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Blood transfusion and its complication.pptx
1.
2. • Blood transfusion is the process of transferring blood or
blood components from one person into the blood
stream of another person
• Although, it is a life saving procedure, but it may also
lead to some adverse reactions.
INTRODUCTION
3. • Anemia of any cause
• Loss of blood because of trauma and surgery
• Bleeding disorder such as coagulopathy &
thrombocytopenia
Indications of transfusion
4. • Donor must be healthy without any diseases like
syphilis, HIV, HBV, HCV, Malaria etc.
• Only compatible blood must be transfused and Rh
compatibility must be confirmed.
PRECAUTIONS TO BE TAKEN BEFORE TRANSFUSION
OF BLOOD
5. • Blood grouping is based on type of antigen present on
the red blood cells.
• There are more than 300 blood group systems but, ABO
and Rh (Rhesus) are of the importance from the clinical
point of view.
• Other blood group systems are MNS, Lutheran, Kell,
Lewis, Duffy, Kidd etc.
BLOOD GROUP
8. • Gene present on Chromosome no. 1
• This is an ANTIGEN found in red cells.
• Human being can be divided into Rh +ve and Rh –ve group.
• Rh +ve does not possess Anti Rh antibodies in the serum.
• Rh –ve does not have any antibodies in plasma unless sensitized by
previous transfusion/ pregnancy.
• First transfusion fails to produce any symptoms but further transfusion
will definitely produce serious reaction.
• Approx. 85% of population are Rh +ve
15% are Rh -ve
Rh Factor
9. • Combines blood from an individual donor and recipient, to determine if
a transfusion reaction is likely to occur.
Two kinds :
- Major crossmatch (donor RBCs and recipient plasma/ serum)
- Minor crossmatch (donor plasma/ serum and recipient RBCs)
Crossmatching
11. • Safest form of blood transfusion involves pre-operative collection of patie
nt’s own blood for reinfusion during an elective surgery (only in cases wh
ere haemoglobin is more than 11gm% and hemotocrit value of 34%)
• One or two units of blood are safely drawn and stored one or two weeks
prior to surgery.
• The patient is put on good nourishing diet for haemopoietic regeneration
and build up of haemoglobin level prior to surgery.
Autologous Transfusion
12. • Autotransfusion eliminates the risk of viral hepatitis and HIV infection
• It avoids blood incompatibility and other transfusion reactions.
• It ensures the availability of blood especially when no donor is available.
Allogenic Transfusion
It involves the transfusion of blood or blood components obtained from com
patible donor to a patient.
Advantages
13. 1. Acute and peri operative blood loss:
If >30-40% of rapid blood loss : transfuse RBCs and use volume expanders
If <30-40% of rapid blood loss : RBCs are not usually needed but we volume
expanders
2. Monitor vital signs :
Tachycardia and hypotension not corrected with volume expanders, RBCs
needed.
Red Blood Cell transfusion guidelines
14. 3. Measure haemoglobin
If Hb >10g/dl – RBCs rarely needed
If Hb <7g/ dl – RBCs usually needed
If Hb 7-10g/dl – RBCs may be needed, determined by additional clinical
conditions. For cardiac disease patients, threshold goes up to Hb <10gm%
4. Hematocrit values
Hematocrit at which blood transfusion required in otherwise healthy
patient is <21%. For cardiac disease patient it is <30%
Red Blood Cell transfusion guidelines
15. 5. Chronic Anaemia :
• Transfusion done only to decrease symptoms and to minimize risk generally
at Hb of less than 7g/dl).
• Transfusion not done above 7g/dl Hb unless patient is symptomatic.
• Nutritional and mild blood loss anemia with specific therapeutic agents as
indicated (iron, folic, B12).
Red Blood Cell transfusion guidelines
16. • Low preoperative Hb/Hct value, either before intervention or on the day of
surgery
• Female sex
• Age more than 65 years
• Estimated surgical blood loss
Preoperative prediction for need of Transfusion
18. AGE BLOOD VOLUME
Neonates
• Premature 95ml/kg
• Full term 85ml/kg
• Infants 80ml/kg
Adults
• Men 75ml/kg
• Women 65ml/kg
Average blood volume
19. 1. Clot in a clenched fist ≈ 500 ml
2. Gravimetric method (swab weighing method):-
wet weight – dry weight = x in grams ≈x in ml
3. Colorimetric method:- Hb in g %
pre op Hb – post op Hb = x in g %
1 g % of Hb = 1 unit of blood
4. The filled drains or suction bottles are subtracted from their empty weight.
5. Blood loss is also estimated by blood on surgical drapes, blood on the floor
and beneath the patient.
ESTIMATING BLOOD LOSS
20. • It depends upon ongoing blood loss.
• Patient’s medical condition and Hb value.
Preoperative blood transfusion requirement
21. IMMEDIATE DELAYED
• - Acute haemolytic transfusion reaction - Delayed haemolytic
• transfusion reaction
• - Febrile non haemolytic transfusion reaction - Transmission of infections
• - Allergic Reactions - Iron overload
• - Anaphylactic reactions - Graft vs host disease
• - Transfusion associated lung injury - Post transfusion purpura
• - Circulatory overload
• - Bacterial contamination of donor unit
Complications
22. • A medical emergency, results from intravascular destruction of donor RBCs by
antibodies in the recipient
• Happens due to mismatched blood transfusion
• Leads to antigen antibody reactions, followed by complement activation &
intravascular hemolysis
Acute hemolytic transfusion reaction
23. • Fever with chills
• Reddish/ brownish coloured urine
• Decreased urine output
• Flank pain
• Fainting or Dizziness
• Flushing of the skin
Clinical features
24. • Stop transfusion
• Monitor vitals
• I/V fluids
• Diuretics – Mannitol, Furosemide
• Urine alkalization
• I/ V Sodium bicarbonate (75-100 meq)
• Try to maintain urine output at least 75-100 ml/hr
• Supportive management
• Send remaining blood to blood bank for any error in paper work or
crossmatching
Management
25. • Causes : release of cytokines from leukocytes during storage of blood
• Reaction of allo antibodies in the recipient with transfused WBCs – release of
pyrogens
• Reaction begins in 30-60 minutes after transfusion
Febrile non hemolytic transfusion reaction
27. • Stop transfusion
• Workup for other causes
• Oral / rectal antipyretics
• IM/ IV antihistamines
PREVENTION
• Slow rate of transfusion
Management
28. • Occurs due to reaction between donor’s plasma proteins & IgE antibodies of
recipient’s plasma i.e., release of histamine
• Occurs within few minutes
C/F :
• Mild urticaria
• Rashes
• Pruritus
MANAGEMENT:
• Slow down the rate of transfusion
• IV antihistamine
Allergic reaction
29. • Rare
• Occurs within few minutes of transfusion
C/F :-
• Hypotension
• Shock
• Breathlessness
• Bronchospasm
Anaphylactic reaction
30. • Stop transfusion
• Maintenance of Airway, Oxygen
• Start I/V fluid
• Inj. Adrenaline 0.3-0.5mg SC/IM, repeat every 5-10 min
• IV Hydrocortisone
• Supportive management
MANAGEMENT
31. • Occurs within 6 hours
• Most common cause of death after blood transfusion
• Occurs because of Anti HLA Antibody (donor) react with HLA Antigen
(recipient)
• It can be caused by any type of blood product but most commonly it is caused
by FFP.
Transfusion associated acute lung injury
33. • X-RAY : B/L diffuse pulmonary infiltrates
Management:
• Stop transfusion
• Monitor vitals
• Start oxygen
• Supportive treatment
• Send sample for HLA Testing
• Mild cases can be managed by Oxygen therapy but in severe cases, Mechanical
ventilation is needed.
(Most of the cases are resolved within 96 hrs.)
34. • Occurs as a result of transfusion of large amount of blood & blood products in
short duration of time.
• It can cause cardiac failure & pulmonary oedema
Circulatory overload
36. • Stop transfusion
• Head up position
• Start oxygen
• I.V. Diuretics
• Supportive treatment
• In severe cases, Mechanical ventilation is needed.
Management
37. • Common with platelets transfusion, if stored at room temperature, it favours
bacterial proliferation
CAUSES :
• Incomplete sterilisation during venipuncture
• Asymptomatic bacteremia in donor at the time of blood collection
• Tiny breaks in plastic bag
• Thawing of cryoprecipitate or FFP in a water bath
Bacterial contamination of Donor Unit
39. DELAYED HEMOLYTIC TRANSFUSION REACTION :
• Occurs within 1-4 weeks of transfusion.
• Mostly individuals, who are sensitised earlier to certain red cells antigens by
previous transfusion or pregnancy
• Concentration of antibodies is low, so it cannot be detected by tests before
transfusion
• On re- exposure, secondary immune response – destruction of red cells
because of extra vascular haemolysis
C/F :-
• Fever, anemia, jaundice in 5-10 days after transfusion
Delayed complications
41. • Each unit of blood contains 200mg of iron
• Daily physiological loss of iron is 1mg
• Deposition of excess iron in heart, liver, endocrine gland can lead to organ
failure
• Seen in patients who need repeated transfusion.
TREATMENT : Iron chelating therapy - desferrioxamine
Iron Overload
42. • Occurs after 10-12 days after transfusion
• Commonly seen in Immuno-deficient individuals( BM transplant recipients,
premature infants )
• Donor leukocytes react with host tissue
C/F :
• Fever with rashes
• Vomiting
• Diarrhoea
• Hepatitis
• Pancytopenia
PREVENTION : irradiations before transfusion
Graft versus Host Disease
43. • Occurs with 5-10 days after transfusion
• Commonly seen in adults, multiparous women
• Due to previous sensitization to platelet antigens during pregnancy
• It is a fatal condition
• Bleeding from mucous membranes, GI and Urinary tract is common.
MANAGEMENT :
• Plasma exchange
• IV immunoglobulins
Post transfusion purpura
44. If the recipient’s blood type and Rh status is not known with certainty and
transfusion must be started before determination, type O Rh- negative
(universal donor) red cells may be used.
Emergency Transfusion
45. Classical presentation of adverse transfusions reaction is usually masked under
anaesthesia. Transfusion reaction can be suspected if-
• Arrhythmias, tachycardia and hypotension
• Localised or systemic cutaneous reactions
• Bleeding can occur from surgical, oral & nasal site.
Adverse Transfusion Reactions During Surgery Under Anaesthesia
46. Fig: Immediate management of a suspected transfusion reaction. All reactions should be assumed to be hemolytic and investigated accordingly
