Blood transfusion

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Blood transfusion

  1. 1. Introduction Blood transfusion can be life-saving & many areas of surgery could not be undertaken without reliable transfusion support. Tansfusion of blood & its components carries potential risks, which must be outweighed by the patient’s need.
  2. 2. Criteria for Acceptability ofBlood Donors
  3. 3. Blood Group Systems There are more than 400 blood groups have been found The two major blood groups: (1) ABO system (2) Rh system Others: (Kell, Duffy, Kidd)
  4. 4. ABO System Phenotype Antigens Naturally Frequency (%) occuring antibodies O O Anti-A & Anti-B 46 A A Anti-B 42 B B Anti-A 9 AB AB Nil 3
  5. 5. Principles of Cross-match Blood is selected on the basis of ABO & Rh D group. Check compatibility between potential donor red cells & recipient serum. Takes about 40 minutes. O –ve group can be used in extreme emergency situations.
  6. 6. Fresh whole blood Average volume of blood withdrawn is 470mls taken into 63ml of anticoagulant. Refers to the blood that is administered within 24 hours of its donation. Rarely indicated. Poor source of platelets & factor VIII.
  7. 7.  Indications: - Acute blood loss - Sickle cell disease - Cardiac surgery
  8. 8. Red cell concentrates Product of choice for most clinical situations. Concentrated suspension of RBCs can be prepared by removing most of the supernatant plasma after centrifugation. The preparation reduces but does not eliminate reaction caused by plasma components. Reduces Na+, K+, lactic acid & citrate administered. Provides oxygen-carrying capacity.
  9. 9.  Indications: - Severe anemia - Haemolytic anemia - Anaemia in pregnancy
  10. 10. Platelet concentrates Made either from centrifugation of whole blood or from an individual donor using apheresis. An adult dose is manufactured from 4 separate donations pooled together or 1 apheresis collection. Carry a greater risk of bacterial contamination as they cannot be refrigerated.
  11. 11.  Indications: - Leukaemia - Prophylactically to prevent bleeding in patient with bone marrow failure
  12. 12. Fresh frozen plasma Some 200-300ml of plasma can be removed from a unit of whole blood. Prepared by freezing the plasma from 1unit blood at -30C within 6 hours of donation Contains all the coagulation factors present in plasma
  13. 13.  Indications: - Burns - Liver disease - Congenital coagulation disorders - DIC
  14. 14. Cryoprecipitate A single unit of cryoprecipitate can be removed from 1 unit of FFP after controlled thawing. After resuspension in 10-20ml plasma, the cryoprecipitate is frozen once more to -30oc & can be stored for up to a year. Contains Factor VIII, fibrinogen & von Willebrand factor. Indication: DIC
  15. 15. Factor VIII and IXconcentrates Freeze dried preparation of specific coagulation factors prepared from large pools of plasma recombinant coagulation factor concentrates , treatment of choice for inherited coagulation factor deficiencies. Haemophilia A (VIII) Haemophilia B (IX)
  16. 16. Human albumin Human albumin solution 20% 200 g/L albumin and 130 mmol/L sodium Indicated for treatment of acute severe hypoalbuminemia
  17. 17. Granulocyte concentrate Prepared from single donor using cell separatos and are used for pt with severe neutropenia with evidence of bacterial infection. Numbers of granulocytes increase by treating donors with G-CSF and steroids
  18. 18. Blood Storage Blood products Storage Shelf lifeRed cells 2-6 oc 35 daysFrozen red cells 2-6 oc 24 hoursWashed red cells 2-6 oc 6 hoursPlatelet concentrate Room temperature 5 daysFresh frozen plasma -20 to -40 oc 12 monthsCryoprecipitate -20 to -40 oc 12 monthsGranulocyte concentrate Room temperature 24 hours
  19. 19. Types of Blood Transfusion Homologous – from a volunteer donor ; interval between 2 donations of at least 2 months Autologous – pre-operative collection & re-infusion on requirement. - possible if Hb > 11g%; No infection; Fit for anesthesia.
  20. 20. Autologous transfusion1. Pre-operative donation2. Isovolemic haemodilution3. Cell salvagePre-operative donation - blood withdrawn pre-operatively & stored for up to 35-42 days. - up to 5 units of patient’s own blood made available, with the last unit being collected 48-72 hours before surgery.
  21. 21. Isovolemic haemodilution - restricted to patients anticipated with significant blood loss (>1000ml). - up to 1.5L of blood withdrawn + standard anticoagulant  replaced by saline to maintain blood volume. - fall in Hct reduces the loss of RBCs - withdrawn blood re-infused either during or after surgery.
  22. 22. Cell salvage - blood collected from the operation site either directly during surgery or by the use of collection devices attached to surgical drains. - during surgery, blood collected by suction  processed by a cell salvage machine (anticoagulated + washed to remove clots & debris)  returned to patient - post-operative drainage returned to patient, most commonly not washed.
  23. 23. Acute Blood TransfusionReactions Immunological: - acute haemolytic transfusion reaction - transfusion related acute lung injury - febrile non-haemolytic transfusion reaction - allergic reactions Non-immunological: - bacterial contamination - cardiac failure
  24. 24. Chronic Blood TransfusionReactions Immunological: - delayed haemolytic transfusion reaction - alloimmunization - post-transfusion purpura - transfusion associated graft-versus-host disease Non-immunological: - transfusion-transmitted infections (HIV, hepatitis, CMV, Syphilis, Malaria) - iron overload

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