TRANSFUSION OF BLOOD

1
TRANSFUSION OF BLOOD BLOOD PRODUCTS
2
FRESH BLOOD COMPONENTS

• WHOLE BLOOD
• RED BLOOD CELL IN ADDITIVE SOLUTION
• PLATELETS
• FRESH FROZEN PLASMA (FFP)
• CRYOPRECIPITATE

3
PLASMA FRACTION

• HUMAN ALBUMIN
• PROTHROMBIN COMPLEX CONCENTRATES
• IMMUNOGLOBULIN PREPARATION (90 Ig G)

4
RED CELL SEROLOGY

• ABO ANTIGENS
• RHESUS ANTIGENS (Rh)
• OTHER RED CELL ANTIGENS
• Kell antigens
• Duffy antigens
• Kidd antigens

5
PRETRANFUSION TESTING

• TYPE AND SCREEN
• CROSS- MATCHING
• EMERGENCY REQUIREMENTS FOR BLOOD

6
ORDERING BLOOD IN AN EMERGENCY

• Immediately take samples for cross-matching
• Inform the blood bank of the emergency,the volume
  of blood required,and where blood is to be
  delivered
• One individual should take responsibility for all
  communications with the blood bank, and should
  ensure that it is clear who will be responsible
  for the blood delivery
• In cases of exsanguinations use emergency group O
  Rh(D)-negetive blood.
• Do not ask for cross-matched blood in an emergency

7
BLOOD ADMINISTRATION

• Before administrating blood 2 staff members (one
  of whom must be a doctor or trained staff nurse)
  must check
• the patients full identity
• the blood pack,compatability label and report
  form
• the blood pack for signs of haemolysis or leakage
  from the pack.
• Any discrepancies means that the blood must not
  be transfused and that the laboratory must be
  informed

8
TRANSFUSION ERRORS

• Almost all deaths from transfusion reaction are
  due to ABO incompatility
• Errors in patient identification at the time of
  blood sampling or administration are the major
  cause
• When taking the initial blood sample
• check the patients identity verbally and on the
  wrist identification band
• label the sample fully before leaving the bedside
• make sure that the blood request form is clearly
  and accurately completed.

9
ADVERSE EFFECTS OF TRANSFUSION

• ACUTE HAEMOLYTIC REACTIONS
• DELAYED HAEMOLYTIC REACTIONS
• FEBRILE NON-HAEMOLYTIC REACTION
• ALLOIMMUNIZATION
• ALLERGIC REACTIONS
• CARDIAC FAILURE
• GRAFT-VERSUS-HOST REACTION
• TRANSFUSION- ASSOCIATED LUNG INJURY
• IMMUNE MODULATION
• TRANSFUSION-TRANSMITTED INFECTIONS
• BACTERIAL INFECTIONS

10
AUTOLOGOUS TRANSFUSION

• PREOPERATIVE DONATION
• ISOVOLAEMIC HAEMODILUTION
• CELL SALVAGE

11
TRANSFUSION REQUIREMENTS IN SPECIAL SURGICAL
SETTINGS

• MASSIVE TRANSFUSION
• THROMBOCYTOPENIA
• COAGULATION FACTOR DEFICIENCY
• HYPOCALACAEMIA
• HYPERKALEMIA HYPOKALAMIA
• HYPOTHERMIA
• ADULT RESPIARATORY DISTRESS SYNDROME (ARDS)

12
MASSIVE BLOOD TRANSFUSION

• This is defined as the transfusion of the
  equivalent of the the circulating blood volume
  within a 24hour period (in practice 10-20 units
  in an adult)
• Common identifications for massive blood
  transfusion are major trauma, gastrointestinal
  bleeding and obstetrics complications.
• Major problems associated with massive blood
  transfusion include
• underlying coagulopathy
• thrombocytopenia
• lack of coagulation factor 5 8
• hyperkalaemia
• hypothermia

13
METHODS TO REDUCE THE NEED FOR BLOOD TRANSFUSION

• ACUTE VOLUME REPLACEMENT
• HYDROXYETHYL STARCH (HES)
• DEXRAN 70
• DEXTRAN40
• UREA-BRIDGED GELATIN (HAEMACCEL

14
MECHANISM FOR REDUCED BLOOD USE IN SURGERY

• PREOPERATIVE
• Surgery elective Correct the
  Haemoglobin level.
• Stop
  drugs that interfere Haemostasis
• INTRAOPERATIVE
• Posture
• Use of Vasoconstrictors
• Use of tourniquets
• Use of anti-fibrinolytic drugs eg Aprotinin
• Using Fibrin Sealant
• POST OPERATIVELY
• Blood can be salvaged from drains into collection
  devices that permit reinfusion
• Decision to transfuse post operatively should
  depend
• Age of the patient
• Ability to
  tolerate lower levels of anaemia
• Rate amount of
  continuing blood loss

15
TRANSFUSION OF BLOOD BLOOD PRODUCTS

• Clinical Scenarios

16

• A 65 year old man has undergone a left
  nephrectomy 3 days ago. He required 3 units of
  packed cells intra-operatively. He looks pale and
  is dyspnoeic but his vital signs and urinary
  output are satisfactory. You check his FBP. Hb is
  7 PCV 0.28.
• What would you do?

17

• A 34 year old man presents in the resuscitation
  room of the A/E department. He is anxious, short
  of breath, sweating and his BP is 80 systolic,
  Pulse 120. There is a stab wound on the right
  side of the chest. A chest drain was inserted by
  the SHO and 1000mls of blood drained immediately.
  
• What would you do with respect to his fluid

18

• A 57 year old man needs a left hemicolectomy for
  carcinoma. He declares himself to be a Jehovahs
  witness and refuses a blood transfusion under any
  circumstances.
• What will you do?