh -ve
WHO CAN RECEIVE BLOOD FROM WHO CAN RECEIVE BLOOD FROM WHOMWHOM
BLOOD GROUP
Antigens Antibody Can give blood to
Can receive blood from
AB A & b None AB AB,A,B,O
A A B A & AB A & O
B B A B & AB B & O
O None A & b AB,B,A,O
O
People with group O are universal donors and those having group AB are universal acceptors.
INDICATIONS FOR BLOOD INDICATIONS FOR BLOOD TRANSFUSIONSTRANSFUSIONS
Severe blood loss in trauma or from pathological lesion like bleeding ulcer.
During major operative procedures.Severe burns.Severe anemia preoperatively.Severe anemia postoperatively.Surgery on hemophiliacs or
thrombocytopenics.
PREPARATION OF BLOOD PRODUCTS PREPARATION OF BLOOD PRODUCTS FOR TRANSFUSIONFOR TRANSFUSION
Donor should be fit & screened.Blood is collected in sterile bags.Donor is lying on a couch, median cubital
vein is cannulated.410 ml of blood is run in to a bag
containing 75 ml of anticoagulant solution.Blood is constantly mixed with
anticoagulant to prevent clotting.
BLOOD STORAGEBLOOD STORAGE
Blood products must be stored at 4C +- 2C.Stored blood has a shelf life of 3 weeks.After a storage time of 24-72 hr RBCs have
reduced capability to release oxygen to tissues.
If the patient needs massive transfusions its better to give blood that’s less than 7 days old.
BLOOD PRODUCTSBLOOD PRODUCTS
Packed Red cells: They are advised for elderly, chronic anemia's, patients in CCF or small children. Packed cells are obtained by centrifugation.
Platelet concentrates: Platelets rarely survive in stored blood for more than 24 hrs. If separated by centrifugation can survive for 72 hrs.
BLOOD PRODUCTSBLOOD PRODUCTS
White blood cells: They are rapidly destroyed in the stored blood.
Plasma: This is removed after centrifugation of whole blood & may be further processed or fractionated.
BLOOD PRODUCTSBLOOD PRODUCTS
Human Albumin 4.5%: Obtained by repeated fractionation of plasma followed by heat treatment.It can then be stored for months.
Fresh-frozen plasma: Removed from fresh blood & stored at –40 to –50C. It’s a good source of coagulation factors. Used when doing surgery on cirrhotics, hemophiliacs or patients having Christmas disease.
BLOOD PRODUCTSBLOOD PRODUCTS
Cryoprecipitate: Allow FFP to thaw at 4C, the supernatant plasma is removed to obtain the precipitate. It’s a rich source of factor VIII & fibrinogen.
Factor VIII & factor IX concentrates: They are available in fresh dried form.
AUTOTRANSFUSIONAUTOTRANSFUSION
Transfusion with patient’s own blood. Used in emergency situations. Blood is collected from abdominal cavities,
filtered and transfused. For a planed elective procedure patient can donate
his own blood 3 weeks in advance to be transfused later on.
Minimal chances of disease transmission and reactions.
COMPLICATIONS OF BLOOD COMPLICATIONS OF BLOOD TRANSFUSIONSTRANSFUSIONS
CCFTransfusion reaction.Transmission of infections.Thrombophlebitis.Air embolism.Coagulation failure.
Hemolytic ReactionsHemolytic Reactions
Most serious complication due to ABO incompatibility ie transfusion of wrong blood group.
Symptoms include apprehension, headache, fever, chills, pain at the injection site or pain in the back, chest & abdomen.
Symptoms in anesthetized patients are changes in the vital signs & spontaneous bleeding from different sites.
Hemolytic Reactions cont:Hemolytic Reactions cont:
There is hemoglobinuria & oliguria.Free hemoglobin can be detected in plasma
in minutes.Coombs test becomes positive.Treatment is with diuretics ie mannitol iv
infusion; 12.5 g is administered in 3-5 min, followed by cont. infusion to have a urinary out put of 60 ml/hr.
Pyrogenic ReactionsPyrogenic Reactions
Fever is the most common immediate transfusion reaction.
Recipient reaction against white cells in the donor blood.
Treated with antipyretics.Leucocytes-poor blood is considered for
patients with repeated pyretic reactions.
Allergic ReactionsAllergic Reactions
Symptoms are itching, urticaria and bronchospasm.
Usually mild but can be fatal.There is antigen, antibody reaction between
the proteins I the donor plasma & a corresponding antibody in the patient.
Treated with anti-histamines and corticosteroids.
INFECTIONS TRANSMISSIONINFECTIONS TRANSMISSION
Viral hepatitis: Hepatitis B and C can be transmitted through blood. The risk through screened blood is 1:63,000 per unit for B and from 1: 1,00,000 to 1: 500,000 for C. About half will develop chronic liver disease.
INFECTIONS TRANSMISSION cont:INFECTIONS TRANSMISSION cont:
HIV : Improved screening has reduced the transmission of HIV to about 1 in500,000 per unit. Hemophiliacs are especially at risk because of the repeated required transfusions.
Bacterial infections: If blood is left in a warm room for hours bacteria grow in it and can result in severe septicemia in the recipient.
INFECTIONS TRANSMISSION contINFECTIONS TRANSMISSION cont
Malaria: The disease can be transmitted through blood transfusions in endemic areas.
The donor should be screened and treated before donating blood.
In emergency situations the recipient should get prophylactic antimalarials.
Rare ProblemsRare Problems
Thrombophlebitis. Coagulation failure: When large volumes of store
blood is used for replacement. Old blood is deficient in platelets, factor VIII& factor V.
DIC: Occurs after incompatible ABO transfusion or after massive transfusions. Its treated with FFP, cryoprecipitate & platelets concentrates.
HAEMOPHILIAHAEMOPHILIA
Congenital deficiency of factor VIII. X-linked, only men are affected. Patient presents with epistaxis, gums bleed,
swollen joints. Treatment is with fresh blood, FFP, factor VIII
concentrates to bring the factor VIII levels to 20%. Surgery on hemophiliacs is possible if the factor
VIII levels are raised to >50% .
CHRISTMAS DISEASECHRISTMAS DISEASE
Hemophilia B.Congenital deficiency of factor IX.
(Christmas Factor).Presentation is similar to hemophilia.Treatment is FFP, dried concentrates of
human factor IX.
Von Willibrand’s DiseaseVon Willibrand’s Disease
Low plasma levels of factor VIII compliment, factor VIII related antigen and abnormal platelets.
Patient has episodic bleeding manifestations.
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