Hypovolemic Shock Due to Bleeding

Mr. NAZIM JATFRCS

Require Blood transfusionBlood storage bags

RBCs (Red blood Cells) Storage Bags

CPDA BLOOD BAG

• SPECIFICATIONS• Primary Bag capacity available in 150ml to 500ml • Donor needle gauge size: 16G to 17G • Package: Each set packed in one compounded

vacuum pouch

OPTIONAL FEATURES • Attached Blood Sampling Bag • Needle Protector• Tube Holder • "Y" injection port

CPDA BLOOD BAG

Blow-extruded single blood bag type A Blow-extruded single Blood bag type B

TRANSFER BAG

1. Bag capacity available in 150ml to 1000ml 2. Package: Each set packed in one PE compounded

vacuum pouch, and then 100 to 150 sets packed in one carton

3. Standard Set: Two entry ports and one tube with a transfer spike.

4. Optional features: Two entry ports or one entry port, With or without transfer spike, Rolled Bag or Blow-extruded Bag

Transfer Bag

Transfusion

• Blood Transfusion become availabe in 1829• Now a days no severe reactions to transfusion

seen.• Immunosuppresion to host occurs.

Blood & Blood Products

• Donated Blood are leucodepleted as a precaution against creutzfeldt-Jakob Diseases (transmissible spongiform encephalopathies )

Types of Blood Available

1. Whole Blood2. Packed Red Cells3. Fresh Frozen Plasma4. Cryoprecipitate5. Platelets6. Prothrombin Complex Concentrates7. Autologous blood

Packed red cells

• Packed red blood cells are cells that are spun down and concentrated. Each unit is approximately 330ml and has a haematocrit of 50-70%. Packed cells are stored in a SAG-M solution (Saline-adenine-glucose-mannitol)to increase their shelf-life to 5 weeks at 2-60C. (Older storage regimens included storage in CPD – citrate-Phosphate-dextrose solutions –giving cells a shelf-life of 2-3 weeks).

Fresh Frozen Plasma

FFP is rich in coagulation factors• It is removed from fresh blood and stored at -40

to 50 0C with a 2 year shelf life.• It is the first line therapy in the treatment of

coagulopathic haemorrhage.• Rhesus D positive FFP may be given to a Rhesus D

negative woman

Cryoprecipitate

• Cryoprecipitate is a supernatant precipitate of FFp and is rich In factor VIII and fibrinogen.

• It is stored at -30oC with a 2 year shelf life.• It is given in low fibrinogen states or in cases of

factor VIII deficiency.

Platelets

• Platelets are supplied as a pooled platelet concentrate containing about 250×109 cells per litre.

• Platelets are stored on a special agitator at 20-240 C and have a shelf life of only 5 days

• Platelets Transfusions are given to patients with thrombocycopenia.

Prothrombin Complex Concentrates

• Prothrombin complex concentrates (PCCs) are highly purified concentrates prepared frompooled plasma.

• They contain factors II,IX and X; factor VII may be included or produced seperately.

• PCCs are indicated for the emergency reversal of anti- coagulant (warfarin) therapy in uncontrolled haemorrhage.

Autologous blood

• Pre donation of their own blood patients undergoing elective surgery up to 3 weeks surgery of retransfusion.

• Collected in a cell saver, ( which washes and collects red blood cells) which can then be returned to the patient.

Indication of blood Transfusion

• Acute blood loss, to replace circulating volume and maintain oxygen delivery

• Perioperative anaemia, to ensure adequate oxygen delivery during to perioperative phase

• Symptomatic chronic anaemia without hemorrhage or impending surgery.

Indications for blood TransfusionHaemoglobin level (g dl-1) INDICATION

<6 Probably will benefit from transfusion

6-8 Transfusion unlikely to be of benefit in the absence of

bleeding or impending surgery

>8 No indication for transfusion

Blood Groups and Cross Matching

• ABO System– The system consists of 3 allelic genes A, B & O.– Control the synthesis of enzymes that add

carbohydrate residues to cell surface glycoproteins– A & B genes result in specific residues– The O gene is an amorph & doesn’t transform the

glycoprotein.– The system allows for six possible genotypes although

there are four phenotypes.

ABO blood group SystemPhenotype Genotype Antigen Antibodies Frequency (%)

O OO O Anti-A, Anti-B 46

A AA or AO A Anti-B 42

B BB or BO B Anti-A 9

AB AB AB None 3

Rhesus System

The Rhesus D [Rh(D)] antigen is strongly antigenic.Antibodies to the D antigen are not naturally present in the serum of the remaining 15% of individuals but their formation may be stimulated by the transfusion of Rh-positive red cells or they may be acquired during delivery of a Rh(D) positive baby.

TRANSFUSION REACTIONS

• is any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components

TRANSFUSION REACTIONS

@RBC’s !• Nonhemolytic 1-5 % transfusions Causes -Physical or chemical destruction of

blood: freezing, heating, hemolytic drug -solution added to blood -Bacterial contamination

: fever, chills, urticaria– Slow transfusion, diphenhydramine , antipyretic for fever

• Hemolytic– Immediate: ABO incompatibility (1/ 12-33,000) with fatality (1/ 500-800,000)

Majority are group O patients receiving type A, B or AB blood Complement activation, RBC lysis, free Hb (+ direct Coombs Ab test)

Cross Matching

• Full cross matching of blood takes 45 min in most laboratories.

• In more urgent situations, “type-specific” blood is provided can be issued within 10-15 min.

• When blood must be given in an emergency, group O (Universal donor) blood is given (O- to female patients, O+ to male patients)

Complications of blood Transfusion

• From a Single Transfusion– Incompatibility haemolytic transfusion reaction– Febrile transfusion reaction– Allergic reaction– Infection• Bacterial infection (usually as a result of faculty storage)• Hepatitis• HIV• Malaria

– Air embolism– Thrombophylebitis– Transfusion related acute lung injury (usually from FFP)

Complications of blood Transfusion

• From Massive Transfusion– Coagulopathy– Hypocalcaemia– Hyperkalaemia– Hypokalaemia– Hypothermia

Patient who receive repeated transfusions e.g Patient with thalessaemia may develop iron overload

Management of Coagulopathy

• Standard Guidelines– FFP if prothrombin time (PT) or partial Thromboplastin

time (PTT) > 1.5 × normal– Cryoprecipitate if fibrinogen < 0.8 gl-1

– Platelets if platelet count < 50 × 109 ml-1

Blood Substitutes

• Blood substitutes are either biomimetic or abiotic– Biomimetic substitutes mimic the standard oxygen-

carrying capacity of the blood and are haemoglobin based

– Abiotic substutes are synthetic oxygen carriers and are currently primarily per fluorocarbon based.

Plasma Expanders

• Dextran is a complex, branched glucan (polysaccharide made of many glucose molecules) composed of chains of varying lengths (from 3 to 2000 kilodaltons). It is used medicinally as an antithrombotic (anti-platelet), to reduce blood viscosity, and as a volume expander in anemia.

“Blood is still the best possible thing to have in our veins” - Woody Allen

Blood transfusion is a lot like marriage. It should not be entered upon lightly, unadvisedly or wantonly,

or more often than is absolutely necessary” - Beal

Questions & Comments

Questions & Comments

1. CPDA bagsa. Blood storage bags.b. Urine storage bags.c. Its saline storage bagsd. Its coffee storage bagse. Not always sterile

Questions & Comments

2. Following are the true statements about types of blood available for transfusion

a. Whole bloodb. Packed red cellsc. Fresh frozen plasma (FFP)d. Autologous bloode. Blood stored more than 6 months

Questions & Comments

3. Following are true about FFPa. Rich in coagulation factorb. Remove from fresh bloodc. Stored at -40 to 500 C d. It is first line treatment of coagulapathic

haemorrhagee. It can be used even after 4 years

Questions & Comments

4. Autologous blood isa. Blood from other individualb. Blood from same individual taken from 1 vein &

given through the other vein.c. Its blood taken 3 weeks before surgery from the

same patient for the re transfusiond. Its blood collected from animal.e. It is blood mix with saline.

5. Transfusion Reaction area. Always haemolyticb. Never haemolyticc. Can be haemolyticd. Never febrilee. Never associated with vomiting.