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BLOOD TRANSFISION, INDICATIONS AND COMPLICATIONS.ppt

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BLOOD TRANSFISION, INDICATIONS AND COMPLICATIONS.ppt

  1. 1. Blood transfusion : indications and complications CONTENTS Introduction Definition Principles of clinical blood transfusion Indications Complications
  2. 2. INTRODUCTION  Blood transfusion is one of the most important discoveries of modern medicine which appeared after Harvey's scientific explanation about blood circulation (1928)  Its use in surgery has launched great success after blood incompatibility between different persons was challenged with the knowledge of blood GROUPS(A,B,AB,AND O) (Landsteiner ) & Rh FACTORS( C, D ,E ,c ,d ,e (Levine & Stetsen )
  3. 3. INTRODUC.CONT.  Its aim is to restore blood volume and oxygen carrying capacity.  For the purpose of transfusion, blood is collected in a bag with 50ml.Of cpd(citrate phosphate and dextrose or in a bag with cpd-a(adenine solution) and is stored at temperature of 40c .  Can be kept for 5 weeks in cpd bag and for 6 weeks in cpd-a bag.  It is grouped using serum with potent aglutinogens like anti-A anti-B and anti-Rh and by cross matching.
  4. 4. DEFINITION OF BLOOD TRANSFUSION Is the process of transferring blood or blood- based product from one person into the circulatory system of another through blood vessels ,long bones’marrow,sternum,etc.
  5. 5. Types of blood transfusion according to the source 1. Autologous (using patient’s own stored blood) 2. Allogeneic (using stored blood of others)
  6. 6. Components of blood 1. RBC 2. WBC 3. Plasma 4. Platelets 5. Albumin proteins 6. Clotting factors concentrate 7. Fibrinogen concentrate 8. Cryoprecipitate 9. Immunoglobulin (antibodies)
  7. 7. procedures 1. Donation 2. Testing for infections 3. Testing for A B O and Rh groups along with presence any RBC antibodies 4. Pathogen reduction treatment using riboflavin and Uv light / gamma irradiation 5. Compatibility testing (recipient’s ABO and Rh 6. Cross-matching
  8. 8. Principles(chek list) of blood transfusion 1) Is one part of pt.’s Rx. 2) Is done when there is no alternative Rx. 3) Compare the benefits and risks 4) Know the aim(goal) of the planned transfusion 5) There should be informed consent of the pt. 6) Record the reason(indication) for transfusion on the chart 7) Do not use Hgb. as the only criteria
  9. 9. PRINCIPLES OF TRANSF. CONT. 8. Be aware of the risks 9. Minimize the reason for transfusion during surgery 10. The blood should be screened and cross- matched 11. Avoid the concepts of “universal donors and universal receptors” 12. The blood should be at body temperature 13. Always start with few drops and increase progressively 14. Take care of CHF in children, old age and cardiopathic pts. 15. Monitor closely during and after the transfusion
  10. 10. INDICATIONS FOR BLOOD TRANSFUSION  Blood transfusion can be done in: 1. Neonate 2. Children & infants 3. Pregnant 4. Adults
  11. 11. Indication for blood transfusion in neonate 1. Severe unconjugated hyperbilirubinemia 2. Hemolytic diseases 3. Severe pulm. diseases with Hgb. <13gm/dl 4. Severe heart disease with Hgb. <13gm/dl. 5. Acute blood loss with:  Signs of anemia  No signs of anemia but Hgb. <7gm/dl 6. Extensive burn 7. Bleeding disorders (in preop.phase) 8. Intraoperative of major surgery with blood loss.(Cv. Surgery ,gastrectomies etc.)
  12. 12. Indications of blood transfusion in children & infants 1. IF Hgb.<4gm/dl 2. Hgb.=6gm/dl with life threatening signs such as:  Hypoxia with cardiac descompansation  Acidosis  Impaired consciousness  Hyperparasitemia  Cerebral malaria with increasing hemolysis  Septicemia  Meningitis
  13. 13. Indication for transfusion of blood in pregnants A. IF < 36 WEEKS: 1. Hgb <5gm/dl 2. Hgb. 5-7gm/dl with :  Signs of cardiac failure  Infections  Malaria  Hx. Of heart disease B. IF > 36 WEEKS: 1. Hgb. <6gm/dl 2. Hgb. 6-8gm/dl but with other diseases (as indicated above) C. ELECTIVE C/S WITH Hx. OF: 1. APH (ante partum hemorrhage) 2. PPH(postpartum hemorrhage) D. PREVIOUS C/S WITH Hgb.<10gm/dl
  14. 14. Indications of blood transfusion in adults 1. Preoperatively in pts. with malignancies, bleeding disorders and anemia which is likely to cause hypoxia 2. Acute hemorrhagic shock 3. Extensive burn 4. Intraoperative of major surgeries with significant blood loss 5. Chronic anemias with hypoxia and Hgb. <5gm/dl (sickle cell anemia) 6. Septic shock ,Co poisoning ,snake bite with hemolysis
  15. 15. Complications of blood transfusions 1. Transfusion reactions 2. Transmission of diseases 3. Thrombophilebitis 4. Congestive heart failure 5. Disseminated intravascular coagulation(DIC) with uncontrollable bleeding 6. Adult Resp. Distress Syndrome(ARDS) 7. Citrate intoxication 8. Hyperkalemia(long term stored blood) 9. Air embolism 10. Dilution of clotting factors
  16. 16. Blood transfusional reactions 1. Simple pyrexial reaction 2. Allergic reactions to:  Leucocytes & platelets of the donor  Some ingested substances in the blood of the donor to which the receptor is sensible 3. Incompatibility reaction 4. Hemolysis 5. Development of antibodies to RBC and plasma proteins (in hemophilic & pupuric pts. by repeated transfusions)
  17. 17. Transmission of diseases as complication of blood trans fusion  Can be explained by transmission of: 1. Serum hepatitis(HCv HBv) 2. HIV 3. Cytomegalovirus 4. Syphilis 5. Malaria 6. Chaga’s disease
  18. 18. Management of complications of blood transfusions A. Simple pyrexial reaction(presence of pyrogens in the blood/improper sterility technique): Symptoms :fever chills & rigor with generalized pain. Rx. Stop the transfusion  Analgesics-antipyretics  Calcium gluconate10% iv (1gm)  Use disposable sets of blood transfusion
  19. 19. Rx.of complic. of blood transf. cont. B. Allergic reactions: Symptoms:  Chills & rigors  Gen. Skin rushes Rx.: Stop the transfusion  Give antihistaminic drugs(chlorpheniramine maleate 10ml. Iv)  Calcium gluconate iv.
  20. 20. Rx. Of complic. Of blood transf. Cont. C. Incompatibility reactions: Cause : mismatched blood due to error in sampling, labeling or dispatching Symptoms: • Bilateral loin pain • Chest pain • Cyanosis • Fever with chills & rigors • Haematuria • Oliguria with acute renal tubular necrosis Rx. Stop the transfus. • Give oxygen, analgesics (pethidine),hydrocortisone • Iv fluids/manitol 10% • Adrenaline / epinephrine • Hemodialysis
  21. 21. Rx. of complic. of blood transfus. cont. D. Transmission of diseases: Rx. :Strict screening of the blood before transfus. “Prevention is better than cure” E. Thrombophilebitis:  Symptoms: tender hard and cord like vein, fever  Rx. Analgesics-antipyretics, moist &warm compress
  22. 22. Rx. of complic. of blood transfus. cont. E. Congestive heart failure: Cause: rapid transfus. of whole blood in chronically anemic pts.,oldage & children  Excess transfusion of blood. Symptoms: symptoms of lung edema and cardiac failure Rx.  Slow transfusion  Limit the amount of blood transfus.  Give lasix iv  Use packed cell transfusion in chronic anemia.
  23. 23. Rx.of complic. of blood transf. cont. F. Disseminated intravascular coagulation(DIC): Cause :massive blood transfus. resulting in severe afibrinogenemia Symptoms :uncontrollable bleeding (oozing) Rx.: • Give fresh blood • Replace fibrinogen by giving cryoprecipitate and blood clotting factors.
  24. 24. Rx. of complic of blood transfus. cont. G. Adult Resp. Distress syndrome(ARDS): Cause : transfusion of old stored blood with micro emboli Symptoms: Dyspnea Cyanosis Signs of blocked lung. Rx.:  Give fresh blood  Use infusion sets with filters.
  25. 25. contraindications 1. Acute renal failure 2. Acute congestive heart disease 3. Severe MI 4. Uncontrolled hypertension
  26. 26. BIBLIOGRAPHY 1. MANIPAL : MANUAL OF SURGERY,1ST. EDITION, 2000. 2. BAILEY & LOVE’S: SHORT PRACTICE OF SURGERY, 22ND. EDITION,1997.& 25th. edition
  27. 27. THANK U !!! THE END

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