This document discusses pediatric blood transfusions. It begins with background on pediatric age groups and blood group systems. Key points include:
- Blood transfusions in children under 4 months have different indications than those over 4 months due to physiological differences.
- Common blood components transfused include red blood cells, platelets, plasma, and cryoprecipitate. Dosing recommendations are provided.
- Massive blood transfusions in pediatrics are defined as transfusing one or more blood volumes in 24 hours or half a volume in 12 hours. Component therapy using specific ratios is recommended over whole blood.
- Complications of transfusion like acute hemolytic reactions are generally similar between adults and children but special considerations are
Blood groups,blood transfusion,hazards,blood bankRanadhi Das
Austrian Karl Landsteiner(1901) discovered –
Human blood possess different antigenic and immune properties
Blood clumping was an immunological reaction.
Nobel Prize in Physiology and Medicine in 1930.
Adriano Sturli and Alfred von Decastello who were working under
Landsteiner discovered type AB a year later in 1902.
Janský is credited with the first classification of blood into the four types
(A, B, AB, O)in 1907, which remains in use today
It consists of slides about blood, various blood groups , pre-transfusion testing , blood products , conditions where blood transfusion is indicated and the various complications of blood transfusion in the field of oral and maxillofacial surgery.
This PPT is basically based on the topic - Blood transfusion in Bailey & Love and mainly very useful for Final MBBS students.during their course as well as their in clinical practice.
Blood Transfusion
Blood transfusion is the process of transferring blood or blood based products from one person into the circulatory system of another. Safe blood transfusion should be safe to both the donor and the recipient. Blood transfusions can be life saving in some situations such as -Massive blood loss due to trauma or can be used to replace blood lost during surgery.BT may also be used to treat a severe anemia orThrombocytopenia caused by a blood disease.People suffering from hemophilia or sickle disease may require frequent transfusion.
Blood groups,blood transfusion,hazards,blood bankRanadhi Das
Austrian Karl Landsteiner(1901) discovered –
Human blood possess different antigenic and immune properties
Blood clumping was an immunological reaction.
Nobel Prize in Physiology and Medicine in 1930.
Adriano Sturli and Alfred von Decastello who were working under
Landsteiner discovered type AB a year later in 1902.
Janský is credited with the first classification of blood into the four types
(A, B, AB, O)in 1907, which remains in use today
It consists of slides about blood, various blood groups , pre-transfusion testing , blood products , conditions where blood transfusion is indicated and the various complications of blood transfusion in the field of oral and maxillofacial surgery.
This PPT is basically based on the topic - Blood transfusion in Bailey & Love and mainly very useful for Final MBBS students.during their course as well as their in clinical practice.
Blood Transfusion
Blood transfusion is the process of transferring blood or blood based products from one person into the circulatory system of another. Safe blood transfusion should be safe to both the donor and the recipient. Blood transfusions can be life saving in some situations such as -Massive blood loss due to trauma or can be used to replace blood lost during surgery.BT may also be used to treat a severe anemia orThrombocytopenia caused by a blood disease.People suffering from hemophilia or sickle disease may require frequent transfusion.
special staining methods for blood cells - investigation of hemolytic anemias and haemorrhaegic disorders - blood banking serology , ABO blood grouping, Rh typing , special blood groups - blood transfusion, selection of donors, investigation of transfusion reaction.
Anders Perner - When to Pull the Transfusion Trigger?SMACC Conference
The management of the septic patient in ICU is a recurrent topic for debate amongst intensivists. The decision of if and/or when to give blood transfusions is one of the key sources of contention. Dr Anders Perner is one of the most qualified people to weigh in on this debate. In this talk from SMACC Chicago, he delivers his stance on when to pull the transfusion trigger.
Dr Anders Perner is an Intensive Care Specialist at Rigshospitalet and a professor in intensive care at Copenhagen University. He is the chairman of the Scandinavian Critical Care Trials Group and the strategic research program “New resuscitation strategies in patients with severe sepsis’. The contents of this talk are based on the findings of the TRISS trial - Transfusion Requirements in Septic Shock. This trial, Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock was published in the NEJM in October 2014. The aim was to evaluate the recommendations from the Surviving Sepsis Campaign regarding transfusion in septic shock. The recommendation is that after the first 6 hours, transfusion threshold should be a Hb <7g /></9g></ 9g/dL) or a lower transfusion threshold group (Hb</ 7g/dL). They each received 1 unit of leukoreduced PRBC when they reached their respective transfusion threshold. The primary outcome was death within 90 days of randomisation. In this SMACC talk, some of the key findings and limitations of the trial are discussed. So check out this talk and then read the full article available here to see if you agree with 7g/dL – the new normal.
What’s your transfusion trigger? Is it time to rethink it?
special staining methods for blood cells - investigation of hemolytic anemias and haemorrhaegic disorders - blood banking serology , ABO blood grouping, Rh typing , special blood groups - blood transfusion, selection of donors, investigation of transfusion reaction.
Anders Perner - When to Pull the Transfusion Trigger?SMACC Conference
The management of the septic patient in ICU is a recurrent topic for debate amongst intensivists. The decision of if and/or when to give blood transfusions is one of the key sources of contention. Dr Anders Perner is one of the most qualified people to weigh in on this debate. In this talk from SMACC Chicago, he delivers his stance on when to pull the transfusion trigger.
Dr Anders Perner is an Intensive Care Specialist at Rigshospitalet and a professor in intensive care at Copenhagen University. He is the chairman of the Scandinavian Critical Care Trials Group and the strategic research program “New resuscitation strategies in patients with severe sepsis’. The contents of this talk are based on the findings of the TRISS trial - Transfusion Requirements in Septic Shock. This trial, Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock was published in the NEJM in October 2014. The aim was to evaluate the recommendations from the Surviving Sepsis Campaign regarding transfusion in septic shock. The recommendation is that after the first 6 hours, transfusion threshold should be a Hb <7g /></9g></ 9g/dL) or a lower transfusion threshold group (Hb</ 7g/dL). They each received 1 unit of leukoreduced PRBC when they reached their respective transfusion threshold. The primary outcome was death within 90 days of randomisation. In this SMACC talk, some of the key findings and limitations of the trial are discussed. So check out this talk and then read the full article available here to see if you agree with 7g/dL – the new normal.
What’s your transfusion trigger? Is it time to rethink it?
Blood groups. There are 4 main blood groups (types of blood) – A, B, AB and O. Your blood group is determined by the genes you inherit from your parents. Each group can be either RhD positive or RhD negative, which means in total there are 8 blood groups
A PowerPoint presentation outlining the physiology of blood transfusion, and clinical precautions to take in preventing and managing blood transfusion reactions.
Rational use of blood componenets and Safe blood-2.pptxZahid Noor Jan
A very detailed presentation about blood safe transfusions. Blood components, RCC, Platelets, FFPs, its indications, precautions, problems, complications etc.
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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!
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
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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
- 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
2. Pediatric age group
From birth to 18 years of age [IAP]
up to the age of 21 [U.S. FDA]
3. A Little About The History!
1628 English physician William Harvey discovers the
circulation of blood. He was the first known to describe
completely and in detail the systemic circulation and
properties of blood being pumped to the brain and body
by the heart.
1665 The first recorded successful blood transfusion
occurs in England: Physician Richard Lower.( dogs)
1667 successful transfusions from lambs to humans
1795 the first human blood transfusion
1818 first successful transfusion of human blood to a
patient for the treatment of postpartum hemorrhage
1900 Karl Landsteiner, an Austrian physician, discovers
the first three human blood groups, A, B, and C. Blood
type C was later changed to O.
4. The major changes in blood transfusion practice
over the last 100 years have largely occurred based
on the experience of military physicians during the
major conflicts of the 20th century. The first use of
preserved blood for transfusion was carried in 1917
in United States
Transfusion methods altered dramatically around the
time of the Vietnam War in the 1970s, when practice
changed from using whole blood to component
therapy.
5. Human Blood Group Systems
The term human blood group systems is defined by International
Society of Blood Transfusion as systems in the human species
where cell-surface antigens—in particular, those on blood cells—are
"controlled at a single gene locus or by two or more very closely
linked homologous genes with little or no observable recombination
between them",[1]
It includes the common ABO and Rh- (Rhesus) antigen systems, as
well as many others; thirty-five major human systems are identified
as of November 2014.[2]
ABO blood groups were discovered by Landsteiner in 1901 Later on
Rhesus blood groups were discovered by Landsteiner and Wiener in
1940. [3]
1. ISBT (2016). "International Society for Blood Transfusion (ISBT) Committee on Terminology for
Red Cell Surface Antigens, Terminology Home Page". Retrieved 20 February 2016
2. ISBT (2014). "Table of Blood Group Systems v4.0 (November)" (PDF). International Society
of Blood Transfusion. Retrieved 19 February 2016
3. Landsteiner K, Wiener AS (1940). An agglutinable factor in human blood recognized by immune sera for
Rhesus blood. Proc. Soc Exp. Biol. Med. 43:223-224.
6. ABO blood group system
divided into four blood types on the basis of
presence or absence of A and B surface antigens.
The blood groups are A, B, O and AB.
The frequency of four main ABO blood groups varies
in the population throughout the world.
ABO blood group system derives its importance from
the fact that A and B are strongly antigenic and anti A
and anti B naturally occurring antibodies present in
the serum of persons lacking the corresponding
antigen, and these antibodies are capable of
producing intravascular hemolysis in case of
incompatible transfusion
Zaman et al. Study of ABO and Rh-D blood group among the common people of Chittagong city corporation
area of Bangladesh. Journal of Public Health and Epidemiology Vol. 7(9), pp. 305-310, September 2015
7. Rh blood group system
It is the second most important blood group system,
after ABO, and it consists of 50 defined blood-
group antigens, among which the five antigens D, C,
c, E, and e are the most important. The commonly
used terms Rh factor, Rh positive and Rh
negative refer to the D antigen only.
Rh antibodies are immunoglobulin G (IgG) may cross freely from the placenta
into fetal circulation
Rh incompatibility can occur by 2 main mechanisms
1. secondary to fetomaternal hemorrhage
2. when an Rh-negative female receives an Rh-positive blood transfusion
8. Davis PJ, Cladis FP, Motoyama EK (eds). Smith’s Anesthesia for Infants and
Children, 8th ed. Philadelphia, PA: Elsevier Mosby; 2011: Ch. 3
9. Blood components!!!1 unit whole
blood
=350/450ml
plasma
Platelets poor
plasma
200ml
Platelets
50-70ml
RBC
250ml
CPDA1-35 days
SAGM-42days
1-6’C storage
Frozen in hypertonic
saline – 10years
Rapid Freezing with
in 1hour- FFP
Preserves factor 5 &
8
After thawing to be
used within 24 hours
Used with in 5
days
Stored at 20-24’C
Produced by
apharesis or BCT
The total blood requirement for a child may be as low as 25-100 ml and the child may also require multiple transfusions.
This can be achieved by aliquoting one PRBC unit (About 200 ml) into Pedi-packs. This will avoid multiple donor
10. Pediatric Blood transfusion
Children of <4 months
1. Physiological anemia
2. Predominance of HbF
3. the lower oxygen delivering
capacity.
4. inefficient humoral system
with attenuated formation
of antibodies to allogeneic
RBCs
5. the premature infant's have
limited EPO response to
decreased oxygen delivery
6. Relatively Greater blood
volume
Children of >4 months
1. No Physiological anemia
2. Predominance of HbA
3. Better oxygen delivering
capacity
4. Strong immune system
5. Normal EPO response to
decreased oxygen delivery
6. Relatively lower blood
volume
Smith’s Anesthesia for Infants and Children, 9th Edition, by Drs. Peter Davis
and Franklyn Cladis
11. RED BLOOD CELLS
Children of <4 months
Indications:
1. Massive blood loss or acute blood loss
due to trauma, surgery or other cause
associated with hypovolemic shock
2. Hgb < 8 g(dL (Hct < 24%) in stable
neonates with clinical manifestations of
anemia (tachycardia, tachypnea, poor
feeding, poor weight gain, apnea)
3. Hgb < 10 g/dL (Hct < 30%) in neonates
with:
a. 02 requirement < 35% by hood or nasal
cannula
b. On continuous positive airway pressure
(CPAP) or stable ventilator setting (mean
airway pressure < 6 cm of water)
c. Significant apnea or bradycardia,
significant tachycardia or tachypnea
d. Low weight gain (poor feeding)
Children of >4 months
Indications:
1. Massive blood loss or acute blood
loss due to trauma, surgery, or other
cause associated with hypovolemic
shock (>15% total blood volume)
2. Hgb < 8 g/dL emergent/urgent
surgery; symptomatic anemia
(tachypnea, tachycardia,
hypotension), chemo/radiotherapy;
hernodynamically stable pediatric
ICU patients
3. Significant preoperative anemia
when other corrective therapy not
available
4. Hgb < 10 g/dL and severe brain
injury
*Blood center of Wisconsin 2015
12. RED BLOOD CELLS
Children of <4 months
4. Hgb < 12 g/dL (Hct < 35%) in
neonates with:
a. Fi02 requirement > 35%
b. On CPAP or IMV (Intermittent
Mandatory Ventilation) with mean
airway pressure 6-8 cm of water
c. Deteriorating respiratory status
d. With hypotension or shock
requiring vasopressors
e. Recovering from major surgery
f. Severe traumatic brain injury
5. Hgb < 15 g/dL (Hct < 45%) in
neonates
a. With cyanotic congenital heart
disease
Children of >4 months
4. Hgb < 13 g/dL cyanotic heart
disease, ECMO, severe
pulmonary disease
5. Patients with
hemoglobinopathies and/or
chronic hemolytic anemias (e.g.
Sickle cell disease, thalassemia)
and undergo chronic or episodic
transfusions for specific clinical
indications
*Blood center of Wisconsin 2015
13. Dosing Recommendations:
• 10-15 ml/kg of body weight should raise the Hgb by
2-3 g/dL or the Hct by 6%.
• Transfusion rate is dependent on the clinical
condition and age of the infant/pediatric patient; rate of
transfusion should be prescribed by the ordering
physician.
*Blood center of Wisconsin 2015
14. Platelets
Indications: Children of < 4 and >4 months:
1. Active bleeding or prior to invasive procedures
a. Platelet count < 50,000/uL in neonates
b. Platelet count < 100,000/uL in sick preterm
neonates or those who need CNS surgery
c. Platelet dysfunction (acquired, including post-
cardiopulmonary bypass, or inherent), regardless
of platelet count
2. As a part of a massive transfusion protocol
3. Prophylactic use may be indicated in patients with a
platelet count < 30,000/uL (depending on age)
*Blood center of Wisconsin 2015
15. Platelets -Dosing Recommendations:
Children of < 4 months:
• 10-15 ml/kg of body
weight gives an expected
platelet count rise of
30,000/uL to 50,000/uL
Children of < 4 months:
The following dose usually
raises the platelet count
by 30,000/uL to
50,000/uL:
1. If child less than 10 kg
of body weight, 1/4
apheresis platelet
2. If child 10-30 kg of body
weight, 1/2 apheresis
platelet
3. If child greater than 30
kg of body weight, 1
adult apheresis platelet
*Blood center of Wisconsin 2015
16. Plasma
Children of < 4 months:
Indications
1. Documented coagulopathy and bleeding or
thrombosis
2. Support during Disseminated Intravascular
Coagulation (DIC), Massive Transfusion,
and during or within 24 hours after
ECMO/CPB
3. Replacement therapy for clinically
significant deficiency, including:
a. Multiple coagulation factor deficiency (i.e.
liver disease)
b. When specific factor concentrates are not
available (i.e. Factor II, Factor V, Factor X,
Factor XI)
c. Clinically significant plasma protein
deficiency (i.e. ADAMTS13, protein S)
4. Emergent correction of vitamin K deficiency
(i.e. active bleeding, emergent surgery); but this
does not preclude Vitamin K replacement
5. Neonates with unexplained bleeding
unresponsive to other measures may be given
plasma without PT, PTT.
Children of > 4 months:
Indications:
1. Support during Disseminated
Intravascular Coagulation (DIC), Massive
Transfusion, and during or within 24 hours
after ECMO/CPB
2. Replacement therapy for clinically
significant deficiency, including:
a) Multiple coagulation factor deficiency
(i.e. liver disease)
b) When specific factor concentrates
are not available (i.e. Factor II,
Factor V, Factor X, Factor XI)
c) Clinically significant plasma protein
deficiency (i.e. ADAMTS13, protein
S)
3. Emergent reversal of vitamin K
antagonist or correction of vitamin K
deficiency (i.e. active bleeding, emergent
surgery)
17. Dosing Recommendations:
• A dose of 10-20 mL/kg of body weight typically
raises procoagulant factors into hemostatic levels;
monitor for desired outcome.
18. Cryoprecipitate (all ages)
Rich in– Fibrinogen, von Willebrand factor, Factor XIII and
factor VIII
Supplied as single unit for smaller patients(neonates) or as 5-
pool for larger patients
Indications:
1. Hypofibrinogenemia (Fibrinogen < 125 mg/dL) or
dysfibrinogenemia, with active bleeding or undergoing an
invasive procedure'
2. Hemophilia A (deficiency in factor VIII) or von Willebrand
disease, only when virally-inactivated or recombinant
concentrate is unavailable or DDAVP is not appropriate.
3. Replacement therapy in Factor XIII deficiency with active
bleeding or undergoing an invasive procedure'
Dosing Recommendations:One single unit of cryoprecipitate
(20-25mL) per 7 kg of body weight will typically raise the
fibrinogen by 100 mg/dL. Monitor for desired outcome.
*Blood center of Wisconsin 2015
19. Why it is important to give blood?
Anaemia is the commonest encountered abnormal
laboratory finding in critical care (Vincent et al CCM
2006)
Inadequate O2 delivery with severe anemia
RBC transfusion improves O2 delivery
Critically ill patients more susceptible to adverse
effects of oxygen depletion
• impairs oxygen delivery to critical organs
• cardiovascular system must compensate
RBC transfusion should improve outcomes
Sepsis in European Intensive Care Units:
Results of the SOAP Study Vincent et al CCM
2006
20. Anemia from acute inflammatory response
in critical care
Reduction in red cell production
Increased red cell destruction
Blood loss (acute or chronic)
Diminished erythropoietin response
Impaired proliferation and differentiation of erythroid
progenitors in the bone marrow
Phlebotomy
ACCP Critical Care Medicine Board Review: 21st Edition >
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Chapter 22. Anemia and RBC Transfusion in the ICU
2015
21. Trauma resuscitation!
Pediatric massive blood transfusions
Massive transfusion in the pediatric population is defined as the transfusion of blood
components equaling one or more blood volumes within a 24-hour time frame or
half of a blood volume in 12 hours.
Whole blood- obsolete
deficient in clotting factors and has high levels of potassium, ammonia, and hydrogen
ions.
Volume overload
Blood component therapy
Packed red blood cells
Fresh frozen plasma (FFP)
Platelets
Plasma, red blood cell and platelet ratios of 1:1:1
appear to be the best substitution for fresh whole
blood
Sara J. Chidester et al. A pediatric massive transfusion protocol J Trauma Acute Care
Surg. 2012 Nov; 73(5): 10
22. Sara J. Chidester et al. A pediatric massive transfusion protocol J Trauma Acute Care
Surg. 2012 Nov; 73(5): 10
23. Smith’s Anesthesia for Infants and Children, 9th Edition, by Drs. Peter
Davis and Franklyn Cladis
26. Sloan SR, Benjamin RJ, Friedman DF, Webb IJ, Silberstein L. Transfusion medicine. In:
Nathan & Oski’s Textbook of Hematology of Infancy and Childhood, 6th ed. Philadelphia:
Saunders, 2003:1709−56.
Children are quite different from adults during growth
and development, and that should be taken into
different consideration.
27. Transfusion complications
Transfusion complications that are generally common
between adult and pediatric patients include
Acute hemolytic transfusion reactions,
Febrile non-haemolytic transfusion reactions
(FNHTR)
Allergic transfusion reactions,
Delayed hemolytic transfusion reactions,
Transfusion-related acute lung injury,
Transfusion-associated graft-versus-host disease,
and
Infectious complications.
28. Blood grouping and crossmatching
Blood grouping
The most fatal of all transfusion-related reaction is ABO
incompatibility causing complement-mediated intravascular
hemolysis. Hence, correct blood grouping and typing, and cross-
checking with the blood requisition form is of utmost importance.
ABO typing is carried out by testing RBCs for the A and B antigens
and the serum for the A and B antibodies before transfusion. The
next step involves Rh typing with only 15% of the population being
Rh-negative.
Cross-matching
Cross-matching involves mixing of donor RBCs with the recipient
serum to detect fatal reactions. [19] . Among the three phases, the first
two phases are more important as they detect those involved in fatal
HTR. The total time taken for all the three phases is in between 45
and 60 min.
Mitra R, Mishra N, Rath GP. Blood groups systems. Indian J Anaesth 2014 [cited 2017 Feb
10];58:524-8.
Miller RD. Transfusion therapy. In: Miller RD, ErikssonLI, Fleischer LA, Wiener-
Kronish JP, Young LA, editors. Miller's Anesthesia. 7 th ed. Philadelphia: Churchill
Livingstone Elsevier; 2010. p. 1739-66.
29.
30. In emergency lifesaving resuscitation, the risk of
hemolytic transfusion reactions from transfusion of
group O blood to nongroup O recipients constitutes
risk that is outweighed by the benefits.
31.
32.
33.
34. Autologous/placental RBC transfusion
In small pilot studies, there has been no benefit in autologous
transfusion in neonates as compared with standard allogeneic
transfusion.42,43 Additionally, there is limited benefit due to low
volume of collection in extremely low birth weight infants.42,44–46
The shelf-life of umbilical cord blood autologous product is also
shorter at 14–21 days.47 In addition to these concerns, bacterial
contamination and high cost continue to hamper clinical usage.42,44
42. Strauss RG, Widness JA. Is there a role for autologous/placental RBC transfusions
in the anemia of prematurity. Transfus Med Rev. 2010;24(2):125–129.
43. Brune T, Garritsen H, Hentschel R, Louwen F, Harms E, Jorch G. Efficacy, recovery,
and safety of RBCs from autologous placental blood: clinical experience in 52 newborns.
Transfusion. 2003;43(9):1210–1216.
44. Eichler H, Schaible T, Richter E, et al. Cord blood as a source of autologous RBCs
for transfusion of preterm infants. Transfusion. 2000;40(9):1111–1117.
47. Khodabux CM, van Beckhoven JM, Scharenberg JG, El Barjiji F, Slot MC, Brand A.
Processing cord blood from premature infants into autologous red blood cell products for
transfusion. Vox Sang. 2011;100(4):367–373.
35. 82. Cervia JS, Wenz B, Ortolano GA. Leukocyte reduction’s role in the attenuation of infection
risks among transfusion recipients. Clin Infect Dis. 2007;45(8):1008–1013.
83. Fergusson D, Hébert PC, Lee SK, et al. Clinical outcomes following institution of universal
leukoreduction of blood transfusions for premature infants. JAMA. 2003;289(15):1950–1956.
Blumberg N, Fine L, Gettings KF, Heal JM. Decreased sepsis related to indwelling venous access
devices coincident with implementation of universal leukoreduction of blood transfusions.
Transfusion. 2005;45(10):1632–1639.
37. ADVANTAGES OF LEUKOREDUCTION
The reduction in the number of leukocytes, in allogenic
blood products has been proven to be clinically
relevant in the following:
1. Reducing the frequency and severity of Febrile
Non-Hemolytic Transfusion Reactions (FNHTRs).
2. Reducing the risk of cytomegalovirus (CMV)
transmission.
3. Reducing the risk of HLA-alloimmunization and
platelet-refractoriness.
Cervia JS, Wenz B, Ortolano GA. Leukocyte reduction’s role in the attenuation of
infection risks among transfusion recipients. Clin Infect Dis. 2007;45(8):1008–1013.
38. Transfusion Triggers
Restrictive
Hb <7g/dl
Low Hb
Transfusion
Trigger
liberal
HB <10g/dl
High Hb
Transfusion Trigger
“a particular hemoglobin level of discomfort
for the prescribing physician, not defined
by clear physiologic parameters” at which
blood transfusion is required
39. Restrictive versus Liberal Transfusion Strategy.
Definitions for a restrictive versus liberal strategy for blood transfusion
vary in the literature, although hemoglobin criteria for transfusion less
than 8 g/dl and hematocrit values less than 25% are typically reported
as restrictive.
The report suggests
Meta-analysis of RCTs comparing restrictive with liberal transfusion
criteria report fewer red blood cell transfusions when restrictive
transfusion strategies are employed
Anesthesiology 2015; 122:241-75
40. P H B Bolton-Maggs, M F Murphy Blood transfusion Arch Dis Child
2004;89:4–7
41. The availability of blood and platelet transfusion
support has permitted increasingly more intensive
chemotherapy regimes to be used in malignant
disease at all ages,19
Children with haemoglobinopathies such as beta
thalassaemia major, or with red cell aplasia are
dependent on regular transfusions. These children
should have a more extended blood group
undertaken prior to the first transfusion in order to
minimise the development of red cell alloantibodies,
42. George K. IstaphanousPediatr Red blood cell
transfusion in critically ill children: A narrative review
Crit Care Med 2011 Vol. 12, No. 2
43. Multi-centre, prospective, randomized study > 24 h
ICU stay expected Hb < 9.0 g/dL within 72 h Volume
resuscitated or normovolaemic Restrictive: Maintain
7-9 g/dL (APACHE II: 20.8) Liberal: Maintain 10-12
g/dL (APACHE II: 21.3)
44. Avnish Bharadwaj, Mamta Khandelwal1, Suresh Kumar Bhargava2, Perioperative neonatal and paediatric blood
Transfusion. Indian Journal of Anaesthesia | Vol. 58 | Issue 5 | Sep-Oct 2014
45. METABOLIC CONSEQUENCES AND
COMPLICATIONS
OF MASSIVE BLOOD TRANSFUSION
The metabolic consequences of large blood transfusions also occur in adults
but are more frequent in children due to the relationship between blood
component administered and their circulating blood volume
Hypocalcaemia may be treated by administration of calcium fluoride 5-10
mg/kg IV or calcium gluconate 15-30 mg/kg. If the blood loss is continuous
and prolonged infusion of calcium chloride at the rate of10 mg/kg/h may be
used.
Hyperkalaemia Use of blood collected within 7 days and administration
slowly with total volume < 1.0 ml/kg/min is recommended. Intravenous
sodium bicarbonate 1 m mol/kg and calcium chloride 20 mg/kg or calcium
gluconate 60 mg/kg may be used to treat hyperkalaemia causing
arrhythmias. Use of intravenous dextrose insulin, hyperventilation and
sympathomimetics can be useful
HypomagnesaemiaIV magnesium sulphate administered at 25-50 mg/kg
Acid-base disorders
Hypothermia Use of blood warmers, maintaining OT temperature, use of
warming blankets and warm fluids for irrigation and intravenous infusion with
monitoring of electrocardiogram, SpO2, skin and core temperature can be
helpful in preventing hypothermia and consequent complications.
46.
47.
48.
49.
50. Conclusions
The administration of blood per se did not lead to increased
postoperative infection. Clinicians should reconsider withholding
blood transfusion in patients solely owing to concerns of
predisposition to infection.
51.
52. In the present study, we found that shorter storage RBCs
transfusion significantly improved ChE recovery and
reduced the amount and duration of atropine usage
Нese results suggest that RBCs transfusion could
improve clinical therapeutic effects on OPs intoxication
patients. Red blood transfusion may deliver additional
erythrocyte cholinesterase, which could be the potential
target substrate for OP
packed RBCs transfusion has advantages over whole
blood transfusion, since the total volume administrated
into patients is less that could avoid risks of overloading
and fever or allergy by substances in serum
Concludes early blood transfusion can e ٴوectLvel reduce
the extent of toxic symptoms and prevent further
progression, especially when oximes are not available.