Blood Transfusion Kiran(3)

8/2/2019 Blood Transfusion Kiran(3)

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Blood TransfusionDr. kiran kumar

2nd MDS

Gitam Dental college and Hospital

SEMINAR ON


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Blood GroupsCarl landsteiner-1909- first gave the classification

19 Blood group systems & Over 200 antigens were

identified


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Cross matching and compatability


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Other important blood groupsRhgrouping: D antigen.

Bombay blood group.


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Components of blood that can be transfused

WHOLE BLOOD

CELLULAR PLASMA

RBCS WBCS PLATELETS FFP CRYO PPF

packed

frozen

washed


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Most patients require only one particular component

Better patient management is achieved by giving only

the desired and/or essential component.

Blood products have a greater shelf life Blood filtration and other techniques makes Blood safer

Blood products can often be infused regardless of

ABO Blood group

Selection of Components

Use of whole Blood is a waste of resources


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ApheresisProcess of removing a specific

component of the Blood such as

platelets, and returning the remaining

components to the donor.

Allows more of one particular part

of the blood to be collected than could

be separated from a unit of whole blood
http://en.wikipedia.org/wiki/Image:Platelet_apheresis.jpghttp://en.wikipedia.org/wiki/Image:Apheresis.PNG


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blood donation:

300-400ml of whole blood is collected

+

63ml of citrate phosphate dextrose is added

storage period is 21days at a temperature of -2 to 6c.

As 2-3diphospho glycerate increases - release of oxygenreduced.


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Principle of blood transfusionThe transfer of blood or

blood components from oneperson (the donor) into the

bloodstream of another

person (the recipient).


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WHO recommendations for screening tests in blood donationsHIV 1&2HEPATITIS B& C

MALARIA

SYPHILIS

CHAGAS DISEASE

Regular voluntary blood donation.


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Rigth IV selection: The size of the IV catheter is important.

Too small = hemolysis = wasted infusion

Need at least a 20G but preferably an 18G.

Recommended rate of transfusion intially for the

first 15 min it should be 10 drops/min later

40 drops/min


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Check for vital signscheck for temp,B.P,heart rate.

A temperature 100 or higher should be reported

even if it is pre-existing.

If a transfusion reaction occursthis will be

important for careful assessment of the situation


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INDICATIONS FOR BLOOD TRANSFUSION:ACUTE BLOOD LOSS (SURGERY, TRAUMA OR BLEEDING)

15 - 30 percent - should be treated with crystalloids or colloids,not RBCs, in young, healthy patients-40.

30 - 40 percent -- requires rapid volume replacement,and RBC transfusion is probably necessary

800-1500ml of blood.

hematocrit value-30-40

>40 percent -- is life-threatening and volume replacement,including RBC transfusion, is required.

>2000ml of blood.

hematocrit value-


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INDICATIONS FOR BLOOD TRANSFUSION:

Hemoglobin > 10 g/dL -- transfusion is rarely indicated.

Hemoglobin 7-10 g/dL -- indications for transfusion should be based on

the patient's risk of inadequate oxygenation from

ongoing bleeding and/or high-risk factors

.Hemoglobin < 7 g/dL -- transfusion is almost always indicated.

TRANSFUSION THRESHOLD LEVEL7g/dl

7/30 rule

Hemoglobin concentration:


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INDICATIONS FOR BLOOD TRANSFUSION:

peri-operative transfusion- if Hb 7g/dl

if significant blood loss is expected

SPECIAL SITUATIONS:

Severe Thalassemia Or Other Congenital Anemia.

Sickle Cell Disease

Burn Patients

.


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RBC Transfusion

Stored under refrigeration for 42 days

May be frozen for up to 10 years.

One unit contains approx 180ml of red cells

Does not provide platelets or coagulation factors

All RBC transfusions must be ABO/Rh compatible

INDICATIONS:

Hemoglobin levels less than 7/8g/dl or hemocrit level less than 30-40%.

Packed RBC:


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1 unit of packed RBCincreases Hct by5%.


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Platelet Transfusion

Whole

Blood platelet concentrate

Apheresis Platelets

Leukoreduced single donor

17,600 105,600

Colour - cloudy and yellowish

Red blood cell compatibility is generally not necessary

INDICATIONS:

Purpura.

Aplastic anemia.Chemotherapy induced leukemia.

Disseminated intra vascular coagulation(DIC).

Thrombocytopenia.


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Plate let pack contains:

3-510 platelets - 10 times more than normal 1

unit of whole blood

Pt.`s with more than 50,000- not requiredPt.`s with less than 20,000- required if C/F are seen.


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FFP Fresh frozen plasma (FFP) is the plasma from a unit of

whole Blood and frozen at or below -18 c within 8 hours

Kept in a frozen state for one year

Qty : 225 ml

Must be ABO compatible with the recipients red cells

Rh need not be considered.

Control bleeding due to low levels of clotting factors

INDICATIONS:

Clotting deficiencies.

Reversal of warfarin effect.

Antithrombin 111 deficiencies.


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CryoprecipitateIndications:

Acute hemorrhagic episodes of hemophilia

Burns- b/o high opsonin conc.

Septicemia.

1 unit of cryoprecipitate contains -100 units of

factor VIII.


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Adverse effects of transfusion

AcuteAllergic

Anaphylaxis

Hemolytic

Metabolic Transfusion related lung injury

Circulatory overload

Non-hemolytic febrile transfusion reactions

Haemostatic: dilution of clotting factors andthrombocytopenia

Septic shock (bacterially infected units)


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Acute Haemolytic Reaction:

-caused by transfusion of ABO incompatible blood

SYPTOMS:

Chills , fever Facial flushing

Hypotension

Chest pain

Dyspnea

Generalized bleeding Renal failure

DIC

Hemoglobinemia

Shock

Hemoglobinuria

Nausea

Vomitting

Back pain

Pain along infusion vein


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Acute Haemolytic Reaction:

MANAGEMENT:

FIRSTStop the transfusion

Keep the line open with the 0.9% NS Stay with the client. Monitor Vital signs.

Record and Collect urine specimen

Return blood, bag, tubing, labels, transfusion record to

the blood bank


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MANAGEMENT:

Anti histaminic drugs

Analgesics

Corticosteroids

IV fluids for renal clearance.

COMPLICATIONS:

Acute kidney failure

AnemiaLung dysfunction

Shock.


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Late

Delayed haemolytic transfusion reactions.

Sensitization/Alloimmunization.

Immune suppression.

Graft-vs-Host disease.

Transfusion iron overload (haemosiderosis)


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Transfusion AlternativesAcute Volume Repalcement (volume

expanders)

Dextran/ Gelatin/HES-Hydroxy ethyl starch)

Autologous transfusionPreoperative autologous blood donation (PABD)

Cell salvage : Intraoperative blood salvage,

Postoperative blood salvage

Acute normovolemic hemodilution (ANH)
http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/10/webpages/creditslink.htm


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JEHOVAH`S WITNESSES:


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Reservation of blood

direct relation donor


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Conclusion

Avoid unnecessary transfusions

Transfusion of a single unit is often unnecessary

Booking system for blood

Use appropriate component rather than whole blood


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CooperationCooperation

is the Keyis the Key

to Success!!!to Success!!!


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REFERENCES:

Text book of General Medicine-Davidson

Physiology- Sembulingam.

Pharmacology- satoskar.

Hand book of transfusion medicine-Mc clelland.

Practice guidelines to blood transfusion-American red cross.

Screening donated blood for transfusion-transmissible

infections: recommendations- WHO recommendations


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Blood Transfusion Kiran(3)

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