BLOOD TRANSFUSION

DR ABDULLAH BANGWAR

PG SU-III

BLOOD TRANSFUSION

o The most common transplanted organ world wide is blood

o Blood should be transfused in its various products rather than as a whole

o The conditions in which whole blood is needed are : Trauma & Surgery where the all products of blood are being lost, Otherwise various products can be transfused as

per requirement

BLOOD TRANSFUSION

This policy has dual advantagei. Un-necessary transfusion of other

products can be avoided & other patients can get benefit from them

ii. Complications of transfusion can be reduced in this way

BLOOD TRANSFUSION

o For collection of 500 ml of blood,70 ml anticoagulant CPD-A1 solution is added which contain:

~ citric acid ~ sodium citrate ~ sodium biphosphate ~ dextrose ~ adenine

Changes In Blood During Storage

1) Potassium level rises at rate of 1 meq/day. Blood stored for >21 days will have 21 meq more k+ than fresh blood

2) Increase in level of lactic & pyruvic acid causing acidosis

3) PO2 decrease & Pco2 increase4) Level of NH3 raises after 8-5 days of

storage & reaches max level at 21 days, pt with hepatic encephalopathy should not be transfused with stored blood as it worsen the condition

Changes In Blood During Storage

5) Clotting factors remain viable for 24 hours

6) One pint of blood will raises Hb level approximately by one gram (0.8gm)

7) WBCs are rapidly destroyed in stored blood

8) At 4C, platelet survival & function are reduced, but can be stored at 22C for 5-7 days

Indications Of Blood Transfusion

1) SURGICAL: ~ Accidental hemorrhage ~ Hemorrhage from GIT tumors ~ UC ~ Bleeding PUD ~ Hemorrhoids2) PRE-OPERATIVE: Any pt whose HB is < 8 gm% is

considered unfit for anesthesia3) PER-OPERATIVE: Any major surgery

Indications Of Blood Transfusion

4) POST-OPERATIVE: If pt is anemic due to infection or

hemorrhage (reactionary, secondary), blood should be transfused

5) SEVERE BURNS: Specially deep burn in which there is loss

of serum & RBCs destruction6) BLEEDING DISORDERS: Thrombocytopenia & hemophilia7) Aplastic/ hypoplastic anemias

SAFETY MEASURES

1. Positive identification of pt at bed side2. Comparison of name of pt & blood group

on blood bag and slip provided by blood bank

3. Check ABO & Rh group compatibility4. Cross match is must but in emergency

situ we can just rely on grouping b/c cross match takes time

5. Check vitals

SAFETY MEASURES

6. Rate of blood flow should be 40 drops/min, but can be transfused rapidly in sever blood loss

7. Transfusion note should be mentioned8. Emergency medicines should be in hands

at the time of transfusion 9. Screening for HIV 1 & 2, HBV, HCV, CMV

in special circumstances

SAFETY MEASURES

10. Blood donor should be fit with no evidence of any active infection

BLOOD FRACTIONS

1.cells 2.plasma

BLOOD FRACTIONS

1. CELLS: a) Packed Red Cell are indicated in: ~ severe anemia ~ elderly patients ~ children ~ Pt in which there is danger of volume

overload ( CCF, THALASSEMIA ) b) PLATELETS: Thrombocytopenia (DIC, DANGUE

HEMORRHAGIC SHOCK)

BLOOD FRACTIONS

2.PLASMA: a) Purified Protein Fraction (PPF) Suitable for protein replacement e.g.

burn & severe protein loss It can be stored for several month at 4C

b) Fresh Frozen Plasma (FFP) plasma obtained from fresh blood &

rapidly frozen at -50C

BLOOD FRACTIONS FFP is good source of all clotting factors It is treatment of choice for conducting surgery

in pt with abnormal coagulation due to sever liver failure, clotting factor deficiency, hemophilia, christmas disease & acute warfarin toxicity

It can be stored for 2 yearsc) Cryoprecipitate: It is very rich source of antihemophilic factor

(factor VIII) & Fibrinogen, So it is useful in pt with DIC & hemophilia-A

BLOOD FRACTIONS

d) Fibrinogen: Used in DICe) SAG-MITOL BLOOD: Process in which

all plasma is removed and replaced by crystalloid solution containing

S-Sodium chloride A-Adenine G-Glucose M-ManitolThis maintain good cell viability, contain no

protein & is useful for anemia

COMPLICATIONS

A) TRANSFUSION REACTION1. Acute immune hemolytic reaction2. Delayed hemolytic reaction3. Nonimmune hemolytic reaction4. Allergic reaction5. Febrile reaction6. Graft-vs-host disease(GVHD)7. TRALI

COMPLICATIONS

B) Overloading & CCFC) Air embolismD) Transmission of diseasesE) Iron overload F) HyperkalemiaG) Citrate toxicityH) Metabolic acidosisI) HypothermiaJ) hyperamonemia

MASSIVE BLOOD TRANSFUSION

Replacement of total blood volume in less than 24 hours OR acute transfusion of more than half of patient’s estimated blood volume per hour

AUTOTRANSFUSION

Pre-deposit Blood salvage haemodilution