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DR. FIROUZABADI

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Title: DR. FIROUZABADI


1
Primary Postpartum haemorrhage
  • DR. FIROUZABADI

2
Postpartum Hemorrhage
  • EBL gt 500 cc
  • 10 of deliveries
  • If within 24 hrs. pp 1? pp hemorrhage
  • If 24 hrs. - 6 wks. pp 2? pp hemorrhage

3
Postpartum Hemorrhage
  • Incidence
  • 3 of all births
  • 6.4 of cesarean deliveries
  • 3rd most common cause of maternal mortality

4
Postpartum Hemorrhage
  • Definition
  • greater than 500cc blood loss (vaginal delivery)
    or 1000cc blood loss (cesarean)
  • decrease in HCT of 10 or greater
  • obstetrical emergency that can follow vaginal or
    cesarean delivery with clinical instability
    leading to transfusion, shock, renal failure,
    acute respiratory distress, and coagulopathy

5
  • Hemorrhage is the underlying causative factor in
    at least 25 of maternal deaths in industrialized
    and underdeveloped countries

6
Peripartum Hemorrhage
  • Causes of maternal death in US (9.1/100,000)
  • hemorrhage 28.7 (?)
  • embolism 19.7 (?)
  • PIH 17.6 (?)
  • infection 13.1 (?)
  • anesthesia 2.5 (?)

7
  • Hospitalization for delivery and Availability of
    blood for transfusion have reduced the maternal
    mortality rate death from hemorrhage .
  • It remains a cause of maternal mortality.

8
  • Hemorrhage is a reason for admission of pregnant
    women to intensive care units.
  • Hemorrhage has been identified as the single
    most important cause of maternal death,
    accounting for almost half of all post partum
    death in developing countries.

9
  • Incidence of obstetrical hemorrhage can not be
    determined precisely
  • Defined by a post partum HCT drop of 10 volumes
    percent or need for transfusion.
  • 3.9 NVD
  • 6-8 C/S

10
  • Maternal physiology is well prepared for
    hemorrhage
  • increase in blood volume .
  • hypercoagulable state.
  • the tourniquet effect of uterine contractions.

11
  • vital signs may remain near normal until more
    than 30 of blood volume is lost .
  • tachycardia can be attributed to pregnancy,
    stress, pain, and delivery.

12
  • 5 of women delivering vaginally last more than
    1000 ml of blood. Estimated blood loss is
    commonly only about half the actual loss. The
    effect of hemorrhage depend to a degree on the
    non pregnant blood volume, magnitude of PIH,
    degree of anemia at the time of delivery.

13
blood supply to the pelvis
14
blood supply to the pelvis
  • internal iliac (hypogastric) a.
  • ovarian arteries .

Are The main vascular supply to the pelvis .
connected in a continuous arcade on the lateral
borders of the vagina, uterus, and adnexa.
15
blood supply to the pelvis
  • /The ovarian arteries
  • are direct branches of the aorta beneath the
    renal arteries. They traverse bilaterally and
    retroperitoneally to enter the infundibulopelvic
    ligaments.

16
blood supply to the pelvis
  • /The hypogastric artery
  • retroperitoneally posterior to the ureter it
    divides into an anterior and posterior divisions.

17
The hypogastric artery
anterior division
5 visceral branches
  • Uterine
  • superior vesical
  • middle hemorrhoidal
  • inferior hemorrhoidal
  • vaginal

3 parietal branches
  • Obturator
  • inferior gluteal
  • internal pudendal

18
The hypogastric artery
posterior division
  • important collateral to the pelvis.
  • Iliolumbar
  • lateral sacral
  • superior gluteal

19
PHYSIOLOGY OF COAGULATION
20
PHYSIOLOGY OF COAGULATION
  • The four components of coagulation that
    continuously interrelate are

(1) the vasculature, (2) platelets, (3)
plasma-clotting proteins, (4) fibrinolysis.
21
the vasculature
  • A disruption in the vessel wall removes the
    protective covering of the endothelial cells and
    releases tissue thromboplastin, which activates
    the clotting mechanism.

22
platelets
  • Activation of surface receptors causes
    morphologic changes in the platelets (changing
    first to a sphere and then to a spiderlike
    structure with pseudopods) and the generation of
    thromboxane A2 These lead to platelet aggregation
    and eventual formation of a platelet plug.

23
plasma-clotting proteins
  • Activation of the clotting system is initiated in
    two ways
  • the intrinsic or extrinsic pathway.

24
Intrinsic Pathway
  • requires no extravascular component for
    initiation and begins with Factor XII, which is
    activated by contact with injured epithelium.

25
Extrinsic Pathway
  • is activated by the tissue factor
    thromboplastin (which subsequently activates
    Factor VII) when vascular disruption occurs.
    Prothrombin is converted to thrombin, which
    catalyzes the conversion of fibrinogen to fibrin.
    A clot is eventually formed at the site of
    vascular injury.

26
fibrinolysis
  • plasma substrate plasminogen is activated This
    substrate is converted to the active enzyme
    plasmin, which lyses fibrin clots and destroys
    fibrinogen and Factors XII and VII.

27
Etiology of PPH
28
Etiology of PPH
  • The causes of postpartum hemorrhage can be
    thought of as the four Ts
  • tone,
  • tissue,
  • trauma,
  • thrombin

29
Etiology of PPH
Uterine atony
  • Multiple gestation,
  • high parity,
  • prolonged labor
  • chorioamnionitis,
  • augmented labor,
  • tocolytic agents

30
Etiology of PPH
Retained uterine contents
  • Products of conception,
  • blood clots

31
Etiology of PPH
  • Placental abnormalities

Congenital Bicornuate uterus
Location Placenta previa
Attachment
Acquired structural Leiomyoma, previous
surgery
Peripartum Uterine inversion,
uterine rupture, placental abruption
Accreta
32
Etiology of PPH
Lacerations and trauma
  •  Unplanned
  • Vaginal/cervical tear,
  • surgical trauma
  •  Planned
  • Cesarean section,
  • episiotomy

33
Etiology of PPH
  • Coagulation disorders

Acquired DIC, dilutional coagulopathy, heparin
Congenital Von Willebrand's disease
34
prevention
35
Women in whom these factors have been identified
should be advised to deliver in a specialist
obstetric unit
odds ratio for PPH Risk Factor
13 12 5 4 Proven abruptio placentae Known placenta praevia Multiple pregnancy Pre-eclampsia/gestational hypertension
36
The following factors, becoming apparent during
labour and delivery are associated with an
increased risk of PPH.
odds ratio for PPH Risk factor
9 4 5 5 2 2 2 Delivery by emergency Caesarean section Delivery by elective Caesarean section Retained placenta Mediolateral episiotomy Operative vaginal delivery Prolonged labour (gt12 hours) Big baby (gt4 kg)
37
  • In the event of a woman coming to delivery while
    receiving therapeutic heparin,

the infusion should be stopped. Heparin activity
will fall to safe levels within an hour.
Protamine sulphate will reverse activity more
rapidly, if required.
38
Antenatal assessment anemia
  • Detection of anemia more than physiologic anemia
    of pregnancy is important, because anemia at
    delivery increases the likelihood of a woman
    requiring blood transfusion.

39
management
40
Guideline by the RCOG
  • COMMUNICATE.
  • RESUSCITATE.
  • MONITOR / INVESTIGATE.
  • STOP THE BLEEDING.

41
COMMUNICATE call 6
  • Call experienced midwife
  • Call obstetric registrar alert consultant
  • Call anaesthetic registrar , alert consultant
  • Alert haematologist
  • Alert Blood Transfusion Service
  • Call porters for delivery of specimens / blood

42
RESUSCITATE
  • IV access with 14 G cannula X 2
  • Head down tilt
  • Oxygen by mask, 8 litres / min
  • Transfuse
  • Crystalloid
  • Colloid
  • once 3.5 litres infused, GIVE O NEG If no
    cross-matched blood available OR give
    uncross-matched own-group blood, as available
  • Give up to 1 liter Fresh Frozen Plasma and 10
    units cryoprecipitate if clinically indicated

43
MONITOR / INVESTIGATE
  • Cross-match 6 units
  • Full blood count
  • Clotting screen
  • Continuous pulse / BP /
  • ECG / Oximeter
  • Foley catheter urine output
  • CVP monitoring

44
STOP THE BLEEDING
  • Exclude causes of bleeding other than uterine
    atony
  • Ensure bladder empty
  • Uterine compression
  • IV syntocinon 10 units
  • IV ergometrine 500 mg
  • Syntocinon infusion (30 units in 500 ml)
  • prostaglandins
  • Surgery earlier rather than late
  • Hysterctomy early rather than late

45
If conservative measures fail to control
haemorrhage, initiate surgical haemostasis SOONER
RATHER THAN LATER
  • laparotomy
  • Bilateral ligation of uterine arteries
  • Bilateral ligation of internal iliac (hypogastric
    arteries)
  • Hysterectomy

46
  • Resort to hysterectomy SOONER RATHER THAN LATER
    (especially in cases of placenta accreta or
    uterine rupture)

47
  • Whole blood frequently is used for rapid
    correction of volume loss because of its ready
    availability, but component therapy is ideal. A
    general practice has been to transfuse 1 unit of
    fresh-frozen plasma for every 3 to 4 units of red
    cells given to patients who are bleeding
    profusely

48
Genital tract lacerations
  • Genital trauma always must be eliminated first if
    the uterus is firm.

49
Management of uterine atony
  • Explore the uterine cavity.
  • Inspect vagina and cervix for lacerations.
  • If the cavity is empty, Massage and give
    methylergonovine 0.2 mg, the dose can be repeated
    every 2 to 4 hours.
  • Rectal 800mcg. Misoprostol is beneficial.

50
Uterine Atony Prostaglandins
  • ? myometrial intracellular free Ca, enhance
    action of other oxytocics
  • Side effects fever, nausea/vomiting, diarrhea
  • 15-methyl PG F2? (Carboprost, Hemabate)
  • may cause bronchospasm, altered VQ, ?
    shunt, hypoxemia, HTN
  • 250 ?g IM or intramyometrially q 15-30 min, up to
    max 2 mg.
  • contraindications asthma, hypoxemia

51
Management of uterine atony
  • During the administration of uterotonic agents,
    bimanual compression may control hemorrhage. The
    physician places his or her fist in the vagina
    and presses on the anterior surface of the uterus
    while an abdominal hand placed above the fundus
    presses on the posterior wall. This while the
    Blood for transfusion made available.

52
Retained placenta
  • Retained placental fragments are a leading cause
    of early and delayed postpartum hemorrhage.
    Treatment is manual removal, General anesthesia
    with any volatile agent (1.52 minimum alveolar
    concentration (MAC)) may be necessary for uterine
    relaxation
  • On rare occasions, a retained placenta is an
    undiagnosed placenta accreta, and massive
    bleeding may occur during attempted manual
    removal.

53
Placenta accreta
  • Placenta accreta is defined as an abnormal
    implantation of the placenta in the uterine wall,
    of which there are three types

(1) accreta vera, in which the placenta adheres
to the myometrium without invasion into the
muscle. (2) increta, in which it invades into
the myometrium. (3) percreta, in which it invades
the full thickness of the uterine wall and
possibly other pelvic structures, most frequently
the bladder.
54
Placenta accreta
  • In a patient with a previous cesarean section and
    a placenta previa
  • Previous one has 14 risk of placenta accreta.
  • Previous two has 24 risk of placenta accreta.
  • Previous three has 44 risk of placenta accreta.

55
UTERINE RUPTURE
  • Rupture of the uterus is described as complete or
    incomplete and should be differentiated from
    dehiscence of a cesarean section scar.

56
UTERINE RUPTURE
The reported incidence
for all pregnancies is 0.05,
After one previous lower segment cesarean section
0.8
After two previous lower segment cesarean section
is 5
all pregnancies following myomectomy may be
complicated by uterine rupture.
57
UTERINE RUPTURE
  • Complete rupture describes a full-thickness
    defect of the uterine wall and serosa resulting
    in direct communication between the uterine
    cavity and the peritoneal cavity.

58
UTERINE RUPTURE
  • Incomplete rupture describes a defect of the
    uterine wall that is contained by the visceral
    peritoneum or broad ligament. In patients with
    prior cesarean section,

59
UTERINE RUPTURE
  • dehiscence describes partial separation of the
    scar with minimal bleeding, with the peritoneum
    and fetal membranes remaining intact.

60
Management of Rupture Uterus
  • The identification or suspicion of uterine
    rupture must be followed by an immediate and
    simultaneous response from the obstetric team.
  • Surgery should not be delayed owing to
    hypovolemic shock because it may not be easily
    reversible until the hemorrhage is controlled.

61
Management of Rupture Uterus
  • Upon entering the abdomen, aortic compression can
    be applied to decrease bleeding.
  • Oxytocin should be administered to effect
    uterine contraction to assist in vessel
    constriction and to decrease bleeding.
  • Hemostasis can then be achieved by ligation of
    the hypogastric artery, uterine artery, or
    ovarian arteries.

62
Management of Rupture Uterus
  • At this point, a decision must be made to perform
    hysterectomy or to repair the rupture site. In
    most cases, hysterectomy should be performed.
  • In selected cases, repair of the rupture can be
    attempted. When rupture occurs in the body of the
    uterus,
  • bladder rupture must be ruled out by clearly
    mobilizing and inspecting the bladder to ensure
    that it is intact. This avoids injury on repair
    of the defect as well.

63
Management of Rupture Uterus
  • A lower segment lateral rupture can cause
    transection of the uterine vessels. The vessels
    can retract toward the pelvic side wall, and the
    site of bleeding must be isolated before placing
    clamps to avoid injury to the ureter and iliac
    vessels.
  • Typically, longitudinal tears, especially those
    in a lateral position, should be treated by
    hysterectomy, whereas low transverse tears may be
    repaired.

64
Uterine Artery Ligation
  • Uterine artery ligation involves taking large
    purchases through the uterine wall to ligate the
    artery at the cervical isthmus above the bladder
    flap .

65
Hypogastric Artery Ligation
  • The hypogastric artery is exposed by ligating and
    cutting the round ligament and incising the
    pelvic sidewall peritoneum cephalad, parallel to
    the infundibulopelvic ligament The ureter should
    be visualized and left attached to the medial
    peritoneal reflection to prevent compromising its
    blood supply.

66
Hypogastric Artery Ligation
  • .

The common, internal, and external iliac arteries
must be identified clearly. The hypogastric vein,
which lies deep and lateral to the artery, may be
injured as instruments are passed beneath the
artery, resulting in massive, potentially fatal
bleeding.
67
Hypogastric Artery Ligation
  • The hypogastric artery should be completely
    visualized. A blunt-tipped, right-angle clamp is
    gently placed around the hypogastric artery, 2.5
    to 3.0 cm distal to the bifurcation of the common
    iliac artery. Passing the tips of the clamp from
    lateral to medial under the artery is crucial in
    preventing injuries to the underlying hypogastric
    vein .

68
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69
Hypogastric Artery Ligation
  • the artery is double-ligated with a nonabsorbable
    suture, with 1-0 silk, but not divided .The
    ligation is then performed on the contralateral
    side in the same manner.

70
Thank you
  • ?

71
The Use of Blood and Blood Components
  • Various blood components
  • and how they function
  • The indications and
  • contraindications for use

72
Red Blood Cells - RBC Description
  • Whole blood is collected into an anticoagulant
    then centrifuged to separate the red cells from
    the plasma.
  • The plasma is then expressed from the whole blood
    bag and the remaining red blood cells (RBC) are
    filtered.
  • The filtering process removes all but 5 x 106
    white blood cells (WBCs).
  • 85 of the original RBC volume will remain after
    filtration.
  • A typical unit has a volume of 240-340 mL and a
    hematocrit of 80.

73
Red Blood Cells - RBC Function
  • Increase the oxygen carrying capacity of the
    blood by increasing the circulating red blood
    cell mass.
  • Carry oxygen and nourishment to the tissues and
    take away carbon dioxide.

74
Red Blood Cells - RBC Indications
  • Component of choice for virtually all patients
    with a deficit of oxygen carrying capacity, e.g.,
    blood loss or anemia.
  • The majority of the WBC are removed thereby
    decreasing the risk of cytomegalovirus (CMV)
    infection in immunocompromised patients. This is
    because the CMV virus is carried in the WBC.
  • Use of RBC reduces the risk of the patient
    forming antibodies against WBC (HLA) antigens.
    This is especially important for potential organ
    or bone marrow transplant candidates.

75
Red Blood Cells RBC Contraindications
  • RBC should not be used
  • when anemia can be corrected with specific
    medications, e.g., iron, B12, folic acid,
    erythropoietin, etc
  • for volume replacement

76
Platelets PC Descriptions
  • Platelets are prepared from a random unit of
    whole blood collected in CP2D anticoagulant
    solution and filtered to remove leukocytes. PC
    contain less than 8.3 x 106 leukocytes.
  • Platelets are suspended in a small amount of the
    original plasma. A unit contains at least 55 x
    109 platelets suspended in 50-55 mL of plasma.
  • Trace amounts of red blood cells can be present
    in some units.
  • These will appear pink to salmon colored.
  • Platelets may also be obtained by apheresis

77
Platelets - PC Function
  • The primary role of platelets is to prevent
    bleeding of injured blood vessel walls by forming
    an aggregate at the site of injury.
  • Platelets also participate in blood coagulation,
    inflammation and wound healing.
  • The transfusion of platelets to a patient with
    thrombocytopenia or bleeding should produce a
    rise in the platelet count and control bleeding.

78
Platelets - PC Indications
  • For treatment of patients with bleeding due to
    severely decreased production or abnormal
    function of platelets.
  • Treatment of bleeding patients with platelet
    consumption or dilutional thrombocytopenia (in
    most instances of dilutional thrombocytopenia,
    bleeding stops without transfusion).
  • Useful if given prophylacticaly to patients with
    rapidly falling or low platelet counts, less than
    10 x 109/L (10,000/uL), secondary to cancer or
    chemotherapy.
  • Useful in selected cases of postoperative
    bleeding with platelet count less than 50 x 109/L
    (50,000/uL).

79
Platelets PC Contraindications
  • Platelets should not be used if bleeding is
    unrelated to decreased numbers or abnormal
    platelet function.
  • Should not be used in patients with consumption
    of endogenous and exogenous platelets, such as in
    Thrombotic Thrombocytopenia Purpura (TTP) or
    Idiopathic Thrombocytopenia Purpura (ITP), unless
    the patient has a life threatening hemorrhage.

80
Platelet Incubator
Stored with constant agitation
81
Fresh Frozen Plasma - FFP Description
  • Fresh frozen plasma is separated from whole blood
    and frozen within 8 hours of collection. It can
    be obtained from a whole blood donation (approx.
    250 mL) or by apheresis (approx. 500 mL).
  • Fresh frozen plasma contains a normal
    concentration of fibrinogen and the labile
    coagulation factors VIII and V.

82
Fresh Frozen Plasma FFP Function
  • Fresh frozen plasma contains the clotting factors
    that are necessary for hemostasis.
  • Plasma also has volume expansion and oncotic
    properties.

83
Fresh Frozen Plasma FFP Indications
  • The majority of clinical situations for which FFP
    is currently used do not require FFP.
  • FFP is indicated for massive transfusion
    (replacement of the patients blood volume in
    lt 24 hours) with a demonstrated deficiency of
    Factor VIII and V, otherwise frozen plasma is
    adequate.
  • Fresh frozen plasma is also indicated in exchange
    transfusion in neonates.

84
Fresh Frozen Plasma FFP Contraindications
  • Fresh frozen plasma should not be used when a
    coagulopathy can be corrected more effectively
    with specific therapy, such as vitamin K,
    cryoprecipitate, or Factor VIII concentrates.
  • Fresh frozen plasma has the same infectious
    disease risk as whole blood.
  • Fresh frozen plasma should not be used when the
    blood volume can be replaced with other volume
    expanders such as 0.9 sodium chloride, lactated
    ringers, albumin or pentaspan.

85
Frozen Plasma FP
  • Frozen plasma is prepared from whole blood,
    collected in CP2D anticoagulation solution.
  • The plasma is separated after cold centrifugation
    and processed to the frozen state within 24 hours
    of collection.

86
Frozen Plasma FP
  • Frozen plasma contains stable coagulation factors
    such as Factor IX and fibrinogen in
    concentrations similar to FFP, but reduced
    amounts of Factor V
  • and VIII.
  • On average, each unit of frozen plasma contains
    an average of 250 mL (gt100 mL) of anticoagulated
    plasma.
  • The indications and side effects are the same as
    for FFP, except that FP should not be used to
    treat coagulation factor deficiencies of Factor V
    and Factor VIII.

87
Fresh Frozen Plasma (FFP)
Unit of FFP (Approx. 250 mL)
Apheresis FFP (Approx. 500 mL)
88
Cryoprecipitate (Cryo) Description
  • Cryoprecipitate is prepared by thawing fresh
    frozen plasma at a temperature between 1C and
    6C. After centrifugation, the supernatant
    plasma is removed and the insoluble
    cryoprecipitate is refrozen.
  • On average, each unit of cryoprecipitate contains
    80 IU or more Factor VIII (FVIIIC) and at least
    150 mg of fibrinogen in 5-15 mL of plasma.

89
Cryoprecipitate (Cryo) Function
  • Cryoprecipitate provides a source of coagulation
    factors. Factor VIII, Factor XIII and von
    Willebrand Factor.
  • Fibrinogen and fibronectin are present.

90
Cryoprecipitate (Cryo) Indications
  • Currently the main indication for this component
    is as a source of fibrinogen or Factor XIII.
  • It may be used as a source of Factor VIII only
    when inactivated fractionation products or
    recombinant Factor VIII are not available.

91
Cryoprecipitate (Cryo) Contraindications
  • Cryoprecipitate should not be used unless results
    of laboratory studies indicate a specific
    hemostatic defect for which this product is
    indicated.
  • Specific factor concentrates are preferred, when
    available, because of their reduced risk of
    transmissible diseases (because of viral
    inactivation during manufacturing).
  • Cryoprecipitate can be used to make fibrin glue.
    Alternatively, virally inactivated commercial
    products can be purchased for this purpose.

92
Cryoprecipitate (Cryo)
Cryoprecipitate
Pooling Cryoprecipitate
93
Blood its Usage
94
Components
  • Cells
  • Plasma
  • molecules ions
  • water

95
Function
  • Medium of transport
  • Oxygen
  • Carbon dioxide
  • Other gases
  • Ions
  • Carbohydrates, proteins, fats
  • Immune response
  • Humoral
  • cellular

96
Cells
  • Erythrocyres
  • White cells
  • Granulocyes
  • neutophiles
  • Eosinophiles
  • Basophiles
  • Lymphocyes
  • Monocytes
  • Platelets

97
Molecules ions
  • Ions
  • Na, Cl-, K, HCO2-, etc
  • Molecules
  • Proteins enzymes, precursors, active agents,
    immunoglobulins, carriers
  • Proteoglycans
  • Lipoproteins

98
Body Water
  • Intracellular 55
  • Interstitial Fluid 20
  • Plasma 7.5
  • Connective Tissue 7.5
  • Bone Water 7.5
  • Transcellular Fluid 2.5

99
Blood products
  • Whole blood
  • Blood components
  • Red cells
  • Platelets
  • Granulocytes
  • Whole plasma (FFP, reconstituted)
  • Cryoprecipitate
  • Plasma fractions
  • Clotting factor concentrates
  • Immunoglobulin preparations
  • Saline albumin solution
  • Salt-poor albumin

100
Volume replacement
  • Haemorrhage or burns
  • Replacement with RBC mass at early stage
    necessary in massive haemorrhage
  • Initiate with rapid transfusion of plasma
    expanders, electrolyte solutions get blood type
    match in 30 minutes
  • Unmatched Grp O Rh- blood rarely justified

101
Massive Blood Transfusion
  • pH K increase impair myocardial function
  • Citrate lowers ionised Ca
  • Significant hypothermia
  • Platelet WBC aggregates precipitate ARDS

102
Prevention
  • 1 unit of fresh blood for every 5 10 units of
    stored blood
  • IV 10 calcium gluconate 10 mls with every litre
    of transfused citrated blood
  • Warming blood
  • Microaggregate blood filters

103
Fresh Blood
  • DIVC
  • Massive haemorrhage
  • Major liver trauma
  • Bleeding associated with liver disease

104
Clotting factors
  • Clotting disorders
  • Haemophilia
  • Liver disease

105
Complications of Blood Transfusion
  • Febrile reactions
  • Bacterial contamination
  • Immune reactions
  • Physical complications
  • Circulatory overload
  • Air embolism
  • Pulmonary embolism
  • Thrombophlebitis
  • ARDS

106
Complications of Blood Transfusion
  • Metabolic complications
  • Hyperkalaemia
  • Citrate toxicity hypocalcaemia
  • Release of vasoactive peptides
  • Release of plasticizers from PVC-phthalates
  • Haemorrhagic reactions
  • After massive transfusion of stored blood
  • Disseminated intravascular coagulation

107
Complications of Blood Transfusion
  • Transmission of disease
  • Hepatitis, CMV. EBV
  • AIDS (Factor VIII)
  • Syphilis
  • Brucellosis
  • Toxoplasmosis
  • Malaria
  • Trypanosomiasis
  • Haemosiderosis
  • After repeated transfusion in patients with
    haematological diseases

108
Autologous transfusion
  • Uses pt own blood
  • Remove 500 ml store
  • 2 weeks later, may be transfused in op
  • or 1000 mls taken to increase the stored amount
  • Multiplier effect
  • No danger of transmitted infections
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