Blood Transfusion Problems

8/10/2019 Blood Transfusion Problems

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An adult human has about 46 liters of blood circulatingin the body. Among other things, blood transports oxygento various parts of the body.

Blood consists of several types of cells floating around ina fluid called plasma.


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China, 1000 BC

The soul was contained in the blood.

Egyptians bathed in blood for their health.

Pliny and Celsus describe Romans drinking the blood of

fallen gladiators to gain strength and vitality and to cure epilepsy.

Taurobolium, the practice of bathing in blood as it cascaded

from a sacrificial bull, was practiced by the Romans.

Blood in History


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Animal to Human Transfusion

Early lamb blood transfusion


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A blood transfusion is the infusion of whole blood or ablood component such as plasma, red blood cells, or

platelets into the patients venous circulation.


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You may need it if you loose too much bood, such:

Injury or major surgery.

An illness that causes bleeding, such as a bleeding

ulcer. An illness that destroys blood cells, such as hemolytic

anemia or thrombocytopenia.


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PURPOSE OFBLOOD


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Cross matching is the process of derminingcompatibility between blood specimens


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WHAT IS BLOOD GROUP ?

Bloood group is an inherited trait,isdetermined by the type of antigensand antibodies present in the blood

BLOOD TYPES

A - B - AB - O


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BLOOD GROUP ANTIGEN

A A antigen

B B antigen

AB A+B antigens

O -

RH

Negative

Positive


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WHAT IS ANTIGENS ?

An antigens is a substance thatcausing the formation of antibodies

WHAT IS ANTIBODYS ?Antibodies is a protein substancedevelop in the body in response to

the presence of an antigen that hasentered the body
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Life Saving &

Life Threatening Process
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Hemolytic transfusion reaction Febrile non hemolytic transfusion reaction

Alergic reaction

Allo immunization

Graft versus host response

Infection

Bacteria

Volume overload Iron toxicity

Acute transfusion-related acute lung injury (TRALI)


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Malaria

Chagas disease

West nile virus

Variant Creutzfeldt-Jakob disease


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Hep B 1: 140,000

Hep C 1: 225,000

Hep A 1: 1,000,000

HIV 1: 1,500,000 HTLV 1: 650,000

Bacterial 1: 1,000,000

Malaria 1: 1,000,000 Syphylis 1: 1,000,000


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Mistransfusion rate 1 : 14.000 US

1 : 28.000 UK

Half in the clinical arena and 30 % in the laboratory


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Transfusion of mis-matched ABO cells 1: 35,000

ABO incompatible death rate 1:600,000

Transfusion of red cells to wrong patient 1: 17,000

Transfusion of pre-deposited blood to wrongpatient 1:20,000


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Hgb > 10 gr% rarely indicated

Less than < 6 g/dl almost always indicated

6 10 g/dl based on patient risk

Anesth 1996;84: 732 - 747


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Platelet Transfusion Indication Bone marrow failure Autoimmune thrombocytopenia Alloimmune thrombocytopenia

Abnormalities of platelet function Dilutional thrombocytopenia Cardiopulmonary bypass surgery

Contraindications to platelet transfusions

thromboticthrombocytopenic purpura haemolytic uraemic syndrome heparin-induced thrombocytopenia


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Granulocyte Transfusion Indication

Bone marrow failure caused by disease or myelotoxic treatment

Abnormal neutrophil function and persistent infection


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To increase the level of clotting factor


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It is abnormal signs and

symptoms that will occur duringor after transfusion and effectsthe patiens health

Clinical


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Acute Reaction Causes

ClinicalMainifestations Management

Allergic

Sensitivity toplasma

protein ordonorantibody,

which reactswithrecipientantigen

Flushingitching ,rashurticaria, hivesasthmaticwheezing

laryngealedema

anaphylaxis

STOP TRANSFUSIONIMMEDIATELY

KEEP VEIN OPENWITHNS

Notify doctor , infectioncontrol, blood bank

Give antihistamine asdirected.

Send blood samples and bloodbags to blood bank. Collecturine samples for testing.
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Prevention

ASSESSMENT

Before transfusion ask the patient

About past reaction

Have emergency drugs ( Bed Side)

Acute Reaction Causes Clinical Management


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Acute Reaction Causes ClinicalMainifestations

Management

Febrilenon -

hemolytic

hypersensitivity todonor white bloodcells , platelets, or

plasma protein

Flushingsuddenchills

and feverheadacheanixiety

STOP TRANSFUSIONIMMEDIATELY

KEEP VEINOPENwith NS

Notify doctor , infectioncontrol, blood bank

Give antipyretics asdirected.

Check temperature every1/2hrs.or as indicated

send blood samples andblood bags to blood

bank

Collect urine samples fortesting.


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Prevention

ASSESSMENT

Give antipyretic before

transfusion as directed

Leukocyte poor blood

products may not be

recommended for futuretransfusion

Acute Causes Clinical Management


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cuteReaction

Causes C caMainifestations

a age e t

Septicreactions

Transfusion ofblood or blood

componentscontaminated withbacteria

rapid onset ofchils

High feverVomiting ,diarrheaMarkedhypotension

STOPTRANSFUSIOMIMMEDIATEL

KEEP VEIN OPENwith NS Notify doctor , infection

control, blood bank give antipyretics as

directed.check temperature every

1/2hrs.or as indicatedobtain cultures of

patients bloodreturn blood bags &

blood set to blood bank.treat septicemia asdirected ( IV fluids.

Antibiotics...


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Prevention

Do not permit blood to stand atroom temperature longer than

necessary.

Warm temperatures promote bacterial

growth.Inspect blood for gas bubbles,

clotting or abnormal color.

Acute Causes Clinical Management


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Reaction Mainifestationsg

Circulatoryoverload

Fluidadministreted at a

rate or volumegreater than thecirculatory systemcan accommodate .Increased blood inpulmonary vesselsand decreased lungcompliance.

rise in venouspressure

distended neckveins.DyspneaCoughCrackles at baseof lunges

STOPTRANSFUSIOMIMMEDIATEL

KEEP VEIN OPENwith NS Notify doctor ,infection control, bloodbank place patient upright

with feet in dependentposision.administer prescribeddiuretic, oxygen,

morphine , andaminophylline.


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Prevention

concentrated blood productsshould be given whenever

positive.

transfuse at a rate within thecirculatory reserve of the

patient.

monitor central venous

pressure of patient with heart

disease.

Clinical


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Acute Reaction Causes Mainifestations

Hemolytic

reaction

IncompatiblePLASMA

IncompatibleRBCs

Infusion of incompatibleblood product.

Antibodies inRECIPIENTS

plasma

DONORS RBCs

OR

Antibodies in DONOR

plasma

RECIPIENTS RBCs

chills, feverlower back pain

feeling of head fullness,flushingoppressive feelingTachycardia,tachypneahypotension,vascularcollapeshemoglobinurea,hemoglobinemiableedingacute renal failure

MANAGEMENT PREVENTION


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MANAGEMENT

STOPTRANSFUSIONKEEP VEIN OPEN with 0.9% saline.

Notify doctor , infection control,blood bank

Treat shock if present

Draw testing samples, collect

urine samples.

Maintain blood pressure with IVcolloid solutions.

Administer prescribed diuretic,to

maintain blood flow, glomerular

filtration, and renal blood flow.

Monitor urin output.Patient may require dialysis if

renal failure occur

PREVENTION

Verify patient identification from

sample collection to product

infusion.Begin infusion slowly and

observe closely for 30 min

DELAYED Causes Clinical Management


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REACTION Mainifestationsg

Delayed

hemolyticreaction

The destruction oftransfused flood cells

by antibody notdetect

FeverMild jaundice

Decreasedhematocrit

Generaly no acutetreatment is required, but

hemolysis may be enoughto cause shock and renalfalure

PREVENTION

The crossmatch blood sample should be drawn

within 3 days of blood transfusion. antibody

Formation may occur within 90 days oftransfusion

DELAYED Causes Clinical Management


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REACTION Mainifestations

Iron

overlood

Deposition of iron inthe heart, endocrine

organs,liver,spleen,skinand other major organsas a result of multiple,long tearm transfusion.

DiabetesDecreased thyroid

functionHeart failure andother symptomsrelated to majororgan failure

Treat symptomaticallydeferoximine which

removes accumulated ironthrough the kidneys. I.V-I.M-S.C

NO PREVENTION

DELAYED CLINICAL


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REACTION CAUSES MAINIFESTATIONS MANAGEMENT

Hepatitis B

INFECTEDBLOOD

PRODUCTS

Elevated liver enzymesAnorexia, malaise

Nausea and vomitingFeverDark urineJaundice

Treat symptomatically

as instructed bydoctors

Hepatitis C Elevated liverenzymes

Chronic liver diseaseand cirrhosis maydevelop

Treat symptomaticallyas instructed bydoctors

AIDS Night sweatsUnexplained weight loosDiarrheaEtc

As instructed bydoctors

DELAYED CLINICAL


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REACTION CAUSES MAINIFESTATIONS MANAGEMENT

Syphilis INFECTEDBLOOD

PRODUCTS

Generalized rashRegionallymphadenopathy

Presence of chancre

Penicillin therapy

Malaria INFECTEDBLOOD

PRODUCTS

FeverFatigueHepatomegalySplenomegaly

Rest and supportivemanagement

PREVENTION OF DELAYED REACTION

Proper blood screening

In case of malaria

donor should be asked if he has

cold,flu or foreign travel


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GENERAL

CONCIDERATIONSTO

PREVENT BLOOD

TRANSFUSIONREACTION


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LABORATORY

Blood screening for

infectious diseases.

Proper storage (4C)

Antibody screening

Blood compatibility-RH

To protect the donor from

possible risks of donation

and protect the patient

from the risk of transfusion


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PATIENT

Previous allergic reaction

Consent

Name and phone number of a

contact person in case of emergency


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DOCTOR

The physicians order should specifyBlood component, volume, and

rate of transfusion


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NURSE

Only trained and qualified nurses areallowed to perform the

blood transfusion steps


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NURSE

Sending blood sample for cross

matching with CLEAR and CORRECT

Patient name, file number, room number,age, sex, department, bed number,

date,time,nurse name and signature


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BEFORE receiving blood

Doctor order

ConsentPatient assessment

Premedicate the PT.30min. before

transfusion for TABs & before transfusion is

initiated for IV

NURSE


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Blood Transfusion Problems

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