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Blood Transfusion
Blood Transfusion
Blood Transfusion
PLAN
Introduction Types Indication Dosage Complications Alternatives
INTRODUCTION
Donor screening : Hepatitis,HIV,Syphilis, ABO Rh Blood processing: Whole blood as raw material Storage & Preservation of blood & blood components Informed consent Pretransfusion testing:ABO,Rh Transfusion practice
INTRODUCTION
Kabutare : April to July 2013 ,282 BT 15 million transfusions are given yearly in the USA Rwanda/CNTS
INTRODUCTION
Indications Symptoms or signs of anemia, such as tachycardia, tachypnea, lethargy, and exercise intolerance. Level of hemoglobin/hematocrit. The anemia is acute or progressive onset. Coexisting cardiopulmonary problems or infections that might impair the patient's ability to tolerate the anemia. Specific blood components
TYPES
TYPES
Whole blood Packed red blood cells Frozen red blood cells Frozen fresh Plasma Granulocytes Platelets Cryoprecipitate Plasma derivatives
TYPES
TYPES
WHOLE BLOOD
Raw material 1 unit /400-500 mls Conservation 4o C for 35 days in citrate-phosphatedextrose-adenine Storage :Whole blood stored for over 24 hours has reduced levels of platelets and labile clotting factors (V and VIII).
WHOLE BLOOD
Acute bleeding >20-25% blood loss Exchange transfusion (Sickle Cell, Leukemia) Not indicated in chronic anaemia nor in hypovolaemia alone Dosage:10 to 15 mL/kg given over 2 to 4 hours Severe anemia and Heart failure 2mls/kg/hr The first 15 minutes cautious Dont exceed 4 hrs after thawing
PLATELETS
1 unit is 50 mls Dose: 1 unit of PC/10 kg wt. Storage: room temperature 22oc to 24oc 72 hrs. Risk of contamination bacterial growth
PLATELETS
Thrombocytopenia is a risk factor for hemorrhage, and platelet transfusion reduces the incidence of bleeding. Transfusion of platelets should be reserved for patients with counts <10 to 20 109/L or in surgical settings <50 109/L.
RBC that have been preserved with a cryoprotective agent, usually glycerol, may be stored at -65C for up to 10 years The product must be transfused within 24 hours after thawing
GRANULOCYTES
Storage at 20-24 ,Use after collection Infusion for 2-4 hours Indications Severe neutropenia (<500 microg/L) Resistance to antibiotics (24-48h) Decrease use due to Antibiotics
CRYOPRECIPITATE
Cryoprecipitate is formed when FFP is thawed, and each bag contains about 150 mg of fibrinogen and 80 units of factor VIII. Cryoprecipitate has been largely replaced by factor VIII concentrates in the treatment of hemophilia A. The major indication for cryoprecipitate is correction of hypofibrinogenemia, congenital factor XIII deficiency, and for DIC
CRYOPRECIPITATE
A common dose for Fibrinogen replacement is 1-1.5 units per 10kg patient body weight. The volume of one unit of cryoprecipitate is 30 40mls and up to 60mls. Cryoprecipitate should be administered at a rate of 5 10 minutes/unit.
PLASMA DERIVATIVES
Albumin, intravenous immunoglobulin, antithrombin, and coagulation factors. In addition, donors who have high-titer antibodies to specific agents or antigens provide hyperimmune globulins, such as anti-D (RhoGam, WinRho), and antisera to hepatitis B virus (HBV), varicella-zoster virus, CMV, and other infectious agents.
COMPLICATIONS
Hemolysis Recipient antibodies to transfused RBC Osmotic, thermal, or mechanical lysis of cells before infusion Nonhemolytic febrile reactions Recipient antibodies to WBC in blood product Cytokines in blood product Bacteria in blood product
COMPLICATIONS
Allergic Hyperkalemia Pulmonary edema Hypothermia
COMPLICATIONS
Viruses Hepatitis B, C Retroviruses: HIV-1 and HIV-2, human T-cell leukemia viruses, types I and II (HTLV-I/II) Cytomegalovirus (CMV), parvovirus, and Epstein-Barr virus (EBV) (mainly inimmunosuppressed recipients)
COMPLICATIONS
Bacteria Associated with asymptomatic bacteremia in blood donors (Yersinia enterocolitica, Salmonella, and other gram-negative organisms) Caused by contamination during collection (skin flora) or processing of blood Syphilis Parasites Malaria, Trypanosoma cruzi, leishmaniasis
REFERENCES
1.Rudolph's Pediatrics - 21st ed. (2002)Use of blood and blood products - susan A. Galel , J. Lawrence naiman 2. Corwin HL et al: The CRIT study: Anemia and blood transfusion in the critically illCurrent clinical practice in the United States. Crit Care Med 32:39, 2004 3. Taylor RW et al: Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med 34:2302, 2006 4. Blood Banking & Immunohematology , Maurene Viele, MD, & Elizabeth Donegan, MD. Blood Banking & Immunohematology 2001 5. Harrison's Internal Medicine > Chapter 107. Transfusion Biology and Therapy
BLOOD ALTERNATIVES
Volume expanders Growth factors Intra-operative or post-operative blood salvage Blood substitutes
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