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Blood Transfusion Brig Shabbir Rana.  Human blood replacement therapy was accepted in the late nineteenth century  introduction of blood grouping by.

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Presentation on theme: "Blood Transfusion Brig Shabbir Rana.  Human blood replacement therapy was accepted in the late nineteenth century  introduction of blood grouping by."— Presentation transcript:

1 Blood Transfusion Brig Shabbir Rana

2  Human blood replacement therapy was accepted in the late nineteenth century  introduction of blood grouping by Dr. Karl Landsteiner, who identified the major A, B, and O groups in 1900  In 1939 Dr. Philip Levine and Dr. Rufus Stetson followed with the concept of Rh grouping Background

3  Whole blood was considered the standard in transfusion until the late 1970s  Goal-directed component therapy

4  Serologic compatibility for A, B, O, and Rh groups is established routinely  Cross-matching between donors' red blood cells and recipients' sera (the major cross-match) is performed  Rh-negative recipients should receive transfusions only of Rh-negative blood Typing and Cross-Matching

5  Human RBC have mainly 2 types of antigen ABO and Rhesus  Blood group O is universal donor and AB group is universal recipient  Rh antigen is strongly antigenic present in 85% of population Typing and Cross-Matching

6  Rh negative group represents only 15% of the population  The administration of Rh-positive blood is acceptable if Rh-negative blood is not available  Rh-positive blood should not be transfused to Rh- negative females who are of childbearing age Typing and Cross-Matching

7  In emergency situations, type O-negative blood may be transfused to all recipients  Patient with multiple transfusions developed alloantibodies, typing and cross-matching is often difficult  Sufficient time should be allotted preoperatively to accumulate blood that might be required during the operation

8  Up to 5 units can be collected for subsequent use during elective procedures  Patients can donate blood if their hemoglobin concentration exceeds 11 g/dL or if the hematocrit is >34%  The donation is performed 40 days before the planned operation and the last one is performed 3 days before the operation Autologous transfusion

9  Donations can be scheduled at intervals of 3 to 4 days  Administration of recombinant human erythropoietin accelerates generation of red blood cells and allows for more frequent harvesting of blood Autologous transfusion

10  Banked whole blood, once the gold standard, is rarely available  Shelf life is now around 6 weeks  At least 70% of the transfused erythrocytes remain in the circulation for 24 hours after transfusion and are viable Banked Whole Blood

11  Changes in the red blood cells that occur during storage include reduction of intracellular ADP and 2,3- diphosphoglycerate  Alters the oxygen dissociation curve of hemoglobin and results in a decrease in oxygen transport  Clotting factors are relatively stable in banked blood except for factors V and VIII

12  Fresh whole blood refers to blood that is administered within 24 hours of its donation  Use of fresh whole blood may improve outcomes in patients with trauma-associated coagulopathy  Advantage to the use of fresh whole blood is that it provides greater coagulation activity than equal units of component therapy. Fresh Whole Blood

13  Packed red blood cells are the product of choice for most clinical situations  Concentrated suspensions of red blood cells can be prepared by removing most of the supernatant plasma after centrifugation  This preparation reduces, but does not eliminate, reaction caused by plasma components Packed Red Blood Cells

14  It also reduces the amount of sodium, potassium, lactic acid, and citrate administered  Each unit is approximately 330 ml and hematocrit of 50-70% stored in sag-m solution self life 5 wks at 4-6C  They are used for patients who are known to have been previously sensitized Packed Red Blood Cells

15  freezing red blood cells viability is theoretically improved  ATP and 2,3-diphosphoglycerate concentrations are maintained Frozen Red Blood Cells

16  Leukocyte-reduced and leukocyte-reduced/washed red blood cell products are prepared by filtration that removes approximately 99.9% of the white blood cells and most of the platelets  Saline washing (leukocyte-reduced/washed red blood cells). Leukocyte reduction prevents almost all febrile, reactions Leukocyte-Reduced /Washed Red Blood Cells

17  Indications for platelet transfusion include thrombocytopenia caused by massive blood loss  Thrombocytopenia caused by inadequate platelet production  Qualitative platelet disorders  shelf life of platelets is 120 hours from time of donation Platelet Concentrates

18  One unit of platelet concentrate has a volume of approximately 50 Ml  Platelet preparations are capable of transmitting infectious diseases and can provoke allergic reactions  Platelet are stored at 20-24C  Prevention of HLA alloimmunization can be achieved by leukocyte reduction through filtration Platelet Concentrates

19  Fresh-frozen plasma (FFP) prepared from freshly donated blood is the usual source of the vitamin K– dependent factors  only source of factor V  FFP has come to the forefront with the inception of damage control resuscitation in patients with trauma- associated coagulopathy` Fresh-Frozen Plasma

20  FFP is stored at C  Shelf life is 2 yrs  Ist line treatment of hemorrhage due to coagulopathy FFP

21  Human polymerized hemoglobin (PolyHeme) is a universally compatible  Immediately available, disease-free, oxygen-carrying resuscitative fluid  used in massively bleeding patients  Advantages of an artificial oxygen carrier include the absence of blood-type antigens (no cross-match needed) Human Polymerized Hemoglobin (Polyheme)

22  No incidence of viral infections  long-term stability, which allows prolonged periods of storage  Disadvantages include shorter half-life in the bloodstream and the potential to increase cardiovascular complication

23  Oxygen-carrying capacity is primarily a function of the red blood cells  Transfusion of red blood cells should augment oxygen-carrying capacity  Hemoglobin is fundamental to arterial oxygen content and thus oxygen delivery Indications for Replacement of Blood

24  Acute blood loss to replace circulating volume  Perioperative anaemia  Symptomatic chronic anaemia without hemorrhage Indications for Replacement of Blood

25  Maintaining hemoglobin levels between 7 and 9 g/dL had no adverse effect on mortality  Patients with acute myocardial infarctions with ST elevation may, however, benefit from receiving red blood cell transfusions for anemia

26  Most common indication for blood transfusion in surgical patients is the replenishment of the blood volume  A healthy adult can lose up to 15% of total blood volume (class I hemorrhage or up to 750 mL) with only minor effects on the circulation Volume Replacement

27  Loss of 15 to 30% of blood volume (class II hemorrhage or 750 to 1500 mL) is associated with tachycardia and decreased pulse pressure but, importantly, a normal blood pressure  Loss of 30 to 40% (class III hemorrhage or 1500 to 2000 mL) results in tachycardia, tachypnea, hypotension, oliguria, and changes in mental status Volume Replacement

28  Class IV hemorrhage is loss of >40% of blood volume and is considered life-threatening

29  Loss of blood in the operating room can be evaluated by estimating the amount of blood in the wound and on the drapes  weighing the sponges, and quantifying blood suctioned from the operative field  In patients with normal preoperative values, blood loss of up to 20% of total blood volume can be replaced with crystalloid solution LOSS OF BLOOD IN OR

30  Blood loss above this amount may require the addition of packed red blood cells  Transfusion of platelets and/or FFP may be indicated in specific patients before or during an operative procedure

31  Fresh-frozen plasma (FFP) As soon as the need for massive transfusion is recognized. For every 6 units of red blood cells (RBCs), give 6 units of FFP (1:1 ratio).  Platelets For every 6 units of RBCs and plasma, give one 6- pack of platelets Component Therapy Administration during Massive Transfusion

32  Cryoprecipitate After first 6 units of RBCs, check fibrinogen level. If ≤100 mg/dL, give 20 units of cryoprecipitate

33  Transfusion-related events are estimated to occur in approximately 10% of all transfusions  <0.5% are serious  Transfusion-related deaths 0.5% Complications of Transfusion

34  acute lung injury (16 to 22%),  ABO hemolytic transfusion reactions (12 to 15%)  Bacterial contamination of platelets (11 to 18%). Transfusion complication

35  Defined as an increase in temperature >1°C associated with a transfusion and are fairly common  Approximately 1% of all transfusions  Preformed cytokines in donated blood and recipient antibodies reacting with donated antibodies are postulated causes Febrile nonhemolytic reactions

36  Febrile reactions can be greatly reduced by the use of leukocyte-reduced blood products  Pretreatment with acetaminophen reduces the severity of the reaction

37  Bacterial contamination of infused blood is rareGram- negative organisms, especially  Yersinia enterocolitica and Pseudomonas species capable of growth at 4°C  Most cases, however, are associated with the administration of platelets that are stored at 20°C  Bacterial contamination results in sepsis and death in up to 25% of patients Bacterial contamination

38  Clinical manifestations include systemic signs such as fever and chills, tachycardia  Hypotension, and GI symptoms (abdominal cramps, vomiting, and diarrhea)  If the diagnosis is suspected, the transfusion should be discontinued  The blood is send for culture

39  Emergency treatment includes administration of oxygen  Adrenergic blocking agents, and antibiotics  Prevention includes avoidance of out-of-date platelets

40  Allergic reactions are relatively frequent  Reactions usually are mild and consist of rash, urticaria, and fever occurring within 60 to 90 minutes of the start of the transfusion  Allergic reactions are caused by the transfusion of antibodies from hypersensitive donors or the transfusion of antigens to which the recipient is hypersensitive Allergic Reactions

41  Treatment and prophylaxis consist of the administration of antihistamines  In more serious cases, use of epinephrine or steroids may be indicated.

42  Respiratory compromise may be associated with transfusion-associated circulatory overload  Occur with rapid infusion of blood, plasma expanders, and crystalloids, particularly in older patients with underlying heart disease  Central venous pressure monitoring should be considered whenever large amounts of fluid are administered Respiratory Complications

43  Treatment consists of initiating diuresis  Slowing the rate of blood administration  Minimizing delivery of fluids while blood products are being transfused

44  noncardiogenic pulmonary edema related to transfusion  It can occur with the administration of any plasma- containing blood product  Symptoms are similar to those of circulatory overload with dyspnea and associated hypoxemia Transfusion-related acute lung injury

45  Accompanied by fever, rigors, and bilateral pulmonary infiltrates on chest radiograph  Commonly occurs within 1 to 2 hours after the onset of transfusion, but virtually always before 6 hours  Related to anti-HLA or anti–human neutrophil antigen antibodies in transfused blood that primes neutrophils in the pulmonary circulation

46  Treatment includes discontinuation of transfusion  Provision of pulmonary support

47  Acute hemolytic reactions occur with the administration of ABO-incompatible blood and are fatal in up to 6% of cases  Technical or clerical errors in the laboratory and administration of blood of the wrong blood type  Hemolytic reactions are characterized by intravascular destruction of red blood cells and consequent hemoglobinemia and hemoglobinuria Hemolytic Reactions

48  DIC can be initiated activation of factor XII and complement by antibody-antigen complexes  Acute renal insufficiency

49  occur 2 to 10 days after transfusion  Individual has a low antibody titer at the time of transfusion but the titer increases after transfusion  Immunoglobulin G–mediated  Pain at the site of transfusion, facial flushing, and back and chest pain  In anesthetized patients, diffuse bleeding and hypotension are the hallmarks Delayed hemolytic transfusion reactions

50  The Coombs' test usually yields a positive result  Urine output should be monitored and adequate hydration maintained to prevent precipitation of hemoglobin within the tubules

51  malaria, Chagas' disease, brucellosis  Transmission of hepatitis C virus and HIV-1 has been dramatically minimized by the introduction of better screening for these pathogens  The infection rate for these pathogens is now estimated to be <1 per 1,000,000 units transfused Transmission of Disease

52  Hepatitis B virus transmission may still occur in about 1 in 100,000 transfusions in nonimmune recipients

53  Hypocalcemia  Hyperkalamia  Hypothermia  coagulopathy Complication of massive transfusion

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