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Administration of Blood and Blood Component

Administration of Blood and Blood Component. Dr.Azarm. Blood Products. روشهاي صحيح مصرف خون. به منظور كاهش ترانسفوزيونهاي غير ضروري. Dr.Azarm. چرا لازم است خون وفراوردههاي خوني صحيح و هدفمند مصرف شوند؟ ------------------------------------. 1-خون ساختني نيست بلكه بايد اهدا شود.

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Administration of Blood and Blood Component

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  1. Administration of Blood and Blood Component Dr.Azarm

  2. Blood Products

  3. روشهاي صحيح مصرف خون به منظور كاهش ترانسفوزيونهاي غير ضروري Dr.Azarm

  4. چرا لازم است خون وفراوردههاي خوني صحيح و هدفمند مصرف شوند؟------------------------------------ 1-خون ساختني نيست بلكه بايد اهدا شود. 2-در همه جا خون فراوري نمي شود و در دسترس نمي باشد. 3-هميشه اهدا كننده اماده وجود ندارد. 4-عوارض انتقال خون هميشه بايد مد نظر باشد. Dr.Azarm

  5. نكات مهم • خون و فرآورده‌هاي خون بايد در اسرع وقت تزريق شود. • چنانچه فرآورده‌اي براي 30 دقيقه يا بيشتر در دماي اتاق قرار گيرد نبايد تزريق شود. • خون و فرآورده‌هاي خون نبايد در داخليخچال اتاق پرستاري ذخيره شود مگر در مواقع خاص مانند اتاق عمل يا در اتاق recovery. • چنانچه به هر علت واحد خون(RBC) باز نشود و در دماي مناسب قرار داشته باشد و در فاصله زماني كمتر از 30 دقيقه، به بانك خون برگردد مي‌توان از آن استفاده كرد.

  6. نكات مهم • خون نبايد در داخل ظرف حاوي آب داغ قرار گيرد زيرا اين عمل باعث هموليز گويچه‌هاي سرخ و آزاد شدن پتاسيم از گويچه‌هاي سرخ مي‌شود كه مي‌تواند براي زندگي بيمار مخاطره‌آميز باشد. • فرآورده‌اي كه ذوب شده نبايد دوباره منجمد شود و بايد هرچه زودتر مصرف شود. در صورتي كه به هر دليل تاخيري در تزريق رخ دهد، بايد در دماي محيط نگهداري شده و در عرض 4 ساعت مصرف شود. • توجه:مهم‌ترين مرحله نظارت، 15 دقيقه اول تزريق مي‌باشد.

  7. Whole Blood Dr.Azarm

  8. Whole Blood Description: • Up to 510 ml total volume • 450 ml donor blood • 63 ml anticoagulant-preservative solution • Haemoglobin approximately 12 g/ml • Haematocrit 35%–45% • No functional platelets • No labile coagulation factors (V and VIII)

  9. Infection risk Not sterilized, so capable of transmitting any agent present in cells or plasma which has not been detected by routine screening for transfusion-transmissible infections, including: HIV-1 and HIV-2, hepatitis B and C, other hepatitis viruses, syphilis, malaria and Chagas disease

  10. Storage • Between +2°C and +6°C in approved blood bank refrigerator, fitted with a temperature chart and alarm • During storage at +2°C and +6°C, changes in composition occur resulting from red cell metabolism • Transfusion should be started within 30 minutes of removal from refrigerator

  11. Indications • Red cell replacement in acute blood loss with hypovolaemia • Exchange transfusion • Patients needing red cell transfusionswhere red cell concentrates or suspensions are not available

  12. Contraindications Risk of volume overload in patients with: • Chronic anaemia • Incipient cardiac failure

  13. Administration • Must be ABO and RhD compatible with the recipient • Never add medication to a unit of blood • Complete transfusion within 4 hours of commencement

  14. RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-reduced blood’) Description • 150–200 ml red cells from which most of the plasma has been removed • Haemoglobin approximately 20 g/100 ml • Haematocrit 55%–75%

  15. Infection risk • Same as whole blood

  16. Storage • Same as whole blood

  17. Indications • Replacement of red cells in anaemic patients • Use with crystalloid replacement fluids or colloid solution in acute blood loss

  18. A: آنمي همراه با كمبود آهن B: آنمي پرنيسيوز C: كمبود تغذيه‌اي D: عدم جذب گوارشي E : ترميم زخم F: كمبود فولات وB12 G: آنمي همولتيك ارثي H: براي بهبود حال عمومي فقط هنگامي كه خونريزي فعال از دستگاه گوارش يا جاي ديگر بدن باشد نياز به تزريق داريم البته در چنين بيماراني هدف تصحيح هموگلوبيننيست بلكه هموگلوبين در حدي باشد كه بيمار علائم حياتي پايدار داشته باشد. مواردي كه نياز به تزريق وجود ندارد

  19. نوزادان و كودكان : در بيماران با سن كمتر از 4 ماه هموگلوبين كمتر از 13 گرم در دسي‌ليتر همراه با بيماري‌هاي شديد و سيانوتيك قلب و ريه و يا نارسايي قلب هموگلوبين كمتر از 10گرم در دسي‌ليتر همراه با بيماري‌هاي ريوي متوسط از دست رفتن سريع و حاد بيش از 10% حجم خون هموگلوبين كمتر از 8 گرم در دسي ليتر همراه با آنمي علامت‌دار *اين راهنماها يك پيشنهاد مي‌باشد و بايستي در مورد هر نوزاد به تنهايي تصميم‌گيري كرد. در هموگلوبين كمتر از 10 گرم در دسي‌ليتر كه كانديد عمل جراحي بزرگ هستند.

  20. در كودكان با سن بيشتر از 4 ماه • هموگلوبين قبل از عمل جراحي كمتر از 8 گرم در دسي‌ليتر و يا هماتوكريت زير 25% و يا هموگلوبين زير 8 گرم در دسي‌ليتر بعد از عمل كه همراه با علايم و نشانه‌هاي كم خوني باشد. • كاهش و يا از دست رفتن سريع و حاد بيش از 15% حجم خون يا وجود علايم و نشانه‌هاي هيپوولمي كه به تزريق مايعات كريستالوئيد يا كلوئيدي پاسخ نداده باشد. • هموگلوبين كمتر از 13گرم در دسي‌ليتر در بيماري شديد قلبي ريوي (سيانوز-دسترين تنفسي) • هموگلوبين كمتر از 8 گرم در دسي‌ليتر در :

  21. هموگلوبين كمتر از 8 گرم در دسي‌ليتر در : • الف) بيماراني كه تحت شيمي‌درماني يا راديوتراپي هستند. (نارسايي مغز استخوان) • ب ) بيماراني كه دچار كم‌خوني مزمن هستند كه به درمان طبي پاسخ نداده‌اند يا علايم و نشانه‌هاي كم خوني دارند. • عوارض بيماري سيكل‌سل نظير حوادث عروقي مغزي، Acute chest syndrom و آمادگي براي عمل جراحي. • در بيماران بتاتالاسمي هموزيگوت و يا هتروزيگوت كه بيشتر از ساير انواع تالاسمي دچار آنمي شديد مي‌شوند براي جلوگيري از عوارضي مانند رشد نابهنجار استخوان و بهبود در سرعت رشد و كاهش بار آهن بهتر است هموگلوبين در محدودة 10 گرم در دسي‌ليتر كنترل شود. البته قبل از تزريق نبايد هموگلوبين بيشتر از 5/9 گرم در دسي‌ليتر باشد تا از افزايش بار آهن جلوگيري شود.

  22. Administration • Same as whole blood • To improve transfusion flow, normal saline (50–100 ml) may be added using a Y-pattern infusion set

  23. RED CELL SUSPENSION Description • 150–200 ml red cells with minimal residual plasma to which ±100 ml normal saline, adenine, glucose,mannitol solution (SAGM) or an equivalent red cell nutrient solution has been added • Haemoglobin approximately 15 g/100 ml • Haematocrit 50%–70%

  24. Infection: risk Same as whole blood • Storage: Same as whole blood • Indications: Same as red cell concentrate • Contraindications: Not advised for exchange transfusion of neonates. The additive solution may be replaced with plasma, 45% albumin or an isotonic crystalloid solution, such as normal saline

  25. Administration : Same as whole blood • Better flow rates are achieved than with red cell concentrate or whole blood

  26. Frozen RBCs • Add cryoprotectant glycerol to RBCs followed by appropriate freezing (-65°C or lower) allows storage of RBCs for 10 years. • When Cells needed, unit thawed and washed with saline to remove glycerol. Washing “enters” storage bag-unit can be stored for only 24 hours at 1° to 6°C after thawing. • Used primarily to maintain supplies of uncommon RBC phenotypes needed by patients with alloantibodies against frequently occurring RBC antigens • Military uses to maintain emergent blood supplies.

  27. Leukocyte Poor RBCs Leukocyte-Reduced Red Blood Cells Description • A red cell suspension or concentrate containing <5 x 106 white cells per pack, prepared by filtration through a leucocyte-depleting filter • Haemoglobin concentration and haematocrit depend on whether the product is whole blood, red cell concentrate or red cell suspension • Leucocyte depletion significantly reduces the risk of transmission of cytomegalovirus (CMV)

  28. Indications • Minimizes white cell immunization in patients receiving repeated transfusions but, to achieve this, all blood components given to the patient must be leucocyte-depleted • Reduces risk of CMV transmission in special situations • Patients who have experienced two or more previous febrile reactions to red cell transfusion

  29. Contraindications • Will not prevent graft-vs-host disease: for this purpose, blood components should be irradiated where facilities are available (radiation dose: 25–30 Gy) Administration • Same as whole blood • A leucocyte filter may also be used at the time of transfusion if leucocyte-depleted red cells or whole blood are not available

  30. Washed RBCs • Washed RBCS are RBCs washed with saline to remove most of the plasma. • Washed RBCs are not leukoreduced. • Indications-patients who have had severe allergic reactions associated with transfusion or immunoglobulin A (IgA) deficiency. • Washed RBCs must be given through a standard blood filter, can transmit hepatitis and other infectious diseases • Because bag must be entered to introduce saline, washed RBCs must be given within 24 hrs of preparation.

  31. Irradiated WB or RBCs • Blood components exposed to standard dose of ionizing radiation to make viable lymphocytes unable to engraft (to reduce GvH) in premature newborns or highly immunocompromised patients (e.g., bone marrow or solid organ transplant). • “Although no significant adverse red cell structural events have been noted, mild functional impairment manifested by significant leakage of potassium and accumulation of plasma hgb has been noted after gamma irradiation.” • ASA Questions and Answers About Transfusion Practice- 2002

  32. گرم كردن خون • در مواردي كه يك حجم خون و يا بيشتر طي 24 ساعت جايگزين شود، تزريق خون را ماسيو مي‌نامند. يك حجم خون به ميزان ml/Kg 75 يا حدود ml 5000 تخمين زده مي‌شود. • Exchange Transfusion نوزادان • در صورتي كه بيمار داراي Ab‌هاي واكنش‌دهنده در دماي سرد(Cold Antibody) باشد. • زماني كه بيمار آريتمي داشته باشد. • براي زماني كه خون با سرعت 50 ml/minute براي 30 دقيقه يا بيشتر براي بزرگسالان و سرعت 15 ml/Kg/hour براي كودكان تنظيم شده باشد. • براي بيماران در طول عمل جراحي Bypass در فاز re-warming • پلاسمافرزيس درماني يا فرآيند Red cell exchange • تزريق خون در نوزادان و كودكان • سندرم رينود يا وازواكتيو ناشي از سرما

  33. Use of RBCs in Massive Transfusion • If 50-75% blood volume replaced by type 0 Blood (10 U RBCS in adult)- • May need to continue with type 0 blood- • “Otherwise, risk of major cross-match reaction increases. • Patient may have received enough anti-A or anti-B antibodies to precipitate hemolysis if A,B, or AB units subsequently given” • Smith, C.(2003)Current Practices in Fluid and Component Therapy ITACCS. Seminar-Massive Transfusion

  34. FFP

  35. Description • Pack containing the plasma separated from one whole blood donation within 6 hours of collection and then rapidly frozen to –25°C or colder • Contains normal plasma levels of stable clotting factors, albumin and immunoglobulin • Factor VIII level at least 70% of normal fresh plasma level

  36. FFP • Collected by centrifugation of whole blood, or by apheresis as a single donor unit (taken for plasma, or as a by product of RBC or platelet apheresis) • Must be frozen within 6 hours of collection,can be kept frozen for a year, takes 20-30 minutes to thaw, • Before use, should be thawed in the blood bank in water which is between 30°C to 37°C. Higher temperatures will destroy clotting factors and proteins • is then kept at 1-6° and transfused within 24 hours

  37. FFP • Need ABO Compatibility, but Rh Neg patients can receive Rh Pos FFP • 4-5 Units of platelets, one unit WB all have same a similar quantity of coagulation factors as unit of FFP (except for labile factors lost to cold storage in WB)

  38. Indications • Replacement of multiple coagulation factor deficiencies: e.g. —Liver disease —Warfarin (anticoagulant) overdose —Depletion of coagulation factors in patients receiving large volume transfusions • Disseminated intravascular coagulation (DIC) • Thrombotic thrombocytopenic purpura (TTP)

  39. Precautions • Acute allergic reactions are not uncommon, especially with rapid infusions • Severe life-threatening anaphylactic reactions occasionally occur • Hypovolaemia alone is not an indication for use

  40. FFP • Goal- to raise level of clotting factor to 30% of normal • Takes 10-15 cc/kg • Rapid reversal of coumadin 5-8cc/kg FFP (Vitamin K would take 12-18 hours) • Clin Anes Procedures-Mass Gen-2002

  41. Cryoprecipitate

  42. Description • Prepared from fresh frozen plasma by collecting the precipitate formed during controlled thawing at +4°C and resuspending it in 10–20 ml plasma • Contains about half of the Factor VIII and fibrinogen in the donated whole blood: e.g. Factor VIII: 80–100 iu/pack; fibrinogen: 150–300 mg/pack; factor XIII: 40 to 60 U/pack

  43. Cryoprecipitate • Shelf life-Frozen: 1 yr (<–30°C)Thawed: Give within 6 hours • Preferable to be ABO compatible (AABB) May have RBC fragments that can sensitize Rh-D neg patients

  44. Indications • As an alternative to Factor VIII concentrate in the treatment of inherited deficiencies of: — von Willebrand Factor (von Willebrand’s disease) — Factor VIII (haemophilia A) — Factor XIII • As a source of fibrinogen in acquired coagulopathies: e.g. disseminated intravascular coagulation

  45. Cryoprecipitate • A dose of 1 unit (bag) of cryoprecipitate per 7-10 kg body weight raises fibrinogen levels by at least 50 mg/dL. • The half-life of fibrinogen is 3 to 5 days; additional doses given on the basis of lab test results.

  46. Platelets

  47. Description Single donor unit in a volume of 50–60 ml of plasma should contain: • At least 55 x 109 platelets • <1.2 x 109 red cells • <0.12 x 109 leucocytes

  48. Unit of issue May be supplied as either: • Single donor unit: platelets prepared from one donation • Pooled unit: platelets prepared from 4 to 6 donor units ‘pooled’ into one pack to contain an adult dose of at least 240 x 109 platelets

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