blood and blood transfusions

BLOOD & BLOOD TRANSFUSIONS

DR.SHALINI SINGH (PG)

blood and blood transfusions 2

BLOOD


OBJECTIVES

• Properties and functions of blood• Plasma proteins• Bone marrow• Red blood cells• White blood cells• Platelets


• Blood is considered as river of life, fluid of life, fluid of growth, fluid of health.

• Average human has 5 liters of blood i.e 8% of total body weight.

• It is a transporting fluid.• It carries vital substances to all parts of body.


Properties Of Blood

• Color range • Oxygen-rich blood is scarlet

red bright crimson • Oxygen-poor blood is purple

red. • Red color comes from the

several million red cells, present in it

• pH must remain between 7.35–7.45

• Temp 38 c or 100.4 F


• Blood is 5 times more viscous than water.

• Blood is a specialized type of connective tissue in which living blood cells, (formed elements), are suspended in a non living fluid matrix called plasma.• Cellular Part (Formed

Elements) • Non cellular part (Plasma)

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Functions of blood

Blood performs a number of functions.• Distribution • Regulation • Protection

Distribution Functions

Nutritive Function:

Respiratory Function:

Excretory Function:

Transport Function:

blood and blood transfusions


Regulation Functions • Maintainance Functions • Buffering Functions

Protection Functions • Preventing blood loss • Defensive function


PLASMA• Plasma is the fluid portion of the blood. It constitutes about

5% of the body weight. • If blood is allowed to clot, then a clear, straw colored fluid

oozes out. This is the serum . • Serum is similar to plasma, except that serum does not

have clotting factors. • SERUM = PLASMA - FIBRINOGEN


• It contain all the vital substances. • These vital substances include digested

food, salts, hormones, enzymes, substances essential for clotting of blood, and antibodies , which are important for defense.


Separation Of Plasma Proteins

• Precipitation method• Salting out method • Electrophoretic method• cohn’s fractional precipitation method• Ultracentrifugation method • gel filtration chromatography• Immunoelectrophoretic method


PROPERTIES• Molecular weight Albumin- 69,000

globulin- 1,56,000

fibrinogen- 4,00,000• Oncotic pressure- about 25 mm Hg• Specific gravity- 1.026• Buffer capacity- 1/6 of total buffering action

of blood

ORIGIN• In embryo – synthesized by mesenchymal

cells.• In adults – mainly from reticuloendothelial

cells of liver


Functions of plasma

• Helps in transport of substances in the body

• Maintains colloid osmotic pressure of blood

• Causes blood clotting because it contains the fibrinogen and prothrombin

• Stores proteins for supply in needs • Helps provides viscosity to blood • Contains antibodies and antitoxins


BONE MARROW

• The bone marrow is present in the bone cavities. • It can be considered as one of the largest organs in the

body, and also one of the most active. • In children, blood cells are produced in the marrow

cavities of all the bones. • Gradually, it gets replaced by fat (yellow marrow). • In the adult blood cells are produced in the bone marrow

of selected bones (e.g. backbone – vertebral column, ribs, bones of the skull, etc.)


Bones require their own blood supply which travels through the periosteum to the inner bone marrow.

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RED BLOOD CELLS

• RBCs are also called erythrocytes .

• They are tiny (7.5u in diameter, 2u thick) biconcave discs.

• They survive for about 120 days.

• RBCs are non nucleated formed elements in the blood.

• The average normal RBC count is – • for men 5.4 million/uL • for women 4.5 million/uL


Production of Erythrocytes: Erythropoiesis


• Hemoglobin is the most important component of red blood cells.

• It is composed of a protein called heme, which binds oxygen.

• In the lungs, oxygen is exchanged for carbon dioxide.

• Abnormalities of an individuals hemoglobin value can indicate defects in red blood cell balance.

• Both low and high values can indicate disease states.

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Formation of RBCs

• Takes place in the bone marrow. • A feedback exists – if the RBC count

rises, further increases are inhibited.• Low levels of oxygen in the

atmosphere stimulate the formation of RBCs.

• This is an important part of the body’s adjustment to high altitudes. People living in the mountains actually do have higher RBC counts than usual.

• RBC formation is regulated by a substance secreted by the kidneys.


• Destruction of RBCs • About 5 X 10 11 RBCs are

destroyed everyday, in the liver and spleen.

• Functions of RBCs • Carriage of oxygen. • Hemoglobin (Hb) – the red pigment

– acts as the vehicle for the transport of oxygen from the lungs, via the heart to the rest of the body.

• Also carries CO2, though greater amounts of CO2 are transported dissolved in plasma.

• Average Hb level in normal men 16gdL and 14gdL in normal women.


• Iron is essential for the synthesis of Hb. • Hence after excessive bleeding iron supplements (tonics)

plus a diet rich in iron are necessary for more Hb to be formed.

• Carriage of CO2 (less significant) – as described above, most of the CO2 is dissolved in plasma.

• Presence of specific substances on their surface, which are responsible for ‘typing’ blood into different groups.

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Variations in number of RBCsPHYSIOLOGIC VARIATIONS• Increase

• Age• Sex• High altitude• Muscular exercise• Emotional conditions • Increased environmental

temperatureAfter meals• Decrease—

• High barometric pressure• During sleep• pregnancy



PATHOLOGIC VARIATIONS• Increase– polycythemia• Decrease-- anemia


WHITE BLOOD CELLS

• WBCs or leukocytes consists of 5 categories of cells.

• Each category has a distinct shape and appearance.

• Some cells are smaller than RBCs (5u in diameter) whereas others are definitely bigger (15 u in diameter).


Formation and destruction of WBCs

• The WBCs are formed in the bone marrow. • The different categories of cells have different stimuli

for production. For e.g. one category (called neutrophils ) are produced in large number whenever there is short or severe (acute) infection.

• There life span also differs. Some categories (e.g. neutrophils) may survive upto 7 hours.

• In contrast other cells ( lymphocytes ) are called ‘ memory cells .’


• They are able to ‘ remember’ an invader for several months, even years.

• If the invader enters the body again, these memory cells are alerted, and the body’s response to the second invasion is much more extensive and rapid.


Functions of WBCs

• WBCs are concerned with defense . • Some of them are concerned with fighting acute (short,

severe) infections, whereas others fight chronic infections.• Some WBCs are capable of moving in the tissues, acting

like vigilant guards. • If they encounter a bacterium, they may consume it or

make it inactive. • The pus which may be seen oozing out of an infected

wound, is made up of dead WBCs . • A particular category of WBCs – the eosinophils – are

increased in allergic reactions and also in cases of worm infestation.


PLATELETS

• The platelets are tiny bodies, 2-4um in diameter. • There are about 0.25 to 0.4 million/uL of circulating blood.• They have a half life of about 7 days. • The platelets are called thrombocytes , because they

release thrombin , which aids in blood clotting.


Platelets (Thrombocytes) Formation Large multinucleated cells that pushes against the wall of the capillary. Cytoplasmic extensions stick through and separate.


OBJECTIVES• Provide overview of transfusion therapy.• Describe pre-transfusion responsibilities.• Describe transfusion responsibilities.• Describe post-transfusion responsibilities.• Describe types of transfusions.• Describe transfusion reactions.• Describe autologous transfusions.


OVERVIEW

• It is a procedure in which a patient receives a blood product through an intravenous line.

• It is the introduction of blood components into the venous circulation.

• Process of transferring blood-based products from one person into the circulatory system of another.

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HISTORY OF BLOOD TRANSFUSION

• Before The Nobel Prize awarded, Karl Landsteiner discovered the ABO human blood groups in 1901, it was thought that all blood was the same. This misunderstanding led to fatal blood transfusions and many death.



• Prof. Karl Landsteiner discovered that blood clumping was an immunological reaction

• Karl Landsteiner's work made it possible to determine blood types

• For this discovery he was awarded the Nobel Prize in Physiology or Medicine in 1930.

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•450ml of blood can save as many as three lives.

•Every two seconds, someone in India needs blood.

•One out of every three of us will need blood in our life time.

•Even with all of today’s modern technology, there is no substitute for blood.

Someone has to give blood

in order for someone to receive blood. blood and blood transfusions


•A person has 5 - 6 liters of blood in their body.

•A person can donate blood every 90 days (3 months).

Body recovers the Blood very quickly:• Blood plasma volume– within 24 - 48

hours• Red Blood Cells – in about 3 weeks • Platelets & White Blood Cells – within

minutes


Purposes

•To replace losses of: Circulating volume Oxygen carrying capacity .•To restore: Metabolic homeostasis. •To replenish: Normal RBC’s (eg. Refractory anemias, Thalasemias, Sickle cell anemias etc)•In cancer patients like ALL; AML; with / orafter Chemothrapy drugs• For emergency surgery, heart surgery


Typical Situations in which blood products are given

• Major injuries after an accident or disaster• Surgery on an organ such as the liver and

the heart• Severe Anemia• Bleeding such as Haemophilia and

Thrombocytopenia• Pre-mature, pre term babies• Cancer patients


What are the different blood groups?

•There are more than 20 genetically determined blood group systems known today

• The AB0 and Rhesus (Rh) systems are the most important ones used for blood transfusions.

• Not all blood groups are compatible with each other. Mixing incompatible blood groups leads to blood clumping or agglutination, which is dangerous for individuals.


ABO blood grouping system

• According to the ABO blood typing system there are four different kinds of blood types: A, B, AB or O (null).


AB0 blood grouping system

• Blood group A If you belong to the blood group A, you have A antigens on the surface of your RBCs and B antibodies in your blood plasma.

• Blood group B If you belong to the blood group B, you have B antigens on the surface of your RBCs and A antibodies in your blood plasma.


Blood group OIf you belong to the blood group O (null), you have neither A or B antigens on the surface of your RBCs but you have both A and B antibodies in your blood plasma.


Possible Blood group Genotypes

ParentAllele

A B O

A AA AB AO

B AB BB BO

O AO BO OO


The ABO blood groups• The most important thing is in assuring a safe blood transfusion.

• The table shows the four ABO phenotypes ("blood groups") present in the human population and the genotypes that give rise to them.

Blood Group

Antigens on RBCs

Antibodies in Serum Genotypes

A A Anti-B AA or AOB B Anti-A BB or BO

AB A and B Neither ABO Neither Anti-A and anti-B OO


The Rhesus (Rh) System

• Well, it gets more complicated here, because there's another antigen to be considered always - the Rh antigen.

• Some of us have it, some of us don't have. • If it is present, then blood is RhD positive, if not it's

RhD negative. • So, for example, some people in group A will have

it, and will therefore be classed as A+ (or A positive).

• While the ones that don't, are A- (or A negative). • And so it goes for groups B, AB and O.


What is that Rh antigens?

•Rh antigens are transmembrane proteins with many loops exposed at the surface of red blood cells.

• They appear to be used for the transport of carbon dioxide and/or ammonia across the plasma membrane.

• They are named for the rhesus monkey in which they were first discovered.

• RBCs that are "Rh positive“ Must express the antigen designated as D.

• A person with Rh- blood does not have Rh antibodies naturally in the blood plasma


• According to above blood grouping systems, you can belong to either of following 8 blood groups:


• A person with Rh- blood can develop Rh antibodies in the blood plasma if he or she receives blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies.

• A person with Rh+ blood can receive blood from a person with Rh- blood without any problems.


Laboratory Determination of the ABO System


Blood Group

Antigens Antibodies Can give blood to

Can receive

blood from

AB A and B None AB AB, A, B, O

A A B A and AB A and O

B B A B and AB B and O

O None A and B AB, A, B, O O


• Rh+ can receive blood from: Rh+ and Rh-• Rh- can receive blood from: Rh- only


BLOOD BANKS

• Blood banks collect, test, and store blood.• Autologous transfusion - If surgery is

scheduled months in advance, patients may be able to donate their own blood and have it stored.


BLOOD STORAGE

• Blood products must be stored at 4C +- 2C.

• Stored blood has a shelf life of 3 weeks.• After a storage time of 24-72 hr RBCs

have reduced capability to release oxygen to tissues.

• If the patient needs massive transfusions its better to give blood that’s less than 7 days old.


Requesting Procedure

• Check the patient’s case note

• Transfusion history• Special requirements

• e.g., irradiated, CMV negative

• Complete request form or order communications


CasenoteSurnameForename

DOBEthnic OriginLocationConsultantSex

Patient Category NHSDate of RequestEntered byOriginatorDate of Specimen

Service (Type of Request)Blood GroupPrevious Transfusion

Units (amount) Date ReqdReaction

Specimen typeVacutainer 7mls pink + 4.5 mls EDTAAntibodies

Specimen taken by Sign and print Name Requesting Medic Sign and Print name

Copy of this request must be filed in the notes. See Trust Transfusion policy

Diagnosis, referral reason, relevant medication

Information found on the Request Forms


PRE-TRANSFUSION RESPONSIBILITIES

• Assess laboratory values• Verify the medical prescription.

• Assess the client’s vital signs, urine output, skin color and history of transfusion reactions.

• Obtain venous access. Use a central catheter or at least a 20-gauge needle, if possible.


Sampling Procedure

• Step 1: Ask the patient to tell you their: Full Name + Date of Birth

• Check this information against the patient’s ID wristband

• Be extra vigilant when checking the identity of the unconscious / compromised patient


Step 2: Check the patient’s ID wristband against documentation

e.g., case notes or request form for:

• First name

• Surname

• Date of birth

• Hospital number


Sampling Procedure

Only bleed one patient at a time using Aseptic non touch technique

Do NOT use pre-labeled tubes

Label the sample tube beside the patient

Send the sample to the laboratory in the most appropriate way for the clinical situation, i.e. routine / emergency

Remember emergency requests must always be phoned through to the Transfusion Laboratory.


Labelling the venous blood sample

• Information to include:-• Full name• Date of birth• Hospital number• Gender• Date• Signature of person who has taken

the sample• At the bedside• By the person taking the sample


IV Blood/ Blood Component Chart


Prescribing a transfusion

• Each unit must be entered separately on the patient’s prescription sheet.

• The entry must specify the type of product

any special requirements the rate of transfusion – max 4hrs/unit


Blood Transfusion Administration


• Obtain blood products from a blood bank; transfuse immediately.

• With another registered nurse, verify the patient by name and number, check blood compatibility and note expiration time.

• Administer the blood product using the appropriate filtered tubing.


Good Documentation

Minimum Transfusion Dataset: the following should be documented in the notes

• Reason for transfusion• Current blood results• Component type and amount to be prescribed• Anticipated outcome• Any reported transfusion adverse events/reactions• Review following the transfusion including how

much blood has been transfused


Warming Blood

• STORED BLOOD IS COLD 4*C• PATIENTS UNDERGOING SURGERY WILL

ALREADY BE LOSING BODY HEAT DUE TO WOUND OR CAVITY EXPOSURE

• LARGE VOLUMES OF COLD BLOOD MAY INDUCE HYPOTHERMIA OR CARDIAC ARYTHMIA


• AT INFUSION RATES>100ml/minute, COLD BLOOD MAY BE A CONTRIBUTING FACTOR IN CARDIAC ARREST. HOWEVER, KEEPING THE PATIENT WARM IS PROBABLY MORE IMPORTANT THAN WARMING THE INFUSEDBLOOD !

• WARMED BLOOD IS MOST COMMONLY REQUIRED IN LARGEVOLUME RAPID TRANSFUSIONS & EXCHANGE TRANSFUSION IN INFANTS.

• BLOOD SHOULD ONLY BE WARMED IN A BLOOD WARMER THAT HAVE A VISIBLE THERMOMETER AND AN AUDIBLE WARNING ALARM AND SHOULD BE PROPERLY MAINTAINED.


Can the Patient be Safely Transfused ?

• Is the product clearly prescribed?• Are any drugs required before or during

transfusion? i.e. antibiotics • Is the rate of transfusion appropriate?• Does the patients condition require medical review prior to

transfusion

All patients having a blood transfusion MUST have a NAMEBAND containing all of their required details


Monitoring of Patient

Base line observations – Temperature, pulse and blood pressure

Further observations (as above) at 15 minutes

A set of observations at the end of transfusion

More frequently if the patient is unwell, unobservable, unconscious or a child.


MONITORING PATIENTS

• Ensure the venflon is secure, patent and there are no signs of inflammation

• Give the patient the call bell • Patients should remain in a clinical area for the

duration of the Transfusion• Review the patients fluid balance and medication.


Pre-administration Procedure

• Step 1: Check the blood component has been prescribed

• Step 2: Undertake baseline observations

• Step 3: Undertake visual inspection

LEAKSDISCOLOURATIONCLUMPING

EXPIRY DATE


Pre-administration checks

• Personal checks:- ANTT- wear personal protective equipment

• Equipment checks:- Personal protective equipment is available and is clean and sterile- A correctly completed prescription chart- Observation chart- Giving set- Disposable bags - Trolley


Administration Procedure

• Step 1: Ask the patient to tell you their

Full Name + Date of Birth

• Check this information against the patient’s ID wristband



• Step 2: Check the patient’s– First name– Surname– Date of birth

– Hospital number

• on the compatibility/

traceability label against

the patient’s ID wristband



• Step 3: Check the compatibility/traceability label with the blood bag label

Any discrepancies DO NOT TRANSFUSE !


Blood Component Bedside Check Procedure

SURNAME

FIRST NAME(s)

HOSPITAL NUMBER

D.O.B.BLOOD GROUP(Patient and Unit)

DONOR NUMBER

EXPIRY DATE

Special Requirements


• Remain with the patient during the first 15-30 minutes of the infusion.

• Infuse the blood product at the prescribed rate.

• Monitor vital signs.


Reporting Incidents/Transfusion Reactions

• Stop the Transfusion and seek Medical Input and inform the Transfusion Laboratory staff

• Check the Blood component matches the patient details

• Replace the unit and giving set with Normal Saline 0.9%

• Send the discontinued unit with giving set attached back to transfusion capped off at the end with a white venflon cap – and any previous transfused bags sealed with the blue plugs all in biohazard bags

• Documentation (complete the checklist)

• Complete a Trust Incident form


TYPES OF TRANSFUSION


Types of BT

• Based on time of transfusion• Fresh whole blood transfusion • Stored CPD Blood

• Based on composition • Whole blood • Blood fraction

• Based on the donor• Autologous blood transfusion• Blood from diff donor

Whole Blood

Packed Red Blood Cells Platelet Rich Plasma

Slow Centrifugation

High Speed Centrifugation

1 Unit of Random Donor Platelets

1 Unit of Fresh Frozen Plasma

Cryoprecipitate

Thawing precipitates the plasma proteins

BLOOD COMPONENTS

Whole Blood

• Storage• 4° for up to 35 days

• Indications• Massive Blood Loss/Trauma/Exchange

Transfusion

• Considerations• Use filter as platelets and coagulation

factors will not be active after 3-5 days• Donor and recipient must be ABO

identical

RBC Concentrate

• Storage• 4° for up to 42 days, can be frozen

• Indications• Many indications—ie anemia, hypoxia,

etc.• Considerations

• Recipient must not have antibodies to donor RBC’s (note: patients can develop antibodies over time)

• Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl)

• Usually transfuse over 2-4 hours (slower for chronic anemia

Platelets

• Storage• Up to 5 days at 20-24°

• Indications• Thrombocytopenia, Plt <15,000• Bleeding and Plt <50,000• Invasive procedure and Plt <50,000

• Considerations• Contain Leukocytes and cytokines• 1 unit/10 kg of body weight increases Plt count

by 50,000• Donor and Recipient must be ABO identical

Plasma and FFP

• Contents—Coagulation Factors (1 unit/ml)• Storage

• Comes in 200ml bags.• FFP--12 months at –18 degrees or colder

• Indications• Coagulation Factor deficiency, fibrinogen

replacement, DIC, liver disease, exchange transfusion, massive transfusion

• Considerations• Plasma should be recipient RBC ABO

compatible• In children, should also be Rh compatible• Account for time to thaw• Usual dose is 20 cc/kg to raise coagulation

factors approx 20%

Cryoprecipitate

• Description• Precipitate formed/collected when FFP is

thawed at 4°• Storage

• After collection, refrozen and stored up to 1 year at -18°

• Indication• Fibrinogen deficiency or dysfibrinogenemia• vonWillebrands Disease• Factor VIII or XIII deficiency• DIC (not used alone)

• Considerations• ABO compatible preferred (but not limiting)• Usual dose is 1 unit/5-10 kg of recipient body

weight

Granulocyte Transfusions

• Prepared at the time for immediate transfusion (no storage available)

• Indications – severe neutropenia assoc with infection that has failed antibiotic therapy, and recovery of BM is expected

• Donor is given G-CSF and steroids or Hetastarch

• Complications• Severe allergic reactions• Can irradiate granulocytes for GVHD

prevention

Leukocyte Reduction Filters• Used for prevention of transfusion

reactions• Filter used with RBC’s, Platelets,

FFP, Cryoprecipitate• Other plasma proteins (albumin,

colloid expanders, factors, etc.) do not need filters—NEVER use filters with stem cell/bone marrow infusions

• May reduce RBC’s by 5-10%• Does not prevent Graft Verses Host

Disease (GVHD)

RBC TransfusionsPreparations

• Type• Typing of RBC’s for ABO and Rh are

determined for both donor and recipient

• Screen• Screen RBC’s for atypical antibodies• Approx 1-2% of patients have

antibodies

• Crossmatch• Donor cells and recipient serum are

mixed and evaluated for agglutination

RBC TransfusionsAdministration

• Dose• Supplied in 250ml bags.• Usual dose of 10 cc/kg infused over 2-4 hours• Maximum dose 15-20 cc/kg can be given to

hemodynamically stable patient • Procedure

• May need Premedication (Tylenol and/or Benadryl)

• Filter use—routinely leukodepleted• Monitoring—VS q 15 minutes, clinical status• Do NOT mix with medications

• Complications• Rapid infusion may result in Pulmonary edema• Transfusion Reaction

Platelet TransfusionsPreparations

• ABO antigens are present on platelets• ABO compatible platelets are ideal• This is not limiting if Platelets indicated

and type specific not available

• Rh antigens are not present on platelets• Note: a few RBC’s in Platelet unit may

sensitize the Rh- patient

Platelet TransfusionsAdministration

• Dose• May be given as single units or as apheresis units• Usual dose is approx 4 units/m2—in children using 1-2

apheresis units is ideal• 1 apheresis unit contains 6-8 Plt units (packs) from a

single donor• Procedure

• Should be administered over 20-40 minutes• Filter use• Premedicate if hx of Transfusion Reaction

• Complications—Transfusion Reaction


Autologous Blood Transfusions

• Collection/infusion of client’s own blood

Four types:• Preoperative autologous blood donation• Acute normovolemic hemodilution• Intra-operative autologous transfusion• Postoperative blood salvage


Preoperative autologous blood donation

• Collecting whole blood from the client, dividing it into components and storing it for later use

• Can be collected weekly as long as client’s H&H are within safe range

• Can be stored up to 40 days; up to 10 years for rare blood types.


Acute normovolemic hemodilution

• Withdrawal of client’s RBCs and volume replacement just before a procedure

• Goal is to decrease RBC loss during surgery

• Blood is stored at room temperature for up to 6hrs and reinfused after surgery.

• Not for anemic clients or those with poor kidney function.


Intra-operative autologous transfusion & Post operative blood salvage• Recovery/reinfusion of client’s own blood

from operative field or bleeding wound.• Special devices collect, filter, drain blood

into transfusion bag• Used for trauma or surgical patients with

severe blood loss• Blood must be reinfused within 6 hours.


TRANSFUSION REACTIONS

Observing / Monitoring the Patient During a Blood / Blood Component Transfusion is part of safe transfusion

Rigors

Haemoglobinuria

Tachycardia Hyper / HypotensionPyrexia

Nausea / vomiting

Breathlessness / coughing Restlessness

Agitation Confusion

Chest, abdominal, muscle, bone or loin

pain

Flushing

Urticaria - Itchy rash

Headache

Collapse

Generally feeling unwell

112blood and blood transfusions


Transfusion-associated graft-versus-host disease (TA-GVHD).• Donor T-cells attack host tissues.• Symptoms occur within 1-2 weeks• Thrombocytopenia• Anorexia• Nausea• Vomiting• Chronic hepatitis• Weight loss• Recurrent infection


DISSEMINATED INTRAVASCULARCOAGULATION(DIC)

• DIC is the abnormal activation of the coagulation and fibrinolytic systems,resulting in the consumption of coagulation factors and platelets.

• DIC may develop during the course of massive blood transfusion,although its cause is less likely to be due to the transfusion itself than related to the underlying reasons for transfusion,such as: • Hypovolaemic shock• Trauma• Obstetric complications


MANAGEMENT

• Treatment of DIC should be directed at correcting the underlying cause and at correction of the coagulation problems as they arise.

Transfusions of blood & blood components

are labour intensive & expensive but are

frequently life saving

In a few patients, however they can result in potentially fatal complications.

It is therefore essential that they are only given when the benefits outweigh the risks

Conclusion


THANX

blood and blood transfusions

Health & Medicine

karl landsteiner

patients id

red blood

transfusion

formed elements

bone marrow

carbon dioxide

cellular part