Blood transfusion

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Blood transfusion

  1. 1. 上海交通大学瑞金临床医学院 外科教研室Dr. Moamar Mortada
  2. 2. Blood Transfusion
  3. 3. • History • Type of Transfusion • Indication • Transfusion Reactions • Autologous transfusion • Component Transfusion Blood Transfusion
  4. 4. History and Significance
  5. 5. Lower (1665) First blood transfusion
  6. 6. Philip (1825) First human blood transfusion
  7. 7. Landsteiner (1900) Discovery of ABO type
  8. 8. How to store blood longer? World war I
  9. 9. Is there any suitable Blood Substitutes World war II
  10. 10. Successful blood transfusion is relatively recent • Crossmatching • Anticoagulation • Plastic storage container Blood Transfusion
  11. 11. Type of Transfusion:  Whole Blood;  Blood Component; RBC PLT FFP Leukocyte concentrate  Plasma Substitutes; Use of whole blood is considered to be a waste of resources Blood Transfusion
  12. 12. • Symptomatic anemia (providing oxygen-carrying capacity) • Transfusion trigger (HCT<30% ; HB<10g/dl) • 1 Unit increases 3% HCT or 1g/dl • Shelf life =42 d (1-6 ℃) Red Blood Cells
  13. 13. • Thrombocytopenia (< 50,000) • Platelet dysfunction • Each unit increase 5,000 PLTs after 1 H Platelets
  14. 14. • Profoundly granulocytopenia (<500) • Serious infection not responsive to antibiotic therapy Granulocytes
  15. 15. • Coagulation factor deficiencies • 1 ml increases 1% clotting factors • Being used as soon as possible • Albumin, hetastarch, crystalliods are equally effective volume expander but safer than FFP • After use of 5 U of RBCs, matching 2 U of FFP Fresh Frozen Plasma (FFP)
  16. 16. --Volume Expander Dextran • Most widely used • Low/Middle M.W. (40,000-70,000) • Massive transfusion could impair coagulation • Occasional ALLERGIC reaction Hydroxyethyl Starch Formulation (HES) • More stable • Containing essential electrolytes • No allergic reaction Plasma Substitutes
  17. 17. Indication:  Acute massive blood loss;  Anaemia and hypoalbuminemia;  Overwhelming Infection;  Dysfunction of Coagulation; Blood Transfusion
  18. 18. Technique of Transfusion:  Approach Route: Peripheral Vein, Center Vein  Filtration before Transfusion:  Velocity of Transfusion: 5-10ml/min Blood Transfusion
  19. 19.  Double Check: Name, Type and Crossmatch  Storage Time: Citrate Phoshate Detrose Acidic Citrate Detrose 21D, 35D  Pre-heat:  No any other Medication:  Observation during / after Transfusion: Attention: Blood Transfusion
  20. 20. Incidence:2% Chills, Fever 39-40.C Headache, Sweatiness Nausea, Vomiting, Flushing 15min-1hr Febrile Reactions : Transfusion Reactions
  21. 21.  Immuno-reaction :  Endo-toxins:  Contamination or Hemolysis:  Analyze possible reasons:  Stop Transfusion :  General Support: Treatment: Febrile Reactions : Transfusion Reactions
  22. 22. Urticaria Abdominal cramps Dyspnea Vomiting Diarrhea Anaphylactic reactions: Transfusion Reactions
  23. 23.  Immuno-reaction: IgE  Hereditary Immunoglobulin: IgA Reason:  Administer antihistamines  Administer epinephrine, diphenhydramine, and corticosteroids:  Support airway and circulation as necessary: Treatment: Anaphylactic reactions:
  24. 24. Burning at the intravenous (IV) line site Fever, Chills, Dyspnea Shock Cardiovascular Collapse Hemoglobinuria, Hemoglobinemia Renal Failure DIC Hemolytic transfusion reactions Transfusion Reactions
  25. 25.  ABO incompatibility  Rh Incompatibility  Non-immune Hemolysis  Immune Hemolysis Reasons: Hemolytic Transfusion Reactions
  26. 26.  Stop Transfusion as soon as reaction is suspected  Check the name, type and crossmatch  Urine Exam  Renal Protection (Aggressive Fluid Resuscitation, Furosemide)  DIC Monitor Treatment: Hemolytic Transfusion Reactions
  27. 27.  Double Check name,type and crossmatch  Operate carefully and routinely  Temperature Monitor Prevention: Hemolytic Transfusion Reactions
  28. 28. Massive transfusion complications: Volume Overload Congestive Heart Failure Tachycardia Tachypnea Cyanopathy Transfusion Reactions
  29. 29.  Volume Overload  Heart Functional Failure  Lung Functional Failure Reasons:  Stop Transfusion  Heart Functional Support  Diuresis (Furosemide) Treatment: Massive Transfusion Complications:
  30. 30. Contamination: Fever Shock DIC Bacterial Contamination Reasons: Transfusion Reactions
  31. 31.  Stop Transfusion  Bacterial Exam and Culture  Antibiotics Treatment:  Double Check  Operate carefully Prevention: Contamination:
  32. 32.  Hepatitis B, Hepatitis C  HIV  Cytomegalovirus (CMV)  Syphilis  Malaria Acquired diseases : Transfusion Reactions
  33. 33.  No risk of infectious disease transmission  No transfusion reactions  No compatibility testing  Reduced demand on blood bank stores  An immediate source of autologous blood Autotransfusion:
  34. 34.  Red Blood Cells Packed RBC  White Blood Cells  Pooled Platelets Blood Cell: Component Transfusion:
  35. 35. • Saving blood source • Less likely carrier of transmitted diseases • Shortage of quality blood • Greater shelf life than whole blood • Helping to make blood safer by filtration • Infusing regardless of ABO type in some blood products giving only essential/desired blood component Component Transfusion:

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