why to? whom to? what to ? in blood transfusion...

1. Himal Pandey
MBBS 2014 August, NMCTH

2. whom to give?
Why to give? &
what to give?

3.  To restore the circulating blood volume
To maintain Adequate oxygen delivery
 Replacement of clotting factors, and other blood
components
AIM

4. Transfusion trigger
 Transfusion trigger is defined as that value of
haemoglobin (Hb) below which RBC transfusion is
indicated.
 History and present scenario
 Perioperative RBC transfusion criteria
Hb 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

5. Indications
-----1. General indications
Acute blood loss
Perioperative anemia- Preoperative, Intraoperative and Post
operative
Severe burns
Infection(septicemia)
Chronic anemia
Hemorrhagic states/coagulation dysfunction

6. --2.Special indications
 Massive 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

7. 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

8. Perioperative Transfusion

9. Severe Burn
Criteria for transfusion
-In child
-In adult

10. Indication of different blood fractions for different condition
1.Whole blood
-acute bllood loss with hypovolemia,exchange transfusion, other means
not available
2.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/dl
3. 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%

11. 4.Cryoprecipitate
-in deficiency of Factor VIII , fibrinogen and von willibrand disease
- Target is to make the plasma fibrinogen level 150 mg/dl
5. 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 hour
6.Prothrombin complex concentrate
-contains II,IX & X
-in emrgency reversal of warfarin therapy
7.Human albumin
-burn, hypoalbuminemia and severe protein loss

12. 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