SlideShare a Scribd company logo
1 of 49
Massive Blood Transfusion Definition, Indications Complications Dr. Maha AL-Madi Urology Resident
[object Object],[object Object],[object Object],[object Object],[object Object],Objectives
Definition of MBT… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Definition of MBT… ,[object Object],[object Object],[object Object]
Definition of MBT… ,[object Object],[object Object]
General Indications … ,[object Object],[object Object]
General Indications …… ,[object Object],[object Object],[object Object],[object Object],[object Object]
General Indications …… ,[object Object],[object Object],[object Object]
General Indications … ,[object Object],[object Object],[object Object],[object Object],[object Object]
Indication for MBT … ,[object Object],[object Object],[object Object],[object Object],[object Object]
General Indications … ,[object Object],[object Object]
Clinical Practice Guidelines and Recommendations *  Clinical practice guideline: RBC transfusion in adult trauma and critical care. Crit Care Med 2009 vol.37 No.12
Clinical practice guidelines..
Clinical practice guidelines..
Clinical practice guidelines..…
Clinical practice guidelines..
Clinical practice guidelines..
Benefits of BT ,[object Object],[object Object],[object Object]
Complications of BT… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of BT… Acute non-hemolytic rxns Hemolytic rxns TRALI GVHD 1.Hypersensitivity rxn 2.Febrile non hemolytic 1. Acute immune  hemolysis 2. Delayed hemolysis Transfusion Rxns Infective Massive BT
Complications of BT… VIRAL CMV (1:10 to 1:30)  EBV (1:200) HBV ( 1 : 50,000) HCV (1 :3000-4000) HIV ( 1: 150,000) HTLV-I/ II(1:250,000 to 1:2 mill PARASITIC Malaria, (1:4 mill)  BACTERIAL 1:200,000 to 1:4.8 mill Yersinia Serratia ,  Pseudomonas Enterobacter Transfusion Rxns Infective Massive BT
Complications of BT… Transfusion Rxns Infective Massive BT
Transfusion Reactions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Transfusion Reactions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transfusion Reactions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Transfusion Reactions ,[object Object],[object Object],[object Object],[object Object]
Transfusion Reactions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transfusion Reactions ,[object Object],[object Object]
Clinical practice guidelines.. ,[object Object]
Transfusion Reactions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of BT… ,[object Object],[object Object],[object Object]
Complications of BT… ,[object Object],[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of MBT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of MBT… ,[object Object],[object Object],[object Object]
Clinical Practice Guidelines. ,[object Object]
Clinical Practice Guidelines. ,[object Object]
 
Alternative to BT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Alternative to BT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
References..  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

More Related Content

What's hot

#Blood loss estimation
#Blood loss estimation#Blood loss estimation
#Blood loss estimationNisar Arain
 
Septic shock management (1)
Septic shock management (1)Septic shock management (1)
Septic shock management (1)shashank agrawal
 
Peripheral Nerve block(ankle block,wrist block, digital block)
Peripheral Nerve block(ankle block,wrist block, digital block)Peripheral Nerve block(ankle block,wrist block, digital block)
Peripheral Nerve block(ankle block,wrist block, digital block)Lih Yin Chong
 
Massive Transfusion Protocol + Blood transfusions
Massive Transfusion Protocol + Blood transfusionsMassive Transfusion Protocol + Blood transfusions
Massive Transfusion Protocol + Blood transfusionsDavid Hersey
 
AUTOLOGOUS BLOOD TRANSFUSION
AUTOLOGOUS BLOOD TRANSFUSIONAUTOLOGOUS BLOOD TRANSFUSION
AUTOLOGOUS BLOOD TRANSFUSIONManan Shah
 
Damage control resuscitation
Damage control resuscitationDamage control resuscitation
Damage control resuscitationSCGH ED CME
 
Blood transfusion in surgery
Blood transfusion in surgeryBlood transfusion in surgery
Blood transfusion in surgeryDrkabiru2012
 
Massive blood transfusion
Massive blood transfusionMassive blood transfusion
Massive blood transfusionAashissh Shah
 
Blood transfusion guidelines in clinical practice
Blood transfusion guidelines in clinical practiceBlood transfusion guidelines in clinical practice
Blood transfusion guidelines in clinical practiceIbrahim khidir ibrahim osman
 
TOURNIQUET AND ITS EFFECTS
TOURNIQUET AND ITS EFFECTS TOURNIQUET AND ITS EFFECTS
TOURNIQUET AND ITS EFFECTS Dr Kumar
 
Rapid sequence intubation
Rapid sequence intubationRapid sequence intubation
Rapid sequence intubationKhairunnisa Azman
 
Resuscitation Fluids
Resuscitation FluidsResuscitation Fluids
Resuscitation FluidsSun Yai-Cheng
 
Endpoints of Resuscitation
Endpoints of ResuscitationEndpoints of Resuscitation
Endpoints of ResuscitationMd Rabiul Alam
 
Indications and complications of blood transfusion
Indications and complications of blood transfusion Indications and complications of blood transfusion
Indications and complications of blood transfusion abhimanyu_ganguly
 
Rapid Sequence Induction & Intubation
Rapid Sequence Induction & Intubation Rapid Sequence Induction & Intubation
Rapid Sequence Induction & Intubation RamanGhimire3
 
Complications of blood transfusion
Complications of blood transfusionComplications of blood transfusion
Complications of blood transfusionraj kumar
 
blood and blood products
blood and blood productsblood and blood products
blood and blood productsBISHAL SAPKOTA
 

What's hot (20)

#Blood loss estimation
#Blood loss estimation#Blood loss estimation
#Blood loss estimation
 
Septic shock management (1)
Septic shock management (1)Septic shock management (1)
Septic shock management (1)
 
Peripheral Nerve block(ankle block,wrist block, digital block)
Peripheral Nerve block(ankle block,wrist block, digital block)Peripheral Nerve block(ankle block,wrist block, digital block)
Peripheral Nerve block(ankle block,wrist block, digital block)
 
Massive Transfusion Protocol + Blood transfusions
Massive Transfusion Protocol + Blood transfusionsMassive Transfusion Protocol + Blood transfusions
Massive Transfusion Protocol + Blood transfusions
 
Perioperative fluid therapy
Perioperative fluid therapyPerioperative fluid therapy
Perioperative fluid therapy
 
AUTOLOGOUS BLOOD TRANSFUSION
AUTOLOGOUS BLOOD TRANSFUSIONAUTOLOGOUS BLOOD TRANSFUSION
AUTOLOGOUS BLOOD TRANSFUSION
 
Damage control resuscitation
Damage control resuscitationDamage control resuscitation
Damage control resuscitation
 
Blood transfusion in surgery
Blood transfusion in surgeryBlood transfusion in surgery
Blood transfusion in surgery
 
Massive blood transfusion
Massive blood transfusionMassive blood transfusion
Massive blood transfusion
 
Blood transfusion guidelines in clinical practice
Blood transfusion guidelines in clinical practiceBlood transfusion guidelines in clinical practice
Blood transfusion guidelines in clinical practice
 
Regional Anesthesia
Regional AnesthesiaRegional Anesthesia
Regional Anesthesia
 
Air embolism
Air embolismAir embolism
Air embolism
 
TOURNIQUET AND ITS EFFECTS
TOURNIQUET AND ITS EFFECTS TOURNIQUET AND ITS EFFECTS
TOURNIQUET AND ITS EFFECTS
 
Rapid sequence intubation
Rapid sequence intubationRapid sequence intubation
Rapid sequence intubation
 
Resuscitation Fluids
Resuscitation FluidsResuscitation Fluids
Resuscitation Fluids
 
Endpoints of Resuscitation
Endpoints of ResuscitationEndpoints of Resuscitation
Endpoints of Resuscitation
 
Indications and complications of blood transfusion
Indications and complications of blood transfusion Indications and complications of blood transfusion
Indications and complications of blood transfusion
 
Rapid Sequence Induction & Intubation
Rapid Sequence Induction & Intubation Rapid Sequence Induction & Intubation
Rapid Sequence Induction & Intubation
 
Complications of blood transfusion
Complications of blood transfusionComplications of blood transfusion
Complications of blood transfusion
 
blood and blood products
blood and blood productsblood and blood products
blood and blood products
 

Viewers also liked

Complications of massive blood transfusion
Complications of massive blood transfusionComplications of massive blood transfusion
Complications of massive blood transfusionKETAN VAGHOLKAR
 
Chest Trauma
Chest Trauma Chest Trauma
Chest Trauma SCGH ED CME
 
Massive transfusion
Massive transfusionMassive transfusion
Massive transfusionRafiq Ahmad
 
Massive blood transfusion
Massive blood transfusionMassive blood transfusion
Massive blood transfusionsalamon raja
 
Management of massive blood loss
Management of massive blood lossManagement of massive blood loss
Management of massive blood losssripalidassa
 
Massive Transfusion in Trauma
Massive Transfusion in TraumaMassive Transfusion in Trauma
Massive Transfusion in TraumaSCGH ED CME
 

Viewers also liked (6)

Complications of massive blood transfusion
Complications of massive blood transfusionComplications of massive blood transfusion
Complications of massive blood transfusion
 
Chest Trauma
Chest Trauma Chest Trauma
Chest Trauma
 
Massive transfusion
Massive transfusionMassive transfusion
Massive transfusion
 
Massive blood transfusion
Massive blood transfusionMassive blood transfusion
Massive blood transfusion
 
Management of massive blood loss
Management of massive blood lossManagement of massive blood loss
Management of massive blood loss
 
Massive Transfusion in Trauma
Massive Transfusion in TraumaMassive Transfusion in Trauma
Massive Transfusion in Trauma
 

Similar to Massive Blood Transfusion

Myeloproliferative Disorders Other Than CML
Myeloproliferative Disorders Other Than CMLMyeloproliferative Disorders Other Than CML
Myeloproliferative Disorders Other Than CMLMohammed A Suwaid
 
Bl.therapy2012
Bl.therapy2012Bl.therapy2012
Bl.therapy2012Hossam atef
 
Physiological triggers for blood transfusion in the icu
Physiological triggers for  blood transfusion in the icuPhysiological triggers for  blood transfusion in the icu
Physiological triggers for blood transfusion in the icuchandra talur
 
renaltransplant.ppt.pptx
renaltransplant.ppt.pptxrenaltransplant.ppt.pptx
renaltransplant.ppt.pptxOmarKhaleel6
 
Rational use of Blood.pptx
Rational use of Blood.pptxRational use of Blood.pptx
Rational use of Blood.pptxbiplabendu talukdar
 
massive transfusion.pptx
massive transfusion.pptxmassive transfusion.pptx
massive transfusion.pptxGETAYE5
 
uproach to anemia in ICU
uproach to anemia in ICUuproach to anemia in ICU
uproach to anemia in ICUBalchandKukreja1
 
L 32 complications of blood transfusion
L 32 complications of blood transfusionL 32 complications of blood transfusion
L 32 complications of blood transfusionBruno Mmassy
 
L 32 complications of blood transfusion
L 32 complications of blood transfusionL 32 complications of blood transfusion
L 32 complications of blood transfusionFiba Farooq
 
Part 4 clinical laboratory data
Part 4  clinical laboratory dataPart 4  clinical laboratory data
Part 4 clinical laboratory dataMaxine Haigh-White
 
blood substitute blood.pptx
blood substitute blood.pptxblood substitute blood.pptx
blood substitute blood.pptxkarthik2567
 
Blood Transfusion
Blood Transfusion	Blood Transfusion
Blood Transfusion Khalid
 
Part 4 laboratory values 2211
Part 4 laboratory values 2211Part 4 laboratory values 2211
Part 4 laboratory values 2211Maxine Haigh-White
 
A case of Upper GI Bleeding.pptx
A case of Upper GI Bleeding.pptxA case of Upper GI Bleeding.pptx
A case of Upper GI Bleeding.pptxAbdelrahmanMokhtar14
 
Hemostasis, surgical bleeding and transfusion
Hemostasis, surgical bleeding and transfusionHemostasis, surgical bleeding and transfusion
Hemostasis, surgical bleeding and transfusionMae Martinquilla
 
Blood transfusion (2)
Blood transfusion  (2)Blood transfusion  (2)
Blood transfusion (2)SADAFQAYYUM5
 
Rational use of Blood.pptx
Rational use of Blood.pptxRational use of Blood.pptx
Rational use of Blood.pptxbiplabendu talukdar
 
Blood transfusion and complications
Blood transfusion and complicationsBlood transfusion and complications
Blood transfusion and complicationsPriyadarshan Konar
 

Similar to Massive Blood Transfusion (20)

Myeloproliferative Disorders Other Than CML
Myeloproliferative Disorders Other Than CMLMyeloproliferative Disorders Other Than CML
Myeloproliferative Disorders Other Than CML
 
Bl.therapy2012
Bl.therapy2012Bl.therapy2012
Bl.therapy2012
 
Physiological triggers for blood transfusion in the icu
Physiological triggers for  blood transfusion in the icuPhysiological triggers for  blood transfusion in the icu
Physiological triggers for blood transfusion in the icu
 
renaltransplant.ppt.pptx
renaltransplant.ppt.pptxrenaltransplant.ppt.pptx
renaltransplant.ppt.pptx
 
Blood Transfusion
Blood TransfusionBlood Transfusion
Blood Transfusion
 
Rational use of Blood.pptx
Rational use of Blood.pptxRational use of Blood.pptx
Rational use of Blood.pptx
 
massive transfusion.pptx
massive transfusion.pptxmassive transfusion.pptx
massive transfusion.pptx
 
uproach to anemia in ICU
uproach to anemia in ICUuproach to anemia in ICU
uproach to anemia in ICU
 
L 32 complications of blood transfusion
L 32 complications of blood transfusionL 32 complications of blood transfusion
L 32 complications of blood transfusion
 
L 32 complications of blood transfusion
L 32 complications of blood transfusionL 32 complications of blood transfusion
L 32 complications of blood transfusion
 
Part 4 clinical laboratory data
Part 4  clinical laboratory dataPart 4  clinical laboratory data
Part 4 clinical laboratory data
 
blood substitute blood.pptx
blood substitute blood.pptxblood substitute blood.pptx
blood substitute blood.pptx
 
Blood Transfusion
Blood Transfusion	Blood Transfusion
Blood Transfusion
 
Part 4 laboratory values 2211
Part 4 laboratory values 2211Part 4 laboratory values 2211
Part 4 laboratory values 2211
 
A case of Upper GI Bleeding.pptx
A case of Upper GI Bleeding.pptxA case of Upper GI Bleeding.pptx
A case of Upper GI Bleeding.pptx
 
Hemostasis, surgical bleeding and transfusion
Hemostasis, surgical bleeding and transfusionHemostasis, surgical bleeding and transfusion
Hemostasis, surgical bleeding and transfusion
 
Blood transfusion (2)
Blood transfusion  (2)Blood transfusion  (2)
Blood transfusion (2)
 
Rational use of Blood.pptx
Rational use of Blood.pptxRational use of Blood.pptx
Rational use of Blood.pptx
 
Sepsis nuts&bolts
Sepsis nuts&boltsSepsis nuts&bolts
Sepsis nuts&bolts
 
Blood transfusion and complications
Blood transfusion and complicationsBlood transfusion and complications
Blood transfusion and complications
 

More from Saeed Al-Shomimi

Pathophysiology of wound healing
Pathophysiology of wound healingPathophysiology of wound healing
Pathophysiology of wound healingSaeed Al-Shomimi
 
Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Saeed Al-Shomimi
 
Retroperitoneal Collections
Retroperitoneal CollectionsRetroperitoneal Collections
Retroperitoneal CollectionsSaeed Al-Shomimi
 
How to do - Abdominal Trauma
How to do - Abdominal TraumaHow to do - Abdominal Trauma
How to do - Abdominal TraumaSaeed Al-Shomimi
 
Breast Cancer during pregnancy
Breast Cancer during pregnancyBreast Cancer during pregnancy
Breast Cancer during pregnancySaeed Al-Shomimi
 
Antibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisAntibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisSaeed Al-Shomimi
 
Esophaegeal resection & reconstruction
Esophaegeal resection & reconstructionEsophaegeal resection & reconstruction
Esophaegeal resection & reconstructionSaeed Al-Shomimi
 
A v fistula in heamodialysis
A v fistula in heamodialysisA v fistula in heamodialysis
A v fistula in heamodialysisSaeed Al-Shomimi
 
Diabetic Foot Examination
Diabetic Foot ExaminationDiabetic Foot Examination
Diabetic Foot ExaminationSaeed Al-Shomimi
 
Solitary Thyroid Nodule
Solitary Thyroid NoduleSolitary Thyroid Nodule
Solitary Thyroid NoduleSaeed Al-Shomimi
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular TraumaSaeed Al-Shomimi
 
Risk Factors of Breast Cancer
Risk Factors of Breast CancerRisk Factors of Breast Cancer
Risk Factors of Breast CancerSaeed Al-Shomimi
 
Surgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSurgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSaeed Al-Shomimi
 
Endocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasEndocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasSaeed Al-Shomimi
 

More from Saeed Al-Shomimi (20)

Pathophysiology of wound healing
Pathophysiology of wound healingPathophysiology of wound healing
Pathophysiology of wound healing
 
Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...
 
Retroperitoneal Collections
Retroperitoneal CollectionsRetroperitoneal Collections
Retroperitoneal Collections
 
Tube thoracostomy
Tube thoracostomyTube thoracostomy
Tube thoracostomy
 
How to do - Abdominal Trauma
How to do - Abdominal TraumaHow to do - Abdominal Trauma
How to do - Abdominal Trauma
 
Breast Cancer during pregnancy
Breast Cancer during pregnancyBreast Cancer during pregnancy
Breast Cancer during pregnancy
 
Antibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisAntibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute Panceriatitis
 
Gallstone
GallstoneGallstone
Gallstone
 
Esophaegeal resection & reconstruction
Esophaegeal resection & reconstructionEsophaegeal resection & reconstruction
Esophaegeal resection & reconstruction
 
A v fistula in heamodialysis
A v fistula in heamodialysisA v fistula in heamodialysis
A v fistula in heamodialysis
 
DVT Current Concept
DVT Current ConceptDVT Current Concept
DVT Current Concept
 
Diabetic Foot Examination
Diabetic Foot ExaminationDiabetic Foot Examination
Diabetic Foot Examination
 
Solitary Thyroid Nodule
Solitary Thyroid NoduleSolitary Thyroid Nodule
Solitary Thyroid Nodule
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular Trauma
 
Risk Factors of Breast Cancer
Risk Factors of Breast CancerRisk Factors of Breast Cancer
Risk Factors of Breast Cancer
 
Liver Trauma
Liver TraumaLiver Trauma
Liver Trauma
 
Surgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSurgical Management in Ulcerative Colitis
Surgical Management in Ulcerative Colitis
 
Endocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasEndocrine Tumors Of The Pancreas
Endocrine Tumors Of The Pancreas
 
Ischemic Colitis
Ischemic ColitisIschemic Colitis
Ischemic Colitis
 
Gastric Carcinoma
Gastric CarcinomaGastric Carcinoma
Gastric Carcinoma
 

Recently uploaded

Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Gabriel Guevara MD
 
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowSonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowRiya Pathan
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknownarwatsonia7
 
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...narwatsonia7
 
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingCall Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingNehru place Escorts
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceNehru place Escorts
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Miss joya
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girlsnehamumbai
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service MumbaiLow Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbaisonalikaur4
 
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment BookingHousewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000aliya bhat
 
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...narwatsonia7
 
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking ModelsMumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Modelssonalikaur4
 
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service BangaloreCall Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalorenarwatsonia7
 

Recently uploaded (20)

Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024
 
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
 
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowSonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Sonagachi Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
 
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
 
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
 
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingCall Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
 
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
Russian Call Girls in Pune Riya 9907093804 Short 1500 Night 6000 Best call gi...
 
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Servicesauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
 
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service MumbaiLow Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
Low Rate Call Girls Mumbai Suman 9910780858 Independent Escort Service Mumbai
 
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment BookingHousewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
 
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
 
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
 
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking ModelsMumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
 
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service BangaloreCall Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
 

Massive Blood Transfusion