1 / 35

Fe & Female Workshop

F.O.G.S.I. Fe & Female Workshop. Organised by Nashik Ob/Gy Society. Hazards of Blood Transfusion. Presented by Dr. Ravindra S. Shivde M.D.,D.G.O. MILESTONES:. Andreas Libavius- 1546-1616 James Blundell- 1818 Karl landsteiner- 1900. Blood Transfusion. General Tonic?.

kyla-guzman
Download Presentation

Fe & Female Workshop

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. F.O.G.S.I. Fe & Female Workshop Organised by Nashik Ob/Gy Society Hazards of Blood Transfusion Presented byDr. Ravindra S. ShivdeM.D.,D.G.O. Hazards of Blood Transfusion

  2. MILESTONES: • Andreas Libavius- 1546-1616 • James Blundell- 1818 • Karl landsteiner- 1900 Hazards of Blood Transfusion

  3. Blood Transfusion General Tonic? Hazards of Blood Transfusion

  4. Risks of Blood Transfusion • Incompatible blood • Allergy, febrile reaction • Infection • Immunosuppression Immunosuppression Infection Noninfectious Hazards Hazards of Blood Transfusion

  5. Risks of blood transfusion( Per unit of blood U.S.A. ) • Minor allergic reactions 1:100 • Viral hepatitis (A,B,C,D,G) 1:50,000 • Hemolytic reactions 1:6,000 • Fatal hemolytic reactions 1:600,000 • HIV infection 1:420,000* • HTLV-I/II 1:200,000 • Bacterial infections 1:2,500 • Acute lung injury 1:500,000 • Anaphylactic shock 1:500,000 • Graft Vs. host disease Rare • Immunosuppression 1:1 Hazards of Blood Transfusion

  6. Transfusion-transmitted infections Post-transfusion purpura 3% Acute lung injury 6% 8% Graft vs host disease 2% Incorrect blood/ componenttransfused 14% 53% Delayed transfusion reaction 15% Acute transfusion reaction Based on 366 spontaneously-reporteddeaths/major complications between October 1996 and September 1998 in the UK and Ireland. Serious Hazards of Transfusion Williamson LM, et al. BMJ. 1999;319:16-9. Hazards of Blood Transfusion

  7. Hazards of Blood Transfusion

  8. Infectious complications • Viruses • HIV-1,2 … • HTLV-I,II • Cytomegalovirus • Epstein-Barr virus • Parvovirus B19 • Creutzfeldt-Jakob disease(CJD) • TTV • West Nile • Spirochetes • Treponema pallidum • Borrelia burgdorferi • Parasites • Plasmodia • Babesia microlti • Trypanosoma crizi • Toxoplasma gondii • Leishmania donovani • Bacteria • Staphylococcus • Salmonella • Yersinia enterocolitica Hazards of Blood Transfusion

  9. Risks of Transfusion: Infectious Disease • HIV = 1 in 1.8 million • HCV = 1 in 1.6 million • HBV = 1 in 220,000 HIV = human immunodeficiency virus. HCV = hepatitis C virus. HBV = hepatitis B virus. Busch MP, et al. JAMA. 2003;289:959-62. Hazards of Blood Transfusion

  10. Risks of Allogeneic Blood ‘TRIM’ Transfusion Related Immune Modulation Hazards of Blood Transfusion

  11. Immune modulation • Allogeneic transfusion may enhance tumor recurrence following colorectal cancer resection (Heiss MM, J Clin Oncol 1994) • Allogeneic transfusion is associated with prolonged hospital stay (Vamvakas EC, Transfusion 2000) • Allogeneic transfusion is associated with increased risk of bacterial infection (35%) and pneumonia (52%) (Carson JL, Transfusion 1999) • Length of storage of transfused RBCs was associated with postoperative pneumonia following CABG surgery, 5% per unit (Vamvakas EC, Transfusion 1999) Hazards of Blood Transfusion

  12. Immune Effects of Blood • Immunologic effects of autologous/allogenic blood Tx • Decreased T-cell proliferation • Decreased CD3, CD4, CD8 T-cells • Increased soluble cytokine receptor • sTNF-R, sIL-2R • Increased serum neopterin • Increased cell-mediated lympholysis • Increased TNF-alfa • Increased suppressor T-cell activity • Reduced natural killer cell activity Hazards of Blood Transfusion McAlister FA et al, Br J Surg 1998;85:171-8. Innerhofer P et al, Transfusion 1999;39:1089-96.

  13. Blood Tx Increases Risk of Postoperative Bacterial Infection • 20 peer-reviewed studies, 1986-2000 • N = 13,152 (Tx 5215, No-Tx 7937) • Association of Blood Tx to Infection • Common OR 3.45 (range 1.43-15.15) • 17 of 20 studies with p < 0.05 • Trauma subgroup • Common OR 5.26 (range 5.03-5.43) • All studies with p < 0.05 (0.005 – 0.0001) • Blood Tx associated with greater risk in trauma pts Hill GE, Minei JP et al. J Trauma 2003;54:908-914 Hazards of Blood Transfusion

  14. Nosocomial Infection Rates in Critically Ill Patients For each unit of PRBCs given, the odds of infection is increased by a factor of 1.5 P < .05 N = 1,717 n = 416 n = 1,301 Adjusted for severity of illness using MPM-0 scores, age, gender (Project IMPACT). Taylor RW et al, Crit Care Med 2002;30:2249-54. Hazards of Blood Transfusion

  15. The Impact of PRBCs on Nosocomial Infection Rates in ICU • Retrospective database study of 1,717 patients using Project IMPACT • NI rates of 3 groups were compared: • Entire cohort • Transfusion group • Nontransfusion group • Patients stratified for age, gender, and probability of survival using Mortality Prediction Model (MPM-0) scores Taylor RW et al, Crit Care Med 2002;30:1-6. Hazards of Blood Transfusion

  16. Do Blood TransfusionsImprove Outcomein Sepsis? Hazards of Blood Transfusion

  17. Mortality Rates in Critically Ill Patients P < .05 N = 1,717 n = 416 n = 1,301 Taylor RW et al, Crit Care Med 2002;30:2249-54. Hazards of Blood Transfusion

  18. TRALI • 1:2000 transfused patients • FDA reports as the third most prevalent transfusion related mortality, after hemolysis and sepsis • Associated with: whole blood, RBC, platelets, FFP and cryo. • CHF – ARDS, fleeting or devastating • Two prominent theories • HLA class I and possible II, and monocyte antigens • 20% of women with multiple gestations carry class I antigens • Mixture of predisposition and infusion of blood related lipid derived mediators Hazards of Blood Transfusion

  19. Donor Leukocytes • Persistence of donor WBCs in trauma patients for up to 1.5 years after an allogeneic blood transfusion • ‘Survival of donor leukocyte subpopulations in immunocompetent transfusion recipients: frequent long-term microchimerism in severe trauma patients’ • 2 x 109 WBCs in one unit of packed red blood cells • 1 x 108 WBCs – centrifuged, buffy coat depleted • 1–5 x 106 WBCs – leukocyte filter, leukocyte-depleted Hazards of Blood Transfusion Lee TH et al, Blood 1999;93:3127–3139

  20. Why is blood transfusionNOT associated withimproved outcome? Hazards of Blood Transfusion

  21. Age of Blood Hazards of Blood Transfusion

  22. Stored RBCs • Increased deformity • Decreased 2,3, DPG • Metabolic acidosis • decreased oxygen carrying capacity • Increased red cell death with increased age of blood (~30% dead) • No improvement in oxygen utilization at the tissue level Hazards of Blood Transfusion

  23. Distribution of Transfused Units by Age of Blood – CRIT Study 60% of Blood transfused is > 20 days old Percentage of Patients 0 - 10 10 - 20 20 - 30 30 - 40 > 40 Oldest Age of Blood in Days In Trauma Subset, 68% of blood is > 20 days old Hazards of Blood Transfusion

  24. Guidelines for Blood Transfusion in Anemia • Anemia is common • No evidence that blood tx for treatment of anemia improves outcome • Critically ill patients can tolerate Hb levels as low as 7 mg/dL • Blood should be transfused for physiologic indications Hazards of Blood Transfusion

  25. How to reduce the hazards? • RBCs should be administered as single units for most operative and inpatient indications (transfuse and reassess strategy) except for ongoing blood loss with hemodynamic instability. 1PRBC 1.3 gm/dl • Tx decisions are clinical judgments that should be based on the overall clinical assessment of the individual patient. Transfusion decisions should not be based on laboratory parameters alone. • Routine premedication is notadvised unless the patient has a history of previous transfusion reactions. Premedication has not been shown to reduce the risk of transfusion reactions. Hazards of Blood Transfusion

  26. WHAT BEFORE ANY TRANSFUSION: • W- whether required?, when? • H- how much? • A- actual component required? • T- time duration and technique of transfusion? Hazards of Blood Transfusion

  27. W- WHETHER REQUIRED? Indications: • Anemia- 60% • Surgery- 42% • Acute hemorrhage- 26% • Pregnancy- 16%. Seventy-four per cent of adult transfusions were inappropriate. Indian Study by Tim Bray et al Hazards of Blood Transfusion

  28. W- WHAT TO TRANSFUSE? • Use Packed red cells to correct volume & oxygenation. • Uncontrolled bleeding and laboratory evidence of coagulopathy –Add fresh frozen plasma. • Bleeding continues :Consider Platelets after investigations. Hazards of Blood Transfusion

  29. THRESHOLD FOR RED CELL TRANSFUSION: HISTORICAL FACTS • MAYO CLINIC in 1900 proposed a target value of 8-10 g/dL. • CURRENT PRACTICE (NIH Consensus) is 7g/dL in the absence of disease • 8-10g/dL in the presence of disease (cardiovascular disease/risk factors/elderly). • Rate of fall of Hb is more important than the actual Hb value • Healthy individuals tolerate Hb levels as low as 5g/dL Hazards of Blood Transfusion

  30. FFP • More than 1 blood volume replaced • Prothrombin time prolonged with INR >1.5 and/or • Continued blood loss Dose: 15 ml/kg or 1 Litre (4 packs) for adult of 60 kg Hazards of Blood Transfusion

  31. Platelets • Platelet count below 50 × 109/l (<50,000/ cmm), in the presence of bleeding. • Increased risk of hemorrhage in coagulopathy- <= 10000/mm3. • Vaginal deliveries or operative procedures ordinarily associated with insignificant blood loss may be undertaken in patients with platelet counts < 50,000/mm3. • Drop in Platelet below this level necessitates transfusion with platelet concentrates. Dose: 4-6 platelet concentrates or one unit of single donor (apheresis) platelets. Hazards of Blood Transfusion

  32. Cryoprecipitate • If the fibrinogen is particularly low(<1g/l) or <100mg/dl. • Factor VIII deficiency • Early use of FFP may avoid the need for cryoprecipitate • Give 10 units initially and repeat based on fibrinogen estimation Note: Cryoprecipitate is not available from all blood centres. 5 units of FFP (1000-1250 ml) contains, typically, the same quantity of fibrinogen as 10 units of cryoprecipitate (approximately 150-250 ml) Dose: one unit/ 5 kg body weight or 10 units in the adult. Hazards of Blood Transfusion

  33. Jehovah’s Witnesses and Associates - World Population • 1985 - 7,792,109 • 1995 - 13,147,201 • 2000 - 14,872,086 • 2007 - 16,675,113 Hazards of Blood Transfusion

  34. What is Acceptable Risk? Hazards of Blood Transfusion

  35. Thank you! Hazards of Blood Transfusion

More Related