blood transfusion ... everything you want to know about blood transfusion .. all blood components .. guidelines etc etc

1. DR MURUGESAN
DR PRAMOD SARWA
1
Blood transfusion

2. OVERVIEW
 HISTORICAL BACKGROUND
 BLOOD COMPONENTS
types available
properties
indication
 PEDIATRIC CONSIDERATION
physiological
 TRASFUSION GUIDELINES
 COMPLICATIONS AND MANAGEMENT
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12. SEGREGATION OF BLOOD PRODUCT
 Whole blood ….. Pc
 Platelet rich plasma …. Platelet
 Platelete poor plasma ….ffp…cryo …f 7
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37. What is different……..
 …
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38. Oxygen delivery
 DaO2
=Cardiac output X CaO2 [oxygen content]
 Oxygen content
[Hb saturation X 1.34 X Hb conc] + 0.003 X PO2
Amount of oxygen carried by 100 ml of blood

39. Fetal hemoglobin
Cardiac reserve Increased metabolism

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41. Fetal hemoglobin
 HbF – 70-80% of full term and 97% of premature infants’
total hemoglobin at birth

42. Fetal hemoglobin
 Shorter life span of 90 days
(HbA- 120 days)
 HbF interacts poorly with
2,3,DPG
 P50 with HbF is 19 mmHg
 P50 with HbA is 27 mmHg
 Leftward shift of ODC

43. ODC

44. Hemoglobin for equivalent
oxygen delivery
P 50 Hb
Adult 27 10
Infants
[>3 month]
30 8.2
Infants
[<3 month]
24 14.7
Motoyama et al. 1990

45. 6 months- 6 years
12
7-13 years 13
6 months- 6 years 12
7- 13 years 13

46. Preoperative hemoglobin
 Term infant with Hb < 9 g/dl
 Preterm infant <7 g/dl
 Haemoglobin levels that are adequate for the older
patients may be suboptimal in the younger infant

47. Fetal hemoglobin
Cardiac reserve Increased metabolism

48. Adult vs children - cardiac
reserve
• Children have a higher cardiac output to blood
volume ratio than adults
Estimated circulating blood volume
Age Blood volume (ml/kg)
Premature infant 90-100
Term infant – 3 months 80-90
Children older than 3 months 70
Very obese children 65
Sandra et al. Pediatric anesthesia 2005