Download to read offline
MASSIVE BLOOD TRANSFUSION AND COMPLICATION OF BLOOD TRANSFUSION.pptx
- 1. MASSIVE BLOOD TRANSFUSIONAND COMPLICATION OF BLOOD TRANSFUSION Farshana jabin, Hepsibah solomon M.Sc.Anesthesia Technology
- 2. DEFINITIO N • Various definitionsof massive blood transfusion (MPT) have been published in the medical literature such as; • Massive blood transfusion defined as the transfusion of more than 10 unit of PRBS in a 24 hour period • Also defined as the replacement of more than 50% of a patient’s blood volume in 12 to 24 hours
- 3. GENERAL INDICATION • In hemorrhagicshock and ongoing hemorrhage and anemia (to increase oxygen carrying capacity • Severe trauma • Ruptured aortic aneurysm • Surgery • Obstetric complication
- 4. GOAL OF MASSIVETRANSFUSION PROTOCOL • Early recognition of blood loss • Maintenance of tissue perfusion and oxygenation by restoration of blood volume and haemoglobin • Arrest of bleeding in combination with use of early surgical or radiological intervention • Judicious use of blood components therapy to correct coagulopathy MTP are designed to interrupt the triad of acidosis, hypothermia, and coagulopathy that develops with massive transfusion there by improving outcome
- 5. • A MASSIVETRANSFUSIONPACK CONTAINS 1. 6 units red blood cells 2. 4 units plasma 3. 1 apheresis platelet unit 4. 1cryopresipitate pooled unit RBC and Plasma delivered first, with a goal delivery time of 15 min
- 7. TARGET OF MASSIVETRANSFUSION PROTOCOL • Mean arterial pressure(MAP) around 60mmhg, systolic arterial pressure 80-100 mmhg • Hb 7-9 g/dl • INR <1.5 ;Activated PTT <42 • Fibrinogen >1g/dl • Platelets >50*10^9/dl • pH >7.2 • Core temperature >35 degree celcius • Ionized calcium >1.1 mmol/L
- 8. MASSIVE TRANSFUSION PROTOCOL Callblood bank and inform that MTP to be initiated Divide team into ABC, Assign each team to do specific task, • TEAM A :Administer blood components • TEAM B : Record keeping, sampling ,labeling, writing notes • TEAM C: Go to blood bank and get blood components
- 9. PRESSURIZED RAPIDTRANSFUSION • Ensuresblood component reaches into patient’s body on time • Ensure infusion matched blood loss there by increases chance of survival • Has in line warmer that decreases chance of hypothermia and there by coagulation problems are taken care of and hemostasis achieved
- 10. ROUND 1 • GiveInjTranexemic acid1gm IV stat and then 8 hourly • Send CBC, Coagulation profile, Fibrinogen level and ABG • Connect pressurized rapid trasfuser • In many trauma situations, there is excessive blood loss, and transfusion needed before the ability to perform pre transfusion testing. in these cases, group O RBCs and AB plasma product should be given until the patients blood type can be determined TRANSFUSE:- • 4 UNIT PRBC • 2 UNIT FFP If no improvement start round 2
- 11. ROUND 2 TRANSFUSE:- • 4UNIT PRBC • 4 UNIT FFP • 1 UNIT SDP OR 6 UNIT PRP Collect lab report to evaluate coagulopathy and acidosis Give Inj Calcium gluconate 10 ml slow IV to prevent tetany Cryoprecipitate infusion if fibrinogen level <100 mg/dl If no improvement then, start round 3
- 12. ROUND 3 • Repeatround + FactorVIIa Indication to giveFactorVIIa • Surgical hemostasis • Temperature 37 degree celcius and ph has been stabilized but patient is still bleeding
- 13. COMPLICATION • ACIDOSIS • HYPERKALEMIA •HYPOTHERMIA • CITRATE TOXICITY • HYPOCALCAEMIA • USUAL TRANSFUSION REACTION PROBLEM • LATE COMPLICATIONS
- 14.