Indication of blood transfusion
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Transcript of Indication of blood transfusion
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Indication of Blood Transfusion
Himal Pandey MBBS 2014 August, NMCTH
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whom to give? Why to give? & what to give?
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To restore the circulating blood volumeTo maintain Adequate oxygen delivery Replacement of clotting factors, and other
blood components
AIM
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Transfusion triggerTransfusion trigger is defined as that value of
haemoglobin (Hb) below which RBC transfusion is indicated.
History and present scenarioPerioperative RBC transfusion criteriaHb level (g/dl) Indications
<6 Likely to be benificial
6 to 8 Unlikely to be benificial in absence of bleeding or surgery
>8 No indication in absence of risk factors
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Indications-----1. General indicationsAcute blood loss
Perioperative anemia- Preoperative, Intraoperative and Post operative
Severe burns
Infection(septicemia)
Chronic anemia
Hemorrhagic states/coagulation dysfunction
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--2.Special indicationsMassive transfusion--indicated in severe trauma, ruptured aortic aneurysm &
other complication
Exchange transfusion-sickle cell anemia, thalassemia, neonatal polycythemia,
severe neonatal jaundice, in some drug toxicity
Autologous transfusion-aka itraoperative blood salvage
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Acute blood loss% of blood loss Blood fraction
components< 20 % crystalloid
20 to 50 % Crystalloid + packed RBC
> 50 % Crystalloid + packed RBC+ albumin/Plasma
> 50 % , bleeding continues
Crystalloid + packed RBC+ albumin/Plasma+ FFP
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Perioperative Transfusion
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Severe Burn Criteria for transfusion-In child -In adult
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Indication of different blood fractions for different condition
1.Whole blood-acute bllood loss with hypovolemia,exchange transfusion,
other means not available2.Packed red cells -in chronic anemias mainly in old age and in children to
minimise the cardiac overload due to transfusion- 1 unit increases the Hb level by 1g/dl3. FFP-in severe liver disease , congenital coagulation factor
deficiency, deficiency of clotting factors following warfarin therapy, DIC,massive transfusion
-1 unit increases clotting factors level by 3%
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4.Cryoprecipitate-in deficiency of Factor VIII , fibrinogen and von willibrand
disease- Target is to make the plasma fibrinogen level 150 mg/dl5. Platelet concentrate-thrombocytopenia and drug induced haemorrhage(aspirin
and clopidogrel)-0.1 unt/kg when platelet drops below 20,000 or after
episodes of bleeding-one platelet concentrate can increase 10,000platelet/cc in
one hour6.Prothrombin complex concentrate-contains II,IX & X-in emrgency reversal of warfarin therapy7.Human albumin -burn, hypoalbuminemia and severe protein loss
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Further Reading
-Bailey and Love’s SHORT PRACTICE OF SURGERY, 24th & 26th edition
-Schwarts Principle of Surgery,-Williams Hematology,-Harrison's Principles of Internal Medicine,18th edition-WHO Blood transfusion safety (Handbook)-https://www.transfusion.com.au-https://www.ncbi.nlm.nih.gov
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