Dr. Asoka de silva

Blood transfusions

Purpose of transfusions

to increase oxygen carrying capacity

to increase circulating volume

other minor reasons

CIRCULATING BLOOD VOLUME 70ML /KG

ACCEPTABLE BLOOD LOSS 10% OF CIRCULATING VOLUME

Functions

Transport

Oxygen

Carbon dioxide

Ions

Carbohydrates, fats, proteins

Protection

Humoral

Cellular

Stored blood

437 blood and 63 ml of CPD solution

Temp 4 degree centigrade

pH 6.7

k 20 m.equ/l

low 2:3 DPG

RBC 80% viable

Red cells can be kept for 42 days

Platelets for three days

Plasma can be frozen for a long time

ACD – 21 daysCPD– 35 daysCPDA—42 days

Complications

Incompatibility

Infections

Allergic reactions

Over transfusion

Pyrogens

Emboli

Contaminated blood

ARDS

HIVHep BHepCSyphillisCytomegalo virusEpstein_Barr virus

Incompatibility

Signs and symptoms depends onIntravascular haemolysisRE system haemolysis

Chest and flank painChills, fever, flushingHeadache, vomiting, tachypneaHypotension, tachycardiaOozing from the woundHaemoglobinuriaLater oliguria, jaundice, anaemia

Haemolytic reactions

Due to an error in either

Typing and cross matching

Documentation and labeling

Checking and cross checking

S & S

Chest pain

Backache

Dyspnea

Hypotension

Fever, chills, headache, nausea, vomiting, and a burning sensation at the site of the infusion

Management

Discontinue

Oxygen

New tubing, vigorous crystalloids .

Mannitol, diuretic therapy dopamine.

Maintain urine output at 1 to 2 ml/kg/hr.

Anti-histamines, steroids

Samples

blood from patient.

Blood from blood pack

urine for HB

Immediate reactions

Haemolytic reactions

Febrile transfusion reactions

Allergic reactions

Transfusion related lung injury

Delayed reactions

Extra vascular haemolytic reactions

Graft versus host reactions

Blood and cancer surgery

Facts

Pts survive longer if no blood is given

Recurrences are less if no blood is given

Immunosuppression

Graft-versus-host disease 

May be due to white cells that we give

Complications of massive transfusions (>35ml/kg/hr)

Potassium

Calcium

Citrate

Clotting factors

pH

Platelets

Temperature

2:3 DPG

Measures to reduce transfusionsAccept lower HB levels

Keep blood loss to a minimum

hypotension

good haemostasis

regional blocks

Auto transfusions

Drugs

desmopressin

antifibrinolitics

Use alternatives

Stored pt’bloodIntra op collectionPost op collection

Autotransfusion may be defined as "collection and reinfusion of the patient's own blood

There is rapid availability

Blood compatibility is not a problem,

There is immediate reinfusion of normothermic blood.

No risk of transmission of infectious diseases

2,3-diphosphoglycerate (2,3-DPG) have been found to be significantly higher

no direct complications of hypocalcemia or hyperkalemia..

Autotransfusion allows preservation of limited stores of banked blood,

Autotransfusion lowers the cost of medical care.

It may be acceptable to those patients whose religious convictions prohibit blood transfusions

Alternatives

Plasma

Crystalloids

Plasma expanders

Dextrans

Polygelatins

Starch preparations

Haemoglobin substitutes

Perflurocarbons

Haemoglobin solutions

Blood banking

Anticoagulation

Storage at 4 degrees

Life span

ChangesATPase pump

K+ H+

Granulocites

Platelets

Factors V & Vll

Blood typing

Blood that lacks A antigen is Type B

Blood that lacks B antigen is Type A

Blood that lacks both Type O

Blood that has both is type AB

Other tests

Rh typing

Antibody screening

Coombs test

In crisis situations

O+ blood is used

In females O-

Type & cross match

Type specific in 10 minutes

Incomplete cross match in 30 minutes

Full cross match is available in 45 minutes

Packed red cells

1 unit increases Hb by 1 G/100ml

Haematocrit by 3%

Similar increase in children by giving 3ml/Kg

A unit should never be given over more than 4hours

A unit not refrigerated should be discarded

platelets

Cross matching is not needed

Rh – females should receive Rh –ve platelets

1 unit will increase by 5000/mm3

Each unit is about 50-70 ml

Usually 6 units are given