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BLOOD TRANSFUSION AND TRANSFUSION REACTIONS

BLOOD TRANSFUSION AND TRANSFUSION REACTIONS. DR VAISHALI JAIN. LEARNING OUTCOMES. At the end of this topic, you should able to: Understand concept of Whole blood and blood components Discuss types and indications of blood transfusion Enlist tests to be performed prior to blood transfusion

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BLOOD TRANSFUSION AND TRANSFUSION REACTIONS

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  1. BLOOD TRANSFUSION AND TRANSFUSION REACTIONS DR VAISHALI JAIN

  2. LEARNING OUTCOMES At the end of this topic, you should able to: • Understand concept of Whole blood and blood components • Discuss types and indications of blood transfusion • Enlist tests to be performed prior to blood transfusion • Understand transfusion reactions in brief

  3. LESSON CONTENTS • Whole blood and blood components • What is blood transfusion? • Blood transfusion- Types, Indications • Pre transfusion testing • Transfusion Reactions: • Classification • Causes • Clinical features • Investigations

  4. WHOLE BLOOD AND BLOOD COMPONENTS • 350ml /450 ml of blood is collected from a donor into a plastic bag containing an anticoagulant • This is called 1 “unit” of whole blood • Whole blood can be used as it is, or is separated into “blood components” • Types of blood components:- • Red blood cell concentrate (packed red blood cells) • Platelet concentrate • Fresh frozen plasma • Cryoprecipitate

  5. BLOOD COMPONENTS

  6. BLOOD TRANSFUSION Transfer of blood or blood components from one person (donor) into another person (recipient)

  7. TYPES OF BLOOD TRANSFUSION • FRESH BLOOD TRANSFUSION Blood less than 24 hours old from the time of collection • AUTOLOGOUS TRANSFUSION Blood collected from a patient for re-transfusion at a later time into the same individual • MASSIVE TRANSFUSION Number of units transfused in a 24 hours period exceeds the recipient’s blood volume • MULTIPLE TRANSFUSION Repeated transfusion of blood over a long period of time (months or year)

  8. INDICATIONS OF BLOOD TRANSFUSION • Whole Blood: • Acute blood loss • Shock • Exchange transfusion in neonate • Packed red blood cells: • Chronic severe Anemia • Leukemia • Thalassemia • Platelets concentrate: • Thrombocytopenia • Bleeding due to platelet dysfunction • Malignancy • Major surgery

  9. INDICATIONS(Contd.) • Fresh frozen plasma: • Liver disorders • DIC • Coagulation factor deficiency (V, VII) • Cryoprecipitate: • Hemophilia A • von Willebrand’s disease • Fibrinogen deficiency

  10. PRE-TRANSFUSION TESTING • ABO and Rh (D) blood grouping : • Patient’s and donor’s blood sample • Cross matching of blood sample: • Major cross match- Pt’s serum + Donor cells • Minor cross match- pt’s cells + Donor serum

  11. BLOOD GROUPING

  12. PRE-TRANSFUSION TESTING (contd.) • Screening for Transfusion transmitted diseases (Donor Sample) HIV 1 and 2 AIDS HBsAg Hepatitis B HCV Hepatitis C Treponemapallidum Syphilis Plasmodium species Malaria

  13. ADVERSE EFFECTS (TRANSFUSION REACTIONS) - Immune mediated

  14. ADVERSE EFFECTS (TRANSFUSION REACTIONS) – Non-Immune mediated

  15. CAUSES OF TRANSFUSION REACTIONS • Clerical errors: • Inadequate labeling • Wrong blood issued • Technical errors: • Error in blood grouping & cross matching • Incorrect interpretation of test results • Others: • Blood contamination during phlebotomy • Blood infusion thr’ small bore needle • Blood cooler to -30⁰C or warmed to > 42⁰ C • Concomitant administration blood & drugs thr’ common set

  16. CLINICAL FEATURES • Fever : Ag-Ab cytokine IL-1 Fever • Rigors: Cytokines • Pain at infusion site: Cytokine • Hypotension: Neuroendocrine response • Hemoglobinuria • Oliguria • Anuria

  17. LABORATORY INVESTIGATIONS • Rule out Clerical errors: Identify blood sample • Compare plasma color on pt’s pre & post transfusion sample - Pink: free Hb red cell destruction - Yellow: increased bilirubin • Check blood color of bag & attached tubing - Purple color / clot in bag bacterial contamination - Color change hemolysis

  18. LABORATORY INVESTIGATIONS (Contd) • Repeat blood grouping on pt’s & donor sample ( Pre and post transfusion sample) • Repeat cross matching • Perform Direct antiglobulin test (DCT) • Blood smear and culture (Donor’s blood) • Others: (Post transfusion sample) • Antibody screening • Serum bilirubin • Free hemoglobin

  19. TRANSFUSION REACTIONINVESTIGATION RECORD • Patient’s particulars • Blood bag details • Regrouping results • Re-cross matching results • Red cell antibody screening results • Urine investigations • Microbiological results • Signature of Technician in-charge

  20. SUMMARY • What is it? Types Indications Pre-transfusion testing Record Causes Clinical features Laboratory investigations BLOOD TRANSFUSION TRANSFUSION REACTIONS

  21. THANK YOU…

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