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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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