Blood Transfusion Kiran(3)
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Transcript of Blood Transfusion Kiran(3)
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Blood TransfusionDr. kiran kumar
2nd MDS
Gitam Dental college and Hospital
SEMINAR ON
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Blood GroupsCarl landsteiner-1909- first gave the classification
19 Blood group systems & Over 200 antigens were
identified
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Cross matching and compatability
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Other important blood groupsRhgrouping: D antigen.
Bombay blood group.
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Components of blood that can be transfused
WHOLE BLOOD
CELLULAR PLASMA
RBCS WBCS PLATELETS FFP CRYO PPF
packed
frozen
washed
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Most patients require only one particular component
Better patient management is achieved by giving only
the desired and/or essential component.
Blood products have a greater shelf life Blood filtration and other techniques makes Blood safer
Blood products can often be infused regardless of
ABO Blood group
Selection of Components
Use of whole Blood is a waste of resources
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ApheresisProcess of removing a specific
component of the Blood such as
platelets, and returning the remaining
components to the donor.
Allows more of one particular part
of the blood to be collected than could
be separated from a unit of whole blood
http://en.wikipedia.org/wiki/Image:Platelet_apheresis.jpghttp://en.wikipedia.org/wiki/Image:Apheresis.PNG -
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blood donation:
300-400ml of whole blood is collected
+
63ml of citrate phosphate dextrose is added
storage period is 21days at a temperature of -2 to 6c.
As 2-3diphospho glycerate increases - release of oxygenreduced.
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Principle of blood transfusionThe transfer of blood or
blood components from oneperson (the donor) into the
bloodstream of another
person (the recipient).
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WHO recommendations for screening tests in blood donationsHIV 1&2HEPATITIS B& C
MALARIA
SYPHILIS
CHAGAS DISEASE
Regular voluntary blood donation.
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Rigth IV selection: The size of the IV catheter is important.
Too small = hemolysis = wasted infusion
Need at least a 20G but preferably an 18G.
Recommended rate of transfusion intially for the
first 15 min it should be 10 drops/min later
40 drops/min
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Check for vital signscheck for temp,B.P,heart rate.
A temperature 100 or higher should be reported
even if it is pre-existing.
If a transfusion reaction occursthis will be
important for careful assessment of the situation
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INDICATIONS FOR BLOOD TRANSFUSION:ACUTE BLOOD LOSS (SURGERY, TRAUMA OR BLEEDING)
15 - 30 percent - should be treated with crystalloids or colloids,not RBCs, in young, healthy patients-40.
30 - 40 percent -- requires rapid volume replacement,and RBC transfusion is probably necessary
800-1500ml of blood.
hematocrit value-30-40
>40 percent -- is life-threatening and volume replacement,including RBC transfusion, is required.
>2000ml of blood.
hematocrit value-
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INDICATIONS FOR BLOOD TRANSFUSION:
Hemoglobin > 10 g/dL -- transfusion is rarely indicated.
Hemoglobin 7-10 g/dL -- indications for transfusion should be based on
the patient's risk of inadequate oxygenation from
ongoing bleeding and/or high-risk factors
.Hemoglobin < 7 g/dL -- transfusion is almost always indicated.
TRANSFUSION THRESHOLD LEVEL7g/dl
7/30 rule
Hemoglobin concentration:
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INDICATIONS FOR BLOOD TRANSFUSION:
peri-operative transfusion- if Hb 7g/dl
if significant blood loss is expected
SPECIAL SITUATIONS:
Severe Thalassemia Or Other Congenital Anemia.
Sickle Cell Disease
Burn Patients
.
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RBC Transfusion
Stored under refrigeration for 42 days
May be frozen for up to 10 years.
One unit contains approx 180ml of red cells
Does not provide platelets or coagulation factors
All RBC transfusions must be ABO/Rh compatible
INDICATIONS:
Hemoglobin levels less than 7/8g/dl or hemocrit level less than 30-40%.
Packed RBC:
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1 unit of packed RBCincreases Hct by5%.
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Platelet Transfusion
Whole
Blood platelet concentrate
Apheresis Platelets
Leukoreduced single donor
17,600 105,600
Colour - cloudy and yellowish
Red blood cell compatibility is generally not necessary
INDICATIONS:
Purpura.
Aplastic anemia.Chemotherapy induced leukemia.
Disseminated intra vascular coagulation(DIC).
Thrombocytopenia.
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Plate let pack contains:
3-510 platelets - 10 times more than normal 1
unit of whole blood
Pt.`s with more than 50,000- not requiredPt.`s with less than 20,000- required if C/F are seen.
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FFP Fresh frozen plasma (FFP) is the plasma from a unit of
whole Blood and frozen at or below -18 c within 8 hours
Kept in a frozen state for one year
Qty : 225 ml
Must be ABO compatible with the recipients red cells
Rh need not be considered.
Control bleeding due to low levels of clotting factors
INDICATIONS:
Clotting deficiencies.
Reversal of warfarin effect.
Antithrombin 111 deficiencies.
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CryoprecipitateIndications:
Acute hemorrhagic episodes of hemophilia
Burns- b/o high opsonin conc.
Septicemia.
1 unit of cryoprecipitate contains -100 units of
factor VIII.
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Adverse effects of transfusion
AcuteAllergic
Anaphylaxis
Hemolytic
Metabolic Transfusion related lung injury
Circulatory overload
Non-hemolytic febrile transfusion reactions
Haemostatic: dilution of clotting factors andthrombocytopenia
Septic shock (bacterially infected units)
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Acute Haemolytic Reaction:
-caused by transfusion of ABO incompatible blood
SYPTOMS:
Chills , fever Facial flushing
Hypotension
Chest pain
Dyspnea
Generalized bleeding Renal failure
DIC
Hemoglobinemia
Shock
Hemoglobinuria
Nausea
Vomitting
Back pain
Pain along infusion vein
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Acute Haemolytic Reaction:
MANAGEMENT:
FIRSTStop the transfusion
Keep the line open with the 0.9% NS Stay with the client. Monitor Vital signs.
Record and Collect urine specimen
Return blood, bag, tubing, labels, transfusion record to
the blood bank
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MANAGEMENT:
Anti histaminic drugs
Analgesics
Corticosteroids
IV fluids for renal clearance.
COMPLICATIONS:
Acute kidney failure
AnemiaLung dysfunction
Shock.
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Late
Delayed haemolytic transfusion reactions.
Sensitization/Alloimmunization.
Immune suppression.
Graft-vs-Host disease.
Transfusion iron overload (haemosiderosis)
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Transfusion AlternativesAcute Volume Repalcement (volume
expanders)
Dextran/ Gelatin/HES-Hydroxy ethyl starch)
Autologous transfusionPreoperative autologous blood donation (PABD)
Cell salvage : Intraoperative blood salvage,
Postoperative blood salvage
Acute normovolemic hemodilution (ANH)
http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/10/webpages/creditslink.htm -
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JEHOVAH`S WITNESSES:
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Reservation of blood
direct relation donor
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Conclusion
Avoid unnecessary transfusions
Transfusion of a single unit is often unnecessary
Booking system for blood
Use appropriate component rather than whole blood
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CooperationCooperation
is the Keyis the Key
to Success!!!to Success!!!
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REFERENCES:
Text book of General Medicine-Davidson
Physiology- Sembulingam.
Pharmacology- satoskar.
Hand book of transfusion medicine-Mc clelland.
Practice guidelines to blood transfusion-American red cross.
Screening donated blood for transfusion-transmissible
infections: recommendations- WHO recommendations
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