Blood transfusion

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  • 1. BLOOD TRANSFUSIONBY Dr. HASSAN TAHA ANESTHESIA SPECIALIST
  • 2. OBJECTIVES  History of blood transfusion  Purposes for blood transfusion  Function and properties of blood  Time of blood transfusion  Blood component  Properties and indication of transfusion for every one  Complications and management of blood transfusion
  • 3. HISTORYHISTORY The science of blood transfusion dates to the first decade of the 19th century, with the discovery of distinct blood types leading to the practice of mixing some blood from the donor and the receiver before the transfusion.  First blood transfusion was done by LOWER in 1665 from dog to dog  In 1901 Sir Austrian Karl Landsteiner discovered blood groups.  He was awarded nobel prize for this discovery in 1930.
  • 4. BLOOD TRANSFUSION  It is a procedure in which a patient receives a blood product through an intravenous line.  It is the introduction of blood components into the venous circulation.  Process of transferring blood-based products from one person into the circulatory system of another.
  • 5. PURPOSES  To replace blood lost during surgery or a serious injury.  To restore oxygen-carrying capacity of the blood.  To provide plasma factors to prevent or treat bleeding.  Done if patient’s body is not capable of making blood properly because of an illness or acute los of blood.
  • 6. FUNCTION AND PROPERTIES OF BLOOD  A vehicular organ that perfuses all other organs  Blood and interstitial fluid deliver nutrients to cells and remove wastes  Haemostatic governors are carried to and from appropriate sites  Blood resembles an average 8% of body weight
  • 7. FUNCTION OF BLOOD • TRANSPORT:  suspended cells include RBCs that carry O2 , One RBCs can carry 1 billion O2 molecule  Platelets that contributes to the haemostatic process ,  Chemicals dissolved in plasma (nutrients, waste, hormones, etc)  metabolic heat for disposal ONE cubic ml of blood contain 400.000 platelets
  • 8. FUNCTION OF BLOOD • REGULATION:  plasma contains pH buffers  plasma water absorbs heat  plasma solutes maintain osmolality
  • 9. FUNCTION OF BLOOD • PROTECTION:  plasma precursor proteins form blood clot when stimulated  suspended WBCs attack bacteria and viruses ( body’s defense )  plasma contains antibodies and opsonins for immunity
  • 10. BEFOR TRANSFUSION WE MUST DETERMINE- W.H.A.T- FOR ANY PROCEDURE
  • 11. Blood transfusions can be grouped into two main types depending on their source:  Homologous transfusions, or transfusions using the stored blood of others.  Autologous transfusions, or transfusions using one's own stored blood. BLOOD TRANSFUSIONBLOOD TRANSFUSION
  • 12. When Hb concentration falls below “acceptable” valuesWhen Hb concentration falls below “acceptable” values and SaO2 is adequate, SVO2 or oxygen extraction ratioand SaO2 is adequate, SVO2 or oxygen extraction ratio may be useful in predicting adequate tissue oxygenationmay be useful in predicting adequate tissue oxygenation 20% loss – no need20% loss – no need 20%-30% loss - plasma substitution20%-30% loss - plasma substitution >30% - Blood transfusion>30% - Blood transfusion WHENE BLOOD TRANSFUTIONWHENE BLOOD TRANSFUTION ))INDICATIONINDICATION((
  • 13. .
  • 14. FRESH WHOLE BLOODFRESH WHOLE BLOOD  Blood that has been drawn recently (within 24 hours) butBlood that has been drawn recently (within 24 hours) but NOT separated into its components.NOT separated into its components.  Contains red blood cells, plasma, clotting cascade factors,Contains red blood cells, plasma, clotting cascade factors, and plateletsand platelets  Anticoagulant (CPDA-1)-63mlAnticoagulant (CPDA-1)-63ml  Hct 35-45% . 1 Unit- 450mlHct 35-45% . 1 Unit- 450ml
  • 15.  Contents of fresh bloodfresh blood o RBC’sRBC’s o WBC’sWBC’s o PlateletsPlatelets o PlasmaPlasma o Clotting factorsClotting factors If refrigerated within 8 hours of collection, store up to 5 days,If refrigerated within 8 hours of collection, store up to 5 days, the product only has RBCs and plasma as platelets becomethe product only has RBCs and plasma as platelets become non-viable at 4oCnon-viable at 4oC Indications  Acute loss of whole bloodAcute loss of whole blood  Massive transfusionMassive transfusion  Cardiovascular bypass surgeryCardiovascular bypass surgery
  • 16. 1. PACKED RED BLOOD CELL ( PRBCs )PACKED RED BLOOD CELL ( PRBCs )  (PRBCs) 1 unit contain (250 ml and Hct.70%)  Healthy, normovolemic individual, tissue oxygenation is maintained and anemia tolerated at Hct as low as 18-25% (Hb 6gm%).  RBC transfusion is rarely indicated when Hb > 10 g/dl and is almost always indicated when Hb < 6 g/dl.  Fastest way to increase the oxygen-delivering capacity of the blood.Fastest way to increase the oxygen-delivering capacity of the blood.  A unit of whole blood or packed red cells will raise the hematocriteA unit of whole blood or packed red cells will raise the hematocrite by 3% and the hemoglobin by 1 gm/dlby 3% and the hemoglobin by 1 gm/dl
  • 17.  RBCs made and destroyed by a rate of 2-3 million per second .  D5W lyses RBC’s.  ONE cubic ml of blood contain 5 million of RBCsONE cubic ml of blood contain 5 million of RBCs  We have approximately 25-30 trillion RBCs in our blood at any given time  Each RBCs has 250 million hemoglobin molecule  Every hemoglobin molecule can hold 4O2 molecule so one RBCs can carry 1 billion O2 molecule  One cubic milliliter of blood has only 5.000-10.000 white WBCs
  • 18. Contents  RBC’s  20% Plasma Indications  Replace O2 carrying capacity with less volume  Severe anemia, slow blood loss, CHF
  • 19. 2. FFP ( initial therapeutic dose : 10-15 ml/kg )( initial therapeutic dose : 10-15 ml/kg )  4-5 units of FFP- in deterioration of normal hemostasis4-5 units of FFP- in deterioration of normal hemostasis Stored at -30 CStored at -30 C (shelf life of 12 months) . Thawed rapidly at 37 C.shelf life of 12 months) . Thawed rapidly at 37 C. ONE unit increase coagulation factors 2-3 %ONE unit increase coagulation factors 2-3 % Infused intravenously through a standard blood set with on-lineInfused intravenously through a standard blood set with on-line filterfilter ABO group must be compatibleABO group must be compatible Infusion of 1 unit should be complete within 4 hr of thawingInfusion of 1 unit should be complete within 4 hr of thawing  ContentsContents Clotting factorsClotting factors FibrinogenFibrinogen  ProthrombinProthrombin Albumin & GlobulinsAlbumin & Globulins
  • 20.  indicationindication  Isolated factor deficienciesIsolated factor deficiencies  Reverse warfarin therapyReverse warfarin therapy  Correction of coagulopathy associated with liver diseaseCorrection of coagulopathy associated with liver disease  Used in patients who are received massive bloodUsed in patients who are received massive blood transfusion with microvascular bleedingtransfusion with microvascular bleeding  Antithrombin III deficiencyAntithrombin III deficiency  TTP ( Thrombotic thrombocytopenic purpura )TTP ( Thrombotic thrombocytopenic purpura ) ## Do not use for volumeDo not use for volume
  • 21. 3. platelets 1 unit (50-70 ml, stored at +20 to +24c for 5 days)1 unit (50-70 ml, stored at +20 to +24c for 5 days)  indicationindication  thrombocytopenia or dysfunction platelets inthrombocytopenia or dysfunction platelets in the presence bleedingthe presence bleeding  prophylactic : plt. counts below 10,000 to 20,000prophylactic : plt. counts below 10,000 to 20,000  prophylacticprophylactic preoperative : plt. counts belowpreoperative : plt. counts below 50,00050,000  Microvascular bleeding in surgical patientMicrovascular bleeding in surgical patient with platelets < 50,000with platelets < 50,000  Neuro/ ocular surgery > 75,000Neuro/ ocular surgery > 75,000
  • 22. 4. Cryoprecipitate4. Cryoprecipitate  Concentrate of factor VIII, von Willebrand’s factor and fibrinogenConcentrate of factor VIII, von Willebrand’s factor and fibrinogen  20 ml containing 150-300 mg of fibrinogen and 80-120 IU of factor VIII20 ml containing 150-300 mg of fibrinogen and 80-120 IU of factor VIII  Stored at -30 C (shelf life 12 month)Stored at -30 C (shelf life 12 month)  Also thawed at 37 CAlso thawed at 37 C  1U/ 10kg1U/ 10kg ↑↑ fibrinogen 50 mg/dL (usually a 6- pack)fibrinogen 50 mg/dL (usually a 6- pack)  Transfusion should be complete within 4 hourTransfusion should be complete within 4 hour indicationsindications  Hemophilia AHemophilia A  Factor XIII deficiencyFactor XIII deficiency Hypofibrinogenemia (congenital or acquired)Hypofibrinogenemia (congenital or acquired) Microvascular bleeding (fibrinogen < 80-100mg/dL)Microvascular bleeding (fibrinogen < 80-100mg/dL)
  • 23. Complication of Blood Transfusion A. Immediate reactions – Febrile reactionFebrile reaction – Allergic reactionsAllergic reactions – Hemolytic transfusion reactionHemolytic transfusion reaction – Circulatory over loadCirculatory over load – Air embolismAir embolism – Potassium toxicityPotassium toxicity – Citrate toxicityCitrate toxicity – Reaction due to infected bloodReaction due to infected blood
  • 24. B-Delayed transfusion reactions ThrombophlebitisThrombophlebitis infectioninfection -- AIDS (HIV) Hepatitis (HBV, HCV)AIDS (HIV) Hepatitis (HBV, HCV) -- Syphilis (Treponema pallidum / Spirochetes)Syphilis (Treponema pallidum / Spirochetes) -- Malaria , C.M.V & otherMalaria , C.M.V & other Immunological sensitization or alloimmunizationImmunological sensitization or alloimmunization Post transfusion purpuraPost transfusion purpura hemolytic transfusion reactions (HTR)hemolytic transfusion reactions (HTR) Complication of massive transfusionComplication of massive transfusion
  • 25. Hemolytic transfusion reactions (HTR) • Incompatibility between donors and recipient 99% of causes is human error and preventable by •  Adequate knowledge of blood groupsAdequate knowledge of blood groups  Careful attention to all details of the techniquesCareful attention to all details of the techniques - blood group incompatibility- blood group incompatibility - outdated and infected blood- outdated and infected blood - Haemolysed blood- Haemolysed blood - Incorrect anticoagulant- Incorrect anticoagulant
  • 26. Chills & rigorsChills & rigors Chest painChest pain Back painBack pain Nausea, vomitingNausea, vomiting Flushing, sweatingFlushing, sweating Pain at infusion sitePain at infusion site Abdominal discomfortAbdominal discomfort Anxiety & RestlessnessAnxiety & Restlessness Symptoms of hemolytic transfusion reactionsSymptoms of hemolytic transfusion reactions
  • 27.  SignsSigns Fever with rigorsFever with rigors TachycardiaTachycardia DyspnoeaDyspnoea TachypnoeaTachypnoea PallorPallor HypotensionHypotension HemoglobinuriaHemoglobinuria Anuria / OliguriaAnuria / Oliguria CyanosisCyanosis Shock & DICShock & DIC Unexplained bleedingUnexplained bleeding
  • 28.  Under anesthesia and sedationUnder anesthesia and sedation  Bleeding from wound / needle sitesBleeding from wound / needle sites  Persistent hypotensionPersistent hypotension  Tachycardia, hyperthermiaTachycardia, hyperthermia Lab evidenceLab evidence  direct antiglobulin test ( DAT ) positivedirect antiglobulin test ( DAT ) positive  Indirect bilirubin increasedIndirect bilirubin increased  HemoglobinemiaHemoglobinemia  HemoglobinuriaHemoglobinuria
  • 29. ManagementManagement  Stop transfusion immediatelyStop transfusion immediately  Maintain IV access with crystalloidMaintain IV access with crystalloid  Maintain BP, pulseMaintain BP, pulse  Ventilation & oxygenationVentilation & oxygenation  IV diuretics - mannitol IVIV diuretics - mannitol IV  frusemide IV bolusfrusemide IV bolus  Send blood samples to blood bank-5ml of plain blood &Send blood samples to blood bank-5ml of plain blood & 2ml of EDTA blood2ml of EDTA blood  CBC and blood pictureCBC and blood picture  Urine sample for hemoglobinuria
  • 30. If intravascular hemolysis is confirmedIf intravascular hemolysis is confirmed  Monitor renal statusMonitor renal status  Monitor coagulation statusMonitor coagulation status  If Hb is markedly reduced ,compatible red cell transfusionIf Hb is markedly reduced ,compatible red cell transfusion may be required to combat hypoxemia.may be required to combat hypoxemia.  Treat DIC if it occursTreat DIC if it occurs
  • 31. Don’ts for Blood TransfusionDon’ts for Blood Transfusion  Don’t use blood without mandatory screening test.Don’t use blood without mandatory screening test.  Don’t delay initiation of blood transfusion.Don’t delay initiation of blood transfusion.  Don’t warm blood without proper monitoring.Don’t warm blood without proper monitoring.  Don’t transfuse 1 unit over more than 4 hours.Don’t transfuse 1 unit over more than 4 hours.  Don’t use 1 transfusion set for >4 hours or >2 units ofDon’t use 1 transfusion set for >4 hours or >2 units of blood.blood.  Don’t leave patients unmonitored.Don’t leave patients unmonitored.  Don’t add any medication to blood bags.Don’t add any medication to blood bags.  Don’t forget to return unused blood to the blood bank forDon’t forget to return unused blood to the blood bank for safe disposal.safe disposal.  Don’t store platelets in a refrigerator.Don’t store platelets in a refrigerator.