Medicine 5th year, 11th lecture/part two (Dr. Sabir)

2,005 views

Published on

The lecture has been given on Apr. 17th, 2011 by Dr. Sabir.

Published in: Health & Medicine
0 Comments
8 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,005
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
114
Comments
0
Likes
8
Embeds 0
No embeds

No notes for slide

Medicine 5th year, 11th lecture/part two (Dr. Sabir)

  1. 1. Blood Transfusion Dr. Sabir
  2. 2. Blood Transfusion <ul><li>. Types : </li></ul><ul><li>1- whole blood </li></ul><ul><li>2- packed RBCs </li></ul><ul><li>3- fresh frozen plasma </li></ul><ul><li>4- platelets </li></ul><ul><li>5- granulocyte transfusion </li></ul><ul><li>6- cryopercipitate transfusion </li></ul>
  3. 3. Fresh Frozen Plasma <ul><li>. Stored frozen, when thawed to 37 o C should be transfused within 24 hrs </li></ul><ul><li>. unit = 200ml increases the level of each clotting factor 2-3% </li></ul><ul><li>. Dose = 10-15 mlKg </li></ul><ul><li>. Indications : - isolated factor deficiency </li></ul><ul><li> - warfarin reversal </li></ul><ul><li> - liver disease </li></ul><ul><li> - massive blood transfusion </li></ul><ul><li> - antithrombin III deficiency when heparin is needed </li></ul>
  4. 4. Platelets <ul><li>. Stored at 20-24 0 C for 5 days (shelf life) , </li></ul><ul><li>. Unit 50-70 ml, survival only for 1-7 days </li></ul><ul><li>. Each unit increase platelet count by 5000-10,000 </li></ul><ul><li>. Side effects : </li></ul><ul><li>- Rh sensitization </li></ul><ul><li>- Anti A, anti B reaction </li></ul><ul><li>- HLA typing </li></ul><ul><li>- proliferating bacteria </li></ul><ul><li>. Indications : </li></ul><ul><li>a- thrombocytopenia (DIC, massive transfusion, prophylactic preop, ITP) </li></ul><ul><li>b- thrombasthenia (bleeding, prophylactic preop,) </li></ul>
  5. 5. Transfusion Reactions <ul><li>Acute Hemolytic TR </li></ul><ul><li>Non-immune-mediated hemolysis </li></ul><ul><li>Delayed Hemolytic TR </li></ul><ul><li>Febrile Non-hemolytic TR </li></ul><ul><li>Allergic TR </li></ul><ul><li>Anaphylactic & anaphylactoid R </li></ul><ul><li>Transfusion-related acute lung injury </li></ul><ul><li>Transfusion-associated circulatory overload </li></ul><ul><li>Metabolic reactions </li></ul><ul><li>Transfusion-associated GVHD </li></ul><ul><li>Iron overload </li></ul><ul><li>Post-transfusion hemosiderosis </li></ul><ul><li>Alloimmunization </li></ul><ul><li>Post-transfusion purpura </li></ul><ul><li>Bacterial contamination reaction </li></ul><ul><li>Transfusion-transmitted diseases </li></ul>
  6. 6. Signs and Symptoms of AHTR <ul><li>Chills , fever </li></ul><ul><li>Facial flushing </li></ul><ul><li>Hypotension </li></ul><ul><li>Renal failure </li></ul><ul><li>DIC </li></ul><ul><li>Chest pain </li></ul><ul><li>Dyspnea </li></ul><ul><li>Generalized bleeding </li></ul><ul><li>Hemoglobinemia </li></ul><ul><li>Hemoglobinuria </li></ul><ul><li>Shock </li></ul><ul><li>Nausea & vomiting </li></ul><ul><li>Back pain </li></ul><ul><li>Pain along infusion vein </li></ul>
  7. 7. Acute Hemolytic Transfusion Reactions <ul><li>Acute onset within minutes or 1-2 hours </li></ul><ul><li>after transfuse incompatible blood </li></ul><ul><li>Most common cause is ABO-incompatible </li></ul><ul><li>transfusion </li></ul>
  8. 8. Management of AHTR <ul><li>Stop the transfusion </li></ul><ul><li>Keep IV fluid </li></ul><ul><li>Notify patient’s physician and blood bank </li></ul><ul><li>Take care of patient </li></ul><ul><li>Perform bedside clerical checks </li></ul><ul><li>Return unit, set to blood bank </li></ul><ul><li>Collect appropriate post transfusion blood </li></ul><ul><li>sample for evaluation </li></ul>
  9. 9. Non-Immune-Mediated Hemolysis <ul><li>Causes </li></ul><ul><ul><ul><li>Physical or chemical destruction of </li></ul></ul></ul><ul><ul><ul><li>bood: freezing, heating, drugs </li></ul></ul></ul><ul><ul><ul><li>solutions added to blood </li></ul></ul></ul><ul><ul><ul><li>Bacterial contamination </li></ul></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>depends on the causes </li></ul></ul><ul><ul><ul><li>mild reaction  supportive treatment </li></ul></ul></ul><ul><ul><ul><li>severe reaction  intensive treatment </li></ul></ul></ul>
  10. 10. Delayed Hemolytic Transfusion Reaction <ul><li>Signs & Symptoms </li></ul><ul><ul><ul><li>mild fever with chill </li></ul></ul></ul><ul><ul><ul><li>mild anemia </li></ul></ul></ul><ul><ul><ul><li>mild to moderate jaundice </li></ul></ul></ul><ul><ul><ul><li>Uncommon  hemoglobinemia, Hemoglobinuria, shock, renal failure </li></ul></ul></ul>
  11. 11. Febrile Nonhemolytic Transfusion Reaction <ul><li>Signs & Symptoms </li></ul><ul><ul><ul><li>Fever with or without chills </li></ul></ul></ul><ul><ul><ul><li>most symptoms are mild </li></ul></ul></ul><ul><ul><ul><li>severe reaction :- hypotension, cyanosis, tachycardia, tachypnea, dyspnea, cough etc. </li></ul></ul></ul>
  12. 12. Febrile Nonhemolytic Reaction <ul><li>Treatment </li></ul><ul><li>discontinue blood transfusion </li></ul><ul><li>Antipyretic for fever </li></ul><ul><li>Prevention </li></ul><ul><li>using prestorage leukocyte –reduced red blood cell or platelet </li></ul>
  13. 13. Allergic Transfusion Reactions <ul><li>Signs & Symptoms </li></ul><ul><li>- Urticaria </li></ul><ul><li>- severe reactions are rare </li></ul><ul><li>Therapy & Prevention </li></ul><ul><li>- Antihistamine </li></ul><ul><li>- Plasma – deficient blood components </li></ul>
  14. 14. Anaphylactic and Anaphylactoid reactions <ul><li>Signs & Symptoms </li></ul><ul><li>- Anaphylactic  coughing, dyspnea, nausea, emesis, bronchospasm, flushing of skin, chest pain, hypotension, abdominal cramps, diarrhea, shock, and death. </li></ul><ul><li>- Anaphylactoid (less severe)  urticaria, periorbital swelling, dyspnea, or perilaryngeal edema </li></ul>
  15. 15. Anaphylactic and Anaphylactoid reactions <ul><li>Therapy and Prevention </li></ul><ul><li>Stop transfusion </li></ul><ul><li>Keep IV line open </li></ul><ul><li>Medication :- epinephrine, corticosteroid </li></ul><ul><li>Wash RBCs and blood components </li></ul><ul><li>Transfuse IgA deficiency blood </li></ul>
  16. 16. Transfusion-related Acute Lung Injury (TRALI) <ul><li>Acute and severe type of transfusion reaction </li></ul><ul><li>Symptoms and signs </li></ul><ul><li>Fever </li></ul><ul><li>Hypotension </li></ul><ul><li>Tachypnea </li></ul><ul><li>Dyspnea </li></ul><ul><li>Diffuse pulmonary infiltration on X-rays </li></ul><ul><li>Clinical of noncardiogenic pumonary edema </li></ul>
  17. 17. Transfusion-related Acute Lung Injury (TRALI) <ul><li>Therapy and Prevention </li></ul><ul><li>Adequate respiratory and hemodynamic supportive treatment </li></ul><ul><li>If TRALI is caused by pt. Ab  use LPB </li></ul><ul><li>If TRALI is caused by donor Ab  no special blood components </li></ul>
  18. 18. Transfusion-associated Circulatory Overload (TACO) <ul><li>Patients at significant risk </li></ul><ul><li>Children </li></ul><ul><li>Elderly patients </li></ul><ul><li>Chronic anemia </li></ul><ul><li>Cardiac disease </li></ul><ul><li>Thalassemia major or Sickle cell disease </li></ul>
  19. 19. Symptoms and Signs <ul><li>Dyspnea </li></ul><ul><li>Coughing </li></ul><ul><li>Cyanosis </li></ul><ul><li>Orthopnea </li></ul><ul><li>Chest discomfort </li></ul><ul><li>Headache </li></ul><ul><li>Restlessness </li></ul><ul><li>Tachycardia </li></ul><ul><li>Systolic hypertension increase > 50 mm.Hg </li></ul>
  20. 20. Therapy <ul><li>Rapid reduction of hypervolemia </li></ul><ul><li>Respiratory and cardiac support </li></ul><ul><li>Oxygen therapy </li></ul><ul><li>Diuretic </li></ul><ul><li>Therapeutic phlebotomy </li></ul>
  21. 21. Metabolic Reaction <ul><li>Citrate toxicity </li></ul><ul><li>Hyperkalemia </li></ul><ul><li>Hypothermia </li></ul><ul><li>Coagulopathy in massive transfusion </li></ul><ul><li>Air embolism </li></ul>
  22. 22. Transfusion-associated Graft-versus-Host Disease ( TA-GVHD) <ul><li>Patient at risk </li></ul><ul><li>Bone marrow transplantation </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Radiation treatment </li></ul><ul><li>Newborn </li></ul>
  23. 23. Graft-versus-Host Reaction <ul><li>Signs & Symptoms </li></ul><ul><li>Onset ~ 3 to 30 days after transfusion </li></ul><ul><li>Clinical significant – pancytopenia </li></ul><ul><li>Other effects include fever, liver enzyme, </li></ul><ul><li>copious watery diarrhea, </li></ul><ul><li>erythematous skin erythroderma </li></ul><ul><li>and desquamation </li></ul>
  24. 24. Graft-versus-Host Reaction <ul><li>Therapy </li></ul>Drugs :- corticosteroids, methotrexate, azathioprine, antithymocyte globulin But no adequate therapy Prevention Irradiation of Blood Components avoid potential fatalities
  25. 25. Iron overload 1 unit of PRCs has ~ 250 mg of Iron Removed by body 1 mg / day accumulate iron Hemosiderosis
  26. 26. Posttransfusion Hemosiderosis <ul><li>Affected organ :- heart, liver, endocrine glands </li></ul><ul><li>Signs & Symptoms </li></ul><ul><li>- muscle weakness, fatigue, weight loss, mild jaundice, anemia, mild diabetes, and cardiac arrhythmia </li></ul><ul><li>Therapy  Iron – chelating agent </li></ul><ul><li>Prevention  transfuse with young RBCs </li></ul>
  27. 27. Alloimmunization <ul><li>Signs & Symptoms </li></ul><ul><ul><ul><li>mild  slight fever and Hb </li></ul></ul></ul><ul><ul><ul><li>severe  platelet refractoriness with bleeding </li></ul></ul></ul><ul><li>Therapy & Prevention </li></ul><ul><ul><ul><li>depends on type and severity </li></ul></ul></ul>
  28. 28. Posttransfusion Purpura <ul><li>Rare complication </li></ul><ul><li>Rapid onset of thrombocytopenia as a result of anamnestic production of platelet alloantibody </li></ul><ul><li>Usually occurs in multiparous woman </li></ul><ul><ul><ul><li>Purpura and thrombocytopenia occur ~ 1-2 wk after transfusion </li></ul></ul></ul>
  29. 29. Posttransfusion Purpura <ul><li>Therapy and Prevention </li></ul><ul><ul><ul><li>Corticosteroids </li></ul></ul></ul><ul><ul><ul><li>Exchange transfusion </li></ul></ul></ul><ul><ul><ul><li>Plasmapheresis </li></ul></ul></ul>
  30. 30. Bacterial contamination reaction <ul><li>Cause gram –ve, gram +ve bacteria </li></ul><ul><li>most frequent – Yersinia enterocolitica </li></ul><ul><li>Pathophysiology </li></ul><ul><li>Bacteria growing in cold temperature </li></ul><ul><li>Produced endotoxin </li></ul>
  31. 31. Symptoms & Signs <ul><li>Acute onset within ~ 30 min after transfusion </li></ul><ul><li>Dryness and flushing skin </li></ul><ul><li>Fever, hypotension, shaking chills, muscle pain, vomitting, abdominal cramps, bloody diarrhea, hemoglobinuria, shock, renal failure, and DIC. </li></ul><ul><li>Treatment: broad-spectrum antibiotics </li></ul>
  32. 32. Transfusion – Transmitted Diseases <ul><li>Viral Infections </li></ul><ul><ul><ul><li>Hepatitis Viruses :- HBV, HCV </li></ul></ul></ul><ul><ul><ul><li>Retroviruses :- HIV </li></ul></ul></ul><ul><ul><ul><li>Herpesviruses :- CMV, EBV </li></ul></ul></ul><ul><ul><ul><li>Parvovirus :- Human B19 parvovirus </li></ul></ul></ul><ul><ul><ul><li>Prion :- infectious particle of CJD </li></ul></ul></ul>
  33. 33. Transfusion – Transmitted Diseases <ul><li>Bacterial Infection </li></ul><ul><ul><ul><li>Gram -ve and +ve </li></ul></ul></ul><ul><ul><ul><li>Syphilis </li></ul></ul></ul><ul><ul><ul><li>Lyme disease </li></ul></ul></ul>
  34. 34. Transfusion – Transmitted Diseases <ul><li>Parasitic Infections </li></ul><ul><ul><li>Malaria </li></ul></ul><ul><ul><li>Chagas disease </li></ul></ul><ul><ul><li>Toxoplasmosis </li></ul></ul><ul><ul><li>Leishmaniasis </li></ul></ul>
  35. 35. Steps to take when a transfusion reaction occurs <ul><li>Stop the transfusion immediately </li></ul><ul><li>Leave the needle in the vein and begin infusing normal saline </li></ul><ul><li>Obtain vital signs </li></ul><ul><li>Begin O 2 if pulmonary symptoms are prominent </li></ul><ul><li>Carry out PE : lung, heart, skin, signs of abnormal bleeding </li></ul>
  36. 36. Steps to take when a transfusion reaction occurs <ul><li>Obtain a new blood sample for repeat RBC compatibility test and inspection for hemolysis </li></ul><ul><li>Obtain a urine sample if the patient can void </li></ul><ul><li>Obtain a chest x-ray if pulmonary symptoms are prominent </li></ul><ul><li>Begin definitive treatment </li></ul>

×