Dr. Asoka de silva
Blood transfusions
Purpose of transfusions
to increase oxygen carrying capacity
to increase circulating volume
other minor reasons
CIRCULATING BLOOD VOLUME 70ML /KG
ACCEPTABLE BLOOD LOSS 10% OF CIRCULATING VOLUME
Functions
Transport
Oxygen
Carbon dioxide
Ions
Carbohydrates, fats, proteins
Protection
Humoral
Cellular
Stored blood
437 blood and 63 ml of CPD solution
Temp 4 degree centigrade
pH 6.7
k 20 m.equ/l
low 2:3 DPG
RBC 80% viable
Red cells can be kept for 42 days
Platelets for three days
Plasma can be frozen for a long time
ACD – 21 daysCPD– 35 daysCPDA—42 days
Complications
Incompatibility
Infections
Allergic reactions
Over transfusion
Pyrogens
Emboli
Contaminated blood
ARDS
HIVHep BHepCSyphillisCytomegalo virusEpstein_Barr virus
Incompatibility
Signs and symptoms depends onIntravascular haemolysisRE system haemolysis
Chest and flank painChills, fever, flushingHeadache, vomiting, tachypneaHypotension, tachycardiaOozing from the woundHaemoglobinuriaLater oliguria, jaundice, anaemia
Haemolytic reactions
Due to an error in either
Typing and cross matching
Documentation and labeling
Checking and cross checking
S & S
Chest pain
Backache
Dyspnea
Hypotension
Fever, chills, headache, nausea, vomiting, and a burning sensation at the site of the infusion
Management
Discontinue
Oxygen
New tubing, vigorous crystalloids .
Mannitol, diuretic therapy dopamine.
Maintain urine output at 1 to 2 ml/kg/hr.
Anti-histamines, steroids
Samples
blood from patient.
Blood from blood pack
urine for HB
Immediate reactions
Haemolytic reactions
Febrile transfusion reactions
Allergic reactions
Transfusion related lung injury
Delayed reactions
Extra vascular haemolytic reactions
Graft versus host reactions
Blood and cancer surgery
Facts
Pts survive longer if no blood is given
Recurrences are less if no blood is given
Immunosuppression
Graft-versus-host disease
May be due to white cells that we give
Complications of massive transfusions (>35ml/kg/hr)
Potassium
Calcium
Citrate
Clotting factors
pH
Platelets
Temperature
2:3 DPG
Measures to reduce transfusionsAccept lower HB levels
Keep blood loss to a minimum
hypotension
good haemostasis
regional blocks
Auto transfusions
Drugs
desmopressin
antifibrinolitics
Use alternatives
Stored pt’bloodIntra op collectionPost op collection
Autotransfusion may be defined as "collection and reinfusion of the patient's own blood
There is rapid availability
Blood compatibility is not a problem,
There is immediate reinfusion of normothermic blood.
No risk of transmission of infectious diseases
2,3-diphosphoglycerate (2,3-DPG) have been found to be significantly higher
no direct complications of hypocalcemia or hyperkalemia..
Autotransfusion allows preservation of limited stores of banked blood,
Autotransfusion lowers the cost of medical care.
It may be acceptable to those patients whose religious convictions prohibit blood transfusions
Alternatives
Plasma
Crystalloids
Plasma expanders
Dextrans
Polygelatins
Starch preparations
Haemoglobin substitutes
Perflurocarbons
Haemoglobin solutions
Blood banking
Anticoagulation
Storage at 4 degrees
Life span
ChangesATPase pump
K+ H+
Granulocites
Platelets
Factors V & Vll
Blood typing
Blood that lacks A antigen is Type B
Blood that lacks B antigen is Type A
Blood that lacks both Type O
Blood that has both is type AB
Other tests
Rh typing
Antibody screening
Coombs test
In crisis situations
O+ blood is used
In females O-
Type & cross match
Type specific in 10 minutes
Incomplete cross match in 30 minutes
Full cross match is available in 45 minutes
Packed red cells
1 unit increases Hb by 1 G/100ml
Haematocrit by 3%
Similar increase in children by giving 3ml/Kg
A unit should never be given over more than 4hours
A unit not refrigerated should be discarded
platelets
Cross matching is not needed
Rh – females should receive Rh –ve platelets
1 unit will increase by 5000/mm3
Each unit is about 50-70 ml
Usually 6 units are given