Blood transfusion in obstetric haemorrhageWafaa Benjamin
Blood transfusion may be a life-saving procedure but it is not without risk.
Obstetric conditions associated with the need for blood transfusion (whether emergency or not) may lead to morbidity and mortality if not managed correctly.
Adverse events associated with transfusion are increasingly important:
So, strict adherence to correct sampling, cross-match and administration procedures is therefore of paramount importance, even in an emergency.
Blood transfusion in obstetric haemorrhageWafaa Benjamin
Blood transfusion may be a life-saving procedure but it is not without risk.
Obstetric conditions associated with the need for blood transfusion (whether emergency or not) may lead to morbidity and mortality if not managed correctly.
Adverse events associated with transfusion are increasingly important:
So, strict adherence to correct sampling, cross-match and administration procedures is therefore of paramount importance, even in an emergency.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
This presentation describes in detail about managing Rh negative pregnancy- to identify and manage Rh non-isommunized and Rh isoimmunized pregnancies, with recent advances
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Rh incompatibility or iso-immunization is very uncommon. This presentation deals with some basics about blood groups and pathogenesis of it. This will be useful for under and postgraduates in the field of obstetrics.
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
Ovarian Hyperstimulation Syndrome(OHSS), is a Rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy where a patient's ovaries become swollen and fluid builds up around her abdomen
This presentation describes in detail about managing Rh negative pregnancy- to identify and manage Rh non-isommunized and Rh isoimmunized pregnancies, with recent advances
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Rh incompatibility or iso-immunization is very uncommon. This presentation deals with some basics about blood groups and pathogenesis of it. This will be useful for under and postgraduates in the field of obstetrics.
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
Endoscopic Hemostasis - for Endoscopy NursesJarrod Lee
Endoscopic hemostasis is an important first line treatment modality in bleeding from the gastrointestinal tract. It is also a prerequisite skill for anyone performing therapeutic endoscopy, where bleeding is the most common intra-procedural endoscopic complication. This lecture is aimed at endoscopy nurses assisting the endoscopist, and gives an overview of endoscopic hemostasis in routine endoscopy today.
as an oral and maxillofacial surgeon, we should know how to manage a patient with known bleeding disorders in our regular practice to avoid unfortunate incidents
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
BLOOD & BLOOD COMPONENTS IN OBSTETRICS BY DR SHASHWAT JANI
1. Dr. Shashwat Jani.
M. S. ( Obs – Gyn )
Diploma in Advance Laparoscopy.
Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : 99099 44160.
E-mail : drshashwatjani@gmail.com
3. Why ???
• Commonest Cause of Maternal Mortality and
Morbidity . . .
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
3
4. Two Main Causes Of Maternal
Morbidity And Mortality Are
Chronic Anemia Of Pregnancy.
Major Obstetric Haemorrhage.
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
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5. Why Mothers Die
Due To Hemorrhage …???
Inadequate resources and personnel – for
example, home delivery attempts.
Failure to prepare for obstetric hemorrhage –
for example, no IV site started on admission.
Delay in recognition of hemorrhage.
Delay in treatment of hemorrhage.
Treatment failures / Expertise not available
Delay in transport
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
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6. Obstetrical Hemorrhage
New definition:
Blood loss associated with pregnancy or
parturition that meets one or more of the
following Criteria:
Triggers emergency pathological response
Decreases hct by 10 points
Requires blood transfusion
Causes maternal or perinatal death
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
6
8. Massive Blood Loss
May be defined as…
• Loss of blood at a rate in excess of 150 ml.
per minute.
• Loss of 50% of blood volume within 3
hours.
• Loss of one blood volume within a 24 hour
period.
(7% of lean body weight (5 litres in an
adult) RCOG 2015 Green-Top Guidelines
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
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9. Immediate Effect Of
Massive Blood Loss
Tissue Hypoxia
Acidosis
Release of Proinflammatory Cytokine
Development of Systemic Inflammatory
Response Syndrome (SIRS)
DIC
Death
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
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10. Goal Of Transfusion
To provide the most appropriate blood
product for the patient.
Variety of components can be
obtained from one unit of blood hence
many patients may benefit from one unit of
blood.
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
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11. Aim
To restore or maintain :
1. Blood volume
2. O2 carrying capacity
3. Hemostasis
4. Leucocyte function
(Ref. : Blood banking & transfu Med 2nd edi)
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
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13. ‘ WHAT ‘
For Any Procedure
• W - Whether required
• H - How much required
• A - Actual component required
• T - Time duration of transfusion
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
13
15. Whole Blood…
450 ml of blood
63 ml of anticoagulant solution.
Hct – 36 - 44%
No components have been removed.
Store at 1-6 oC
Shelf life – ( Anticoagulants )
• Citrate-Phophate-Dextrose (CPD) - 21 days
• CPDA-1 (adenine) - 35 days
• AS-1, AS-3, AS-5 – 42 days
Infuse within 4 hours of issue
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
15
16. …Whole Blood
Indications:
– Acute blood loss > 25% TBV
– At present there is no role of whole blood except
in acute emergency and in remote area.
Drawbacks:
– After storage for >24 hours, platelets and WBC
are non-functional
– Factor V and VIII (labile factors) decrease with
storage
– Fluid overload
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
16
17. • Massive transfusion of stored whole blood
can aggravate coagulopathy due to:
- Dilutional thrombocytopenia
- Coagulation factor depletion
- Acidosis
- Hypothermia
Solution:
• 1 unit of fresh blood for every 5 – 10 units of stored
blood
• IV 10% calcium gluconate 10 mls with every litre of
transfused citrated blood
• Warming blood ???
• Use Microaggregate blood filters.
Drawbacks…
17
19. Component Therapy Benefits
Allows optimal survival of each constituents
Allows transfusion of only specific blood
component required by pt.
Avoids the use of unnecessary component
which could be contraindicated in pt.
Several patients can be treated with the
blood from one donor
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
19
21. Packed Red Cells
• Made by spinning whole blood and expressing off the
supernatant
• 200 mL red blood cell volume.
• Hct ~70%.
• Do not provide viable platelets or coagulation factors.
• One unit ↑Hb by 2.5 g/dl
• Must be ABO & Rh compatible
• Stored at 1-6 oC
• Shelf-life:
• 21 days (CPD)
• 35 days (CPDA-1)
• 42 days AS-1
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
21
22. • Mainly used for increasing
hemoglobin and O2 carrying capacity.
• In an extreme situation and
when the blood group is unknown,
group O RhD-negative red cells should be
given (although they may be incompatible
for patients with irregular antibodies).
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
22
25. FFP
• Separated from whole blood within 8 hrs. by
centrifugation
• Contains all clotting factors
• Volume 200-250 cc
• Kept at –18°C
• Dose : 15 ml/kg or 4 units in an adult
• Infusion rate – 10 min – 1 hr.
• ABO compatibility required
• Contents no platelet
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
25
27. Guidelines: FFP Use
• Usual dosing: 10-15ml/Kg
• 15-20% rise in factor levels
• Evidence for its use as prophylaxis in non bleeding
patients, is limited
• 1 FFP after 3 PCV
• Subsequent FFP transfusion should be guided by the
results of clotting tests if they are available in a timely
manner, aiming to maintain PT and APTT ratios at less
than 1.5 x normal.
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
27
29. Platelet Concentrate
( Random Donor Platelets)
• Differential centrifugation
• Volume - 60ml
• Store at 20-24 oC with constant & gentle
agitation
• Use within 5 days
• Bacterial contamination a problem
• 1 unit raise the platelet count by
5000 - 10000 / microlitre.
• ABO matched platelets preferable
• Single donor costly but more effective 29
30. Platelets: Risk of Spontaneous
Hemorrhage
Count Site
> 40,000 Minimal
20-40,000 GI Mucosa
5-20 Skin, Mucus Membranes
< 5 CNS, Lung
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
30
31. Prophylactic Platelet TX Guidelines
Platelet Count/μl Recommendation
0-5,000 Always
5-10,000 If Febrile or Minor Bleeding
11-20,000 If coagulopathy / minor
procedure
>20,000 If Major Bleed / invasive
procedure
>50,000 May or May not give
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
31
32. Transfused Platelets / Survival
• 6 units = 1 single donor unit (SDP);
available as ¼, ½ and full SDP
• Dose : Adult 1 unit/8-10 kg
• Lifespan: 7-10 Days Native
2-3 Days Transfused
• Factors shortening Lifespan:
• Fever, Sepsis
• HLA, Platelet Specific Abs
• DIC
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
32
35. Cryoprecipitate
• Plasma concentrate, rich in fibrinogen, factor
VIII, vWF, factor XIII & fibronectin
• Volume - 15ml/unit
• 1 unit contains 100 clotting units of Factor VIII
and 250 mg of fibrinogen
• Stored frozen at < - 18oC
• Infuse within 6 hrs of thawing
• Adult dose is 10 units or 1U/10kg
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
35
36. Dose
• At a standard dose of two 5-unit pools should be
administered early in major obstetric hge.
• Subsequent cryoprecipitate transfusion should be
guided by fibrinogen results, aiming to keep levels
above 1.5 g/l.
No anti-D prophylaxis is required if a RhD-negative
woman receives RhD-positive FFP or cryoprecipitate.
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
36
37. Indications
• Fibrinogen <40 mg/dl
• Fibrinogen <100 mg/dl with bleeding or
surgery
• DIC in obstetric patient
• Abnormal fibrinogen
• Factor XIII deficiency
• vwD with bleeding or surgery
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
37
38. D I C
Diagnosis
– D dimer
– Prolong CT
– Prolong PT
– Prolong aPTT
– Platelet
– Fibrinogen
– Early diagnosis essential
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
38
39. Management
• Restoration of Blood Volume
• Judicious use of Blood Products
–Cryoprecipitate with FFP
–Cryoprecipitate is better as replenish
• Fibrinogen
• Factor VIII
• Factor XIII
• Von Willebrand factor (vWF)
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
39
40. Plasma Derivatives
• Factor VIII Concentrate
• Factor IX Concentrate
• AT-III Concentrate
• Factor XIII concentrate
• Albumin
• IV Immunoglobulin
• Rh Immunoglobulin
Recombinant activated factor VII (rFVIIa) is synthesized human factor VII that is
available for reconstitution and infusion in patients with massive hemorrhage.
Decrease in RBC requirement ,a trend toward improved survival and reductions
in critical morbidities.
40
41. Blood/ Start infusion Complete infusion
blood product
Whole blood/ within 30 min. of within 4 hour
red cells removing pack (less in high
from ambient temperature)
refrigerator
Platelet immediately within 20 min
concentrates
FFP within 30 min within 20 min
Time Limits for Infusion
42. Complications of
Blood
Transfusion
• Febrile reactions
• Bacterial contamination
• Immune reactions
• Physical complications
– Circulatory overload
– Air embolism
– Pulmonary embolism
– Thrombophlebitis
– ARDS
• Metabolic complications
– Hyperkalaemia
– Citrate toxicity & hypocalcaemia
– Release of vasoactive peptides
– Release of plasticizers from PVC-
phthalates
• Haemorrhagic reactions
– After massive transfusion of stored
blood
– Disseminated intravascular
coagulation
• Transmission of disease
– Hepatitis, CMV. EBV
– AIDS (Factor VIII)
– Syphilis
– Brucellosis
– Toxoplasmosis
– Malaria
– Trypanosomiasis
• Haemosiderosis
– After repeated transfusion in
patients with haematological
diseases
2/27/2017 42
43. Does Consent Required For Blood
Transfusion ?
• The doctor is required to get two separate
consents from the patient.
• One for surgery or procedure and another for
blood transfusion, if anticipated
• Surgery involves risk and blood transfusion
involves additional risk
• Inform all transfusion reactions to a ADR
registry
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
43
44. LEAKS
DISCOLOURATION
CLUMPING
EXPIRY DATE
If there is ANY discrepancy –
DO NOT transfuse
Pre-administration Procedure
Step 3: Undertake visual inspection
Step 1: Check the blood component has been prescribed
Step 2: Undertake baseline observations
2/27/2017 44
45. Does hypocalcemia occur with
administration of blood?
With 4-5units of transfusion, calcium binds
with citrate preservatives.
This is self resolving with metabolism of citrate
by liver and kidney.
Hypocalcemia will not impede blood
coagulation.
Hypocalcemia with hypothermia and acidosis
is dangerous & it will decrease cardiac output, causes
bradycardia and dysrhythmia thus calcium gluconate
indicated here (WHO).
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
45
46. Whether blood should warmed prior
to transfusion?
• No evidence for slow transfusion
• For rapid transfusion of > 50 ml /kg / hr , its
required. ( Ideal is warmer machine ).
“ Blood should never be warmed in a bowl of
hot water as this could lead to haemolysis of
the red cells which could be life‐threatening
when transfused. “
2/27/2017
Dr Shashwat Jani.
+91 9909944160.
46