Discuss the Indications and Complications of Blood Transfusion

7/31/2019 Discuss the Indications and Complications of Blood Transfusion

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5/19/12

DISCUSS THE INDICATIONS ANDCOMPLICATIONS OF BLOODTRANSFUSION AND THEIRMANAGEMENT

BY

DR TELLA A.O.


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OUTLINE

INTRODUCTION

BRIEF HISTORICAL BACKGROUND

PRINCIPLES OF BLOOD TRANSFUSION

DONATION AND COLLECTION OF BLOOD

BLOOD PRODUCTS AND THEIR INDICATIONS

EFFECTS OF STORAGE OF BLOODCOMPLICATIONS/HAZARDS OF TRANSFUSION

PREVENTION & MANAGEMENT OFCOMPLICATIONS


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INTRODUCTION

Blood is a vehicular organ that perfuse allother organs.

Association of blood with life & vitality

known from time immemorial.BT is a form of organ transplantation that is

very invaluable esp. in surgical patients.

Has potential hazards which have increasedsensitivity to its use.


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HISTORICAL PERSPECTIVE

First man-to man BT in 1818 by J. Blundell

Landsteiner discovered ABO blood grps in1900 & later, Rh factor was recognized by

Levine & Stetson in 1939.Methods of collecting & storage of blood

became available thereafter.

First blood bank established in 1937 at CookCounty Hospital in Chicago.


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PRINCIPLES OF BLOODTRANSFUSIONAvoid BT if at all possible.

Proper testing of donated blood is ensured.

Only components needed should be given.

Anaemia should be corrected before electivesurgery.

If 1 unit is needed, then BT is not necessary.

However, single unit transfusions may bejustifiable in some settings.


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PRINCIPLES (contd)

Avoid automatic transfusion threshold.

Hb conc. Alone is not enough indicator forBT.

Informed consent.

Appropriate identification of the bloodcomponent selected for the patient.

Vital sign monitoring.

Blood should be administered slowly duringthe 1st 30 min.

No medications/drugs should be added to the


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BLOOD DONATION &COLLECTIONAppropriate donor selection.

Pre-donation screening.

Blood collection process manually or usingautomated collection devices. The vol.collected is standardized for the collectionbag used e.g. 450 ml + 63ml CPDA-1 bag.

Blood component separation.Post-donation observation & ADR to donation.


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BLOOD PRODUCTS

BLOOD COMPONENTS:(A)Oxygen carrying components-->

- RBC concentrate/Packed RBCs.

- Leucocyte poor RBCs.-RBC + additive solution.-Washed RBCs.

- Frozen red cells/Deglycerolized RBCs.(B)Platelet Products:

- Platelet rich plasma (PRP)

- Platelet concentrate


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Immune Serum Globulin

- Immune serum globulin(IgG)

- Hepatitis B immune globulin

- Varicella zoster immune globulin

- Rh immune Globulin

- Tetanus Immune globulin- Rabies

- Rubella

- Hepatitis A.


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INDICATIONS FOR BLOODTRANSFUSION

COMPONENTS

COMPOSITION

VOLUME INDICATIONSFOR USE

Whole Blood Allcomponents

450/500ml Hypovolaemic anaemia;Massive BT;EBT; DIC

Packed RBCs RBCs; WBCS;Plts; Plasma;

(Hct=75%)

250ml Symptomaticanaemia

WashedRBCS

RBCs; Noplasma;

reduced

180ml Symptomaticanaemia;

Allergic


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COMPONENTS COMPOSITION VOLUME INDICATIONSFOR USE

Plateletconcentrates

Plts 5.5X1010/unit;

WBCs; RBCs; Plasma50ml/unit Thrombocytop

enia;Chemotherapy-inducedanaemia

Granulocytes WBCs1.0X1010/unit; Lymphocytes;Platelets

220ml Neutropenia;Infectionsunresponsiveto antibiotics

FFP All coagulationfactors

220ml Def. of labile& stablefactors

Thawed

plasma

Reduced

factors V andVIII

220ml Def. of stable

factors


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BLOOD STORAGE &PRESERVATIONWhole blood is refrigerated after collection

ASAP at T of 2-6C.

The shelf-life of the blood depends on the

anticoagulant used:ACD {67.5ml} --- 21 daysCPD {63ml} --- 21 daysCPDA-1 {63ml} --- 1-35 days

SAGM --- 42 days


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STORAGE OF OTHER COMPONENTS:1) Platelet concentrate 22C for up to 7 days.2) Fresh Frozen plasma At -18C for up to 12 months.3) Cryoprecipitate Below -18C for up to 12 months.4) Frozen Deglycerolized RBCs

Preserved with glycerol or dimethyl-1-sulpoxide at -80C for years.


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EFFECTS OF STORAGE

RBCs: ATP; 2,3-DPG; K+ plasma.

Leucocytes: Not viable after 24 hrs.

Platelets: Not viable after 24 hrs but remainsfor 2 weeks.

Electrolytes--K+;Na+;Ca++.

Clotting factors.

pH: Continuing RC glycolysis generates lacticacid.


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COMPLICATIONS/HAZARDS OFBLOOD TRANSFUSION

(A) IMMEDIATE BTR IMMUNOLOGIC:

-Immediate Haemolytic

BTR.-Allergic & AnaphylacticBTR

NON-IMMUNOLOGIC:-Febrile TR

-Bact. Contamination-Circulatory overload-Cardiac arrest-Embolism(air/particles)-Acute lung injury


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DELAYED BTR

IMMUNOLOGIC:-Post-transfusion TP-Delayed Haemolytic BTR-Graft versus Host disease.-Tansfusion-related immunomodulation

NON-IMMUNOLOGIC-Thrombophlebitis-Transmission of diseases:HBV;HCV;HIV;CMV;EBV;Syphilis;Malaria;Chagas dx;Toxoplasmosis;-Iron overload-Citrate toxicity-Haemosiderosis

-Cxns of massive BT.


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TRANSFUSION REACTIONS MECHANISMS

Febrile NHTR Incomp. btw Ag on donorWBCs/plts & Ab in the

recipient plasma; Bactpyrogens

Immediate HTR Immune Ab of Rh system; Ab

of the IgM/IgG class whichactivates complemt

Allergic & AnaphylacticReactions

Hypersensitivity to donorplasma proteins (IgE-mediated)

Transfusion-related AcuteLung injury

Ab in donor plasma reactivewith recipients WBCs

(agglutination occurs in pulm.


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MASSIVE BLOOD TRANSFUSION

Transfusion of equivalent of TBV within 24hrs.

Transfusion of more than half of the TBV in 1

hr.TBV is 70ml/kg in adults and 80-90ml/kg in

children.

Indications include massive blood loss fromtrauma; ruptured aortic aneurysm; massiveGI bleeding; Liver transplantation etc.


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PROBLEMS OF MASSIVE BT

Haemolytic BTR: Usually due to error.

Circulatory overload.

Cardiac arrest:

-Hypothermia; -hyperkalaemia;-hypocalcaemia; -Acidosis.

Respiratory complications:

-ARDS; TR-ALI Impaired oxygen delivery.

Bleeding diasthesis.


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ACUTE TRANSFUSIONREACTIONS


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MANAGEMENT OFTRANSFUSION REACTIONSSTOP THE TRANSFUSION IMMEDIATELY.

Infusion of N/S.

Monitoring of V/S: T, Pulse,RR & BP.

O is given if pulm. symptoms areprominent.

Brief P/E is carried out to assess the patient.

Sample is taken & sent with the blood for re-crossmatching.

Freshly voided urine sample/catheter

specimen.


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PREVENTION OF TRANSFUSIONREACTIONAppropriate pre-testing & proper labelling.

Improved blood bank services.

Encouraging voluntary non-remunerated

blood donation.

Exploiting Autologous Transfusion:-Autologous pre-donation

-AISH-Intraoperative blood salvage

Use of pharmacologic agents:EP ;Haematinics

Good anaesthetic & surgical management.


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CHALLENGES OF BLOODTRANSFUSION

Limitations of our blood banks- storage &blood separation.

Religious objections to blood transfusion.

Blood procurement in emergencies.

Blood procurement in cases of candidatesfor massive blood transfusion.

Blood for patients with AIHD


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BLOOD SUBSTITUTES &ALTERNATIVES

PLASMA SUBSTITUTES: These are colloid and

crystalloid solutions used for maintaining the

circulation volume following acute haemorrhage,

shock, burns and septicaemias. Plasma substituteshave no 02 carrying capacity and also lack

haemostatic properties.

Crystalloids No oncotic activity

Colloids temporary oncotic activity (short half life)

Plasma substitutes are used in emergency prior to the

availability of compatible blood and appropriate

blood product.


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CRYSTALLOIDS:-0.9% saline solution.-Ringers Lactate.-Darrows solution.

-5% Dextrose.

COLLOIDS:-Dextrans.

-Hydroxylethyl starch.-Gelatin (Haemacel).


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CRYSTALLOIDS VS COLLOIDS

Solutions Advantages Disadvantages

Crystalloids Readily available Lackof oncotic

Easy storage pressure inplasma

Easy administration

Non-immunogenic

Non-toxic

Do not inhibit synthesis

of albumin


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ARTIFICIAL O CARRIERS

Synthetic O2 carrying agents are stillexperimental:

Two classes exist Perfluorochemicals

and,Chemically modified Hb

The perfluorochemicals are fluorinatedhydrocarbons. They readily dissolve

oxygen, but are poorly soluble in plasma.One of these compounds fluorosol DAhas been studied in animals and is currentlybeing studied in humans.

Side effects: hypotension and DIC,


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CONCLUSION

Blood transfusion is an essential componentof therapy for a wide variety of disorders.However, the hazards of allogeneic BT havealso been well documented over the years.

Thus while researches are on-going todiscover the perfect blood substitute, thereis always the need to weigh benefits against

risks so as to make the best use of this scarcehuman resource.


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Discuss the Indications and Complications of Blood Transfusion

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