It contains indications of blood and blood products and perioperative blood therapy that we usually follow in Aiims Patna ..its is most recent one made in April 2020
It contains indications of blood and blood products and perioperative blood therapy that we usually follow in Aiims Patna ..its is most recent one made in April 2020
A PowerPoint presentation outlining the physiology of blood transfusion, and clinical precautions to take in preventing and managing blood transfusion reactions.
Blood products Transfusion and related complications,
Types of cell salvage, blood warming and autologous blood,
With intraoperative blood lots monitoring and transfusion
A PowerPoint presentation outlining the physiology of blood transfusion, and clinical precautions to take in preventing and managing blood transfusion reactions.
Blood products Transfusion and related complications,
Types of cell salvage, blood warming and autologous blood,
With intraoperative blood lots monitoring and transfusion
Surgery resident postgraduate presentation on the use of blood and products presented dept of surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
I missed the Critical Care Congress at Pune. Couldn't make it because of certain personal reasons. However, I was to deliver a talk on ROLE OF BLOOD COMPONENTS & rFVIIa IN OBSTETRICS on 21 Jul 13 at 11 am. Feel duty bound to share the presentation with all who wanted to hear it there. I have uploaded it at Slideshare and queries, if any, may be addressed to navneetmagon@gmail.com.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Guidelines for
Blood Transfusion Practice
By
Dr . Magdy Shafik Ramadan
Senior Pediatric and Neonatology consultant
M.S, Diploma, Ph.D of Pediatrics
2. • Blood transfusion is an important part of
day‐to‐day clinical practice.
• Blood and blood products provide unique
and life‐saving therapeutic benefits to
patients.
• Nursing staff plays a very important role and
crucial role in the blood transfusion
procedure
3. outlines
• 1- History
• 2- purpose
• 3- blood and blood component
• 4 – guidelines for use of blood and blood
component
• 5- الدم نفل خطوات
• 6- Other aspects of transfusion
• 7-Transfusion Therapy in Special Conditions
• 8- Transfusion reaction
4. History
• in 1915, Richard Lewison l in New York
City initiated the use of sodium citrate as an
anticoagulant.
• • This discovery transformed the blood
transfusion procedure from direct (vein-to-
vein) to indirect.
• • In the same year, Richard Weil
demonstrated the feasibility of refrigerated
storage of anticoagulated blood
5. • The introduction of a citrate-glucose
solution by Francis Peyton Rous and JR
Turner two years later permitted storage of
blood in containers for several days, thus
opening the way for the first "blood depot"
established in Britain during World War I.
• -1930s, the Soviet Union had set up a system
of at least sixty large blood centers and
more than 500 subsidiary ones, all storing
"canned" blood and shipping it to all
corners of the country.
6. • • News of the Soviet experience traveled to
America, where in 1937 Bernard Fantus,
director of therapeutics at the Cook County
Hospital in Chicago, established the first
hospital blood bank in the United States.
• •Within a few years, hospital and community
blood banks were established across the
United States.
7. • • Willem Johan Kolff organized the first
blood bank in Europe (in 1940).
• • An important breakthrough came in 1939-
40 when Karl Landsteiner, Alex Wiener,
Philip Levine, and R.E. Stetson discovered
the Rh blood group system, which was
found to be the cause of the majority of
transfusion reactions up to that time.
8. • Three years later, the introduction acid-
citrate-dextrose (ACD) solution, which
reduces the volume of anticoagulant,
permitted transfusions of greater volumes
of blood and allowed longer term storage.
• • Carl Walter and W.P. Murphy, Jr.,
introduced the plastic bag for blood
collection in 1950.
9. • Replacing breakable glass bottles with
durable plastic bags allowed for the
evolution of a collection system capable of
safe and easy preparation of multiple blood
components from a single unit of Whole
Blood.
• • An anticoagulant preservative, CPDA-1
was introduced in 1979. It decreased
wastage from expiration and facilitated
resource sharing among blood banks.
Newer solutions contain adenine and extend
the shelf life of red cells to 42 days.
11. Purpose
• Restore blood volume
• Replace clotting factors
• Improve oxygen carrying capacity
• Restore blood elements that are
depleted
• Prevent complications
• To raise the haemoglobin level
• To provide antibodies
12. •
Blood Components
• A blood component is a constituent of blood,
separated from whole blood, such as:
• Red cell concentrate
• Plasma
• Platelet concentrate
• Cryoprecipitate, prepared from fresh
frozen plasma; rich in Factor VIII and
fibrinogen
13.
14. • A plasma derivative is made from human
plasma proteins prepared under
pharmaceutical manufacturing conditions,
such as:
• Albumin
• Coagulation factor concentrates
• Immunoglobulin
15. • 1-Whole blood
• Description:
• 450 mL whole blood in 63 mL
anticoagulant‐preservative solution of which Hb
will be approximately 1.2 g/dL and haematocrit
(Hct) 35‐45%.
• Storage:
• Between +2°C and +6°C in an approved blood
bank refrigerator, fitted with a temperature
monitor and alarm.
• Indications:
• Red cell replacement in acute blood loss with
hypovolaemia.
• Exchange transfusion.
16. Contraindications:
Risk of volume overload in patients with:
Chronic anemia.
Incipient cardiac failure.
• 2-packed red blood cells (PRBC
• Description:
• 150‐200 mL red blood cells from which most of the
plasma has been removed. Hb concentration will be
approximately 20 g/100 mL (not less than 45 g per
unit) and Hct 55‐75%.
17. • Indications:
• Replacement of red cells in anaemic patients.
• 1 unit of PRBCs = raises hematocrit by 2-3%
• 3-Platelet concentrates (PC)
• Description:
• A single donor unit consists of 50‐60 mL plasma
that should contain ≥55 x 109 platelets.
• Storage:
• PCs may be stored for up to 5 days at +20°C to
+24°C (with agitation). PCs require continuous
agitation
• during storage, on a platelet shaker and in an
incubator that maintains the required storage
18. • Dosage:
• 1 unit of platelet concentrate/10 kg;
• for an adult of 60‐70 kg, 4‐6 single donor units containing
at least 240 x 109 platelets should raise the platelet count
by 20‐40 x 109/L. Increment will be less if there is
splenomegaly, disseminated intravascular coagulation
(DIC) or septicaemia.
• Indications:
• Treatment of bleeding due to:
• Thrombocytopenia.
• Platelet function defects.
• Prevention of bleeding due to thrombocytopenia as in
bone marrow failure
19. • Administration:
• should be infused as soon as possible because of
the risk of bacterial proliferation.
• a unit should be infused over a period of not more
than 30 minutes.
• Do not give platelet concentrates prepared from
RhD positive donors to an RhD negative female
with childbearing potential.
• Give platelet concentrates that are ABO
compatible, whenever possible
20. 4-Fresh Frozen Plasma (FFP)
• Unit of issue:
200‐300 mL.
• Storage:
• FFP is stored at –25°C or colder for up to 1
year. Before use, it should be thawed in the blood
transfusion centre between +30°C and +37°C.
• Dosage: 15 mL/kg.
• Administration:
• Should be ABO compatible.
• Infuse as soon as possible after thawing.
• Labile coagulation factors rapidly degrade; use
within 6 hours of thawing.
21. • FFP may be beneficial if PT and/or partial
thromboplastin time (PTT) >1.5 times normal.
• 1 unit of FFP = increases level of any clotting
factor by 2-3%
• 5-Cryoprecipitated anti‐haemophilic factor
(Cryo‐AHF)
• Description:
• Cryo‐AHF is prepared from FFP by collecting the
precipitate formed during controlled thawing at
+4°C and re‐suspending in 10‐20 mL plasma. It is
stored at –25°C or colder for up to 1 year after the
date of phlebotomy.
22. • Cryo‐AHF contains about half the Factor VIII
and fibrinogen as a pack of fresh whole blood:
e.g. Factor VIII: 80‐100 iu/ pack; fibrinogen:
150‐300 mg/ pack.
• Administration:
• ABO compatible product should be used.
• After thawing, infuse as soon as possible.
• Must be transfused within 6 hours of thawing
23. Guidelines for blood transfusion
Indications
NB: Hb should not be the sole deciding factor for
transfusion.
Haemoglobin (Hb)
trigger for
transfusion
•If there are signs or symptoms of impaired oxygen transport
•Lower thresholds may be acceptable in patients without symptoms
and/or where specific therapy is available e.g. sickle cell disease or
iron deficiency anemia
< 7 g/dL
•Preoperative and for surgery associated with major blood loss.< 7 – 8 g/dL
•In a patient on chronic transfusion regimen or during marrow
suppressive therapy.
< 9 g/dL
•Not likely to be appropriate unless there are specific indications.
Acute blood loss >30-40% of total blood volume.
< 10 g/dL
24. Guidelines for blood component therapy
IndicationsPlatelet Count
trigger for
transfusion
As prophylaxis in bone marrow failure.< 10 x 109 /L
Bone marrow failure in presence of additional risk factors:
fever, antibiotics, evidence of systemic haemostatic failure
< 20 x 109 /L
In patients undergoing surgery or invasive procedures.
•Diffuse microvascular bleeding- DIC
< 50 x 109 /L
•Brain or eye surgery.
Any Bleeding Patient
•Appropriate when thrombocytopenia is considered a
major contributory factor.
< 100 x 109 /L
•In inherited or acquired qualitative platelete function
disorders, depending on clinical features & setting.
Any platelet count
25. Guidelines for blood component transfusion
Indications
•Multiple coagulation deficiencies associated with acute
DIC.
•Inherited deficiencies of coagulation inhibitors in patients
undergoing high-risk procedures where a specific factor
concentrate is unavailable.
•Thrombotic thrombocytopenia purpura (plasma exchange
is preferred)
•Replacement of single factor deficiencies where a specific or
combined factor concentrates is unavailable. •Immediate
reversal of warfarin effect in the presence or potentially life-
threatening bleeding when used in addition to Vitamin K & /
or Factor Concentrate (Prothrombin concentrate)
•The presence of bleeding and abnormal coagulation
parameters following massive transfusion or cardiac bypass
surgery or in patients with liver disease deficiency.
FFP trigger for
transfusion
Indications PT &
PTT are more
than 1.5 times the
upper limit of
normal range
Fibrinogen< 1gm/L •Congenital or acquired
fibrinogen deficiency including DIC. •Hemophilia A,
von Willebrand disease (if the concentrate is not
available). •Factor XIII
Cryoprecipitate
trigger for
transfusion
26. Preparation for Transfusion
• Take a blood sample for cross match for red and
white blood cell products.
• ► Send a minimum of 2 ml in an EDTA
• ► Specimens are appropriate for only 72 hrs.
31. • The blood unit must be discarded if:
• It has been out of the refrigerator for longer
than 30 minutes, or
• The seal is broken, or
• There is any sign of haemolysis, clotting or
contamination
33. Duration times for transfusion
• Complete
transfusion
• Start transfusion• Blood products
• ≤ 4 hours
• Discard unit if this
period is exceeded
• Within 30 minutes
of
• removing from
refrigerator
• Whole blood /
PRBC
• Within 30 minutes• Immediately• Platelet concentrate
• Within 30 minutes• As soon as possible• FFP
• Within 30 minutes• As soon as possible• Cryoprecipitate
34. Other aspects of transfusion
• 1 -Warming blood
• 2 -Use of medication at time
of transfusion
• 3- Use of fresh blood
35. 1 -Warming blood
• Warmed blood is most commonly required
in:
• Large volume rapid transfusions:
- Adults: more than 50 mL/kg/hour.
- Children: more than 15 mL/kg/hour
• Exchange transfusion in infants
• Patients with clinically significant cold
agglutinins.
36. • Blood should only be warmed in a blood
warmer.
• Blood should never be warmed in a bowl of
hot water as this could lead to hemolysis of
the red cells which could be life‐threatening
when transfused.
37. Use of medication at time of transfusion
• It is generally not recommended to routinely use
pre‐medication like anti‐histamines, steroids
• or other medication before transfusion.
• This practice may mask or delay the signs and
• symptoms of an acute transfusion reaction.
38. Addition of medicine or other fluids with
blood and blood components
• Medicines or other fluids should never be infused
within the same line as blood and blood
components.
• The exception is normal saline (sodium chloride
0.9%) which may be used in special
circumstances, e.g. when the flow is slow due to
increased Hct.
• Use a separate IV line if an intravenous fluid has
to be given at the same time as blood transfusion.
39. Use of fresh blood
• Stored blood less than 7 days old is termed “fresh
blood
• Uses ( to avoid biochemical overload) to raise Hb:
- Renal and liver dysfunction.
- Patient requiring massive blood transfusion.
- Patient with raised plasma potassium due to extensive
burns, or intravascular haemolysis.
- Neonate requiring exchange transfusion
41. • Emergency Transfusion
• • Group O–negative RBC units should be used,
especially if the patient is a female of childbearing
poriod.
• A male patient or an older female patient can be
switched from Rh- negative to Rh-positive RBCs if
few O- negative units are available and massive
transfusion is required.
42. Massive Blood Transfusion
• Massive blood transfusion may be defined as the
replacement of one blood volume (equivalent to 10
units of blood) in any 24 hour period,
• or half of the blood volume (5 units of blood) in
any four hour period in an adult.
• or Transfusion >4 units in 1 hour.
44. • The goals to the management of massive
transfusion include
• early recognition of blood loss,
• maintenance of tissue perfusion, oxygenation by
restoration of blood volume and Hb,
and the cessation of bleeding by several means
including early surgical or radiological intervention,
and the judicious use of blood component therapy to
correct coagulopathy.
45. • Massive Transfusion Protocol
Values for which to aimParameter
>35°CTemperature
pH >7.2, base excess < –6, lactate <4
mmol/L
Acid‐base status
>1.1 mmol/LIonised calcium (Ca)
This should not be used alone as a
transfusion trigger; and, should be
interpreted in context with
haemodynamic status, organ and tissue
perfusion
Haemoglobin (Hb)
≥50 x 109 /LPlatelets (Plt)
≥1.5 x of normalPT/APTT (activated
partial
thromboplastin time)
≥1.0 g/LFibrinogen
46. • Mortality is high in massive transfusion and its
aetiology is multifactorial
• hypotension, acidosis, coagulopathy, shock
• administering large volumes of blood and
intravenous fluids may itself give rise to the
following complications:
• Acidosis
• Hyperkalaemia
• Citrate toxicity and hypocalcaemia
47. Acidosis
• Acidosis in a patient receiving a large volume
transfusion is more likely to be the result of
inadequate treatment of hypovolaemia than due
to the effects of transfusion.
• Under normal circumstances, the body can readily
neutralize this acid load from transfusion.
48. Hyperkalaemia
• The storage of blood results in a small increase in
extra‐cellular potassium concentration
• increase the longer it is stored.
• This rise is rarely of clinical significance, other
than in neonatal exchange transfusions.
49. Citrate toxicity and hypocalcaemia
• Hypocalcaemia, particularly in combination with
hypothermia and acidosis, can cause a reduction
in cardiac output, bradycardia, and other
dysrhythmias.
• It is therefore unnecessary to attempt to neutralize
the acid load of transfusion.
50. • Management
If there is prolongation of PT, give ABO
compatible fresh frozen plasma in a dose of 15
mL/kg
If the APTT is also prolonged, Factor
VIII/fibrinogen concentrate is recommended in
addition to FFP.
If none is available, give 10‐15 units of ABO
compatible cryoprecipitate, which contains
Factor VIII and fibrinogen.
51. • Consider PC (platelets concentrates)transfusion
in cases where the platelet count falls below 20 x
109/L, even if there is no clinical evidence of
bleeding.
• The prophylactic use of platelet concentrates in
patients receiving large volume blood transfusions
is not recommended.
52. Transfusion in Pediatrics
• Transfusion of Neonates and Infants:
Pre‐transfusion testing:
• Maternal samples:
• ABO and RhD group
• Antibody screen (5 mL clotted blood)
• Infant samples:
• ABO and RhD group
• Direct antiglobulin test (DAT)
• Antibody screen if maternal sample unavailable
53. • If the maternal antibody screen is negative and the
infant’s red cells are DAT negative, cross
matching is unnecessary and blood of the baby’s
group can be issued.
• If the maternal antibody screen and/or the
neonatal DAT are positive, serological
investigation and full compatibility testing will be
necessary .
• After the first four months of life, cross matching
procedures should conform to the requirements
• for older children/adults.
• .
54. Neonatal Platelets Transfusion
• stable healthy term infant with a platelet count as low
as 20,000- 30,000/μL may be allowed a platelet
transfusion.
• Prophylactic platelet transfusions should be
considered for ill neonates with platelet count less
than 20,000-50,000/μL.
• Infants receiving indomethacin or
thrombolytics/anticoagulants should have a platelet
count of more than 75,000/μL.
55. • Platelets are administered in 10 ml/kg aliquots/hr.
• Infants receive type specific or group O platelets
in plasma compatible with the infant.
• 1 unit = increases the average adult client’s
platelet count by about 5,000 platelets/microliter
58. Guidelines for recognition and
management of acute transfusion
reactions
• Category 1: Mild reactions
Possible causeSymptomsSigns
HypersensitivityPruritusUrticaria
Rash
59. • Immediate management of Category 1:
Mild reactions
• Slow the transfusion.
• Administer antihistamine IM.
• If no clinical improvement within 30
minutes or if signs and symptoms worsen,
treat as Category 2 .
• If improved, restart transfusion slowly.
60. Category 2: Moderately severe reactions
Possible causeSymptomsSigns
HypersensitivityAnxiety
Pruritus
Palpitations
Mild dyspnoea
Headache
Flushing
Urticaria
Rigors
Fever
Restlessness
Tachycardia
61. • Immediate management of Category 2:
Moderately severe reactions
• 1-Stop the transfusion and keep IV line open with
normal saline in another site.
• 2- Return the blood unit with transfusion
administration set, freshly collected urine and new
blood samples (1 clotted and 1 anticoagulated),
drawn from a vein opposite to the transfusion site,
to the blood transfusion centre for laboratory
investigations.
62. • 3-Administer antihistamine IM and oral or rectal
antipyretic.
• 4-Give IV corticosteroids and bronchodilators if
there are anaphylactoid features
• 5-If clinical improvement occurs, restart
transfusion slowly with new blood unit.
• 6-If no clinical improvement within 15 minutes or
if signs and symptoms worsen, treat as Category 3.
• 7-Collect urine for next 24 hours for evidence of
haemolysis and send for laboratory investigations.
• 8-If available, a leucocyte reduction filter (WBC
filter) may be used in repeated transfusion
63. Category 3: Life‐threatening reactions
Possible causeSymptomsSigns
Acute intravascular
haemolysis
(mismatched blood
transfusion)
Bacterial
contamination and
septic shock
Fluid overload
Anaphylaxis
Transfusion related
acute lung
injury (TRALI
Anxiety
Chest pain
Pain along the
transfusion line
Respiratory
distress/shortness
of breath
Loin/back pain
Headache
Dyspnoea
Rigor
Fever
Restlessness
Hypotension (fall of
20% in
systolic BP)
Tachycardia (rise of
20% in
heart rate)
Haemoglobinuria (Hb
in urine)
Unexplained
bleeding (DIC)
64. Immediate management of Category 3:
Life‐threatening reactions
• Stop the transfusion and keep IV line open with
normal saline in another site.
• Infuse normal saline to maintain systolic BP.
• Maintain airway and give high flow oxygen by
mask.
• Give adrenaline (as 1:1000 solution) 0.01 mg/kg
body weight by slow intramuscular injection.
• Give IV corticosteroids and bronchodilators if
there are anaphylactoid features
65. • Give diuretic: e.g. frusemide 1 mg/kg IV or
equivalent.
• Check a fresh urine specimen visually for signs
of haemoglobinuria.
• Send blood unit with transfusion set, fresh urine
sample and new blood samples (1 clotted and 1
anticoagulated), drawn from a vein opposite the
infusion site, with the appropriate request form to
the blood transfusion centre for investigation.
• Start a 24‐hour urine collection and record all
intake and output. Maintain fluid balance chart.
•
66. • Assess for bleeding from puncture sites or
wounds. If there is clinical or laboratory evidence
of DIC, give platelets (adult: 4‐6 units) and either
cryoprecipitate (adult: 12 units) or FFP (adult: 3
• Units.
• Reassess. If hypotensive:
– Give further saline.
– Give inotrope, if available
• If urine output falls or there is laboratory evidence
of acute renal failure (rising K+, urea,
• creatinine
67. – Maintain fluid balance accurately.
– Give further diuretic: e.g. frusemide 1 mg/kg IV or
equivalent.
– Consider dopamine infusion, if available.
– Seek expert help: the patient may need renal dialysis
• If bacteraemia is suspected (rigor, fever, collapse,
no evidence of a haemolytic reaction), start a
• broad‐spectrum antibiotic IV.
68. Investigating acute transfusion reactions
• Record the following information on the patient’s
notes:
– Type of transfusion reaction.
– Time lapse between start of transfusion and
when reaction occurred.
– Volume, type and bag number of blood
products transfused
69. • Immediately take post‐transfusion blood samples
(1 clotted and 1 anti‐coagulated) from the vein
opposite the transfusion site and forward to the
blood centre for investigation of the following:
– Repeat ABO and RhD group.
– Repeat antibody screen and cross match.
– Full blood count.
– Coagulation screen.
– Direct antiglobulin test.
– Urea and creatinine.
– Electrolytes.
70. Also return the following to the blood centre:
– Blood bag and transfusion set containing red cell
and plasma residues from the transfused unit.
– Blood culture in a special blood culture bottle.
– First specimen of the patient’s urine following
the reaction.
– Completed transfusion reaction report form
• After the initial investigation of the reaction, send
patient’s 24‐hour urine sample to the blood
• transfusion centre for laboratory investigation.
71. Haemolytic transfusion reaction
• The most common cause of reaction is ABO
incompatible transfusion. This almost always
arises
from:
- Errors in the blood request form.
- Taking blood from the wrong patient into a
pre‐labelled sample tube.
- Incorrect labelling of the blood sample tube
sent to the blood transfusion centre.
- Inadequate checking of the blood label against
the patient’s identity
72. • In the conscious patient, signs and symptoms
usually appear within minutes of commencing the
transfusion, sometimes when <10 mL blood has
been given.
• In an unconscious or anaesthetized patient,
hypotension and uncontrollable bleeding, from the
transfusion site, may be the only sign of an
incompatible transfusion
73. • 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.
74. • Bacterial contamination and septic shock
• Blood may become contaminated by:
- Bacteria from the donor’s skin entering the
blood unit during collection (usually staphylococci).
- Bacteraemia present in the blood of the donor
during collection (e.g. Yersinia).
- Improper handling during blood processing.
- Defect or damage to the blood bag.
- Thawing FFP or cryoprecipitate in a
water‐bath (often contaminated).
75. • Some contaminants, particularly Pseudomonas
species, grow at +2°C to +6°C and can survive or
multiply in refrigerated red cell units.
• Staphylococci grow in warmer conditions and
are able to proliferate in PCs which are stored at
+20°C to +24°C.
76. Transfusion Associated Circulatory Overload
• May occur when:
- Too much fluid is transfused.
- The transfusion is given too rapidly.
- Renal function is impaired.
Fluid overload is particularly likely to happen in
patients with:
- Chronic severe anaemia.
- Underlying cardiovascular disease
77. Anaphylactic reaction
1- rare complication of transfusion of blood
components or plasma derivatives.
2-The risk is increased by rapid infusion, typically
when fresh frozen plasma is used.
3-IgA deficiency in the recipient is a rare cause of
very severe anaphylaxis.
4-Cytokines in the plasma may occasionally cause
broncho‐constriction and vaso‐constriction in
recipients
78. • 5-Occurs within minutes of starting the transfusion
and is characterized by:
- Cardiovascular collapse.
- Respiratory distress.
- No fever.
6- fatal if it is not managed rapidly and aggressively
79. Transfusion Related Acute Lung Injury
• caused by donor plasma that contains antibodies
against the patient’s leucocytes.
• Rapid failure of pulmonary function usually
presents within 1‐4 hours of starting transfusion,
with diffuse opacity on the chest X‐ray.
• There is no specific therapy. Intensive respiratory
and general support in an intensive care unit is
required.
83. 2 Post‐transfusion purpura
• This is a rare but potentially fatal complication of
transfusion of red cells or platelet concentrates,
caused by antibodies directed against platelet‐specific
antigens in the recipient.
• Most commonly seen in multigravida female
patients.
• Signs and symptoms:
• – Signs of bleeding.
• – Acute, severe thrombocytopenia 5‐10 days after
transfusion, defined as a platelet count of <100 x
109/L.
84. • Management:
• High dose corticosteroids.
• Give high dose IV immunoglobulin, 2 g/kg or 0.4
g/kg for 5 days.
• Plasma exchange.
• If available, give platelet concentrates that are
negative for the platelet‐specific antigen against
which the antibodies are directed
• Recovery of platelet count after 2‐4 weeks is usual.
• Unmatched platelet transfusion is generally
ineffective
85. 3-Transfusion associated
graft‐versus‐host disease (TA‐GVHD)
• Occurs in patients such as:
– Immuno‐deficient recipients of bone marrow
transplants.
- Immuno‐competent patients transfused with
blood from individuals with whom they have a
compatible HLA tissue type, usually blood relatives
particularly 1st degree.
86. Signs and symptoms typically occur 10‐12 days after
transfusion and are characterized by:
- Fever.
– Skin rash and desquamation.
– Diarrhoea.
– Hepatitis.
– Pancytopenia
87. Management
Treatment is supportive; there is no specific
therapy.
Prevention
Do not use 1st degree relatives as donors, unless
gamma irradiation of cellular blood components is
carried out to prevent the proliferation of transfused
lymphocytes.
88. 4-Transfusion transmitted infections
• HIV, Hepatitis B and C, syphilis, malaria.
• Cytomegalovirus (CMV).
• Other TTIs include human parvovirus B19,
brucellosis, Epstein‐Barr virus, toxoplasmosis,
Chagas disease, infectious mononucleosis and Lyme’s
disease.
Since a delayed transfusion reaction may occur days,
weeks or months after the transfusion, the association
with the transfusion may easily be overlooked