Haemorrhage and Blood Transfususion

7/29/2019 Haemorrhage and Blood Transfususion

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Haemorrhage and blood

Tranasfususion

By

Harisha N. L.


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Plan of presentation

Introduction to haemorrhage

Classification of haemorrhage

Pathophysiology

Management

Indications of blood transfusion

Principal aims and complications of blood

transfusion


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Introduction

Haemorrhage is a serious condition must be

recognised and managed aggressively to

reduce the severity and duration of shock andto avoid multiple organ failure or death.


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CLASSIFICATION OF HAEMORRHAGE


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Depending upon nature of bleeding

external haemorrhage

epistaxis

haematemesis

Internal haemorrhage

Spinic rupture and Liver laceration following

injury


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Depending on nature of the vessel

involved

Arterial haemorrhage

Venous haemorrhage

Capillary haemorrhage


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Depending on timing of haemorrhage

Primary

Reactionary

secondary


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Depending on duration of haemorrhage

Acute

Chronic


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PATHOPHYSIOLOGY


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Classification of the evolution of

haemorrhagic shockClass I

When blood loss is less than 750 ml (


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Class II

Loss of 800 to 1500 ml (15-30% blood volume)

relults in moderate shock

In addition to peripheral venoconstriction adrinaline

or noradrinaline causes powerful vasoconstriction ofveins and arteries

Clinically patient shows heart rate of 100 to 120 beats

per minute and elevated diastolic pressure

Urine output is reduced to about 0.5 ml/Kg/hr

Extremities may look pale and patient is confused and

thirsty


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Class III

Loss of 1500-2000 ml (30-40% of blood volume)

All signs and symptoms of class II get worsened

Systolic and diastolic pressure decreases and heart

rate increases above 120 beats/minute

Pulse becomes thready

The respiratory rate increases more than 20 per

minute

Urine output drops to 10 to 20 ml/Kg/hr

Patient appears pale drowsy or confused


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Class IV

Blood loss more than 2000 ml

Pulse is thready and more than 120 beats perminute

BP is very low or unrecordable

If blood loss persists organs damage can occur


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MANAGEMENT


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TreatementGeneral measures

Hospitalisation

Care of air way, breathing and circulation

Oxygen should be given by face mask to all patients

who are conscious

In unconscious endotracheal intubation and

ventilation with oxygen may be necessary Intra venous administration of ringer lactate and

colloids such as gelatins and hetastarch

blood transfusion


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Treatement

Specific measures Pressure and packing

Position and rest

Tourniquets Surgical methods

Application of artery forceps(spencer wells forceps)

Application of ligatures for bleeding vessels

Cauterisation (diathermy)Application of bone wax

Silver clips are used to control bleeding from cerebral vessels

(Cushing's clip)


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BLOOD TRANSFUSION


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Indications Acute haemorrhage

Major operations where blood loss is inevitable

In case of burns

Preoperative transfusion when patient is already anaemic and there

is no time for iron therapy In anaemic patients when the hemoglobin level is below 10

gm/100 ml

In certain coagulation disorders like haemophilia

Christmas disease, thrombocytopenic purpura and few blooddiseases like leukaemia, aplastic anaemia

During chemotherapy for malignant diseases

in treating cases of Rh incompatability, erithroblastosis, foetalis


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The Principle Aims of Blood

Transfusion Improve oxygen carrying capacity of blood.

Symptomatic improvement.

Reduce hypovolaemia.

1 UNIT of Blood should increase the Hb byapprox.1g/dL.

If no improvement or reduction in Hb thinkabout ongoing blood loss or destruction.

You need treat the underlying cause.


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Blood and Blood Product Transfusion

Whole Blood

Packed Cells

Platelets

Fresh Frozen Plasma (FFP)

Cryoprecipitate


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complications Transfusion reactions

Incompatibility

Pyrexial reactions

Allergic reactions

Sensitization to leucocytes and platelets

Transmission of diseases

serum hepatitis

AIDS

Bacterial infections

Reactions caused by massive transfusion

Acid base imbalance

Hyper kalaemia

Citrate toxicity

Hypothermia

Failure of coagulation


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Blood Transfusion - Acute Complications IComplication Cause Incidence / Likely timing with

regard transfusion

Treatment

Acute Intravascularhaemolysis ABO incompatibility(Commonest cause is administrative!)1:6x10

5

Occurs within a few mls of

starting transfusion

(Mortality 10%)

Shouldnt happen!STOP THE BLOOD!

Supportive treatment

Treat complications ARF and

DIC

Febrile Non-haemolytic

reactions

Anti Leucocyte Ig or

Cytokines in platelet transfusions

Commonest in patients receiving

multiple transfusions orpreviously pregnant

Becoming rarer because of

leucocyte depletion in many

transfusion practices.

Occurs towards the end of or up tohours after transfusion

Unpleasant but not life

threatening

Paracetamol and cooling.

Urticaria Transfusion contains plasma proteins

or allergens causing an acute IgE

mediated allergic response

Occurs with plasma and platelet

rather than red cell transfusions.

1 2% of all transfusions

Peri-transfusion

May occur recurrently

Unpleasant but not life

threatening

Anti-histamines

(can be given prophylactically

in known patients)

Infective shock Bacterial contaminat ion of transfused

blood

Rare; 1:5x 105

First 100mls of blood ie early

Often fatal!

That of Septicaemia and shock

fluids, IV antibiotics

Anaphylaxis Anti-IgA antibodies ?others

Patients are often IgA deficient as

well!

Extremely rare Life threatening

A.B.C / Crash team call

IV / IM adrenaline, steroids,

aHistamines, Oxygen

Nebulisers.


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Blood Transfusion - Acute

Complications II Non-cardiogenic Pulmonary oedema

Caused by donor blood containing anti-Leucocyte

antibodies Occurs at the start of the transfusion

Can be life threatening

Treat for(a) Acute transfusion reaction

(b) Respiratory failure (ARDS), Shock and Pulmonary

oedema


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Blood Transfusion Delayed Complications

Complication Cause Incidence / Timing Treatment

Delayed Red cell haemolysis Recipient IgG vs Red cell

antigens

Occurs in previouslytransfused or pregnant

patients; Initial cross match

will not contain IgG but

subsequent cross matches

should!

5 10 days after transfusion


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THANK YOU

Haemorrhage and Blood Transfususion

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