8/4/2019 (1) The Blood

1/29

THE BLOOD

Oxygen transport

Chemical nutrients for and wasteproducts from metabolic activities

Homeostatic governors: Hormones

Coagulation factors

8/4/2019 (1) The Blood

2/29

Blood Components

Formed Elements: Cells

Red cellsO2 carrying capacity

White cells--- Body defenses Platelets--Haemostasis

Plasma : Coagulation factors

Proteins Hormones

Antibodies etc

8/4/2019 (1) The Blood

3/29

Blood Transfusion

History:1667 : Sheep to human { Emerez }

1900 : Blood grouping A,B,O {Landesteiner}

1914 : First successful blood transfusion

1937 : First blood bank

1940 : Rhesus system

8/4/2019 (1) The Blood

4/29

Blood Loss

Loss of 10-20% of blood volume can becompensated immediately by shift ofinterstitial fluid

30-40 hours :blood volume replacement

5-6 weeks :Red cells and HB

8/4/2019 (1) The Blood

5/29

Blood preservation

Solutions

Acid citrate dextrose ACD

Citrate phosphate dextrose CPD

Citrate phosphate double dextrose

adenine CP2D

Cooling

Freezing

8/4/2019 (1) The Blood

6/29

Distribution of ABO groups in Britain

B.Group RBC Ag Serum AbFrequency

A A AntiB 42%

B B Anti A 8%

AB A&B Nil 3%

O Neither AntiA&B 47%

8/4/2019 (1) The Blood

7/29

Rhesus antibody Rh (D)

Positive in 85%

Negative in 15%

No antigen present against it but it can formlater

8/4/2019 (1) The Blood

8/29

Effects of banking on blood 1. Red cells:

Anaerobic metabolism

DecreaseATP& 23D

Results: Alters O2 dissociation curve Increase affinity of RBC to O2

Decrease O2 transport function

8/4/2019 (1) The Blood

9/29

Effects ofBanking on blood Platelates..Lysis

Clotting factors: ..II,VII, IX, XI are Stable

. V,VIII, are Unstable.

Plasma changes:

8/4/2019 (1) The Blood

10/29

Fresh whole blood Within 24 hours :

Good source of factor V & VII

Platelates ? 6 hours to lyse

Indications : RARE

Hazards Transmitting infective agents

8/4/2019 (1) The Blood

11/29

Packed Red Cells Reduced risk of hepatitis

Improved RBC viability Maintained ATP% 23DPG

Less danger of circulatory overload

Less reactions secondary to allergens

8/4/2019 (1) The Blood

12/29

Fresh Frozen Plasma Main indications:

Factors V&VIII deficiency

Hypovolemia ??

8/4/2019 (1) The Blood

13/29

Leucocyte and platelets washed RBC

After washing with normal saline

Only used for patients sensitive toWBCs or platelets

8/4/2019 (1) The Blood

14/29

Platelets Rich Plasma

(Platelets Concentrate)

Massive blood loss

Massive blood transfusion Inadequate destruction

Qualitative disorders The development of iso-immunity is an

important factor limiting its use aftermultiple transfusions

8/4/2019 (1) The Blood

15/29

CONCENTRATESAntihemophilic factor VIII

Cryoprecipitate Fibrinogen

Albumin

8/4/2019 (1) The Blood

16/29

Indication of transfusion of

blood and it

s products 1.Volume replacement:

Difficult to evaluate accurately How much can we loose before showing

significant symptoms and signs.

Operative estimation

8/4/2019 (1) The Blood

17/29

Indication for transfusion of

blood and its products2.Improvement of oxygenation

Chronic anaemiaAcute anaemia

8/4/2019 (1) The Blood

18/29

Indication for transfusion of

blood and its products3 . Replacement of clotting factors:

Dilutional coagulopathy Specific factors VIII,IX etc..

8/4/2019 (1) The Blood

19/29

Indications for Transfusion Traumatic accidents and hemorrhage.

During major operative procedures. Sever burns.

Post operative.

Preoperative. To arrest hemorrhage in hemolytic

anemias

8/4/2019 (1) The Blood

20/29

8/4/2019 (1) The Blood

21/29

In case of multiple donors Cross-match between donors

Major and minor cross-match Cold agglutinin titer estimation

8/4/2019 (1) The Blood

22/29

Methods of administration Intravenous route

Rate: 5ml per minute

Then 10-20 per minute

When fast administration is needed:

USEBLOODWARMER

8/4/2019 (1) The Blood

23/29

Massive Transfusion 2500 ml Single transfusion

5000 ml within 24 hours

Effects : Delusionalthrombocytopenia

Decrease factors V,VIII IX

Acidosis

Hemolytic transfusion reactions due to crossincompatability

8/4/2019 (1) The Blood

24/29

Complications I..Hemolytic Reactions Major incompatibility

Sequences:

Hemoglobinemia

Hemoglobinuria

Disseminated intravascularcoagulopathy

Decreased Hb

Incr

eas

e biliru

bin

8/4/2019 (1) The Blood

25/29

CLINICAL MANIFESTATIONS

OF INCOMPATABILITY

Heatsensation Pains

Chills Respiratorydistress

Fever Hypotension

Tachycardia

#Hypotensionandexcessive bleedinginanesthetizedpatientsduringsurgery

8/4/2019 (1) The Blood

26/29

Management

Stop transfusion

Bloodsample for:

Cross-matching

Bilirubin

Others

MonitoringvitalsignsandUrinaryoutput

Alkalinazationofurine

8/4/2019 (1) The Blood

27/29

Complications II Allergic reactions

Causedmostlyby: minorantibodies

preservativesManifestations: Urticaria

fever

Anaphylactic reactions

Treatment: AntihistaminsAdrenalin

Steroids

8/4/2019 (1) The Blood

28/29

Complications III Transmission of infectious diseases

Malaria Brucella Syphilis

Viral Hepatitis B & C

HIV { AIDS}

8/4/2019 (1) The Blood

29/29

Fate ofBanked whole blood

after transfusion

Fresh blood 70% viable in 24hours

Banked 14 days 50% viable in 60days

Banked 28 days 25% viable in 60days