seminar on blood transfusion prepared by Dr nigat

2.  Introduction about blood cells
 Blood product and principle
Of transfusion
 Indication for use of blood products
 Massive blood transfusion
 Complications of transfusion
 Referance

3.  Blood is a fluid connective tissue that consists of plasma,
blood cells,coagulation factor and immunoglobulins that
circulates throughout our body for delivering oxygen and
nutrients to various cells and tissues.
 Blood components and functions
 RBCs – small anucleated cell which contain hemoglobin.
 Platelets- small anucleated, discoid cells which intervene in
haemostasis in the body.
 WBCs – granulocytes and mononuclear cells.

4.  Blood cells are suspended in plasma.
 Albumin- maintains oncotic pressure of the blood.
 Immunoglobulin – are proteins present in the serum and cells
of the immune system, which function as antibodies.
 Coagulation factors - are proteins in the blood that help to
control bleeding.

6.  ABO system
 Has A and B antigens which are present on red cell membrane.
 Has naturally occurring antibodies in the individual serum.
 Rhesus system
 is an inherited protein found on the surface of red blood cells.
 If your blood has the protein, you're Rh positive.
 Rh positive is the most common blood type.

7.  Transfusion is the process of transferring whole blood or
blood- based product from one person into the circulatory
system of another through blood vessels ,long bone marrow,
sternum, etc.
 Transfusion in the ED typically is done for acute blood loss
and/or circulatory shock.
 It uses autologus or allogenic or homologous transfusion.
 Most of the time blood is transfused to provide hemoglobin.
 Blood is commonly donated as whole blood.

8.  The Principle Aims of Blood Transfusion are to:-
 (1) Improve oxygen carrying capacity of blood.
 (2) Symptomatic improvement.
 (3) Reduce hypovolaemia.
 Young adults can tolerate 30 – 40% of blood volume loss with
adequate crystalloid replacement alone.
 General Recommendations for blood Transfusion
 CABG operation ≤ 8 g/ dL
 Peri operative period to keep Hgb > 10g/dL
 Symptomatic anaemia and blood loss ≤ 7g/dL
 Severe and critical illness to Keep the Hb ≥ 10 g/ dL
 Hemorrhage (sudden loss of 25 % or more of the blood
volume).

9. 1. Autologous
using patient’s own stored blood.
preoperative autologous blood donation.
2. Allogeneic (using stored blood of others)
 is when a donor and a recipient are not the same person.
 Most common method of blood transfusion practice.

10.  Blood donor selection
 Voluntary activity.
 Donors should be between 18-65 years and over 51kg in
weight.
 Who is FIT for donation
 Hb not less than 12g/dL
 No major operation in the last 6 months
 No blood donation in past 6 months
 No blood transfusion within the last 12 months
 No pregnancy within the last 12months
 No clinical malaria in the past 1 month
 Free from severe hypertension, splenomegaly, hepatomegaly,
bleeding disorders and allergic conditions such as asthma.

11.  Free of history or clinical evidence and not a carrier of the
following disease :
 Viral hepatitis
 HIV infection
 Syphilis
 Trypanosomiasis
 Brucellosis
 Unvaccinated within the last 3 weeks
 Must not belong to any of the risk groups for HIV infection eg
homosexual, IV drug abusers and prostitute or their clients.

12.  To avoid transfusion reactions, the donor and recipient blood
are tested typically ordered as “type and screen” for the
recipient.
 If the screen is positive, then the recipient’s plasma is cross-
matched against the specific blood unit intended for
transfusion.
 Blood type can be determined in approximately 15 minutes,
whereas it takes about 45 to 60 minutes to perform a serologic
cross-match.
12

13.  Type O Rh-negative (universal donor) blood may be used in
critical circumstances because these transfused red cells do not
contain major blood group antigens (A or B).
 Type O Rh-positive blood may be used if type O Rh-negative
is not available, but should be avoided in girls and women of
childbearing potential.

14.  Type and screen
 determines ABO and Rh status and the presence of most
commonly encountered antibodies
 Type O red cells are mixed with pt serum Antibody
screen
 Risk of adverse rxn is 1:1000
 Takes about 5 mins
 Type and cross match
 Determines ABO and Rh status as well as adverse rxn to
even low incidence antigens
 Type O red cells are mixed with pt serum Antibody
screen
 Donor red cells are then mixed with the pt’s serum to
determine possible incompatibility
 Risk of rxn is 1:10,000
 Takes about 45 mins

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16.  Blood to be transfused should be identified and checked
against the recipient’s name , group, hospital number and
ward.
 The drip is set up under strict asepsis using 17 gauge or large
needle.
 The rate should initially be 20-30 drops/min i.e.2-3ml/min and
then It is increase after half an hour to 60-80 drops /min.
 If there is blood loss the rate of infusion should be rapid,
squeezing the bag containing the blood if necessary.
 In the elderly and very young, the rate should be slow-about
40 drops or less /min .
 The patients general condition, pulse and BP should be
monitored throughout the transfusion.

17.  All procedures that are undertaken to render blood safety for
utilization in patients.
 Includes:
 preparing national guidelines
 Meticulous donor selection
 Aseptic blood collection
 Grouping
 screening for TTI
 organized storage
 proper distribution and transport
 appropriate use

18.  Fresh blood - is the blood used within 3 hours of collection.
 About 1% of cells are loss for every day of storage.
 The metabolism of glucose by erythrocytes produce lactic
acid, pyruvic acid & CO2.
 The accumulation of this substances on the storage produce
progressive PH decrement.
 The acidosis impairs enzyme function & reduce cellular
viability.
 Red blood cell (RBC) storage methods aim to ensure viability
of at least 75% of the cells 24 hours after infusion.
 For this blood collection bags contain an anticoagulant.
 collected in bag containing anticoagulants; CPDA.

19. 
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21.  Any therapeutic substance prepared from whole blood is
known as blood product
PRBC
Platelets
FFP
Cryopreciptate
Fibrinogen concentrate
Prothrombin complex concentrate
Coagulation factor VIIa (Recombinant)

22.  Transfusion is only one part of the patient’s management.
 Modern transfusion practice uses blood that has been
separated into specific components
 Blood loss should be minimized to reduce the patient’s need
for transfusion.
 The patient with acute blood loss should receive effective
resuscitation (intravenous replacement fluids, oxygen, etc.)
while the need for transfusion is being assessed.

23.  The patient’s haemoglobin value, although important, should
not be the sole deciding factor in starting transfusion.
 This decision should be supported by the need to relieve
clinical signs and symptoms and prevent significant morbidity
or mortality.
 For actively bleeding patients, transfusion is based on
clinically estimated blood loss rather than hemoglobin levels
 because the fall in measured hemoglobin will lag behind the
clinical impact of acute blood loss.

24.  The clinician should be aware of the risks of transfusion-
transmissible infections in the blood products that are
available for the individual patient.
 Transfusion should be prescribed only when the benefits to the
patient are likely to outweigh the risks.
 The clinician should record the reason for transfusion clearly.

25.  Blood products are provided using standardized preparations
as “units”.
 Whole blood is stored at temprature of 2 – 6c’ for 21 days.
 to slow the erythrocyte metabolism.
 to minimize the accumulation of acidic substance.
 increase post transfusion survival of RBCs.
 Advantages of whole blood
 supplies red cells, volume and stable coagulation
factors.
 Disadvantages - circulatory overload
 Indication of whole blood transfusion
 Massive hemorrhage with possibility of recurrence.
 Exchange transfusion in neonates.

26.  Prepared by centrifugation of whole blood or by
automated apheresis collection.
 The primary reason for PRBC transfusion is to
increase oxygen-carrying capacity.
 Different additive solutions add different half-life.
 Avoid the following Solutions not compatible with
pRBC:
 LR (theoretical clot formation due to calcium)
 D5W, hypotonic solutions (RBC hemolysis)

27.  A single PRBC unit will raise the hg by 1 g/dL and hct by 3%
in adults.
 In children, 10-15 mL/kg of PRBCs will raise the hct by 6% to
9% and the hg level by approximately 2 to 3 g/Dl
 Single-unit PRBC transfusions should not exceed 4 hours to
prevent contamination.
 PRBCs should be transfused more rapidly in patients with
hemodynamic instability.

28.  PRBCs may be further treated for specific clinical
applications:
 leukocyte reduced PRBCs
 Irradiated PRBCs
 washed PRBCs
 Frozen PRBC
 Rejuvenated PRBCs
 Aliquots PRBC

29.  Leukocyte-reduced PRBCs have 70% to 85% of the white
cells removed. Usese:
1.to decrease the occurrence of nonhemolytic febrile reactions
2. to prevent sensitizationto human leukocyte antigen antibodies
found on white cells in patientswho may be eligible for bone
marrow transplantation, and
(3) to minimize the risk of intracellular virus transmission, such
as cytomegalovirus.
 Irradiated cells are used in transplant patients,neonates, and
immunocompromised patients, and with directed donations
from relatives of the patient.
 Aliquots PRBC -

30.  Washed PRBCs
 are indicated in patients who have a hypersensitivity to
plasma, such as immunoglobulin A deficiency or persistent
febrile reactions.
 Frozen RBC
 red cells may be frozen and saved for up to 10 years for later
use.
 Rejuvenated PRBCs
 Method used to increase levels of 2,3‐DPG and ATP in
pRBCs.
 This process requires incubating the pRBCs with a
rejuvenation solution and subsequent washing.

31.  Multiple factors related to the patient’s clinical status and O2
delivery should be considered.
 The 2 indications for ED transfusion are acute blood loss and
profound anemia.
 In trauma consider transfusion in unstable patient based on
response to initial 2 lit bolus of iv crystalloid.
 Patients with cardiovascular disease or risk factors- symptoms
of anemia or Hgb<8g/dl.
 In patient with MI maintain the hemoglobin ≥9 g/dL.
 Patients with upper GI bleeding- goal Hgb 7g/dl, if comorbid
condition goal 9g/dl.
 If variceal bleeding – avoid transfusing to a Hgb level of >
10g/dl

32.  1. Hg < 6 in any young healthy patients
2. Usually unnecessary when Hg >10
3. At Hgb 6-10 g/dl, the decision to transfuse is based on :
 Ongoing indications of organ ischemia
 Potential or ongoing blood loss
 Volume status
 Risk factors for complications of inadequate O2
 Other indication
 1. symptomatic chronic anemia without hemorrhage.
 2. Acute sickle cell crisis.
 3. cardiac failure.
 4. Acute blood loss (30 % or more).
 5. Perioperative anemia.

33.  Platelet products are used for the treatment or prophylaxis of
bleeding.
 Platelets are prepared from whole blood or random donor
platelets or via automated apheresis.
 Platelet viability is optimal at 22° C but storage is limited to
48 hours.
 One single-donor platelet unit of about 50ml will increase the
platelet count by 20-40x10*9/L.
 One unit from platephresis containing 150-300 ml raise the
count by 50-60x10*9/L

34.  Whole blood derived platelets have a volume of 40–70 ml and
must contain 5.5x 10*10 platelets.
 Apheresis platelets have a volume of ~300 ml and must
contain3.0x10*11 platelets in 75% of the products tested.
 Platelets are stored at room temperature (20–24°C) with gentle
agitation for a maximum of 5 days.

35.  Failure of platelets to rise appropriately may be due to :
Increased consumption of platelets
active thrombosis,
destruction, or
sequestration
 Platelet transfusions are usually ABO-type specific be cause
the platelets are bathed in plasma.
 As with PRBCs, platelets can be leukocyte reduced or washed.

36.  Relative contraindications to the transfusion of platelets are
disorders associated with platelet activation:
Thrombotic thrombocytopenic purpura
Heparin-induced thrombocytopenia in which cases
transfusion may worsen thrombosis

38.  Fluid portion from whole blood
 Contains all coagulation factors (platelets)
 1 unit increases clotting factors 2-3%
 Use ABO-compatible; Rh-incompatible is OK
 Stored frozen; takes 30 min to thaw
 FFP is used for replacement of multiple coagulation
deficiencies in cases such as
 Liver failure
 Warfarin-induced overanticoagulation
 Disseminated intravascular coagulation
 Massive transfusion in bleeding patients

39.  FFP is plasma obtained after the separation of whole blood
from erythrocytes and platelets and then frozen within 8 hours
of collection.
 FFP takes approximately 20 to 40 minutes to thaw, Once
thawed, FFP can be transfused up to 5 days later.
 stored at 1-6°C if not transfused immediately.
 FFP is stored at -18°C or colder for up to 1 year .
 with approval from the FDA, FFP can be stored at -65°C or
colder for up to 7 years.

40.  Each unit of FFP has a volume of 200 to 250 mL and
contains approximately 1 unit of each coagulation factor
and 2 milligrams of fibrinogen per milliliter.
 In general, 1 unit of FFP will increase most coagulation
factors by 3% to 5% in a 70kg adult.
 Trauma centers and other specialty hospitals may keep
pre thawed units of FFP available.
 Transfused FFP should be ABO-type compatible, and Rh
compatibility is unnecessary.
 Type AB is the universal donor for FFP, and in
emergencies, universal donor FFP can be given minutes
after thawing.

42. Definition
– Fraction of plasma that precipitates when FFP is thawed at
4𝑜𝐶
Use
◦ Contains Factors VIII, XIII, I (fibrinogen),vWF
◦ 1 unit contains ~5X more fibrinogen than 1 unit FFP
◦ fibrinogen level 5 to 7 mg/Dl
Storage
– Use within 4-6 hours after thawed to replace Factor
VIII
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43.  It is prepared by slowly thawing FFP to 1–6°C, thereby
leading to formation of a precipitate
 Each unit of cryoprecipitate, which is approximately 15 ml,
must contain:-
 Fibrinogen (150 mg)
 Factor VIII (80 IU)
 Von Willebrand’s Factor (80–120IU)
 Factor XIII (40–60 IU) and fibronectin.

44.  Cryoprecipitate may be used in bleeding patients with
fibrinogen levels <100 milligrams/dL (< 1 g/L) due to
 Severe liver disease
 Uremia
 Disseminated intravascular coagulation
 Dilutional coagulopathy.
 Cryoprecipitate may also be included in some massive
transfusion protocols.
 Cryoprecipitate used as a replacement of fibrinogen

45. 1. Rarely when fibrinogen >150 mg/dl
2. When fibrinogen <100 mg/dl with micro-vascular bleeding
3. During massive transfusion when fibrinogen level not
available
4. Bleeding patients with vWDisease
5. Congenital fibrinogen deficiency, hemophilia A
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47.  Fibrinogen concentrate is derived from pooled human plasma
 Used to treat bleeding episodes in patients with congenital
fibrinogen deficiency.
 Fibrinogen is dosed according the patient’s baseline fibrinogen
level, the target level (in most circumstances >150
milligrams/dL).
 advantages over cryoprecipitate:-
 Minimal risk of disease transmission due to viral inactivation
 accurate dosing because each vial is assayed for fibrinogen
content:
 a lower volume for infusion
 No need for thawing
 No requirement of ABO testing and compatibility.

48.  are blood-derived concentrations of vitamin K–dependent
clotting factors.
 It does not require thawing, does not necessitate ABO-
compatibility testing, and does not carry the risk of volume
overload.
 Thrombosis is the major complication of prothrombin
complex concentrate.
 Because prothrombin complex concentrate’s effects are
transient, vitamin K should usually be co-administered for
sustained warfarin reversal.

49.  Three-factor prothrombin complex concentrate is approved for
treatment of hemophilia B
 Four-factor prothrombin complex concentrate is approved for
urgent reversal of over anticoagulation from vitamin K
antagonists
 Prothrombin complex concentrate does not
 Require thawing
ABO-compatibility testing
 Carry the risk of volume overload, all of which can hinder
fresh frozen plasma use.

50.  Primarily used for treatment of hemophilia A and B.
 The major drawbacks to this product are risk of thrombosis
(up to 4% in patients with acquired hemophilia) and the high
cost.

52.  1. Neonates
 2. Pregnancy
 <36 wks and >36 wks
 3. Malaria

53.  Massive blood transfusion may be defined as
 Replacement of a blood volume equivalent within 24 hours.
(>10 units within 24 hours.)
 half of the blood volume (5 units of blood) in any 4 hour
period in an adult.
 Transfusion >4 units in 1 hour.
 Replacement of 50% of blood volume in 3‐4 hours or blood
loss exceeding 150 ml/min.
 In children transfusion of >40ml/kg
 So as a consequence massive transfusion can cause the lethal
triad of trauma ( Hypothermia, acidosis and coagulopathy).
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54. Massive Transfusion Protocol in other word
 Defined as rapid hemorrhage control through early
administration of blood products in a balanced ratio 1:1:1
(plasma:platelets:RBCs) ; a ratio that is the closest approximation
to reconstituted whole blood.
 A massive transfusion protocol (MTP) should be used in
critically bleeding patients anticipated to require massive
transfusion.
Several parameters should be measured early and frequently
(every 30‐60 minutes, or after transfusion of blood component).
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56.  MTPs are designed to ensure optimal transfusion therapy to
prevent and treat the multifactorial coagulopathy which can
occur early after injury.
 This include
1. Notification of the transfusion service and laboratory,
2. laboratory testing algorithms
3. Blood product preparation.
4. Other patient care needs (e.g. blood warmers).

57.  Actual or anticipated 4 units RBCs in <4 hours +
hemodynamicaly unstable +/- anticipated ongoing bleeding
 Severe thoracic, abdominal, pelvic or multiple long bone
trauma
 Major Obstetric, GI or surgical bleeding
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58. 
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59. 3. Citrate Toxicity
• Citrate is in CPDA storage solution as a Ca2+
chelator
• Massive transfusion can cause an acute
hypocalcemia
• Binds magnesium also causing hypomagnesemia
4. Acid-Base Abnormalities
• At 21 days, stored blood has pH <7.0, due mostly
to CO2 production, which is rapidly blown off after
transfusion
• Acidosis more commonly occurs due to ↓ " tissue
perfusion
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60. 5. Hyperkalemia
K+ moves out of PRBCs during storage
If EKG changes occur, stop transfusion and treat
hyperkalemia
6. Impaired O2-Carrying Capacity
 2,3-DPG decreases in stored blood, causing a left-shifted
O2- Hb dissociation curve.
7.Others
citrate in liver is metabolized to bicarbonate.
 Rarely with massive transfusions, hepatic metabolism is
overwhelmed, and hypocalcemia can develop.
 Excess HCO3 causes alkalemia, driving potassium into
the cells and causing hypokalemia.
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61.  When complication occur important points to recorded is
1. Type of reaction
2. Time the reaction occur after the start of the transfusion.
3. The blood product, its volume , type and pack number.
 The decision to transfuse should be based on the evaluation of
risk, benefits and alternatives.

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65.  Up to 20% of all transfusions may result in some type of
adverse reaction.
 Two important first steps in any confirmed or suspected
transfusion reaction are to:-
(1) immediately stop the transfusion, and
(2) contact the blood bank that issued the transfusion product
 Transfusion reactions are classified based on time of
occurance :
A. IMMEDIATE REACTIONS
B. DELAYED REACTIONS

66. 1.Febrile Non-Hemolytic Reaction
 IS a temperature increase of ≥ 2’C with or without cold shivers
during or in the first 2 hours after transfusion with normalization
of the temperature within 24 hours after transfusion or cold
shivers within this same period.
 Its due to recipient reaction to residual donor WBCs or platelets
Benign; occurs with 0.5-1% of transfusions
Treatment: paracetamol, antihistamine, slow transfusion
-
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67.  Occur when Recipient antibodies directed against HLA
and/or leukocyte-specific antigens on donor white blood
cells and platelets.
 Febrile transfusion reactions are more common in
patients who have been exposed to foreign blood
antigens.
 The febrile transfusion reaction is usually self-limited and
will respond to antipyretics.

68.  Occurs within minutes AND is life-threatening
 The risk is increased by rapid infusion, typically when fresh
frozen plasma is used.
 Due to pre-existing anti-IgA antibodies in a recipient with IgA
deficiency.
 A cause is found in only a minority of anaphylactic transfusion
reactions.
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69.  Allergic reactions to plasma, platelets, and red blood cells are
relatively common.
 are caused by an immune response to transfused plasma
proteins.
 Manifest with urticaria and pruritus during the infusion.
 Antihistamine therapy usually will control the symptoms.

70.  Sn/Sx – Occur within minutes
 Mild
 urticaria, pruritis
 Severe
 dyspnea, bronchospasm, hypotension, tachycardia, shock
 Rx.:
 An UTR is the only transfusion reaction in which the blood
product can be continued. However, the transfusion should
first be stopped and if the urticaria is extensive, 25 to 50 mg of
diphenhydramine can be given orally or intravenously.
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71.  Result of a mismatched blood transfusion, and causes acute
intravascular hemolysis.
 Even a small volume (5‐10 mL) of incompatible blood can
cause a severe reaction and larger volume increases the risk.
 Causes:
 ABO incompatible transfusion.
 Antibodies in the patient’s plasma against other red cell
antigens present on transfused blood ,such as those of the
Kidd, Kell or Duffy blood group systems, can also cause acute
hemolysis.
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72.  With acute hemolytic reaction, most of the transfused cells are
destroyed, which may result in activation of the coagulation
system, DIC , and release of anaphylatoxins and other
vasoactive amines.
 serum haptoglobin will be decreased, serum LDH will be
elevated, and a direct antigen (Coombs) test usually will be
positive.

73.  Sn/Sx - fever/cold shivers, N/V, back pain,
hemoglobinuria, ,low back pain, flushing, dyspnea,
tachycardia, hypotension & shock no or only slight increase
in Hb or unexpected decrease in Hbs,
 In the conscious patient - usually appear within minutes of
starting the transfusion, sometimes when <10 mL blood has
been given.
 In an unconscious/anaesthetized patient, hypotension and
uncontrollable bleeding from the transfusion site, may be the
only sign of an incompatible transfusion.
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74.  Stop transfusion immediately
 Institute supportive care
 Infuse normal saline 10 to 20ml/kg and diuretic to
maintain urine output of 100 to 200ml/hr or >1ml/kg/hr
 Low dose dopamine for hypotension
 For active bleeding- platelets, plasma, and/or
cryoprecipitate for DIC.

75. Management
 maintaining adequate renal function and combating the
consequences of any DIC and/or increased tendency to bleed.
 Then further treatment is symptomatic, with special attention
paid to possible DIC. No effect of Steroids for treatment
 Evaluation - Retype and crossmatch Direct and indirect
Coombs tests CBC, creatinine, PT, aPTT Haptoglobin, indirect
bilirubin, LDH, plasma free hemoglobin ,Urine for
hemoglobin
Prevention:
 Correctly label blood sample and request form.
 Place the patient’s blood sample in the correct sample tube.
 Always check the blood unit against the identity of the patient
at the bedside before transfusion.
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76.  An acute RDS that occurs ~4 hours after transfusion
 TRALI is an uncommon but complex process that is thought to
be due to granulocyte recruitment and degranulation within the
lung.
 It is usually a complication of FFP or platelet transfusion.
 Due to plasma-containing products (platelets and FFP > pRBCs)
usually donor antibodies reacting to recipient leukocytes
 Incidence: 1 in 2500
 Mortality 5-10% - Leading cause of transfusion-related
mortality
 Sn & Sx: Dyspnea, hypoxemia, hypotension, fever, pulmonary
edema.
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78.  Diagnosis of exclusion: first R/O sepsis, volume overload, and
cardiogenic pulmonary edema
 Treatment: supportive care, MV, diuretics are not indicated
(etiology= microvascular leak, not fluid overload)
 TRALI is usually self-limited and resolves within 48 hours with
supportive care
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80.  fluid overload, can result in heart failure and pulmonary
edema.
 May occur when:
 Too much fluid is transfused.
 The transfusion is given too rapidly.
 Renal function is impaired.
 likely to happen in patients with chronic severe anemia
and underlying cardiovascular disease.
 The incidence of this transfusion complication is between
2 and 8%, with a mortality of 5 – 20%.
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82.  Most fatalities related to contaminated blood products comes
from platelets commonly implicated bacteria being s. Aureus
and E.coli.
 Most patients with septic reaction develop fever ≥39ºc or an
increase of ≥ 2ºc over the pre transfusion value, during or
within 4 hours of the transfusion.

83.  Most cases of transmission are thought to occur during the
window period between infection and antibody production in
the donor.
 This window can be reduced by antigen testing of donated
blood for known viral antigens.

85.  Bacterial infection
 Source
 Donor skin during collection
 Donor blood
 Improper handling during blood processing
 Blood has to be screened for HCV, HBV core Ab, HIV-1, HIV-
2, HTLV, syphilis

86.  Delayed blood transfusion reaction can begin within 3 to 10
days.
 1.Thrombophlebitis
 Its more common in lower limb veins because of immobidity
of legs
 Clinical features: pain, redness, tenderness and later
thickening of the vein, pyrexia.
 Treatment: analgesics, culture and sensitivity.
 2. Delayed haemolytic reaction
 Mild jaundice,Production of antibodies,Hemolysis of red cells.
 3. post-transfusiona thrombocytopaenic purpura
 Anamnestic production of production of platelet alloantibody.
 Treatment: spontaneous, prednisolone, IV immunoglobulin,
plasmapheresis.

87. Rosens 8th edition
Uptodate 21.2