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Blood transfusion By Dr.Syed Alam Zeb


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Dr.Syed Alam Zeb

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Blood transfusion By Dr.Syed Alam Zeb

  1. 1. BLOOD TRANSFUSION Dr. Syed Alam Zeb Surgical B,Kth Peshawar
  2. 2. THE DISCOVERY OF BLOOD GROUPS <ul><li>In 1901 Sir Austrian Karl Landsteiner discovered blood groups. </li></ul><ul><li>He was awarded nobel prize for this discovery in 1930. </li></ul>
  3. 3. WHAT IS BLOOD MADE OF? <ul><li>RBCs </li></ul><ul><li>WBCs </li></ul><ul><li>PLATELTS </li></ul><ul><li>PLASMA </li></ul>
  4. 4. BLOOD GROUPING <ul><li>ABO & Rh System. </li></ul><ul><li>ABO group depends which antigen is on the RBC & what antibody is in plasma. </li></ul>
  5. 5. ABO BLOOD GROUPS <ul><li>Blood group A: They have A antigen on cell surface and B antibody in plasma. </li></ul>
  6. 6. ABO BLOOD GROUPS <ul><li>Blood group B: They have B antigens on cell & A antibody in plasma. </li></ul>
  7. 7. ABO BLOOD GROUPS <ul><li>Blood group AB: They have both the A & B antigens on cell surface and no anti-body in plasma. </li></ul>
  8. 8. ABO BLOOD GROUPS <ul><li>Blood group O: They have no antigen on cell surface but have both A & B antibodies in plasma. </li></ul>
  9. 9. RH factor grouping: <ul><li>Rh+ : n They have Rh antigen on RBC surface but don’t have Rh antibody. </li></ul>
  10. 10. RH factor grouping <ul><li>Rh-ve: They don’t have Rh antigens on cells & normally don’t have Rh antibodies BUT they develop Rh antibodies if trasfused with RH +ve blood. </li></ul>
  11. 11. RH factor grouping <ul><li>Rh-ve cant receive blood from Rh+ve. </li></ul><ul><li>Rh+ve can receive blood from Rh-ve. </li></ul>
  12. 12. BLOOD GROUP NOTATION A Rh +ve B Rh +ve AB Rh +ve O Rh +ve A Rh -ve B Rh -ve AB Rh -ve O Rh -ve
  13. 13. WHO CAN RECEIVE BLOOD FROM WHOM BLOOD GROUP Antigens Antibody Can give blood to Can receive blood from AB A & b None AB AB,A,B,O A A B A & AB A & O B B A B & AB B & O O None A & b AB,B,A,O O
  14. 14. <ul><li>People with group O are universal donors and those having group AB are universal acceptors. </li></ul>
  15. 15. INDICATIONS FOR BLOOD TRANSFUSIONS <ul><li>Severe blood loss in trauma or from pathological lesion like bleeding ulcer. </li></ul><ul><li>During major operative procedures. </li></ul><ul><li>Severe burns. </li></ul><ul><li>Severe anemia preoperatively. </li></ul><ul><li>Severe anemia postoperatively. </li></ul><ul><li>Surgery on hemophiliacs or thrombocytopenics. </li></ul>
  16. 16. PREPARATION OF BLOOD PRODUCTS FOR TRANSFUSION <ul><li>Donor should be fit & screened. </li></ul><ul><li>Blood is collected in sterile bags. </li></ul><ul><li>Donor is lying on a couch, median cubital vein is cannulated. </li></ul><ul><li>410 ml of blood is run in to a bag containing 75 ml of anticoagulant solution. </li></ul><ul><li>Blood is constantly mixed with anticoagulant to prevent clotting. </li></ul>
  17. 17. BLOOD STORAGE <ul><li>Blood products must be stored at 4C +- 2C. </li></ul><ul><li>Stored blood has a shelf life of 3 weeks. </li></ul><ul><li>After a storage time of 24-72 hr RBCs have reduced capability to release oxygen to tissues. </li></ul><ul><li>If the patient needs massive transfusions its better to give blood that’s less than 7 days old. </li></ul>
  18. 18. BLOOD PRODUCTS <ul><li>Packed Red cells : They are advised for elderly, chronic anemia's, patients in CCF or small children. Packed cells are obtained by centrifugation. </li></ul><ul><li>Platelet concentrates : Platelets rarely survive in stored blood for more than 24 hrs. If separated by centrifugation can survive for 72 hrs. </li></ul>
  19. 19. BLOOD PRODUCTS <ul><li>White blood cells : They are rapidly destroyed in the stored blood. </li></ul><ul><li>Plasma: This is removed after centrifugation of whole blood & may be further processed or fractionated. </li></ul>
  20. 20. BLOOD PRODUCTS <ul><li>Human Albumin 4.5%: Obtained by repeated fractionation of plasma followed by heat treatment.It can then be stored for months. </li></ul><ul><li>Fresh-frozen plasma: Removed from fresh blood & stored at –40 to –50C. It’s a good source of coagulation factors. Used when doing surgery on cirrhotics, hemophiliacs or patients having Christmas disease. </li></ul>
  21. 21. BLOOD PRODUCTS <ul><li>Cryoprecipitate: Allow FFP to thaw at 4C, the supernatant plasma is removed to obtain the precipitate. It’s a rich source of factor VIII & fibrinogen. </li></ul><ul><li>Factor VIII & factor IX concentrates : They are available in fresh dried form. </li></ul>
  22. 22. AUTOTRANSFUSION <ul><li>Transfusion with patient’s own blood. </li></ul><ul><li>Used in emergency situations. </li></ul><ul><li>Blood is collected from abdominal cavities, filtered and transfused. </li></ul><ul><li>For a planed elective procedure patient can donate his own blood 3 weeks in advance to be transfused later on. </li></ul><ul><li>Minimal chances of disease transmission and reactions. </li></ul>
  23. 23. COMPLICATIONS OF BLOOD TRANSFUSIONS <ul><li>CCF </li></ul><ul><li>Transfusion reaction. </li></ul><ul><li>Transmission of infections. </li></ul><ul><li>Thrombophlebitis. </li></ul><ul><li>Air embolism. </li></ul><ul><li>Coagulation failure. </li></ul>
  24. 24. Hemolytic Reactions <ul><li>Most serious complication due to ABO incompatibility ie transfusion of wrong blood group. </li></ul><ul><li>Symptoms include apprehension, headache, fever, chills, pain at the injection site or pain in the back, chest & abdomen. </li></ul><ul><li>Symptoms in anesthetized patients are changes in the vital signs & spontaneous bleeding from different sites. </li></ul>
  25. 25. Hemolytic Reactions cont: <ul><li>There is hemoglobinuria & oliguria. </li></ul><ul><li>Free hemoglobin can be detected in plasma in minutes. </li></ul><ul><li>Coombs test becomes positive. </li></ul><ul><li>Treatment is with diuretics ie mannitol iv infusion; 12.5 g is administered in 3-5 min, followed by cont. infusion to have a urinary out put of 60 ml/hr. </li></ul>
  26. 26. Pyrogenic Reactions <ul><li>Fever is the most common immediate transfusion reaction. </li></ul><ul><li>Recipient reaction against white cells in the donor blood. </li></ul><ul><li>Treated with antipyretics. </li></ul><ul><li>Leucocytes-poor blood is considered for patients with repeated pyretic reactions. </li></ul>
  27. 27. Allergic Reactions <ul><li>Symptoms are itching, urticaria and bronchospasm. </li></ul><ul><li>Usually mild but can be fatal. </li></ul><ul><li>There is antigen, antibody reaction between the proteins I the donor plasma & a corresponding antibody in the patient. </li></ul><ul><li>Treated with anti-histamines and corticosteroids. </li></ul>
  28. 28. INFECTIONS TRANSMISSION <ul><li>Viral hepatitis : Hepatitis B and C can be transmitted through blood. The risk through screened blood is 1:63,000 per unit for B and from 1: 1,00,000 to 1: 500,000 for C. About half will develop chronic liver disease. </li></ul>
  29. 29. INFECTIONS TRANSMISSION cont: <ul><li>HIV : Improved screening has reduced the transmission of HIV to about 1 in500,000 per unit. Hemophiliacs are especially at risk because of the repeated required transfusions. </li></ul><ul><li>Bacterial infections: If blood is left in a warm room for hours bacteria grow in it and can result in severe septicemia in the recipient. </li></ul>
  30. 30. INFECTIONS TRANSMISSION cont <ul><li>Malaria: The disease can be transmitted through blood transfusions in endemic areas. </li></ul><ul><li>The donor should be screened and treated before donating blood. </li></ul><ul><li>In emergency situations the recipient should get prophylactic antimalarials. </li></ul>
  31. 31. Rare Problems <ul><li>Thrombophlebitis. </li></ul><ul><li>Coagulation failure: When large volumes of store blood is used for replacement. Old blood is deficient in platelets, factor VIII& factor V. </li></ul><ul><li>DIC: Occurs after incompatible ABO transfusion or after massive transfusions. Its treated with FFP, cryoprecipitate & platelets concentrates. </li></ul>
  32. 32. HAEMOPHILIA <ul><li>Congenital deficiency of factor VIII. </li></ul><ul><li>X-linked, only men are affected. </li></ul><ul><li>Patient presents with epistaxis, gums bleed, swollen joints. </li></ul><ul><li>Treatment is with fresh blood, FFP, factor VIII concentrates to bring the factor VIII levels to 20%. </li></ul><ul><li>Surgery on hemophiliacs is possible if the factor VIII levels are raised to >50% . </li></ul>
  33. 33. CHRISTMAS DISEASE <ul><li>Hemophilia B. </li></ul><ul><li>Congenital deficiency of factor IX. (Christmas Factor). </li></ul><ul><li>Presentation is similar to hemophilia. </li></ul><ul><li>Treatment is FFP, dried concentrates of human factor IX. </li></ul>
  34. 34. Von Willibrand’s Disease <ul><li>Low plasma levels of factor VIII compliment, factor VIII related antigen and abnormal platelets. </li></ul><ul><li>Patient has episodic bleeding manifestations. </li></ul>
  35. 35. THANKS