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BLOOD TRANSFUSION

BLOOD TRANSFUSION. Begashaw M (MD). Definition. is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream. I ndications. In acute hemorrhage is based on: • volume lost >2000 • rate of bleeding • hemodynamic status.

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BLOOD TRANSFUSION

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  1. BLOOD TRANSFUSION Begashaw M (MD)

  2. Definition • is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream

  3. Indications In acute hemorrhage is based on: • volume lost >2000 • rate of bleeding • hemodynamic status

  4. Indications In Chronic blood loss: -Healthy, younger individuals HCT<21% -Cardio respiratory compromised patients HCT < 25-33% If severe ,even <40%

  5. Perioperative red blood cell transfusion criteria

  6. Component therapy • specific factor deficiencies -factor VIII concentrates -classic hemophilia

  7. ABO blood group system • -Blood group O is the universal donor • -Blood group AB is the universal recipient

  8. Cross matching o Blood grouping -ABO and Rhesus antigens o Antibody screening • Detects atypical red cell antibodies in recipients serum o Crossmatching • Tests donor red cells against patients serum

  9. Blood products • Whole blood • Packed red cells • Granulocyte concentrates • Platelet concentrates • fresh frozen plasma • Plasma protein fraction • Human albumin 25% • Cryoprecipitate • Clotting factors - Factor VIII / IX

  10. Blood Components

  11. Component therapy • Factor VIII for classic hemophilia • Platelet transfusion for patients with bone marrow suppression

  12. preparation

  13. Whole blood • is collected in citrate phosphate dextrose- adenine solution (CPDA-) • 450 ml of whole blood and approximately 60ml of anticoagulant preservative • within 24 hours-freshwhole blood • shelf life of 35 days • one unit of whole blood raises the recipient’s hematocritby 3%

  14. Whole blood

  15. Packed RBC • are remains after plasma has been separated from whole blood • One unit raises the recipient’s hematocrit by 3% • warmed to a temperature not exceeding 37 c before transfusion • Shelf life is 35 days

  16. Packed RBC

  17. Platelet concentrate • Platelets are separated from one unit of blood • may be stored for 3-7 days • One unit of platelet concentrate contains about 5.5×1010 platelets and increases the platelet count by 5000/ml • For a patient with platelet count below 25,000/mm3, 6-8 units are usually given • Platelet concentrate must be administered through a special platelet filter

  18. Fresh frozen plasma _is anti-coagulated plasma separated from a person’s blood and frozen within 6 hours _stored up to 1 year _contains all clotting factors _provides proteins for volume expansion

  19. Cryoprecipitate _is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 degree centigrade _white precipitate _shelf life of about 1 year _contains factor VIII, fibrinogen and factor XIII _treatment: -classic hemophilia -DIC

  20. FRESH FROZEN PLASMA

  21. Cryoprecipitate

  22. Protein Albumin - for oncotic support and plasma expansion - disadvantage-rapid excretion & expense Plasma protein fraction -Similar to albumin but contains additional protein molecules

  23. Complications of Blood Transfusion

  24. Complications • Hemolytic transfusion reactions • Non-hemolytic transfusion reaction

  25. Hemolytic transfusion reactions • Intravascular hemolytic transfusion reactions • life threatening reactions • due to incompatibility of the ABO system • are very rare occurring in 1 out of 15,000 -20,000 transfusions

  26. Pathophysiology • all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuriaand renal failure • activate the complement system with subsequent release of vasoacative amines causing hypotension • Complement activation -intravascular thrombosis, DIC & hemorrhage

  27. Clinical features • Patient feels unwell and agitated • back pain and pain at infusion site • shortness of breath, rigors • hypotension, oliguria and bleeding from venepuncture sites • Urinalysis will show haemoglobinuria

  28. Management • Discontinue transfusion immediately and remove giving set • Check unit of blood against patients identity • Give intravenous crystalloid • Transfer to ICU • Take blood for CBC, haemoglobin, clotting, repeat grouping • Monitor urine output

  29. Non-hemolytic transfusion reaction • Febrile reaction: - in 0.5% -1% - is usually treated with antipyretic drugs • Allergic reaction: • in 2-3% • manifests by urticariaand rashes • Antihistamins, steroids or epinephrine

  30. Transmission of disease-include: • Hepatitis • HIV • Malaria • Epstein- bar virus, cytomegalovirus • Brucellosis

  31. Other complications • Citrate toxicity • Acidosis • Hyperkalemia

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