DISCUSS THE INDICATIONS AND COMPLICATIONS OF BLOOD TRANSFUSION AND THEIR MANAGEMENT to edit Master subtitle style Click

BY DR TELLA A.O.

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OUTLINE

INTRODUCTION HISTORICAL BACKGROUND OF BLOOD TRANSFUSION AND COLLECTION OF BLOOD

BRIEF

PRINCIPLES DONATION BLOOD

PRODUCTS AND THEIR INDICATIONS OF STORAGE OF BLOOD OF TRANSFUSION

EFFECTS

COMPLICATIONS/HAZARDS PREVENTION

& MANAGEMENT OF COMPLICATIONS

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INTRODUCTION
Blood

is a vehicular organ that perfuse all other organs. of blood with life & vitality known from time immemorial. is a form of organ transplantation that is very invaluable esp. in surgical patients. potential hazards which have increased sensitivity to its use.

Association BT

Has

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HISTORICAL PERSPECTIVE
First

man-to man BT in 1818 by J. Blundell

Landsteiner

discovered ABO blood grps in 1900 & later, Rh factor was recognized by Levine & Stetson in 1939. of collecting & storage of blood became available thereafter. blood bank established in 1937 at Cook County Hospital in Chicago.

Methods First

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PRINCIPLES OF BLOOD TRANSFUSION

Avoid

BT if at all possible. testing of donated blood is ensured. should be corrected before elective

Proper Only

components needed should be given.

Anaemia

surgery.
If

1 unit is needed, then BT is not necessary. However, single unit transfusions may be justifiable in some settings.

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PRINCIPLES (contd)
Avoid Hb

automatic transfusion threshold.

conc. Alone is not enough indicator for consent.

BT.
Informed Appropriate Vital

identification of the blood component selected for the patient. sign monitoring. should be administered slowly during the 1st 30 min. medications/drugs should be added to the
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Blood No

BLOOD DONATION & COLLECTION

Appropriate

donor selection. screening.

Pre-donation Blood

collection process manually or using automated collection devices. The vol. collected is standardized for the collection bag used e.g. 450 ml + 63ml CPDA-1 bag. component separation. observation & ADR to donation.

Blood

Post-donation

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BLOOD PRODUCTS
BLOOD

COMPONENTS: (A)Oxygen carrying components--> - RBC concentrate/Packed RBCs.

- Leucocyte poor RBCs. -RBC + additive solution. -Washed RBCs. - Frozen red cells/Deglycerolized RBCs. (B)Platelet Products: - Platelet rich plasma (PRP) - Platelet concentrate
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(C) Granulocytes-usually by leucopheresis.

PLASMA

DERIVATIVES: Plasma Products - Fresh frozen plasma - Cryoprecipitate - Stored plasma (X, IX, XII, VII)

Coagulation

factor concentrates

- factor VIII - factor IX

Oncotic

Agents
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- Albumin

 Immune

Serum Globulin

- Immune serum globulin(IgG) - Hepatitis B immune globulin - Varicella zoster immune globulin - Rh immune Globulin - Tetanus Immune globulin - Rabies - Rubella - Hepatitis A.
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INDICATIONS FOR BLOOD TRANSFUSION

COMPONENT COMPOSITIO VOLUME S N Whole Blood All 450/500ml components INDICATIONS FOR USE Hypovolaemi c anaemia; Massive BT; EBT; DIC Symptomatic anaemia

Packed RBCs RBCs; WBCS; 250ml Plts; Plasma; (Hct=75%) Washed RBCS RBCs; No plasma; reduced 180ml
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Symptomatic anaemia; Allergic

COMPONENTS COMPOSITION VOLUME Platelet concentrates

Plts 5.5X1010/unit; 50ml/unit WBCs; RBCs; Plasma

Granulocytes

WBCs1.0X1010/unit 220ml ; Lymphocytes; Platelets

FFP

All coagulation 220ml factors Reduced 220ml factors V and VIII 5/19/12

Thawed plasma

INDICATIONS FOR USE Thrombocytop enia; Chemotherapy -induced anaemia Neutropenia; Infections unresponsive to antibiotics Def. of labile & stable factors Def. of stable factors

BLOOD STORAGE & PRESERVATION

Whole The

blood is refrigerated after collection ASAP at T of 2-6C. shelf-life of the blood depends on the anticoagulant used: ACD {67.5ml} --21 days CPD {63ml} --21 days CPDA-1 {63ml} --1-35 days SAGM --42 days

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 STORAGE

OF OTHER COMPONENTS: 1) Platelet concentrate 22C for up to 7 days. 2) Fresh Frozen plasma At -18C for up to 12 months. 3) Cryoprecipitate Below -18C for up to 12 months. 4) Frozen Deglycerolized RBCs Preserved with glycerol or dimethyl-1sulpoxide at -80C for years.

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EFFECTS OF STORAGE
RBCs:

ATP; 2,3-DPG; K+ plasma. Not viable after 24 hrs.

Leucocytes: Platelets:

Not viable after 24 hrs but remains for 2 weeks. factors.

Electrolytes--K+;Na+;Ca++. Clotting pH:

Continuing RC glycolysis generates lactic acid.

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COMPLICATIONS/HAZARDS OF BLOOD TRANSFUSION (A) IMMEDIATE BTR

IMMUNOLOGIC: NON-IMMUNOLOGIC:

-Immediate Haemolytic BTR. -Allergic & Anaphylactic BTR

-Febrile TR -Bact. Contamination -Circulatory overload -Cardiac arrest -Embolism (air/particles) -Acute lung injury

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DELAYED BTR
IMMUNOLOGIC: NON-IMMUNOLOGIC

-Thrombophlebitis -Post-transfusion TP -Transmission of diseases: -Delayed Haemolytic BTR HBV;HCV;HIV;CMV;EBV;Syphilis;Malaria;Chaga -Graft versus Host disease. s dx;Toxoplasmosis; -Tansfusion-related immunomodulation -Iron overload -Citrate toxicity -Haemosiderosis -Cxns of massive BT.

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TRANSFUSION REACTIONS Febrile NHTR

MECHANISMS Incomp. btw Ag on donor WBCs/plts & Ab in the recipient plasma; Bact pyrogens Immune Ab of Rh system; Ab of the IgM/IgG class which activates complemt Hypersensitivity to donor plasma proteins (IgEmediated) Ab in donor plasma reactive with recipients WBCs (agglutination occurs in pulm.

Immediate HTR

Allergic & Anaphylactic Reactions

Transfusion-related Acute Lung injury

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MASSIVE BLOOD TRANSFUSION

Transfusion

of equivalent of TBV within 24 of more than half of the TBV in 1

hrs.
Transfusion

hr.
TBV

is 70ml/kg in adults and 80-90ml/kg in children. include massive blood loss from trauma; ruptured aortic aneurysm; massive GI bleeding; Liver transplantation etc.

Indications

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PROBLEMS OF MASSIVE BT
Haemolytic Circulatory Cardiac

BTR: Usually due to error. overload.

arrest: -Hypothermia; -hyperkalaemia; -hypocalcaemia; -Acidosis. complications: -ARDS; TR-ALI oxygen delivery. diasthesis.
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Respiratory Impaired Bleeding

ACUTE TRANSFUSION REACTIONS

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MANAGEMENT OF TRANSFUSION REACTIONS

STOP

THE TRANSFUSION IMMEDIATELY. of N/S. of V/S: T, Pulse,RR & BP.

Infusion

Monitoring O

is given if pulm. symptoms are prominent. P/E is carried out to assess the patient. is taken & sent with the blood for recrossmatching. voided urine sample/catheter specimen.
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Brief

Sample Freshly

PREVENTION OF TRANSFUSION REACTION

Appropriate Improved

pre-testing & proper labelling.

blood bank services.

Encouraging Exploiting

voluntary non-remunerated blood donation. Autologous Transfusion: -Autologous pre-donation -AISH -Intraoperative blood salvage of pharmacologic agents: EP ;Haematinics anaesthetic & surgical management. 5/19/12

Use

Good

CHALLENGES OF BLOOD TRANSFUSION

Limitations Religious Blood Blood Blood

of our blood banks- storage & blood separation. objections to blood transfusion. procurement in emergencies.

procurement in cases of candidates for massive blood transfusion. for patients with AIHD

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BLOOD SUBSTITUTES & ALTERNATIVES

PLASMA SUBSTITUTES: These are colloid and crystalloid solutions used for maintaining the circulation volume following acute haemorrhage, shock, burns and septicaemias. Plasma substitutes have no 02 carrying capacity and also lack haemostatic properties. Crystalloids No oncotic activity Colloids temporary oncotic activity (short half life)

Plasma substitutes are used in emergency prior to the availability of compatible blood and appropriate blood product. 5/19/12

 CRYSTALLOIDS:

-0.9% saline solution. -Ringers Lactate. -Darrows solution. -5% Dextrose. COLLOIDS: -Dextrans. -Hydroxylethyl starch. -Gelatin (Haemacel).

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CRYSTALLOIDS VS COLLOIDS
Solutions Advantages Disadvantages Lack pressure in Crystalloids Readily available of oncotic plasma Easy storage Easy administration Non-immunogenic Non-toxic Do not inhibit synthesis of albumin
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ARTIFICIAL O CARRIERS
Synthetic O2 carrying agents are still experimental: Two classes exist

and,

Perfluorochemicals

Chemically modified Hb
The perfluorochemicals are fluorinated hydrocarbons. They readily dissolve oxygen, but are poorly soluble in plasma. One of these compounds fluorosol DA has been studied in animals and is currently being studied in humans. Side effects: hypotension and DIC,
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CONCLUSION
Blood

transfusion is an essential component of therapy for a wide variety of disorders. However, the hazards of allogeneic BT have also been well documented over the years. while researches are on-going to discover the perfect blood substitute, there is always the need to weigh benefits against risks so as to make the best use of this scarce human resource.

Thus

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THANK YOU.
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5/19/12