Post on 19-Jan-2017
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BLOOD COMPONENT TRANSFUSION
DR TANVEER ALAM
PAEDS ONCOLOGY
SKMCH & RC
What is history of transfusion? What are Blood components ? How are the blood component separated ? What are the Indications for transfusion ? What is the dose of administration in paeds? What are complications? How to minimize the errors? What are the SKMCH protocol?
Blood transfused in humans since mid-1600’s 1828 – First successful transfusion 1900 – Landsteiner described ABO groups 1916 – First use of blood storage 1939 – Levine described the Rh factor
HISTORY OF TRANSFUSIONS
BLOOD components Any therapeutic substance prepared from human bloodWHOLE BLOOD Unseparated blood collected into an approved container
containing an anticoagulant preservative solutionBLOOD COMPONENT • RBCs• platelets• Plasma• Cryoprecipitate• GCSF• Human albumin 4.5%
DEFINITIONS
FIRST CENTRIFUGATION
Whole Blood Main Bag
Satellite Bag 1
Satellite Bag 2
RBC’sPlatelet-rich Plasma
First
Closed System
SECOND CENTRIFUGATION
Platelet-rich Plasma
RBC’s PlateletConcentrate
RBC’s
Plasma
Second
StorageOn 4° for up to 35 days
Indications Massive Blood Loss/Trauma/Exchange TransfusionConsiderations Donor and recipient must be ABO identical
Dosage10 to 20 ml /kg
Never add medication to a unit
WHOLE BLOOD TRANSFUSION
Storage4° for up to 42 days, can be frozenIndicationsMany indications ie anemia Hb < 7, hypoxia, etc.dosageDose 10 to 15ml/kg Usually transfuse over 2-4 hours orVolume required = required rise in Hb in g/dl x wt in kg x 4 or3-4 mls/kg of red cells raises Hb by 1g/dl
PRBCS TRANSFUSION
StorageUp to 5 days at 20-24°
Indications Lumbar puncture - transfuse prior to LP to bring platelets > 50 x
109/l. Major surgery - maintain platelet count > 50 x 109/l (critical sites;
brain, spine, eyes > 100 x 109/l). Minor surgery - maintain platelet count at >50 x 109/l Line insertion - > 50 x 109/l. Line removal - > 50 x 109/l. Bone marrow trephine - Usually no need to transfuse - discuss
with operator. In some patients (e.g. aplastics or ITP), platelet transfusion should be avoided if possible.
Bone marrow aspirate - no need to transfuse.
PLATELETS TRANSFUSION
Dosage of platelets 10-20mls/kg for children There may be a higher requirement in the following circumstances: Active haemorrhage Sepsis Splenomegaly Consumptive coagulopathy – e.g. DIC
PLATELETS TRANSFUSION CONTINUE…
Storage FFP--12 months at –18 degrees or colder Indications Coagulation Factor deficiency, fibrinogen replacement, DIC,
liver disease, exchange transfusion, massive transfusion,warfarin overdose, INR > 1.5 TO 2 befor surgery
Dose : 10-20mls/Kg
Considerations Plasma should be recipient RBC ABO compatible In children, should also be Rh compatible Usual dose is 20 cc/kg to raise coagulation factors approx 20%
FFP TRANSFUSION
Rich source of Factor VIII, von Willebrand’s factor and fibrinogen Stored at -400C Dose of cryoprecipitate 5 ml/kg Cryoprecipitate is available in most ABO groups Use within 4h of thawing use Haemophilia (Factor VIII deficiency) Fibrinogen deficiency & dysfibrinogenaemia Von Willebrand’s disease
CRYOPRECIPITATE
Rich in protein This may be stored for several months in liquid form at 40C Suitable for replacement of protein e.g. following severe burns ,liver
disfuntion
HUMAN ALBUMIN 4.5 PER CENT
INDICATION & DOSEIn severe neutropenia in myelosuppresive chemotherapyInitially 5mcg/kg/SC & can increase 5mcg/kg every cycle till anc10,000/mm3 BONE MARROW TRANSPLANT10mcg/kg/day IV over 4 to 24 hoursIN SEVERE CHRONIC NEUTROPENIASITEAbdomen (not around umbbilicus) ,thighs ,hips ,arm (rotate the site)Keep refrigerated and do not shake before administration
G-CSF (FILGRASTIM
21
Blood/ Start infusion Complete infusionblood product
Whole blood/ within 30 min. of within 4 hourred cells removing pack (less in high from ambient temperature)
refrigerator
Platelet immediately within 20 minconcentrates
FFP within 30 min within 20 min
Time Limits for Infusion
AcuteLate
Infective
COMPLICATIONS OF BLOOD TRANSFUSION
ACUTE TRANSFUSION REACTIONS
Hemolytic Reactions Febrile Reactions Allergic Reactions Coagulopathy with Massive transfusions Bacteremia
Urticarial rash itch
Layrngeal edemaBronchospasm
and cutaneous flushing
Termination of transfusion IV crystalloids Maintenance of airway Oxygen Adrenaline IV antihistamine salbutamol
Signs and symptoms Management
ALLERGIC AND ANAPHYLAREACTIONS
Chills, feverLow back pain
HeadacheChest painDyspneaCyanosis
Restlessness, anxiety Hypotension
Red urine
Stop transfusionO2 supply
urine output monitoringTreat shock
Volume replacement
Signs/Symptoms Management
HEMOLYTIC REACTION
CoughChest painDyspnea
Distended neck veinsFrothy sputum
Slow infusionoxygen
DiureticsVasodilators
Signs/Symptoms Management
VOLUME OVERLOAD
CausesPulmonary microvascular occlusion by microaggregates of platelets, leucocytes and fibrinPresentation
Fever, breathlessness, nonproductive cough, hypoxemia
TRANSFUSION RELATED ACUTE LUNG INJURY
Delayed haemolytic Transfusion reactionOccurs in patients whose level of antibodies to antigen is so low that it escapes detection by pretransfusion screen. Following transfusion , the secondary immune response raises the antibody titre to a level that results in delayed destruction of transfused cellsPresentation- fever falling Hb, jaundice & haemoglobinuria after 5-10 days SENSITIZATION Development of antibodies to donated white cells & platelets GRAFT-VERSUS-HOST DISEASESOccurs in immunodeficient patientsImmunocompetent patients after tansfusion of blood from a relative Disease is caused by T-lymphocytesPrevented by administrating gamma-irradiated cellular components to immunodeficient patients & blood from relative should be gamma irradiated
LATE COMPLICATIONS
Every unit of blood contains 250 mg of ironRepeated transfusions cause iron overload of monocyte-macrophage systemBecomes significant after 100 unitsInvolves liver, pancrease, myocardium and the endocrine glands
TreatmentChelation therapy with desferrioxamine
HAEMOSIDEROSIS
Transmission of infective diseasesSerum hepatitis virus
HIV Bacterial infection-result of faulty storage
Malaria
INFECTIVE COMPLICATIONS
Arrange required blood product as you suspect any need If a patient need blood in emergency doctor can request blood bank Patient can get blood at exchange basis too We take consent for all type of blood transfusion when patient
admit on floor Written orders for blood transfusion should be given by Dr Repeat the sample after completion of transfusion If any reaction occur manage the patient immedietly Fill the blood reaction form and send the blood sample for culture
and recross match and remaining blood to the blood bank Document the probelum online
HOW DO WE DO IT IN SKMCH &RC