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Physiological triggers for blood transfusion in the icu
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# Blood transfusion indications and reactions

blood transfusion reactions

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### Blood transfusion indications and reactions

1. 1. Blood transfusion indications and reactions Dr.Sarmistha DNB Jr.RESIDENT TIRUMALA HOSPITALS
2. 2. Indications for transfusion • Blood transfusions are given to increase oxygen- carrying capacity and intravascular volume. • Hemoglobin value at which blood should be given will have to be a clinical judgment based on many factors-  cardiovascular status, age  Anticipated additional blood loss  Arterial oxygenation  Mixed venous oxygen tension
3. 3. Cardiac output, blood volume Oxygen extraction ratio
4. 4. Indications 1. Blood loss greater than 20% of blood volume 2. Hb level less than 8 g/dL 3. Hb level less than 9 to 10 g/dL with major disease (e.g., emphysema, ischemic heart disease) 4. Hb level of less than 10 g/dL with autologous blood 5. Hb level less than 11 to 12 g/dL and ventilator dependent
5. 5. • The transfusion point can be determined preoperatively from the hematocrit and by estimating blood volume • Patients with a normal hematocrit should generally be transfused only aft er losses greater than 10–20% of their blood volume.
6. 6. Average blood volumes.
7. 7. The amount of blood loss can be calculated as- • 1. Estimate blood volume • 2. Estimate the red blood cell volume (RBCV) at the preoperative hematocrit (RBCV preop ). • 3. Estimate RBCV at a hematocrit of 30% (RBCV 30% ), assuming normal blood volume is maintained. • 4. Calculate the RBCV lost when the hematocrit is 30%; RBCV lost = RBCV preop – RBCV 30% . • 5. Allowable blood loss = RBCV lost × 3.
8. 8. • Example • An 85-kg woman has a preoperative hematocrit of 35%. How much blood loss will decrease her hematocrit to 30%? Estimated blood volume = 65 mL/kg × 85 kg = 5525 mL. RBCV 35% = 5525 × 35% = 1934 mL. RBCV 30% = 5525 × 30% = 1658 mL. Red cell loss at 30% = 1934 − 1658 = 276 mL. Allowable blood loss = 3 × 276 mL = 828 mL.
9. 9. Therefore, transfusion should be considered only when this patient’s blood loss exceeds 800 mL. Increasingly, transfusions are not recommended until the hematocrit decreases to 24% or lower (hemoglobin <8.0 g/dL), but it is necessary to take into account the rate of blood loss and comorbid conditions (eg, cardiac disease, in which case transfusion might be indicated if only 800 mL of blood is lost).
10. 10. Clinical guidelines commonly used include: (1) one unit of red blood cells will increase hemoglobin 1 g/dL and the hematocrit 2– 3% in adults; (2) a 10-mL/kg transfusion of red blood cells will increase hemoglobin concentration by 3 g/dL and the hematocrit by 10%.
11. 11. complications 1-Changes in Oxygen Transport Changes in Oxygen Transport RBCs are transfused primarily to increase transport of oxygen to tissues. An increase in the circulating red cell mass produces an increase in oxygen uptake in the lung and a corresponding probable increase in oxygen delivery to tissues. The respiratory function of red cells may be impaired during preservation, making it difficult for them to release oxygen to the tissues immediately after transfusion.
12. 12. 2-coagulation defect Unless a patient has a preoperative coagulopathy (aspirin,antiplatelet drugs hemophilia), A transfusion induce coagulopathy usually occurs only after a large amount of blood has been given (6 to 10 units of PRBCs) This coagulopathy is caused by a combination of factors, of which the most important are the volume of blood given and the duration of hypotension or hypo perfusion. The patient who is hypotensive and has received many units of blood probably has a coagulopathy from a condition that resembles disseminated intravascular coagulation (DIC) and dilution of coagulation factors from stored bank blood
13. 13. • Clinical manifestations include oozing into the surgical field, hematuria, gingival bleeding, petechial bleeding from venipuncture sites, and ecchymoses • 3-dilutional thrombocytopenia • Considering survival time and viability, total platelet activity is only 50% to 70% of the original in vivo activity after 6 hours of storage in bank blood at 4°c.After 24 or 48 hours of storage, platelet activity is only about 10%or 5% of normal
14. 14. • 4-Low levels of Factors V and VIII • These factors gradually decrease to 15%and 50% normal, respectively, after 21 days of storage • 5-Disseminated Intravascular Coagulation-like Syndrome • 6- Citrate Intoxication and Hyperkalemia • 7-Temperature A decrease in body temperature as small as 0.5 to I.0°C may induce shivering postoperatively; this may increase oxygen consumption by as much as 400%. To meet the demands of elevated oxygen consumption, cardiac .output must be Increase
15. 15. • Perhaps the safest and most common method of warming blood is to pass it through plastic coils immersed in warm water (37 to 38°C) bath • 7-Acid-Base Abnormalities the pH of bank blood continues to decrease to about 6.9 after 21 days of storage.
16. 16. Transfusion reactions • 8- Hemolytic Transfusion Reaction • Such a reaction can occur from infusion of as little as 10 mL of blood. Between 20% and 60% of patients with severe symptomatic hemolytic reactions may die, and these deaths usually result from AB0 blood group incompatibility between the donor and the patient
17. 17. • Haptoglobin, which is a protein that can bind about 100 mg of hemoglobin per 100 mL of plasma • A sample of plasma that contains 2 mg/dL of hemoglobin is faintly pink or light brown. When the level of hemoglobin reaches 100 mg/dL, the plasma is red. When the level of plasma hemoglobin reaches 150 mg/dL, hemoglobinuria occur
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blood transfusion reactions

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