Blood transfution

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Blood transfution
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Blood Transfusion
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Blood Transfusion

• History
• Type of Transfusion
• Indication
• Transfusion Reactions
• Autologous transfusion
• Component Transfusion

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History and Significance
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First blood transfusion
Lower (1665)
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First human blood transfusion
Philip (1825)
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Discovery of ABO type
Landsteiner (1900)
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World war I
How to store blood longer?
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World war II
Is there any suitable Blood Substitutes
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Blood Transfusion
Successful blood transfusion is relatively recent

• Crossmatching
• Anticoagulation
• Plastic storage container

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Blood Transfusion
Type of Transfusion

• Whole Blood
• Blood Component
• RBC PLT FFP Leukocyte concentrate
• Plasma Substitutes

Use of whole blood is considered to be a waste of
resources
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Red Blood Cells

• Symptomatic anemia (providing oxygen-carrying
  capacity)
• Transfusion trigger
• (HCTlt30 HBlt10g/dl)
• 1 Unit increases 3 HCT or 1g/dl
• Shelf life 42 d (1-6 ?)

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Platelets

• Thrombocytopenia
• (lt 50,000)
• Platelet dysfunction
• Each unit increase 5,000 PLTs after 1 H

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Granulocytes

• Profoundly granulocytopenia (lt500)
• Serious infection not responsive to antibiotic
  therapy

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Fresh Frozen Plasma (FFP)

• Coagulation factor deficiencies
• 1 ml increases 1 clotting factors
• Being used as soon as possible
• Albumin, hetastarch, crystalliods are equally
  effective volume expander but safer than FFP
• After use of 5 U of RBCs, matching 2 U of FFP

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--Volume Expander
Plasma Substitutes

• Dextran
• Most widely used
• Low/Middle M.W. (40,000-70,000)
• Massive transfusion could impair coagulation
• Occasional ALLERGIC reaction
• Hydroxyethyl Starch Formulation (HES)
• More stable
• Containing essential electrolytes
• No allergic reaction

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Blood Transfusion
Indication

• Acute massive blood loss
• Anaemia and hypoalbuminemia
• Overwhelming Infection
• Dysfunction of Coagulation

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Blood Transfusion
Technique of Transfusion

• Approach Route
• Peripheral Vein, Center Vein
• Filtration before Transfusion
• Velocity of Transfusion
• 5-10ml/min

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Blood Transfusion
Attention

• Double Check Name, Type and Crossmatch
• Storage Time Citrate Phoshate Detrose
• Acidic Citrate Detrose
• 21D, 35D
• Pre-heat
• No any other Medication
• Observation during / after Transfusion

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Transfusion Reactions
Febrile Reactions
Incidence2 Chills, Fever 39-40.C Headache,
Sweatiness Nausea, Vomiting, Flushing 15min-1hr

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Transfusion Reactions
Febrile Reactions

• Immuno-reaction
• Endo-toxins
• Contamination or Hemolysis

Treatment

• Analyze possible reasons
• Stop Transfusion
• General Support

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Transfusion Reactions
Anaphylactic reactions
Urticaria Abdominal cramps Dyspnea Vomiting
Diarrhea
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Anaphylactic reactions
Reason

• Immuno-reaction IgE
• Hereditary Immunoglobulin IgA

Treatment

• Administer antihistamines
• Administer epinephrine, diphenhydramine, and
  corticosteroids
• Support airway and circulation as necessary

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Transfusion Reactions
Hemolytic transfusion reactions
Burning at the intravenous (IV) line
site Fever, Chills, Dyspnea Shock Cardiovascul
ar Collapse Hemoglobinuria, Hemoglobinemia Rena
l Failure DIC
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Hemolytic Transfusion Reactions
Reasons

• ABO incompatibility
• Rh Incompatibility
• Non-immune Hemolysis
• Immune Hemolysis

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Hemolytic Transfusion Reactions
Treatment

• Stop Transfusion as soon as reaction is suspected
• Check the name, type and crossmatch
• Urine Exam
• Renal Protection
• (Aggressive Fluid Resuscitation, Furosemide)
• DIC Monitor

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Hemolytic Transfusion Reactions
Prevention

• Double Check name,type and crossmatch
• Operate carefully and routinely
• Temperature Monitor

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Transfusion Reactions
Massive transfusion complications
Volume Overload Congestive Heart Failure
Tachycardia Tachypnea Cyanopathy
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Massive Transfusion Complications
Reasons

• Volume Overload
• Heart Functional Failure
• Lung Functional Failure

Treatment

• Stop Transfusion
• Heart Functional Support
• Diuresis (Furosemide)

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Transfusion Reactions
Contamination
Fever Shock DIC
Reasons
Bacterial Contamination
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Contamination
Treatment

• Stop Transfusion
• Bacterial Exam and Culture
• Antibiotics

Prevention

• Double Check
• Operate carefully

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Transfusion Reactions
Acquired diseases

• Hepatitis B, Hepatitis C
• HIV
• Cytomegalovirus (CMV)
• Syphilis
• Malaria

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Autotransfusion

• No risk of infectious disease transmission
• No transfusion reactions
• No compatibility testing
• Reduced demand on blood bank stores
• An immediate source of autologous blood

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Component Transfusion
Blood Cell

• Red Blood Cells
• Packed RBC
• White Blood Cells
• Pooled Platelets

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Component Transfusion

• Saving blood source
• Less likely carrier of transmitted diseases
• Shortage of quality blood
• Greater shelf life than whole blood
• Helping to make blood safer by filtration
• Infusing regardless of ABO type in some blood
  products

giving only essential/desired blood component