5thsembloodtransfusion

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5thsembloodtransfusion

  1. 1. Blood Transfusion <br /> Dr. Tanuj Paul Bhatia<br />
  2. 2. Indications <br />Elective transfusion<br /> - Correction of anemia before surgery<br /> - In preparation for major surgery<br />Emergency transfusion<br /> - Hemorrhage <br /><ul><li>Post Traumatic
  3. 3. Operative/Post operative
  4. 4. Spontaneous </li></li></ul><li>Blood Grouping<br />More than 400 antigen systems have been identified.<br />Expressed on red cell membranes.<br />Such antigens capable of interacting with serum antibodies in recipient.<br />HOWEVER, only a small proportion have potential to cause clinically significant hemolysis. <br />
  5. 5. ABO system<br />System of sugar residue antigens.<br />MOST IMPORTANT ANTIGEN SYSTEM<br /> WHY?<br />IgM<br />Presence of naturally occuringIgM antibodies in the serum<br />
  6. 6. They occur spontaneously.<br />Are directed against A and/or B antigens that the individual’s own red cells do not carry.<br />Can cause fatal reactions by causing lysis of incompatible red cells within intravascular compartment. <br />
  7. 7.
  8. 8. Rhesus system<br />Antibodies are IgG type.<br />These are induced antibodies and not naturally occuring.<br />Require a past exposure to cause reactions <br /> e.g. Previous blood transfusions or exposure to fetal red cells during pregnancy. <br />
  9. 9. Mainly cause red cell destruction in RE system i.e. Extra vascular hemolysis.<br />Consists of 47 antigens.<br />c, C, D, e and E are most important. <br />Rh positive = D antigen present<br />Rh negative = Absent D antigen<br />
  10. 10. Other blood group systems<br />Many other systems<br />Most likely to be implicated in hemolytic transfusion reactions are<br /><ul><li>Kell,
  11. 11. Kidd, and
  12. 12. Duffy.</li></li></ul><li>Cross-matching<br />Blood routinely grouped according to ABO and Rhesus systems.<br />After matching donor and recipient blood groups, cross matching is done.<br />Donor RBC are incubated with recipient’s serum to look for evidence of hemolysis<br /><ul><li>Macroscopic evidence
  13. 13. Microscopic evidence</li></li></ul><li>Physiology of stored blood<br />Several metabolic and functional changes occur.<br />Easily compensated by an individual with moderate hepatic, renal or bone marrow function.<br />Blood is stored at 4-8 C mixed with anticoagulant, most commonly CPD-A (citrate-phosphate-dextrose-adenine).<br />
  14. 14. Red cell changes<br />Depletion of ATP and 2,3 DPG.<br />RBC become rigid and less effective in oxygen delivery to tissues. <br />White cell and platelet changes<br />No useful function in blood stored for more than 24 hrs.<br />Coagulation factors<br />V, VIII and XI fall in 24 hrs<br />IX and X become ineffective in 7 days. <br />
  15. 15. Biochemical changes<br />Becomes acidotic<br />Becomes hyperkalemic<br />Due to spontaneous red cell lysis<br />Readily compensated except in seriously compromised patients and massive transfusion.<br />Microaggregates<br />Granulocyte –platelet aggregates start to form within 24 hrs of storage.<br />Can form pulmonary microemboli .<br />Thus BT set should have an appropriate <br /> filter.<br />
  16. 16. Whole blood and component therapy<br />
  17. 17. Whole blood <br />Fresh whole blood<br />Rich in all blood elements including coagulating factors.<br />Stored whole blood<br />Looses many properties as explained.<br />CPD-A blood can be stored at 4-8 C for 35 days<br />CPD blood for 21 days<br />
  18. 18. Whole blood(contd.)<br />Indication<br /> - Acute , active blood loss with hypovolaemia<br />- Exchange transfusion<br />Contraindication<br /> - Riskof volume overload : Chronic anaemia<br /> Incipient cardiac failure<br />1 unit increases Hb by about 1.4 g/dl<br />
  19. 19. Packed red cells<br /><ul><li>Units with red blood cells and some plasma
  20. 20. With anticoagulant like CPD-A
  21. 21. Hematocrit is 75% to 80%
  22. 22. Indication</li></ul>- Replacement of red cells in<br />anaemic patients.<br /> - Use with crystalloid or colloid solution in acute blood loss.<br /> Dosage 10 - 15 ml / kg<br />
  23. 23. Fresh frozen plasma<br />Contains approx. 200 ml of plasma.<br />Frozen within hours to preserve the level of coagulation factors.<br />Stored at -40 C, has a shelf life of 6 months.<br />Should be thawed for 30 minutes in waterbath before admi.<br />To be given within 30 min after thawing.<br />
  24. 24. FFP(contd.)<br />Indications<br />Coagulopathieseg. Due to liver disease.<br />DIC<br />
  25. 25. Cryoprecipitate<br />Prepared from FFP by thawing and separating and refreezing jelly like precipitate.<br />Enriched with factor VIII, Fibronectin and Fibrinogen. <br />Volume is about 20 ml. <br />Indicated in patients with Hemophillia, uncontrollable hemmorhage and <br /> DIC.<br />
  26. 26. Platelet concentrates<br />Each unit of platelets are suspended in 30-50 ml of plasma .<br />5 to 6 such units are combined to make a ‘Pool of platelets’ to raise platelet count by atleast 30 x 10⁹/l in a 70 kg man.<br />The only blood product not kept refrigerated, stored at 22 C under gentle agitation.<br />Shelf life is less than 5 days.<br />Indicated in DIC, Dengue fever, Bone marrow failure.<br />
  27. 27. Transfusion reactions(Hazards of transfusion)<br />‘Reaction’ = ‘Any unwanted effect of blood transfusion’<br />Doctor should always be sure that transfusion is absolutely necessary and consider alternatives.<br />Upto 1 L of blood loss can safely be restored with crystalloids alone if bleeding has <br /> stopped .<br />
  28. 28. 1. Immediate and life threatening<br />Profound intravascular haemolysis,<br />Air embolism,<br />Circulatory overload,<br />Complications of massive blood transfusion.<br />
  29. 29. 2. Immediate but not life threatening<br />Severe extravascularhemolysis,<br />Febrile reactions,<br />Atopic reactions.<br />
  30. 30. 3. Late reactions<br />Delayed immune mediated hemolysis<br />Local reactions<br />Transmission of infection<br />
  31. 31. Hemolytic reactions<br />Fortunately rare<br />Cause = transfusion of mismatched blood due to clerical or technical error.<br />Always check labels on blood bags as well as patients blood group before starting transfusion.<br />Signs and symptoms<br />Pain at infusion site<br />Shortness of breath<br />Chest pain<br />Facial flushing, vomiting<br />Fever and rigors<br />
  32. 32. Hemolytic reactions(contd.)<br />Patient may go for shock, renal failure, DIC and jaundice.<br />Rx<br />Stop transfusion immediately<br />Maintain venous access and saline infusion<br />Injchlorpheniramine 10 mg iv given stat<br />Steroids<br />Insert urinary catheter<br />Management of complications<br />
  33. 33. Febrile reactions and minor allergic reactions<br />Nonhemolytic febrile reactions and minor allergic reactions are the most common transfusion reactions.<br />Each occurring in 3-4% of all transfusions.<br />Nonspecific symptoms of fever, chills, and malaise.<br />Rx<br />Stop transfusion<br />Inj CPM 10 mg iv <br />Send to lab for re-crossmatching<br />
  34. 34. Complications of massive blood transfusion<br />Massive transfusion is defined as the replacement of more than one-half of the blood volume within a 24-hour period .<br />Or replacement of 10 units of blood over the course of a few hours .<br />
  35. 35. Complications are…<br />Volume overload,<br />Hypothermia,<br />Coagulopathy,<br />Hyperkalemia,<br />Metabolic acidosis,<br />
  36. 36. Transmission of infection<br />HIV<br />HBV<br />HCV<br />Syphilis<br />All donors and all of donated blood is to be screened for the above.<br />
  37. 37. THANK YOU<br />

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