Component therapy provides specific blood products like red blood cells, platelets, fresh frozen plasma, and cryoprecipitate to address distinct clinical needs like restoring oxygen capacity, hemostasis, or coagulation factors. The goal is to use the most appropriate blood product for each patient's needs while maximizing the benefits from each blood unit. Indications for transfusion include restoring or maintaining blood volume, oxygen carrying capacity, hemostasis, and leukocyte function. Careful consideration of each patient's clinical situation and test results is important for determining the best component therapy.
management of massive post par-tum hemorrhage is a very challenging & crucial.management with blood transfusions & drugs will reduce the mortality & morbidity.
Hemostasis, Coagulation, Intrinsic, Extrinsic & common Pathways of Clotting, Common bleeding disorders & their investigations, BT, CT, PT, APTT, TT, Blood & its products, Blood transfusion & its complication.
management of massive post par-tum hemorrhage is a very challenging & crucial.management with blood transfusions & drugs will reduce the mortality & morbidity.
Hemostasis, Coagulation, Intrinsic, Extrinsic & common Pathways of Clotting, Common bleeding disorders & their investigations, BT, CT, PT, APTT, TT, Blood & its products, Blood transfusion & its complication.
Blood transfusion is one of the commonest accompaniments of surgical practice. With a growing incidence of major polytrauma by vehicular accidents, bomb blasts and fires, awareness of the basic concepts underlying massive blood transfusion practice with special reference to the complications is essential. The paper outlines the pathophysiologic mechanisms underlying the various complications of massive blood transfusion.
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
Blood transfusion is one of the commonest accompaniments of surgical practice. With a growing incidence of major polytrauma by vehicular accidents, bomb blasts and fires, awareness of the basic concepts underlying massive blood transfusion practice with special reference to the complications is essential. The paper outlines the pathophysiologic mechanisms underlying the various complications of massive blood transfusion.
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
Blood products Transfusion and related complications,
Types of cell salvage, blood warming and autologous blood,
With intraoperative blood lots monitoring and transfusion
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.
A number of groups have issued clinical practice guidelines for blood component therapy in an effort to improve transfusion practices, minimize the incidence of adverse transfusion reactions, and decrease costs. This slideshow by Dr Somnath Longani, Consultant, Midland Healthcare & Research Center Lucknow explains about the Blood Component Therapy in detail.
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
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Component therapy in obstetrics
1. Component Therapy in
Obstetrics
Dr. V. L. Deshmukh
M.D.(Obst.&Gyn)
Associate Professor
Dept. of Obstet. & Gynaec.
Govt. Medical College
AURANGABAD
2. Introduction
• Goal of transfusion therapy is 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.
3. Indications
Indications for transfusion of blood or
blood products are to restore or
maintain :
1. Blood volume
2. O2 carrying capacity
3. Hemostasis
4. Leucocyte function
(Ref. : Blood banking & transfu Med 2nd
edi)
5. . Animal to animal --- Richard Lower ,1665
• Animal to human --- Jean Denis , 1667
. Human to human
--1818, James Blundell
-- 1900 The elucidation of the
ABO blood group system
by Landsteiner
-- 1914 Lewisohn - used citrate
-- 1940 Landsteiner and Wiener,
in, describe Rh typing
6.
7.
8.
9. Whole Blood
• Indication when O2 carrying capacity is low
& associated with clinical symptoms of
hypovolumia.
• Limited clinical settings
• When blood loss is more than 20% of the
total blood volume e.g. Placenta previa,
abruptio placenta.
(Reference : National Guidelines for Transfusion
Therapy, Nov. 2002)
10. Whole blood
(Contd..)
1. Identification
2. Equipment : 19 Gauge needle & transf. Set.
3. NO ADDITION OF ANY DRUG OR
SOLUTION.
4. Infusion rate – initially slow, 2-3 hrs.
5. Administration 5 ml/min for 15 min then
increase the rate.
(Ref. : Menitove JE. Transfusion : Blood and blood components
IN : Manual of Clinical Hematology, 2nd
edi, 1995)
11. Whole Blood
• Outcome :
↑ Hb% - 1 g%
↑ Hct – 3%
Take Universal Biohazard Precautions
(Ref : High risk obstet. CE Online. Crit Care Nurse 2006, Aug
24(4):54-61)
12. PCV
• 250-300 ml
• Expiry 35 days
• CPDA – preservative
• Dose
• Infusion Same as whole blood
• Outcome
• Indication : When O2 carrying capacity is
low & no need to increase the plasma
volume
13. PCV
• PCV in anaemic patient should be used to
correct symptoms that are a direct result
of anaemia only when it is determined that
other treatment regimens are not effective.
e.g. pregnancy at term
Patient with labour with Hb < 7 gm%
Pregnant patient with Hb < 5 gm%
Ref : Menitove JE. Transfusion : Blood and blood
components IN : Manual of Clinical Hematology, 2nd
edi, 1995.
14. Platelets
• Indication – thrombocytopenia
• Decision to transfuse depends on :
- Clinical condition of patient
- Number of platelets in patients body
- Function of the platelets in patients
body
- Cause of thrombocytopenia
• Recommended levels :
- Normal delivery – 20,000/dl
- LSCS operative - > 50,000/dl
15. Platelets
Thrombocytopenia and pregnancy :
• Gestational thrombocytopenia
• HELLP
• Severe PIH/Eclampsia
• Drug induced
• Infections – bacterial/viral
• TTP
• ITP
• Massive blood transfusion
• APA syndrome
• Abrptio placenta
Ref : Scientific foundation of ObGy, 2nd
edi
16. Platelets
• Concept of CCI
• Corrected count increment
• CCI – 10 min – 1 hr > 7,5000/dl
18 to 24 hrs > 4,600/dl
• If CCI less at 10 min to 1 hr causes are :
rapid destruction by antiplatelet antibodies
• If CCI less at 24 hrs causes are : sepsis,
DIC, fever
(Ref : Menitove JE. Transfusion : Blood and blood
components IN : Manual of Clinical Hematology, 2nd
edi,
1995)
17. 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
18.
19. FFP
Indications :
• Coagulation factor deficiency
• Acute DIC
• Treatment of TTP
• Documented coagulopathy in setting of
massive transfusion
• Liver disease
Efficacy of transfusion is assessed with PT,
APTT or special factor assay
(Ref : Menitove JE. Transfusion : Blood and blood
components IN : Manual of Clinical Hematology, 2nd
edi, 1995)
21. Cryoprecipitate
• Cold insoluble portion of plasma
• FFP – thawed at 1-6°C – cryo is obtained
• Content : Factor VIII, fibrinogen, XIII, VIII
WF factor
• Dose – 10 bags increase the fibrinogen
level by 75 mg/dl, factor VIII – by 30%
• Indication – Acute DIC
22. Components Factor
Component Coagulation factor Volume
PCV -- 250 cc
FFP All coagulation factors
+ fibrinogen
200 cc
Platelets Platelets + All
coagulation factors
50 cc
Cryo VIII C, Von. Will 5-20 cc
Ref : Obstet Gynecol Clin N Am 2007;34:443-58.
23. • China, 1000 BC
The soul was contained in the blood.
• Egyptians bathed in blood for their health.
• Romans drinking the blood of
fallen gladiators to gain strength and
vitality and to cure epilepsy.
• The practice of bathing in blood as it
cascaded from a sacrificial bull, was
practiced by the Romans.
Blood in History
24. DIC
• Multyorgan dysfunction caused by
microthrombi
• Bldg is caused by consumption of
platelet, fibrinogen, factor V,VIII
• Secondary fibrinolysis
25. DIC
• Whenever exposure of blood to
tissue factor takes place, DIC occurs
• Tissue factor is a result of exposure
of the endothelial cells to foreign
substance e.g. malignancy, placenta,
traumatized tissue
• Endotoxins liberated from sepsis act
on the endothelial cells
26. DIC
• ENDOTHELIAL DAMAGE
• Thromboplastin released
• Microthrobi formation
• DIC
• Consumption of all coagulation
factors
27. Test for Hemostatic Function
Test Volume Interpretation
Blood
smear
1.2 – 3.8
lac/mm
Platelets
Bleeding
time
3-8 min To assess platelet plug formation
deranged in throbocyto. Function
defect of platelets. Von Will def.
Normal in coagulation factor defect
Prothrom
bin time
17-16 sec. Extrinsic pathway
Common pathway
aPTT 22-37 sec Intrinsic pathway
Common pathway
28. Test for Hemostatic Function
Test Volume Interpretation
TT 10-12 sec. Fibrinogen to fibrin conversion
CT 4-11 min Prolonged only in severe deficiency
Fibrinogen 150-600
ng/dl
Hypofibrinogenemia
FDP -- Fibrinolysis
CRT 1 hr – 40-
60% clot
retracts
Prolonged in thrombocytopenia &
platelet dysfunction
Ref : Obs & Gynae today, ISSN 0971-8133 Vol V(4), 2000)
30. Haemorrhage
• Rapid & continuing blood loss is life
threatening.
• Ensure tissue oxygenation is maintained
at a level consistent with avoidance of
critical ischaemic organ damage or
irreversible organ failure.
• Blood grouping & Rh typing
• Co-ordinated effort between clinician &
blood bank
• Massive haemorrhage protocol outlined in
every institute
32. Haemorrhage
• Haem in obs may be due to acute blood
loss
• Secondary to placenta previa, rupture
uterus
• Or it may be due to DIC
• In conditions like HELLP, severe PIH
• ABRUPTIO PL -blood loss may be due to
DIC +acute blood loss
• All this conditions can lead to massive
haem
33. Blood
Volume
% Supine Sitting
B.P P B.P P
N 100 N N N N
- 500 -5 N N N N or ^
-1000 -10 : 15 N N or ^ N or ^ ^
- 1500 -20 N or v ^ v ^ or v
- 2000 - 30 v ^ or v vv ^ or v
Response Of BP and P to Hypovolemia
34. Massive Haemorrhage
Definition :
• Ongoing blood loss in adult > 150 ml/min
• Replacement of > 50% of blood volume in
3 hrs.
• In 24 hrs – 10 units of blood transfusion
required e.g. Atonic PPH, Rupture uterus
(Ref : Am Soc Anaes Pract. Guidelines for Obst Anaes – An
Updated Report 2007;106(4):1-21.
35. Massive Haemorrhage
• Call for senior help early
• Inform blood bank
• Specific :
- Adequate oxygenation
- Patent airway
- Restore circulating blood volume
- Start component therapy
36. Component Therapy
• Early RBC transfusion
• Anticipate coagulopathy
• Maintain or restore normothermia
• Evaluate therapeutic response
(Ref : Need for maternal critical care in Obst : A
population based analysis. Int J Obstet Anaesth
2003;11(4):260-64)
37. Massive Haemorrhage
1. Direct contact and briefing
2. Good communication between
anaesthetist, haematologist and
surgical colleauges.
3. Management of patient should be
tailored according to cause of
haemorrhage and disturbed
hemostatic system.
4. Metabolic disturbances from
gradual loss of large blood will differ
from that of a acute massive loss.
38. Massive Haemorrhage
1. Patent airway
2. 100% O2
3. IV access
4. Laboratory test - Full blood count
- PT
- APTT
- Fibrinogen
- KFT
- Electrolytes
39. Massive Haemorrhage
• Send laboratory tests every 4 hourly or
after replacement of 1/3rd
of blood volume
to access the efficacy of treatment.
• If coagulopathy detected expert advice
from haematologist for interpretation and
optimum correction.
Ref : A multicenter randomized control clinical trial of
transfusion requirement in critical care. N Engl J Med
1999;6:409-17.
40. Massive Haemorrhage
Restore volume :
• Perfusion pressure should be maintained
• Prolonged hypoperfusion leads to
- Increase capillary permeability
- Consumption of coagulation factor in
microvasculature.
- Release of inflammatory mediators
• Leading to coagulopathy & secondary end
organ injury
41. Massive Haemorrhage
• Restore volume :
The volume
Timing Imp. for good outcome
Extent
• Monitoring depend on ;
CVP
Output
Heart rate
• Increase in B.P. due to inotropes is
deceptive
42. Massive Haemorrhage
• Restore volume : 2 lit. of fluid in adult
Crystalloid Colloid
Cheap Expansion of BV efficiently
Easy to admin. ↑ microvascular flow
No adv. Effect Better preserv. Of oncotic
pressure
No effect on coagu. Can cause allergic reaction
Short lived in circu. Adverse effect on coagulation
& renal function
(Ref : Hippala S. Replacement of massive blood loss. Vox
Sang 1998;74:399-407.)
43.
44. Component Therapy
• Start component therapy
• Decision by senior, experience staff
• Supply RBCs
• Request platelets
• Request FFP - When blood loss I > 1.5
times of blood volume 15 mg/kg = 1 lit or 4
units till PT, APTT is < 1.5 times normal
• Request cryo if fibrinogen is < 100 mg/dl
45. Component Therapy
• Hemostatic defects in large transfusions
is due to dilution & consumption
• Massive transfusion leads to dilution of
coagulation factors
• Reduction in platelets, and clotting factors
• Prolonged of PT & APTT
• Sequence –
Deficiency of fibrinogen & coagulation
factors, thrombocytopenia
46. Component Therapy
• In emergency – checking and
administration of blood products should
be strictly carried out.
• Most transfusion related morbidity is due
to incorrect blood transfusion.
• Hemodyanamic, hemostatic and metabolic
derangements occur with the clinical
condition and speed and effectiveness of
resuscitation.
47. Component Therapy
• Early use of FFP may eliminate the
use of cryoprecipitate, but if
fibrinogen level < 100 mg/dl
– cryoprecipitate is given.
• Minimum dose in adult of
cryoprecipitate is 10 packs gives
1.5 – 3.0 gm of fibrinogen.
• Platelets if < 50,000/dl - supply
48. DIC
Should be kept in mind :
- PT
- APTT Diagnosis
- Dilutional thrombocyto.
Give 4-6 units FFP
5 pints of platelets
10 units of cryo
Send blood sample regularly to assess the
coagulation status
Ref : Guidelines National blood users group, Nov. 2002
49. DIC
• Send : Hb, Hct, platelets, PT, APTT,
serum fibrinogen.
• Monitoring & coagulation screening
should be continued
• If bleeding recurs, the monitoring
should be intensified.
50. Normothermia
• Restore normothermia
• Hypothermia is exaberated due to cold
blood infusion and low ambient temp.
• Hypothermia leads to increase blood loss,
prolonged PT, APTT, platelet dysfunction,
enhance fibrinolysis & increase release of
potassium.
• Monitor core temperature because it is
important reversible hemostatic factor
51. Evaluation
• Evaluate the response
- Pulse
- B.P.
- CVP
- Output
- Hemoglobin
- Hct
Note the details of blood component used
e.g. timing and volume
52. Massive Haemorrhage
– New invention
• Promising new alternative drug.
• Identical in structure & function to
human factor VIIa
• Used in uncontrolled bleeding which is
life threatening.
• rFVIIa it augments the intrinsic clotting
pathway by binding with tissue factor &
directly activating factor IX & X
53. Massive Haemorrhage
– new invention
• Used effectively offlable to control PPH
• Effective dose is 50-100 µg/kg IV every 2
hrly. Until hemostasis is achieved.
• Ensure adequate platelet & clotting factors
are present.
• Give in early phases of shock, good in
action
• Action decreased by hypothermia and
acidosis
• No risk of viral transfusion
54. 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
55. Important Points
1. Errors in transfusion
2. Transfusion transmitted infections
3. Adverse effects associated with
transfusion
4. Autologous transfusion
5. Intraoperative cells salvage
57. Conclusion
• Deaths are avoidable if early and
effective intervention in initial golden
hour is provided
• It has a major impact on eventual
outcome