BLOOD TRANSFUSION Begashaw M (MD). Definition is the procedure of introducing the blood of a donor,...
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Transcript of BLOOD TRANSFUSION Begashaw M (MD). Definition is the procedure of introducing the blood of a donor,...
BLOOD TRANSFUSION
Begashaw M (MD)
Definition
• is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream
Indications
In acute hemorrhage is based on:• volume lost >2000• rate of bleeding• hemodynamic status
Indications
In Chronic blood loss:-Healthy, younger individuals HCT<21%-Cardio respiratory compromised patients
HCT < 25-33% If severe ,even <40%
Perioperative red blood cell transfusion criteria
Component therapy
• specific factor deficiencies -factor VIII concentrates -classic
hemophilia
ABO blood group system
-Blood group O is the universal donor-Blood group AB is the universal recipient
Cross matching
o Blood grouping-ABO and Rhesus antigenso Antibody screening• Detects atypical red cell antibodies in
recipients serumo Crossmatching• Tests donor red cells against patients
serum
Blood products
• Whole blood• Packed red cells• Granulocyte concentrates• Platelet concentrates• fresh frozen plasma• Plasma protein fraction• Human albumin 25%• Cryoprecipitate• Clotting factors - Factor VIII / IX
Blood Components
Component therapy
• Factor VIII for classic hemophilia • Platelet transfusion for patients with
bone marrow suppression
preparation
FRESH UNIT WHOLE BLOOD+CPDAPRBCs 80% HCT
STORED AT 1-6 degree celcius
PLASMA AND 70% OF PLTS
PLT PELLET
and CLOTTIN
G FACTOR
S EXCEPT FACTOR
III
PLASMA STORED AT -18 to-30 DEGREE
CELCIUS
THAW
AT 4 degree celcius
CRYOPRECIPITATE
PROTEINS
Whole blood
• is collected in citrate phosphate dextrose- adenine solution (CPDA-)
• 450 ml of whole blood and approximately 60ml of anticoagulant preservative
• within 24 hours-freshwhole blood• shelf life of 35 days • one unit of whole blood raises the
recipient’s hematocrit by 3%
Whole blood
Packed RBC
• are remains after plasma has been separated from whole blood
• One unit raises the recipient’s hematocrit by 3%
• warmed to a temperature not exceeding 37 c before transfusion
• Shelf life is 35 days
Packed RBC
Platelet concentrate
• Platelets are separated from one unit of blood
• may be stored for 3-7 days • One unit of platelet concentrate contains
about 5.5×1010 platelets and increases the platelet count by 5000/ml
• For a patient with platelet count below 25,000/mm3, 6-8 units are usually given
• Platelet concentrate must be administered through a special platelet filter
Fresh frozen plasma_is anti-coagulated plasma separated from a
person’s blood and frozen within 6 hours_stored up to 1 year_contains all clotting factors _provides proteins for volume expansion
Cryoprecipitate
_is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 degree centigrade
_white precipitate_shelf life of about 1 year_contains factor VIII, fibrinogen and factor XIII _treatment: -classic hemophilia -DIC
21
FRESH FROZEN PLASMA
Cryoprecipitate
Protein
Albumin - for oncotic support and plasma
expansion - disadvantage-rapid excretion & expensePlasma protein fraction-Similar to albumin but contains additional
protein molecules
Complications of Blood Transfusion
Complications
• Hemolytic transfusion reactions• Non-hemolytic transfusion reaction
Hemolytic transfusion reactions
• Intravascular hemolytic transfusion reactions
• life threatening reactions• due to incompatibility of the ABO
system• are very rare occurring in 1 out of
15,000 -20,000 transfusions
Pathophysiology
• all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuria and renal failure
• activate the complement system with subsequent release of vasoacative amines causing hypotension
• Complement activation -intravascular thrombosis, DIC & hemorrhage
Clinical features
• Patient feels unwell and agitated• back pain and pain at infusion site• shortness of breath, rigors• hypotension, oliguria and bleeding from
venepuncture sites• Urinalysis will show haemoglobinuria
Management
• Discontinue transfusion immediately and remove giving set
• Check unit of blood against patients identity
• Give intravenous crystalloid• Transfer to ICU• Take blood for CBC, haemoglobin,
clotting, repeat grouping• Monitor urine output
Non-hemolytic transfusion reaction
• Febrile reaction: - in 0.5% -1% - is usually treated with antipyretic
drugs• Allergic reaction: - in 2-3% - manifests by urticaria and rashes- Antihistamins, steroids or epinephrine
• Transmission of disease-include:- Hepatitis- HIV- Malaria- Epstein- bar virus, cytomegalovirus- Brucellosis
Other complications
• Citrate toxicity• Acidosis• Hyperkalemia