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Medicine 5th year, 11th lecture/part two (Dr. Sabir)
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Medicine 5th year, 11th lecture/part two (Dr. Sabir)

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The lecture has been given on Apr. 17th, 2011 by Dr. Sabir.

The lecture has been given on Apr. 17th, 2011 by Dr. Sabir.

Published in: Health & Medicine

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  • 1. Blood Transfusion Dr. Sabir
  • 2. Blood Transfusion
    • . Types :
    • 1- whole blood
    • 2- packed RBCs
    • 3- fresh frozen plasma
    • 4- platelets
    • 5- granulocyte transfusion
    • 6- cryopercipitate transfusion
  • 3. Fresh Frozen Plasma
    • . Stored frozen, when thawed to 37 o C should be transfused within 24 hrs
    • . unit = 200ml increases the level of each clotting factor 2-3%
    • . Dose = 10-15 mlKg
    • . Indications : - isolated factor deficiency
    • - warfarin reversal
    • - liver disease
    • - massive blood transfusion
    • - antithrombin III deficiency when heparin is needed
  • 4. Platelets
    • . Stored at 20-24 0 C for 5 days (shelf life) ,
    • . Unit 50-70 ml, survival only for 1-7 days
    • . Each unit increase platelet count by 5000-10,000
    • . Side effects :
    • - Rh sensitization
    • - Anti A, anti B reaction
    • - HLA typing
    • - proliferating bacteria
    • . Indications :
    • a- thrombocytopenia (DIC, massive transfusion, prophylactic preop, ITP)
    • b- thrombasthenia (bleeding, prophylactic preop,)
  • 5. Transfusion Reactions
    • Acute Hemolytic TR
    • Non-immune-mediated hemolysis
    • Delayed Hemolytic TR
    • Febrile Non-hemolytic TR
    • Allergic TR
    • Anaphylactic & anaphylactoid R
    • Transfusion-related acute lung injury
    • Transfusion-associated circulatory overload
    • Metabolic reactions
    • Transfusion-associated GVHD
    • Iron overload
    • Post-transfusion hemosiderosis
    • Alloimmunization
    • Post-transfusion purpura
    • Bacterial contamination reaction
    • Transfusion-transmitted diseases
  • 6. Signs and Symptoms of AHTR
    • Chills , fever
    • Facial flushing
    • Hypotension
    • Renal failure
    • DIC
    • Chest pain
    • Dyspnea
    • Generalized bleeding
    • Hemoglobinemia
    • Hemoglobinuria
    • Shock
    • Nausea & vomiting
    • Back pain
    • Pain along infusion vein
  • 7. Acute Hemolytic Transfusion Reactions
    • Acute onset within minutes or 1-2 hours
    • after transfuse incompatible blood
    • Most common cause is ABO-incompatible
    • transfusion
  • 8. Management of AHTR
    • Stop the transfusion
    • Keep IV fluid
    • Notify patient’s physician and blood bank
    • Take care of patient
    • Perform bedside clerical checks
    • Return unit, set to blood bank
    • Collect appropriate post transfusion blood
    • sample for evaluation
  • 9. Non-Immune-Mediated Hemolysis
    • Causes
        • Physical or chemical destruction of
        • bood: freezing, heating, drugs
        • solutions added to blood
        • Bacterial contamination
    • Treatment
      • depends on the causes
        • mild reaction  supportive treatment
        • severe reaction  intensive treatment
  • 10. Delayed Hemolytic Transfusion Reaction
    • Signs & Symptoms
        • mild fever with chill
        • mild anemia
        • mild to moderate jaundice
        • Uncommon  hemoglobinemia, Hemoglobinuria, shock, renal failure
  • 11. Febrile Nonhemolytic Transfusion Reaction
    • Signs & Symptoms
        • Fever with or without chills
        • most symptoms are mild
        • severe reaction :- hypotension, cyanosis, tachycardia, tachypnea, dyspnea, cough etc.
  • 12. Febrile Nonhemolytic Reaction
    • Treatment
    • discontinue blood transfusion
    • Antipyretic for fever
    • Prevention
    • using prestorage leukocyte –reduced red blood cell or platelet
  • 13. Allergic Transfusion Reactions
    • Signs & Symptoms
    • - Urticaria
    • - severe reactions are rare
    • Therapy & Prevention
    • - Antihistamine
    • - Plasma – deficient blood components
  • 14. Anaphylactic and Anaphylactoid reactions
    • Signs & Symptoms
    • - Anaphylactic  coughing, dyspnea, nausea, emesis, bronchospasm, flushing of skin, chest pain, hypotension, abdominal cramps, diarrhea, shock, and death.
    • - Anaphylactoid (less severe)  urticaria, periorbital swelling, dyspnea, or perilaryngeal edema
  • 15. Anaphylactic and Anaphylactoid reactions
    • Therapy and Prevention
    • Stop transfusion
    • Keep IV line open
    • Medication :- epinephrine, corticosteroid
    • Wash RBCs and blood components
    • Transfuse IgA deficiency blood
  • 16. Transfusion-related Acute Lung Injury (TRALI)
    • Acute and severe type of transfusion reaction
    • Symptoms and signs
    • Fever
    • Hypotension
    • Tachypnea
    • Dyspnea
    • Diffuse pulmonary infiltration on X-rays
    • Clinical of noncardiogenic pumonary edema
  • 17. Transfusion-related Acute Lung Injury (TRALI)
    • Therapy and Prevention
    • Adequate respiratory and hemodynamic supportive treatment
    • If TRALI is caused by pt. Ab  use LPB
    • If TRALI is caused by donor Ab  no special blood components
  • 18. Transfusion-associated Circulatory Overload (TACO)
    • Patients at significant risk
    • Children
    • Elderly patients
    • Chronic anemia
    • Cardiac disease
    • Thalassemia major or Sickle cell disease
  • 19. Symptoms and Signs
    • Dyspnea
    • Coughing
    • Cyanosis
    • Orthopnea
    • Chest discomfort
    • Headache
    • Restlessness
    • Tachycardia
    • Systolic hypertension increase > 50 mm.Hg
  • 20. Therapy
    • Rapid reduction of hypervolemia
    • Respiratory and cardiac support
    • Oxygen therapy
    • Diuretic
    • Therapeutic phlebotomy
  • 21. Metabolic Reaction
    • Citrate toxicity
    • Hyperkalemia
    • Hypothermia
    • Coagulopathy in massive transfusion
    • Air embolism
  • 22. Transfusion-associated Graft-versus-Host Disease ( TA-GVHD)
    • Patient at risk
    • Bone marrow transplantation
    • Chemotherapy
    • Radiation treatment
    • Newborn
  • 23. Graft-versus-Host Reaction
    • Signs & Symptoms
    • Onset ~ 3 to 30 days after transfusion
    • Clinical significant – pancytopenia
    • Other effects include fever, liver enzyme,
    • copious watery diarrhea,
    • erythematous skin erythroderma
    • and desquamation
  • 24. Graft-versus-Host Reaction
    • Therapy
    Drugs :- corticosteroids, methotrexate, azathioprine, antithymocyte globulin But no adequate therapy Prevention Irradiation of Blood Components avoid potential fatalities
  • 25. Iron overload 1 unit of PRCs has ~ 250 mg of Iron Removed by body 1 mg / day accumulate iron Hemosiderosis
  • 26. Posttransfusion Hemosiderosis
    • Affected organ :- heart, liver, endocrine glands
    • Signs & Symptoms
    • - muscle weakness, fatigue, weight loss, mild jaundice, anemia, mild diabetes, and cardiac arrhythmia
    • Therapy  Iron – chelating agent
    • Prevention  transfuse with young RBCs
  • 27. Alloimmunization
    • Signs & Symptoms
        • mild  slight fever and Hb
        • severe  platelet refractoriness with bleeding
    • Therapy & Prevention
        • depends on type and severity
  • 28. Posttransfusion Purpura
    • Rare complication
    • Rapid onset of thrombocytopenia as a result of anamnestic production of platelet alloantibody
    • Usually occurs in multiparous woman
        • Purpura and thrombocytopenia occur ~ 1-2 wk after transfusion
  • 29. Posttransfusion Purpura
    • Therapy and Prevention
        • Corticosteroids
        • Exchange transfusion
        • Plasmapheresis
  • 30. Bacterial contamination reaction
    • Cause gram –ve, gram +ve bacteria
    • most frequent – Yersinia enterocolitica
    • Pathophysiology
    • Bacteria growing in cold temperature
    • Produced endotoxin
  • 31. Symptoms & Signs
    • Acute onset within ~ 30 min after transfusion
    • Dryness and flushing skin
    • Fever, hypotension, shaking chills, muscle pain, vomitting, abdominal cramps, bloody diarrhea, hemoglobinuria, shock, renal failure, and DIC.
    • Treatment: broad-spectrum antibiotics
  • 32. Transfusion – Transmitted Diseases
    • Viral Infections
        • Hepatitis Viruses :- HBV, HCV
        • Retroviruses :- HIV
        • Herpesviruses :- CMV, EBV
        • Parvovirus :- Human B19 parvovirus
        • Prion :- infectious particle of CJD
  • 33. Transfusion – Transmitted Diseases
    • Bacterial Infection
        • Gram -ve and +ve
        • Syphilis
        • Lyme disease
  • 34. Transfusion – Transmitted Diseases
    • Parasitic Infections
      • Malaria
      • Chagas disease
      • Toxoplasmosis
      • Leishmaniasis
  • 35. Steps to take when a transfusion reaction occurs
    • Stop the transfusion immediately
    • Leave the needle in the vein and begin infusing normal saline
    • Obtain vital signs
    • Begin O 2 if pulmonary symptoms are prominent
    • Carry out PE : lung, heart, skin, signs of abnormal bleeding
  • 36. Steps to take when a transfusion reaction occurs
    • Obtain a new blood sample for repeat RBC compatibility test and inspection for hemolysis
    • Obtain a urine sample if the patient can void
    • Obtain a chest x-ray if pulmonary symptoms are prominent
    • Begin definitive treatment