Blood and blood transfusions

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Blood and blood transfusions

  1. 1. BLOOD & BLOOD TRANSFUSIONS DR.SHALINI SINGH (PG)
  2. 2. BLOOD blood and blood transfusions 2
  3. 3. OBJECTIVES • Properties and functions of blood • Plasma proteins • Bone marrow • Red blood cells • White blood cells • Platelets blood and blood transfusions 3
  4. 4. • Blood is considered as river of life, fluid of life, fluid of growth, fluid of health. • Average human has 5 liters of blood i.e 8% of total body weight. • It is a transporting fluid. • It carries vital substances to all parts of body. 4blood and blood transfusions
  5. 5. Properties Of Blood • Color range • Oxygen-rich blood is scarlet red bright crimson • Oxygen-poor blood is purple red. • Red color comes from the several million red cells, present in it • pH must remain between 7.35– 7.45 • Temp 38 c or 100.4 F 5blood and blood transfusions
  6. 6. • Blood is 5 times more viscous than water. • Blood is a specialized type of connective tissue in which living blood cells, (formed elements), are suspended in a non living fluid matrix called plasma. • Cellular Part (Formed Elements) • Non cellular part (Plasma) 6blood and blood transfusions
  7. 7. 7blood and blood transfusions
  8. 8. Functions of blood Blood performs a number of functions. • Distribution • Regulation • Protection Distribution Functions Nutritive Function: Respiratory Function: Excretory Function: Transport Function: 8 blood and blood transfusions
  9. 9. Regulation Functions • Maintainance Functions • Buffering Functions Protection Functions • Preventing blood loss • Defensive function 9blood and blood transfusions
  10. 10. PLASMA • Plasma is the fluid portion of the blood. It constitutes about 5% of the body weight. • If blood is allowed to clot, then a clear, straw colored fluid oozes out. This is the serum . • Serum is similar to plasma, except that serum does not have clotting factors. • SERUM = PLASMA - FIBRINOGEN blood and blood transfusions 10
  11. 11. • It contain all the vital substances. • These vital substances include digested food, salts, hormones, enzymes, substances essential for clotting of blood, and antibodies , which are important for defense. blood and blood transfusions 11
  12. 12. 12blood and blood transfusions
  13. 13. Separation Of Plasma Proteins • Precipitation method • Salting out method • Electrophoretic method • cohn’s fractional precipitation method • Ultracentrifugation method • gel filtration chromatography • Immunoelectrophoretic method blood and blood transfusions 13
  14. 14. PROPERTIES • Molecular weight Albumin- 69,000 globulin- 1,56,000 fibrinogen- 4,00,000 • Oncotic pressure- about 25 mm Hg • Specific gravity- 1.026 • Buffer capacity- 1/6 of total buffering action of blood ORIGIN • In embryo – synthesized by mesenchymal cells. • In adults – mainly from reticuloendothelial cells of liver blood and blood transfusions 14
  15. 15. Functions of plasma • Helps in transport of substances in the body • Maintains colloid osmotic pressure of blood • Causes blood clotting because it contains the fibrinogen and prothrombin • Stores proteins for supply in needs • Helps provides viscosity to blood • Contains antibodies and antitoxins 15blood and blood transfusions
  16. 16. BONE MARROW • The bone marrow is present in the bone cavities. • It can be considered as one of the largest organs in the body, and also one of the most active. • In children, blood cells are produced in the marrow cavities of all the bones. • Gradually, it gets replaced by fat (yellow marrow). • In the adult blood cells are produced in the bone marrow of selected bones (e.g. backbone – vertebral column, ribs, bones of the skull, etc.) 16blood and blood transfusions
  17. 17. 17blood and blood transfusions
  18. 18. Bones require their own blood supply which travels through the periosteum to the inner bone marrow. 18blood and blood transfusions
  19. 19. RED BLOOD CELLS • RBCs are also called erythrocytes . • They are tiny (7.5u in diameter, 2u thick) biconcave discs. • They survive for about 120 days. • RBCs are non nucleated formed elements in the blood. • The average normal RBC count is – • for men 5.4 million/uL • for women 4.5 million/uL 19
  20. 20. 20blood and blood transfusions Production of Erythrocytes: Erythropoiesis
  21. 21. • Hemoglobin is the most important component of red blood cells. • It is composed of a protein called heme, which binds oxygen. • In the lungs, oxygen is exchanged for carbon dioxide. • Abnormalities of an individuals hemoglobin value can indicate defects in red blood cell balance. • Both low and high values can indicate disease states. 21blood and blood transfusions
  22. 22. Formation of RBCs • Takes place in the bone marrow. • A feedback exists – if the RBC count rises, further increases are inhibited. • Low levels of oxygen in the atmosphere stimulate the formation of RBCs. • This is an important part of the body’s adjustment to high altitudes. People living in the mountains actually do have higher RBC counts than usual. • RBC formation is regulated by a substance secreted by the kidneys. 22
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  24. 24. • Destruction of RBCs • About 5 X 10 11 RBCs are destroyed everyday, in the liver and spleen. • Functions of RBCs • Carriage of oxygen. • Hemoglobin (Hb) – the red pigment – acts as the vehicle for the transport of oxygen from the lungs, via the heart to the rest of the body. • Also carries CO2, though greater amounts of CO2 are transported dissolved in plasma. • Average Hb level in normal men 16gdL and 14gdL in normal women. blood and blood transfusions 24
  25. 25. • Iron is essential for the synthesis of Hb. • Hence after excessive bleeding iron supplements (tonics) plus a diet rich in iron are necessary for more Hb to be formed. • Carriage of CO2 (less significant) – as described above, most of the CO2 is dissolved in plasma. • Presence of specific substances on their surface, which are responsible for ‘typing’ blood into different groups. blood and blood transfusions 25
  26. 26. blood and blood transfusions 26
  27. 27. Variations in number of RBCs PHYSIOLOGIC VARIATIONS • Increase • Age • Sex • High altitude • Muscular exercise • Emotional conditions • Increased environmental temperatureAfter meals • Decrease— • High barometric pressure • During sleep • pregnancy blood and blood transfusions 27
  28. 28. PATHOLOGIC VARIATIONS • Increase– polycythemia • Decrease-- anemia blood and blood transfusions 28
  29. 29. WHITE BLOOD CELLS • WBCs or leukocytes consists of 5 categories of cells. • Each category has a distinct shape and appearance. • Some cells are smaller than RBCs (5u in diameter) whereas others are definitely bigger (15 u in diameter). blood and blood transfusions 29
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  31. 31. Formation and destruction of WBCs • The WBCs are formed in the bone marrow. • The different categories of cells have different stimuli for production. For e.g. one category (called neutrophils ) are produced in large number whenever there is short or severe (acute) infection. • There life span also differs. Some categories (e.g. neutrophils) may survive upto 7 hours. • In contrast other cells ( lymphocytes ) are called ‘ memory cells .’ blood and blood transfusions 31
  32. 32. • They are able to ‘ remember’ an invader for several months, even years. • If the invader enters the body again, these memory cells are alerted, and the body’s response to the second invasion is much more extensive and rapid. blood and blood transfusions 32
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  34. 34. Functions of WBCs • WBCs are concerned with defense . • Some of them are concerned with fighting acute (short, severe) infections, whereas others fight chronic infections. • Some WBCs are capable of moving in the tissues, acting like vigilant guards. • If they encounter a bacterium, they may consume it or make it inactive. • The pus which may be seen oozing out of an infected wound, is made up of dead WBCs . • A particular category of WBCs – the eosinophils – are increased in allergic reactions and also in cases of worm infestation. blood and blood transfusions 34
  35. 35. PLATELETS • The platelets are tiny bodies, 2-4um in diameter. • There are about 0.25 to 0.4 million/uL of circulating blood. • They have a half life of about 7 days. • The platelets are called thrombocytes , because they release thrombin , which aids in blood clotting. blood and blood transfusions 35
  36. 36. Platelets (Thrombocytes) Formation Large multinucleated cells that pushes against the wall of the capillary. Cytoplasmic extensions stick through and separate. blood and blood transfusions 36
  37. 37. blood and blood transfusions 37
  38. 38. OBJECTIVES • Provide overview of transfusion therapy. • Describe pre-transfusion responsibilities. • Describe transfusion responsibilities. • Describe post-transfusion responsibilities. • Describe types of transfusions. • Describe transfusion reactions. • Describe autologous transfusions. blood and blood transfusions 38
  39. 39. OVERVIEW • 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. blood and blood transfusions 39
  40. 40. HISTORY OF BLOOD TRANSFUSION • Before The Nobel Prize awarded, Karl Landsteiner discovered the ABO human blood groups in 1901, it was thought that all blood was the same. This misunderstanding led to fatal blood transfusions and many death. blood and blood transfusions 40
  41. 41. • Prof. Karl Landsteiner discovered that blood clumping was an immunological reaction • Karl Landsteiner's work made it possible to determine blood types • For this discovery he was awarded the Nobel Prize in Physiology or Medicine in 1930. blood and blood transfusions 41
  42. 42. • 450ml of blood can save as many as three lives. • Every two seconds, someone in India needs blood. • One out of every three of us will need blood in our life time. • Even with all of today’s modern technology, there is no substitute for blood. Someone has to give blood in order for someone to receive blood.blood and blood transfusions 42
  43. 43. •A person has 5 - 6 liters of blood in their body. •A person can donate blood every 90 days (3 months). Body recovers the Blood very quickly: • Blood plasma volume– within 24 - 48 hours • Red Blood Cells – in about 3 weeks • Platelets & White Blood Cells – within minutes blood and blood transfusions 43
  44. 44. Purposes •To replace losses of: Circulating volume Oxygen carrying capacity . •To restore: Metabolic homeostasis. •To replenish: Normal RBC’s (eg. Refractory anemias, Thalasemias, Sickle cell anemias etc) •In cancer patients like ALL; AML; with / orafter Chemothrapy drugs • For emergency surgery, heart surgery blood and blood transfusions 44
  45. 45. Typical Situations in which blood products are given • Major injuries after an accident or disaster • Surgery on an organ such as the liver and the heart • Severe Anemia • Bleeding such as Haemophilia and Thrombocytopenia • Pre-mature, pre term babies • Cancer patients blood and blood transfusions 45
  46. 46. What are the different blood groups? •There are more than 20 genetically determined blood group systems known today • The AB0 and Rhesus (Rh) systems are the most important ones used for blood transfusions. • Not all blood groups are compatible with each other. Mixing incompatible blood groups leads to blood clumping or agglutination, which is dangerous for individuals. blood and blood transfusions 46
  47. 47. ABO blood grouping system • According to the ABO blood typing system there are four different kinds of blood types: A, B, AB or O (null). blood and blood transfusions 47
  48. 48. AB0 blood grouping system • Blood group A If you belong to the blood group A, you have A antigens on the surface of your RBCs and B antibodies in your blood plasma. • Blood group B If you belong to the blood group B, you have B antigens on the surface of your RBCs and A antibodies in your blood plasma. blood and blood transfusions 48
  49. 49. Blood group O If you belong to the blood group O (null), you have neither A or B antigens on the surface of your RBCs but you have both A and B antibodies in your blood plasma. blood and blood transfusions 49
  50. 50. Possible Blood group Genotypes blood and blood transfusions 50 Parent Allele A B O A AA AB AO B AB BB BO O AO BO OO
  51. 51. The ABO blood groups • The most important thing is in assuring a safe blood transfusion. • The table shows the four ABO phenotypes ("blood groups") present in the human population and the genotypes that give rise to them. blood and blood transfusions 51 Blood Group Antigens on RBCs Antibodies in Serum Genotypes A A Anti-B AA or AO B B Anti-A BB or BO AB A and B Neither AB O Neither Anti-A and anti-B OO
  52. 52. The Rhesus (Rh) System • Well, it gets more complicated here, because there's another antigen to be considered always - the Rh antigen. • Some of us have it, some of us don't have. • If it is present, then blood is RhD positive, if not it's RhD negative. • So, for example, some people in group A will have it, and will therefore be classed as A+ (or A positive). • While the ones that don't, are A- (or A negative). • And so it goes for groups B, AB and O. blood and blood transfusions 52
  53. 53. What is that Rh antigens? •Rh antigens are transmembrane proteins with many loops exposed at the surface of red blood cells. • They appear to be used for the transport of carbon dioxide and/or ammonia across the plasma membrane. • They are named for the rhesus monkey in which they were first discovered. • RBCs that are "Rh positive― Must express the antigen designated as D. • A person with Rh- blood does not have Rh antibodies naturally in the blood plasma blood and blood transfusions 53
  54. 54. • According to above blood grouping systems, you can belong to either of following 8 blood groups: blood and blood transfusions 54
  55. 55. • A person with Rh- blood can develop Rh antibodies in the blood plasma if he or she receives blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. • A person with Rh+ blood can receive blood from a person with Rh- blood without any problems. blood and blood transfusions 55
  56. 56. Laboratory Determination of the ABO System blood and blood transfusions 56
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  61. 61. blood and blood transfusions 61 Blood Group Antigens Antibodies Can give blood to Can receive blood from AB A and B None AB AB, A, B, O A A B A and AB A and O B B A B and AB B and O O None A and B AB, A, B, O O
  62. 62. • Rh+ can receive blood from: Rh+ and Rh- • Rh- can receive blood from: Rh- only blood and blood transfusions 62
  63. 63. BLOOD BANKS • Blood banks collect, test, and store blood. • Autologous transfusion - If surgery is scheduled months in advance, patients may be able to donate their own blood and have it stored. blood and blood transfusions 63
  64. 64. BLOOD STORAGE • Blood products must be stored at 4C +- 2C. • Stored blood has a shelf life of 3 weeks. • After a storage time of 24-72 hr RBCs have reduced capability to release oxygen to tissues. • If the patient needs massive transfusions its better to give blood that’s less than 7 days old. blood and blood transfusions 64
  65. 65. Requesting Procedure • Check the patient’s case note • Transfusion history • Special requirements • e.g., irradiated, CMV negative • Complete request form or order communications blood and blood transfusions 65
  66. 66. blood and blood transfusions 66 Casenote Surname Forename DOB Ethnic Origin Location Consultant Sex Patient Category NHS Date of Request Entered by Originator Date of Specimen Service (Type of Request) Blood Group Previous Transfusion Units (amount) Date Reqd Reaction Specimen type Vacutainer 7mls pink + 4.5 mls EDTA Antibodies Specimen taken by Sign and print Name Requesting Medic Sign and Print name Copy of this request must be filed in the notes. See Trust Transfusion policy Diagnosis, referral reason, relevant medication Information found on the Request Forms
  67. 67. PRE-TRANSFUSION RESPONSIBILITIES • Assess laboratory values • Verify the medical prescription. • Assess the client’s vital signs, urine output, skin color and history of transfusion reactions. • Obtain venous access. Use a central catheter or at least a 20- gauge needle, if possible. blood and blood transfusions 67
  68. 68. Sampling Procedure • Step 1: Ask the patient to tell you their: Full Name + Date of Birth • Check this information against the patient’s ID wristband • Be extra vigilant when checking the identity of the unconscious / compromised patient blood and blood transfusions 68
  69. 69. Step 2: Check the patient’s ID wristband against documentation e.g., case notes or request form for: • First name • Surname • Date of birth • Hospital number blood and blood transfusions 69
  70. 70. Sampling Procedure  Only bleed one patient at a time using Aseptic non touch technique  Do NOT use pre-labeled tubes  Label the sample tube beside the patient  Send the sample to the laboratory in the most appropriate way for the clinical situation, i.e. routine / emergency  Remember emergency requests must always be phoned through to the Transfusion Laboratory. blood and blood transfusions 70
  71. 71. Labelling the venous blood sample • Information to include:- • Full name • Date of birth • Hospital number • Gender • Date • Signature of person who has taken the sample • At the bedside • By the person taking the sample blood and blood transfusions 71
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  73. 73. IV Blood/ Blood Component Chart blood and blood transfusions 73
  74. 74. Prescribing a transfusion • Each unit must be entered separately on the patient’s prescription sheet. • The entry must specify the type of product any special requirements the rate of transfusion – max 4hrs/unit blood and blood transfusions 74
  75. 75. Blood Transfusion Administration blood and blood transfusions 75
  76. 76. • Obtain blood products from a blood bank; transfuse immediately. • With another registered nurse, verify the patient by name and number, check blood compatibility and note expiration time. • Administer the blood product using the appropriate filtered tubing. blood and blood transfusions 76
  77. 77. Good Documentation Minimum Transfusion Dataset: the following should be documented in the notes • Reason for transfusion • Current blood results • Component type and amount to be prescribed • Anticipated outcome • Any reported transfusion adverse events/reactions • Review following the transfusion including how much blood has been transfused blood and blood transfusions 77
  78. 78. Warming Blood • STORED BLOOD IS COLD 4*C • PATIENTS UNDERGOING SURGERY WILL ALREADY BE LOSING BODY HEAT DUE TO WOUND OR CAVITY EXPOSURE • LARGE VOLUMES OF COLD BLOOD MAY INDUCE HYPOTHERMIA OR CARDIAC ARYTHMIA blood and blood transfusions 78
  79. 79. • AT INFUSION RATES>100ml/minute, COLD BLOOD MAY BE A CONTRIBUTING FACTOR IN CARDIAC ARREST. HOWEVER, KEEPING THE PATIENT WARM IS PROBABLY MORE IMPORTANT THAN WARMING THE INFUSEDBLOOD ! • WARMED BLOOD IS MOST COMMONLY REQUIRED IN LARGEVOLUME RAPID TRANSFUSIONS & EXCHANGE TRANSFUSION IN INFANTS. • BLOOD SHOULD ONLY BE WARMED IN A BLOOD WARMER THAT HAVE A VISIBLE THERMOMETER AND AN AUDIBLE WARNING ALARM AND SHOULD BE PROPERLY MAINTAINED. blood and blood transfusions 79
  80. 80. Can the Patient be Safely Transfused ? • Is the product clearly prescribed? • Are any drugs required before or during transfusion? i.e. antibiotics • Is the rate of transfusion appropriate? • Does the patients condition require medical review prior to transfusion All patients having a blood transfusion MUST have a NAMEBAND containing all of their required details blood and blood transfusions 80
  81. 81. Monitoring of Patient Base line observations – Temperature, pulse and blood pressure Further observations (as above) at 15 minutes A set of observations at the end of transfusion More frequently if the patient is unwell, unobservable, unconscious or a child. blood and blood transfusions 81
  82. 82. MONITORING PATIENTS • Ensure the venflon is secure, patent and there are no signs of inflammation • Give the patient the call bell • Patients should remain in a clinical area for the duration of the Transfusion • Review the patients fluid balance and medication. blood and blood transfusions 82
  83. 83. Pre-administration Procedure • Step 1: Check the blood component has been prescribed • Step 2: Undertake baseline observations • Step 3: Undertake visual inspection blood and blood transfusions 83 LEAKS DISCOLOURATION CLUMPING EXPIRY DATE
  84. 84. Pre-administration checks • Personal checks: - ANTT - wear personal protective equipment • Equipment checks: - Personal protective equipment is available and is clean and sterile - A correctly completed prescription chart - Observation chart - Giving set - Disposable bags - Trolley blood and blood transfusions 84
  85. 85. Administration Procedure • Step 1: Ask the patient to tell you their Full Name + Date of Birth • Check this information against the patient’s ID wristband blood and blood transfusions 85
  86. 86. Administration Procedure • Step 2: Check the patient’s – First name – Surname – Date of birth – Hospital number • on the compatibility/ traceability label against the patient’s ID wristband blood and blood transfusions 86
  87. 87. Administration Procedure • Step 3: Check the compatibility/traceability label with the blood bag label blood and blood transfusions 87 Any discrepancies DO NOT TRANSFUSE !
  88. 88. Blood Component Bedside Check Procedure blood and blood transfusions 88 SURNAME FIRST NAME(s) HOSPITAL NUMBER D.O.B.BLOOD GROUP (Patient and Unit) DONOR NUMBER EXPIRY DATE Special Requirements
  89. 89. • Remain with the patient during the first 15-30 minutes of the infusion. • Infuse the blood product at the prescribed rate. • Monitor vital signs. blood and blood transfusions 89
  90. 90. Reporting Incidents/Transfusion Reactions • Stop the Transfusion and seek Medical Input and inform the Transfusion Laboratory staff • Check the Blood component matches the patient details • Replace the unit and giving set with Normal Saline 0.9% • Send the discontinued unit with giving set attached back to transfusion capped off at the end with a white venflon cap – and any previous transfused bags sealed with the blue plugs all in biohazard bags • Documentation (complete the checklist) • Complete a Trust Incident form blood and blood transfusions 90
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  92. 92. TYPES OF TRANSFUSION blood and blood transfusions 92
  93. 93. Types of BT • Based on time of transfusion • Fresh whole blood transfusion • Stored CPD Blood • Based on composition • Whole blood • Blood fraction • Based on the donor • Autologous blood transfusion • Blood from diff donor blood and blood transfusions 93
  94. 94. Whole Blood Packed Red Blood Cells Platelet Rich Plasma Slow Centrifugation High Speed Centrifugation 1 Unit of Random Donor Platelets 1 Unit of Fresh Frozen Plasma Cryoprecipitate Thawing precipitates the plasma proteins BLOOD COMPONENTS
  95. 95. Whole Blood • Storage • 4 for up to 35 days • Indications • Massive Blood Loss/Trauma/Exchange Transfusion • Considerations • Use filter as platelets and coagulation factors will not be active after 3-5 days • Donor and recipient must be ABO identical
  96. 96. RBC Concentrate • Storage • 4 for up to 42 days, can be frozen • Indications • Many indications—ie anemia, hypoxia, etc. • Considerations • Recipient must not have antibodies to donor RBC’s (note: patients can develop antibodies over time) • Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl) • Usually transfuse over 2-4 hours (slower for chronic anemia
  97. 97. Platelets • Storage • Up to 5 days at 20-24 • Indications • Thrombocytopenia, Plt <15,000 • Bleeding and Plt <50,000 • Invasive procedure and Plt <50,000 • Considerations • Contain Leukocytes and cytokines • 1 unit/10 kg of body weight increases Plt count by 50,000 • Donor and Recipient must be ABO identical
  98. 98. Plasma and FFP • Contents—Coagulation Factors (1 unit/ml) • Storage • Comes in 200ml bags. • FFP--12 months at –18 degrees or colder • Indications • Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease, exchange transfusion, massive transfusion • Considerations • Plasma should be recipient RBC ABO compatible • In children, should also be Rh compatible • Account for time to thaw • Usual dose is 20 cc/kg to raise coagulation factors approx 20%
  99. 99. Cryoprecipitate • Description • Precipitate formed/collected when FFP is thawed at 4 • Storage • After collection, refrozen and stored up to 1 year at -18 • Indication • Fibrinogen deficiency or dysfibrinogenemia • vonWillebrands Disease • Factor VIII or XIII deficiency • DIC (not used alone) • Considerations • ABO compatible preferred (but not limiting) • Usual dose is 1 unit/5-10 kg of recipient body weight
  100. 100. Granulocyte Transfusions • Prepared at the time for immediate transfusion (no storage available) • Indications – severe neutropenia assoc with infection that has failed antibiotic therapy, and recovery of BM is expected • Donor is given G-CSF and steroids or Hetastarch • Complications • Severe allergic reactions • Can irradiate granulocytes for GVHD prevention
  101. 101. Leukocyte Reduction Filters • Used for prevention of transfusion reactions • Filter used with RBC’s, Platelets, FFP, Cryoprecipitate • Other plasma proteins (albumin, colloid expanders, factors, etc.) do not need filters—NEVER use filters with stem cell/bone marrow infusions • May reduce RBC’s by 5-10% • Does not prevent Graft Verses Host Disease (GVHD)
  102. 102. RBC Transfusions Preparations • Type • Typing of RBC’s for ABO and Rh are determined for both donor and recipient • Screen • Screen RBC’s for atypical antibodies • Approx 1-2% of patients have antibodies • Crossmatch • Donor cells and recipient serum are mixed and evaluated for agglutination
  103. 103. RBC Transfusions Administration • Dose • Supplied in 250ml bags. • Usual dose of 10 cc/kg infused over 2-4 hours • Maximum dose 15-20 cc/kg can be given to hemodynamically stable patient • Procedure • May need Premedication (Tylenol and/or Benadryl) • Filter use—routinely leukodepleted • Monitoring—VS q 15 minutes, clinical status • Do NOT mix with medications • Complications • Rapid infusion may result in Pulmonary edema • Transfusion Reaction
  104. 104. Platelet Transfusions Preparations • ABO antigens are present on platelets • ABO compatible platelets are ideal • This is not limiting if Platelets indicated and type specific not available • Rh antigens are not present on platelets • Note: a few RBC’s in Platelet unit may sensitize the Rh- patient
  105. 105. Platelet Transfusions Administration • Dose • May be given as single units or as apheresis units • Usual dose is approx 4 units/m2—in children using 1-2 apheresis units is ideal • 1 apheresis unit contains 6-8 Plt units (packs) from a single donor • Procedure • Should be administered over 20-40 minutes • Filter use • Premedicate if hx of Transfusion Reaction • Complications—Transfusion Reaction
  106. 106. Autologous Blood Transfusions • Collection/infusion of client’s own blood Four types: • Preoperative autologous blood donation • Acute normovolemic hemodilution • Intra-operative autologous transfusion • Postoperative blood salvage blood and blood transfusions 106
  107. 107. Preoperative autologous blood donation • Collecting whole blood from the client, dividing it into components and storing it for later use • Can be collected weekly as long as client’s H&H are within safe range • Can be stored up to 40 days; up to 10 years for rare blood types. blood and blood transfusions 107
  108. 108. Acute normovolemic hemodilution • Withdrawal of client’s RBCs and volume replacement just before a procedure • Goal is to decrease RBC loss during surgery • Blood is stored at room temperature for up to 6hrs and reinfused after surgery. • Not for anemic clients or those with poor kidney function. blood and blood transfusions 108
  109. 109. Intra-operative autologous transfusion & Post operative blood salvage • Recovery/reinfusion of client’s own blood from operative field or bleeding wound. • Special devices collect, filter, drain blood into transfusion bag • Used for trauma or surgical patients with severe blood loss • Blood must be reinfused within 6 hours. blood and blood transfusions 109
  110. 110. TRANSFUSION REACTIONS blood and blood transfusions 110
  111. 111. Observing / Monitoring the Patient During a Blood / Blood Component Transfusion is part of safe transfusion Rigors Haemoglobinuria Tachycardia Hyper / HypotensionPyrexia Nausea / vomiting Breathlessness / coughing Restlessness Agitation Confusion Chest, abdominal, muscle, bone or loin pain Flushing Urticaria - Itchy rash Headache Collapse Generally feeling unwell
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  117. 117. Transfusion-associated graft- versus-host disease (TA- GVHD). • Donor T-cells attack host tissues. • Symptoms occur within 1-2 weeks • Thrombocytopenia • Anorexia • Nausea • Vomiting • Chronic hepatitis • Weight loss • Recurrent infection blood and blood transfusions 117
  118. 118. DISSEMINATED INTRAVASCULARCOAGULATION(DIC) • DIC is the abnormal activation of the coagulation and fibrinolytic systems,resulting in the consumption of coagulation factors and platelets. • DIC may develop during the course of massive blood transfusion,although its cause is less likely to be due to the transfusion itself than related to the underlying reasons for transfusion,such as: • Hypovolaemic shock • Trauma • Obstetric complications blood and blood transfusions 118
  119. 119. MANAGEMENT • Treatment of DIC should be directed at correcting the underlying cause and at correction of the coagulation problems as they arise. blood and blood transfusions 119
  120. 120. Transfusions of blood & blood components are labour intensive & expensive but are frequently life saving In a few patients, however they can result in potentially fatal complications. It is therefore essential that they are only given when the benefits outweigh the risks Conclusion
  121. 121. THANX blood and blood transfusions 121

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