homologous blood trasfusion practice shorts

8/9/2019 Homologous Blood Trasfusion Practice Shorts

1/23

HOMOLOGOUS BLOOD TRASFUSIONHOMOLOGOUS BLOOD TRASFUSIONPRACTICEPRACTICE

Dr . Prasad Ingley.Junior Resident IJunior Resident I II

NKP Salve Institute of Medical Sciences & L.M.H. Nagpur, India.NKP Salve Institute of Medical Sciences & L.M.H. Nagpur, India.


2/23

MUST BEFORE TRANSFUSION

Disposable sterile transfusion sets.

170 to 200 micron filters.

By physician or qualified nurse

Blood grouping.

Cross matching & compatability testing.

Inspection of blood / blood product bag.


3/23


4/23

TTIMEIME LIMITLIMIT FORFOR THETHE INFUSIONINFUSION

Whole blood or packed cellsWhole blood or packed cells start within 30 minutes &

complete within 4 hours.

Platelet concentratePlatelet concentrate As soon as received and complete

within 15 20 minutes.

Do not put in refrigerator.

Fresh frozen plasma As soon as possible after thawing

& complete within 15 20 minutes.


5/23

MMONITORINGONITORING THETHE TRANSFUSEDTRANSFUSED

PATIENTSPATIENTS Before starting the transfusion.

As soon as the transfusion is started.

For 15 minutes after starting transfusion.

At least every hr during transfusion.

On completion of transfusion.

4 hours after completing transfusion.


6/23

MMONITORINGONITORING THETHE TRANSFUSEDTRANSFUSED

PATIENTSPATIENTS

For-

Patients general appearance.

Temperature, BP, Respiratory rate. Signs of any adverse reactions

Fever with back pain (Acute Hemolytic T.R.)

Anaphylaxis, hives or pruritis (urticarial reaction )

Congestive heart failure (Volume overload ) Fever alone (Febrile non hemolytic T.R.)


7/23

PPRECAUTIONSRECAUTIONS DURINGDURING IINFUSIONNFUSION

Only isotonic saline ( 0.9 %) or 5 % albumin can

be used to dilute blood component.

Blood Warming is not required :

Infusion of 2-4 units of refrigerated blood over several

hours causes no harm.


8/23

WWHOHO NEEDSNEEDS WWARMARM BBLOODLOOD??

Adults receiving multiple transfusion

at rate >50 ml/ kg/hr>50 ml/ kg/hr.

Children receiving transfusionsat rate >15 ml/ kg/hr>15 ml/ kg/hr.

Infants receiving exchange transfusions.

Patients receiving rapid transfusion through central venous

catheter. Patients with cold agglutinins.


9/23


10/23


11/23

TRANSFUSION REACTIONSTRANSFUSION REACTIONS

Category I Mild reactions.

SymptomSymptom

& signs& signs

Possible causePossible cause ManagementManagement

Itching,Itching,

rashesrashes

HypersensitivityHypersensitivity --Slow the t/fSlow the t/f

--AntihistaminicsAntihistaminics


12/23


Symptom &Symptom &

signssigns

PossiblePossible

CausesCauses

ManagementManagement

Anxiety,Anxiety,

itching,itching,

flushing,flushing,

rigor, fever,rigor, fever,

palpitationpalpitation

headache,headache,

dyspnoeadyspnoea,,

tachycardiatachycardia

Hypersensitivity,Hypersensitivity,

FNHTRFNHTR--

AbAb-- WBCs/WBCs/

platelets/proteinsplatelets/proteins

((IgAIgA),),contaminationcontamination

Stop t/f, keep IVStop t/f, keep IV

line open, inform,line open, inform,

send blood unit tosend blood unit to

bank with freshbank with fresh

blood and urineblood and urine

samples,samples,

antihistaminic,antihistaminic,

steroids,steroids,

bronchodilatorbronchodilator

Category II Moderate reactions.


13/23


Symptom &Symptom &signssigns

Possible causesPossible causes ManagementManagement

Chest pain,Chest pain,

pain at t/fpain at t/f

site, resp.site, resp.distress, lowdistress, low

back pain,back pain,

fever,fever,

tachycardiatachycardiahypotensionhypotension

, red urine,, red urine,

DICDIC

AcuteAcute hemolysishemolysis,,

bact.bact.

Contamination, fluidContamination, fluidoverload,overload,

anaphylaxis,anaphylaxis,

TRALI.TRALI.

With measures inWith measures in

catgcatg. II. II--

Maintain air way,Maintain air way,

oxygen, adrenalin,oxygen, adrenalin,

diuretics, steroids,diuretics, steroids,

fluid balance,fluid balance,

DICDIC-- plateletsplatelets

HypotensionHypotension--

dopaminedopamine

InfectionInfection-- antibioticsantibiotics

Category III Life threatening .


14/23

MASSIVE BLOOD TRANSFUSIONMASSIVE BLOOD TRANSFUSION

This is defined as the transfusion of the equivalent of the thecirculating 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,obstetrics complications.


15/23

MASSIVE TRANSFUSION

GUIDELINES

Criteria for Activation of the MTG:Criteria for Activation of the MTG: 1. Adult patients requiring > 4 units ofPRBCs in first hour of

resuscitation or pediatric patient requiring > 20 ml/kg of

PRBCs in first hour of resuscitation.

2. Adult patients with the high likelihood of requiringtransfusion of > 10 units ofPRBCs within the first 12 hoursof resuscitation or pediatric patient with the high likelihood of

requiring transfusion of > 0.1 units/kg ofPRBCs within thefirst 12 hours of resuscitation.


16/23

Major problems associated with massiveMajor problems associated with massiveblood transfusion include,blood transfusion include,

Citrate toxicity & hypocalcemia.

Acidosis.

Underlying coagulopathy.

Dilutional thrombocytopenia.

Lack of coagulation factor 5 & 8 & fibrinogen.

Hyperkalaemia.

Hypothermia.

Microaggregates


17/23


18/23

MMANAGEMENTANAGEMENT OFOF AA PATIENTPATIENT WHOWHO ISIS BLEEDINGBLEEDING


19/23

AALGORITHMLGORITHM FORFOR DIAGNOSINGDIAGNOSING && TREATINGTREATING AA MASSIVEMASSIVE BLOODBLOOD LOSSLOSS

Blood to lab 4Blood to lab 4units PRBC in EDunits PRBC in ED

Indication forIndication for

immediate transfusionimmediate transfusion

Give 2 units PRBCSGive 2 units PRBCS

Review lab resultsReview lab results

Coagulopathy present?Coagulopathy present?

PT > transfusion threshold?PT > transfusion threshold?

HCT < 30 % ?HCT < 30 % ?

PC < transfusion threshold?PC < transfusion threshold?

Anticipated ongoingAnticipated ongoing

blood lossblood loss

DeDe--activate massiveactivate massive

transfusion protocoltransfusion protocol

From blood sample CBC,PC,PT,PTT,From blood sample CBC,PC,PT,PTT,

FIBRINOGRNFIBRINOGRN

Indications for type OIndications for type O

blood :blood :BP


20/23

METHODS FOR REDUCED BLOOD USEMETHODS FOR REDUCED BLOOD USE

IN SURGERYIN SURGERY PREOPERATIVEPREOPERATIVE

* Surgery elective Correct the Haemoglobin level.

Stop drugs that interfere Haemostasis

INTRAOPERATIVEINTRAOPERATIVE

y Posture

y Use of Vasoconstrictors

y Use of tourniquets

y Use of anti-fibrinolytic drugs eg Aprotinin

y Using Fibrin Sealant

POST OPERATIVELYPOST OPERATIVELY

y Blood can be salvaged from drains into collection devices that permitreinfusion

y Decision to transfuse post operatively should depend

* Age of the patient

* Ability to tolerate lower levels of anaemia

* Rate & amount of continuing blood loss


21/23

PEDIATRIC

TRANSFUSION

RED CELLS - 10 15 ml/kg.

PLATELETS - 5 - 10 ml/kg.

FFP - 10 15 ml/kg.

CRYOPRECIPITATES 1- 2 unit/kg.


22/23

NO ONE SHOULD DIE WITHOUT BLOOD.NO ONE SHOULD DIE WITHOUT BLOOD.

NO ONE SHOULD DIE WITHOUT BLOODNO ONE SHOULD DIE WITHOUT BLOOD

DONATION.DONATION.


23/23

ThankThank yoUyoU!!

homologous blood trasfusion practice shorts

Documents