6.shockblood transfusion)
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Transcript of 6.shockblood transfusion)
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Hypovolemic Shock Due to Bleeding
Mr. NAZIM JATFRCS
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Require Blood transfusionBlood storage bags
RBCs (Red blood Cells) Storage Bags
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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
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OPTIONAL FEATURES • Attached Blood Sampling Bag • Needle Protector• Tube Holder • "Y" injection port
CPDA BLOOD BAG
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Blow-extruded single blood bag type A Blow-extruded single Blood bag type B
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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
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Transfer Bag
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Transfusion
• Blood Transfusion become availabe in 1829• Now a days no severe reactions to transfusion
seen.• Immunosuppresion to host occurs.
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Blood & Blood Products
• Donated Blood are leucodepleted as a precaution against creutzfeldt-Jakob Diseases (transmissible spongiform encephalopathies )
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Types of Blood Available
1. Whole Blood2. Packed Red Cells3. Fresh Frozen Plasma4. Cryoprecipitate5. Platelets6. Prothrombin Complex Concentrates7. Autologous blood
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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).
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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
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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.
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TRANSFUSION REACTIONS
• is any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components
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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)
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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)
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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)
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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
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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
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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.
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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.
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“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
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Questions & Comments
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Questions & Comments
1. CPDA bagsa. Blood storage bags.b. Urine storage bags.c. Its saline storage bagsd. Its coffee storage bagse. Not always sterile
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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
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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
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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.
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5. Transfusion Reaction area. Always haemolyticb. Never haemolyticc. Can be haemolyticd. Never febrilee. Never associated with vomiting.
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