بسم رب نور
description
Transcript of بسم رب نور
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نور رب بسم
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Prevention & Management of
transfusion reaction
Dr.sh.sharifi
20-21 th feb 2008
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Febrile Rxn
Management Give antipyretics (e.g. aspirin – except
children – Reyes Syndrome) Avoid aspirin in thrombocytopenic pt’s Do not restart transfusion
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Febrile Rxn
Prevention;
Antipyretics Prestorage leukoreduced blood products
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Allergic Rxn
Management Premedicate Pt with antihistamines (e.g.
Benadryl) If signs/symptoms mild &/or transient, restart
transfusion after treatment Do NOT restart transfusion if pulmonary
symptoms/signs, fever present
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Allergic Rxn
Prevention
Prophylactically treat with antihistamines
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TRALI
Management Steroids Aggressive ventilatory support Hemodynamic support
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TRALI
Prevention Typically ,TRALI is adonor specific
phenomen so donor deferred from donating plasma products.
Transfuse washed RBC’s from which plasma is removed
Platelet units can also be washed, but platelet function is significantly reduced
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Circulatory Overload
Management Slow rate of infusion Place Pt in upright position, if possible, with
feet in dependent position Diuretics Oxygen Morphine (if necessary)
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Circulatory Overload
Prevention Vigilant assesment of patients input and
output Slow rate of infusion Pretransfusion and/or intratransfusion
diuretic adminstration
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Septic Rxn
Management Obtain blood cultures from Pt Return blood component bag(s) to blood
bank for further laboratory work-up Treat septicemia with antibiotics Treat shock with fluids & vasopressors
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Septic Rxn
Prevention Collect, process, store, transport, and
transfuse blood components according to contemporary standards of practice (e.g. for FDA standards adhere to cGMP’s – current good manufacturing practices – found in Code of Federal Regulations)
Transfuse blood components within 1 to 2 hrs – do not exceed 4 hrs
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Acute Hemolytic
Management Treat hypotension, renal failure, DIC, etc. Submit blood samples for blood
bank/laboratory tests Avoid, if possible, further transfusions till
work-up complete and/or Pt recovered from rxn
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MANAGEMENT OF ACUTE HEMOLYTIC TRANSFUSION REACTION
1-Stop the transfusion and maintain intravenous access. 2-make initial rapid assessment of patient and requirements for
basic and advanced support. 3-notify transfusion service,collect transfused units(full or
partially),tubing,etc.,and return them to blood bank. 4-Reconfirm identity of blood units and patient. 5-collect appropriate patient blood specimens 6-pending results of initial evaluation,consider the following
supportive approches: A-IV fluid resuscitation to treat hypotension. B-maintenance intravenous fluids at 3000 ml/m2/day with
adminstration of sodium bicarbonate to keep PH>7.0
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Continue….
C-diuretics:mannitol(20%),100 ml/m2 give over 30-60 min,then 30 ml/m2/hr for text 12 hours;furosemide(adults 20-80 mg;infants and children 1-2 mg/ kg to an adult dose)
D-low-dose dopamine,1-5 mcg/kg/min. E-replacement of procoagulant factors and fibrinogen
with fresh frozen plasma and cryoprecipitate and platelets with platelet concentrate.
F-heparin:50-100 u/kg,(unfractionated heparin)and infusion 15-25 u/kg/hr to keep heparin level 0.4-0.7 u/ml.
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prevention
The best way to prevent AHTR is to avoid transfusion
Defining clear-cut and defendable indication for transfusion
Careful determination of the Hb or HCT level for ordering TRX
patient-donor identification Autologousblood safer than homologous
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Serious Hazards of Transfusion Reporting Scheme
Overview of cases from 2004 Report (n=541)
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Distribution of Errors in IBCT Category (2004 Report)
Serious Hazards of Transfusion Reporting Scheme
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Requesting Procedure
Check the patient’s case note Transfusion history Special requirements
- e.g., irradiated, CMV negative
Complete request form or order com
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Sampling ProcedureStep 1: Ask the patient to tell you their:
Full Name + Date of Birth
Be extra vigilant when checking the identity of the unconscious / compromised patient
Check this information against the patient’s ID wristband
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Sampling ProcedureEXAMPLE REQUEST FORM
Step 2: Check the patient’s ID
wristband against documentation
e.g., case notes or request form for:
First name Surname Date of birth Hospital number
ANY HOSPITAL
MACDONALD MORAG
ITU
ANAEMIA
11/07/1956
NOT KNOWN
NOT KNOWN
100198E
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Only bleed one patient at a time
Do NOT use pre-labelled tube
Hand write the sample tube beside the patient
Send the sample to the laboratory in the most appropriate way for the clinical situation, i.e. routine / emergency
Sampling Procedure
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Labelling the venous blood sample
Hand written label to include:- Full name Date of birth Hospital number Gender Date Signature of person who has taken the sample
At the bedside By the person taking the sample
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Component Red blood cells
Platelets
Fresh Frozen Plasma
Cryoprecipitate
Storage
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• First name• Surname• Date of birth• Hospital number
Collection Procedure
Follow procedure for each blood component collected
Step 1: Complete the Blood Collection Form (or follow your local collection procedure) with the following information:
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Collection Procedure
Ensure prompt delivery of the blood component to the clinical area
Step 2: Check the patient’s IDdetails against compatibility/traceability label attached to the blood bag
Step 3: Document removalof unit on blood fridge registeror electronic release system
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LEAKSDISCOLOURATIONCLUMPING
EXPIRY DATE
If there is ANY discrepancy - DO NOT transfuse
Pre-administration Procedure
Step 3: Undertake visual inspection
Step 1: Check the blood component has been prescribed
Step 2: Undertake baseline observations
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Pre-administration checks Personal checks:
- clean your hands- wear personal protective equipment
Equipment checks:- Personal protective equipment is available and is clean and sterile- A correctly completed prescription chart- Observation chart- Giving set- Disposable bags - Trolley
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Administration Process
Equipment• Venous access devices
• Blood administration sets
• Infusion fluids
• Infusion devices
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Administration Procedure
Be extra vigilant when checking the identity of the unconscious / compromised patient
Step 1: Ask the patient to tell you their:
Full Name + Date of Birth
Check this information against the patient’s ID wristband
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Step 2: Check the patient’s First name Surname Date of birth Hospital number
on the compatibility/traceability label against the patient’s ID wristband
Administration Procedure
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If there is ANY discrepancy - DO NOT transfuse
Administration ProcedureStep 3: Check the compatibility/traceability label with the blood bag label
BLOOD GROUP
DONOR COMPONENT
NUMBER
RhD GROUP
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Documentation ProcedureEXAMPLE COMPATIBILITY REPORT FORM
COMPLETE DOCUMENTATIONEnsure that you sign the transfusion documentation to say you have checked the blood component against the patient’s wristband
EXAMPLE COMPATIBILITY/TRACEABILITY LABEL
Ensure donor component number is recorded on the transfusion documentation
Complete documentation for every blood component transfused
G101 602 597 229 N
MACDONALD
MACDONALD
MORAG
MORAG
11/07/19566FEMALE
25 HILL STREETTOWN CENTRE
100198E
100198E
G101 602 597 229 N
20/12/2006
Red Cells
Red Cells
O Rh POS
G101 602 597 229 N
Red Cells
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Monitoring Procedure
• Communicate with patient
• Record vital signs
*Early Check*
• Each unit must be infused within four hours
• Complete documentation
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Immediate Action to Take for Txn Rxn:
1. STOP THE TRANSFUSION 2. Keep IV open with Normal Saline 3. Check all blood component(s) labels, forms, Pt. ID for
errors 4. Notify Pt.’s physician as appropriate 5. Treat rxn 6. Notify Blood Bank; submit work-up specimens; submit
report forms
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Investigations of transfusion reaction are necessary for :
1. Diagnosis
2. Selection of appropriate therapy
3. Transfusion management
4. Prevention of future transfusion reaction.
Investigations should include correlations of clinical data with
laboratory result .
Important clinical data :
1. Diagnosis
2. Medical history of pregnancies, transplant, and previous transfusion.
3. Current medication
4. Clinical signs and symptoms of the reaction.
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5. Question related to the transfusion:
Amount of blood transfused to cause the reaction.
How fast , how long ?
The use of blood warmer.
Any filter used ? Other solutions.
Any drugs given at the time of transfusion
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2. As recquired procedures
•ABO grouping and RH typing, pre and post transfusion•Major compatibility testing , pre and post transfusion•Antibody screening test , pre and post transfusion•Alloantibody identification•Antigen typings•Free hemoglobin in first voidedurine post transfusion•Unconjugated bilirubin 5 – 7 hours post transfusion.
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3. Extended procedures
•Gram stain and bacterial culture of unit
•Quantitative serum Hemoglobin.
•Serum Haptoglobin , pre and post transfusion
•Peripheral blood film.
•Coagulation and renal output study
•Urine hemosiderin
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Inco
mp
atib
le T
rans
fusi
on
6 12 18 24 30
HoursHours
Plasma HEMOGLOBINPlasma HEMOGLOBIN
HaptoglobinHaptoglobin
Urine HemoglobinUrine Hemoglobin
SerumSerum bilirubinbilirubin
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Delayed Hemolytic Trn Rxn
Management Send specimen(s) to Blood Bank for antibody
identification work-up Provide good Pt history
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Delayed Hemolytic Trn Rxn
Prevention Transfuse RBC’s that are phenotype negative
for known clinically significant RBC antibodies in Pt
Delayed Hemolytic Trn Rxn’s can not be predicted
Good Pt records and Blood Bank records are essential
Clinical treatment usually not necessary
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DHTR
In the futureDHTR may be prevented;
Artificial blood substitutes
More sensitive antibody screening method
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In all cases in which transfusion is thought to be the cause of death,the FDA must be notified by phone within 24 h after discovery and this must followed up with a written report within 7 days(21 CFR 606 .170)