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BLOOD TRANSFUSION. Begashaw M (MD). Definition. is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream. I ndications. In acute hemorrhage is based on: • volume lost >2000 • rate of bleeding • hemodynamic status.

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blood transfusion

BLOOD TRANSFUSION

Begashaw M (MD)

definition
Definition
  • is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream
i ndications
Indications

In acute hemorrhage is based on:

• volume lost >2000

• rate of bleeding

• hemodynamic status

indications
Indications

In Chronic blood loss:

-Healthy, younger individuals

HCT<21%

-Cardio respiratory compromised patients

HCT < 25-33%

If severe ,even <40%

component therapy
Component therapy
  • specific factor deficiencies

-factor VIII concentrates -classic hemophilia

abo blood group system
ABO blood group system
  • -Blood group O is the universal donor
  • -Blood group AB is the universal recipient
cross matching
Cross matching

o Blood grouping

-ABO and Rhesus antigens

o Antibody screening

  • Detects atypical red cell antibodies in recipients serum

o Crossmatching

  • Tests donor red cells against patients serum
blood products
Blood products
  • Whole blood
  • Packed red cells
  • Granulocyte concentrates
  • Platelet concentrates
  • fresh frozen plasma
  • Plasma protein fraction
  • Human albumin 25%
  • Cryoprecipitate
  • Clotting factors - Factor VIII / IX
component therapy1
Component therapy
  • Factor VIII for classic hemophilia
  • Platelet transfusion for patients with bone marrow suppression
whole blood
Whole blood
  • is collected in citrate phosphate dextrose- adenine solution (CPDA-)
  • 450 ml of whole blood and approximately 60ml of anticoagulant preservative
  • within 24 hours-freshwhole blood
  • shelf life of 35 days
  • one unit of whole blood raises the recipient’s hematocritby 3%
packed rbc
Packed RBC
  • are remains after plasma has been separated from whole blood
  • One unit raises the recipient’s hematocrit by 3%
  • warmed to a temperature not exceeding 37 c before transfusion
  • Shelf life is 35 days
platelet concentrate
Platelet concentrate
  • Platelets are separated from one unit of blood
  • may be stored for 3-7 days
  • One unit of platelet concentrate contains about 5.5×1010 platelets and increases the platelet count by 5000/ml
  • For a patient with platelet count below 25,000/mm3, 6-8 units are usually given
  • Platelet concentrate must be administered through a special platelet filter
fresh frozen plasma
Fresh frozen plasma

_is anti-coagulated plasma separated from a person’s blood and frozen within 6 hours

_stored up to 1 year

_contains all clotting factors

_provides proteins for volume expansion

cryoprecipitate
Cryoprecipitate

_is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 degree centigrade

_white precipitate

_shelf life of about 1 year

_contains factor VIII, fibrinogen and factor XIII

_treatment:

-classic hemophilia

-DIC

protein
Protein

Albumin

- for oncotic support and plasma expansion

- disadvantage-rapid excretion & expense

Plasma protein fraction

-Similar to albumin but contains additional protein molecules

complications
Complications
  • Hemolytic transfusion reactions
  • Non-hemolytic transfusion reaction
hemolytic transfusion reactions
Hemolytic transfusion reactions
  • Intravascular hemolytic transfusion reactions
  • life threatening reactions
  • due to incompatibility of the ABO system
  • are very rare occurring in 1 out of 15,000 -20,000 transfusions
pathophysiology
Pathophysiology
  • all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuriaand renal failure
  • activate the complement system with subsequent release of vasoacative amines causing hypotension
  • Complement activation -intravascular thrombosis, DIC & hemorrhage
clinical features
Clinical features
  • Patient feels unwell and agitated
  • back pain and pain at infusion site
  • shortness of breath, rigors
  • hypotension, oliguria and bleeding from venepuncture sites
  • Urinalysis will show haemoglobinuria
management
Management
  • Discontinue transfusion immediately and remove giving set
  • Check unit of blood against patients identity
  • Give intravenous crystalloid
  • Transfer to ICU
  • Take blood for CBC, haemoglobin, clotting, repeat grouping
  • Monitor urine output
non hemolytic transfusion reaction
Non-hemolytic transfusion reaction
  • Febrile reaction:

- in 0.5% -1%

- is usually treated with antipyretic drugs

  • Allergic reaction:
  • in 2-3%
  • manifests by urticariaand rashes
  • Antihistamins, steroids or epinephrine
slide32

Transmission of disease-include:

  • Hepatitis
  • HIV
  • Malaria
  • Epstein- bar virus, cytomegalovirus
  • Brucellosis
other complications
Other complications

• Citrate toxicity

• Acidosis

• Hyperkalemia