Blood transfusion ppt

1. BLOOD
TRANSFUSION

2. TOPIC MODULES
1. Blood and its products
a. Whole blood
b. Platelets
c. Red cell preparation
d. Fresh frozen plasma
e. Cryoprecipitates
f. Plasma products
2. Transfusion reactions
• Acute and chronic

3. TRANSFUSION OF FRESH BLOOD
 FOR ACUTE BLOOD LOSS – WHOLE BLOOD
 FOR BLEEDING DISORDERS – PRBC, FFP AND OTHER
BLOOD COMPONENTS DEPENDING ON NATURE OF
DEFICIENCY

4. WHOLE BLOOD
 HAEMATOCRIT 35 –45%
 450ml each unit
 STORAGE 2 – 60C MAX 35 DAYS
 CHANGES IN STORED BLOOD
HYPERKALEMIA
LOW WBCs
THROMBOCYTOPENIA
LOW LEVEL OF LABILE CLOTTING FACTORS
INCREASED LACTATE LEVEL
ACIDOTIC

5. RED CELL PREPARATIONS
 RED CELL HAEMATOCRIT 65-75%
 330ml each unit
 STORAGE 2–6 0C MAX 35 DAYS
 INDICATIONS
TO INCREASE TISSUE OXYGENATION AFTER
HEMORRHAGE
CHRONIC ANEMIA
ELDERLY AND CHILDREN
CARDIAC PATIENTS
 SAME PRECAUTIONS AS WHOLE BLOOD

6. PLATELETS
 EACH UNIT 55000 Platlets/uL
 SHELF LIFE 5 DAYS
 HLA COMPATIBLE OR CROSSMATCHED AND SHOWN TO
BE COMPATIBLE WITH PATIENT SERUM
 INDICATIONS
THROMBOCYTOPENIA
FUNCTIONAL DEFORMITY OF PLATELETS--
(GLANZMAN DISEASE)
BEFORE SURGERY IF PLATELETS COUNT IS BELOW
50,000 cumm
ACUTE DIC (ALONG WITH FFP)

7. FRESH FROZEN PLASMA
 PLASMA FROM FRESH BLOOD IS RAPIDLY FROZEN.
 EACH UNIT = 200 – 300 ml PLASMA
 PLASMA PROTEIN IN SIMILAR CONCENTRATION AS
NORMAL PLASMA
 STORED AT -400C ,SHELF LIFE 24 MONTHS
 THAWED RAPIDLY AT 370C IMMEDIATELY BEFORE USE
 BLOOD GROUP MUST BE COMPATIBLE
 TRANSFUSION SHOULD BE COMPLETED WITHIN 4
HOURS

8. INDICATIONS:
 TO CORRECT ISOLATED PLASMA PROTEIN
DEFICIENCIES, FACTORS II,V,VII,VIII, IX, X, XIII,
ANTITHROMBIN III.
 TO REVERSE ORAL ANTICOAGULATION WITH
WARFARIN
 LIVER DISEASE, MAJOR HEPATIC RESECTION, SEVERE
INJURIES--
 DIC (ALONG WITH PLATELETS)

9. CRYOPRECIPITATES
CONCENTRATE OF FACTOR VIII, VON WILLIBRAND
FACTOR AND FIBRINOGEN
1 UNIT 20 ml
STORAGE = - 300C , MAX. 24 MONTHS
THAWED RAPIDLY BEFORE USE COMPLETED WITHIN
4 HOURS

10. INDICATION
FIBRINOGEN DEFICIENCY
HAEMOPHILIA
VON WILLIBRAND’S DISEASE

11. PLASMA PRODUCTS
i) COAGULATION FACTORS
ii) FACTOR VIII CONCENTRATE (HEMOPHILIA A)
iii) FACTOR IX CONCENTRATE (CHRISTMAS DIS.)
iv) HEPATITIS B IMMUNOGLOBULIN
v) TETANUS IMMUNOGLOBULIN-
vi) HUMAN ANTI D IMMUNOGLOBULIN-
vii) HUMAN RABIES IMMUNOGLOBULIN-
 DO NOT REQUIRE ABO COMPATIBILITY
 SHELF LIFE 24-36 MONTHS

12. INDICATIONS OF BLOOD COMPONENT THERAPY
 Packed RBCs:
 a hemoglobin of 7 to 8 g/dL,
 a markedly decreased oxygen saturation and/or orthostatic
hypotension.
 Platelets:
Indicated for a
 platelet count of less than 50,000/microliter.
 there is active bleeding,
 if a procedure such as surgery is to be performed.
Spontaneous bleeding is unlikely until the platelet count
drops below 10,000 to 20,000/microliter.

13. • FFP:
 In a patient has multiple factor deficiencies and is bleeding.
 Thrombotic thrombocytopenic purpura (TTP).
 The PT and PTT will be prolonged, and the INR generally should be
greater than 1.6.
• Cryoprcipitate:
 Haemophilia
 Hypofibrinogenemia,
 vonWillebrand disease,
 in situations calling for a "fibrin glue."

14. TRANSFUSION
REACTIONS

15. ACUTE REACTIONS
ACUTE HEMOLYTIC REACTIONS
 ABO INCOMPATIBILITY
ANTIGEN ANTIBODY COMPLEX
COMPLEMENT RELATED INTRAVASCULAR HEMOLYSIS
SIGN/SYMPTOMS;
 PAIN AT INFUSION SITE, ALONG VEIN
 CHEST AND BACK PAIN
 FEVER ,RIGORS ,VOMITING
 HYPOTENSION,BREATHLESSNESS
 FLUSHING,BURNING OF FACE
 DIC
 ARF

16. TREATMENT
 STOP TRANSFUSION
 CRYSTALLOID SOLUTIONS
 DIURESIS
 DIALYSIS=ARF
 BLOOD PRODUCTS=DIC
 DEXTROSE+INSULIN FOR
HYPERKALEMIA

17. INVESTIGATION OF ACUTE HEMOLYTIC
TRANSFUSION
1) REPORT TO BLOOD TRANSFUSION DEPARTMENT
2) ESTABLISH THAT THE UNIT ISSUED TO THE PROPER
PATIENT
3) OBTAIN FRESH SAMPLES
4) SEND SAMPLE OF BLOOD UNIT FOR CULTURE
5) RETURN BLOOD TO BLOOD BANK
6) BLOOD FOR Hb %, UREA, S/ELECTROLYTES

18. ALLERGIC REACTIONS
• WITHIN MINUTES
TREATMENT
• ANTIHISTAMINES
• REDUCE TRANSFUSION RATE
S/S
• RASH, ITCHING, laryngeal aedma leading to SOB

19. NON HEMOLYTIC FEBRILE REACTIONS
• CAUSE =GRAFT VS HOST RESPONSE FROM
LEUCOCYTE ANTIGEN=
S/S
• RIGORS,FEVER WITHIN 30 MINUTES
TREATMENT
• SLOW/STOP TRANSFUSION
• ANTIPYRETICS
• PROPHYLACTIC ANTIPYRETICS BEFORE NEXT
TRANSFUSIONS

20. ANAPHYLACTIC REACTIONS;
• RARE 1/ 20000
CAUSE
• IgA ANTIBODIES
• LOW SERUM IgA
S/S
• HYPOTENSION
• LARYNGEAL OEDEMA
• CUTANEOUS FLUSHING
• BRONCHOSPASM

21. TREATMENT
• STOP TRANSFUSION
• AIRWAY
• OXYGEN
• ANTIHISTAMINES
• ADRENALINE
• SALBUTAMOL
• STEROIDS

22. TRANSFUSION RELATED ACUTE LUNG INJURY
(TRALI)
CAUSE
• ANTIBODIES TO LEUKOCYTES IN DONOR BLOOD
S/S
• FEVER,COUGH
• BREATHLESSNESS,HYPOXEMIA

23. TREATMENT;
• GOOD INTENSIVE CARE
• CARDIAC AND PULMONARY SUPPORT
• ANTIBIOTICS
• MAY NEED VENTILATORY SUPPORT
• DEATH DUE TO
MULTI ORGAN FAILURE
INFECTION

24. Solution (Specialized products)
• Washed RBC’s: A unit of packed red blood cells (PRBCs) is
washed to reduce plasma proteins. This reduces the risk for
allergic transfusion reactions. Washing reduces
immunoglobulins, such as anti-IgA that could cause
anaphylactic transfusion reactions in persons with selective
IgA deficiency.
• Leucocyte reduction: Red blood cell and platelet units may be
filtered to remove most of the leukocytes (white blood cells).
This may reduce the risk for febrile transfusion reactions, may
help prevent alloimmunizaton to MHC (HLA) donor antigens, and
help reduce the risk for cytomegalovirus (CMV) infection.

25. Irradiated Blood
• Irradiation is needed to destroy all living
leukocytes (white blood cells), particularly
lymphocytes that could cause transfusion
associated graft versus host disease (TAGVD).

26. SEPTIC SHOCK :
• DISASTROUS COMPLICATION.
• DIFFICULT TO DIFFERETIATE FROM ACUTE
HEMOLYTIC TRANSFUSION REACTION.
• MAJORITY DO NOT SURVIVE
PATHOGENS
• PSEUDOMONAS
• YERSINIA
• STAPHYLOCOCCI

27. METABOLIC COMPLICATIONS
• MASSIVE TRANSFUSION
CONSEQUENCES
• HYPOTHERMIA
• ACIDOSIS
• CITRATE INTOXICATION…HYPOCALCEMIA
• HYPERKALEMIA…..ARRYTHMIAS

28. CIRCULATORY OVERLOAD
• RAPID OR LARGE VOLUMES
SEVERE , CHRONIC ANEMIAS
PRECAUTIONS
• VERY SLOW TRANSFUSION.
• PACKED CELLS
• DIURETICS
COMPLICATION
• PULMONARY OEDEMA

29. LATE REACTIONS
DELAYED HEMOLYTIC TRANSFUSION REACTIONS
LOW LEVEL OF ANTIBODIES TO BLOOD GROUP
ANTIGEN
5 TO 10 DAYS LATE DESTRUCTION OF
TRANSFUSED CELLS
FEVER, FALLING Hb, JAUNDICE, HbURIA

30. HEMOSTATIC REACTIONS:
• THROMBOCYTOPENIA AND LOW LABILE
FACTORS
• MASSIVE TRANSFUSION
PRECAUTION:
• 2 UNITS OF FFP AFTER EVERY 8 PINTS OF
BLOOD

31. HEMOLYTIC DISEASE OF NEW BORN
Rh INCOMPATIBLE TRANSFUSION
IMMUNE SUPPRESSION
WOUND COMPLICATIONS IN PERIOPERATIVE
TRANSFUSIONS

32. TRANSFUSION IRON OVERLOAD
(HEMOSIDEROSIS)
1 UNIT…. 250mg OF IRON
REPEATED TRANSFUSIONS OVER YEARS
 REFRACTIVE ANEMIAS
 THALASSEMIAS
LIVER,PANCREAS,MYOCARDIUM
TREATMENT IS DESFERRIOXAMINE.

33. INFECTIVE
BACTERIAL
 BRUCELLOSIS
 SYPHILIS
 CHAGA’S DISEASE
HELMINTHIC
 FILARIASIS
PROTOZOAL
 MALARIA
 KALA-AZAR
 TRYPANOSOMIASIS
 TOXOPLASMOSIS

34. RICKETTSIAL
RELAPSING FEVER
VIRAL
HEPATITIS A,B,C
EBV
HIV – 1
HIV – 2
CMV