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Blood Transfusions: Dr. Asoka de Silva

This document discusses blood transfusions, including their purpose, functions, storage, complications, and alternatives. The key points are: 1) The main purposes of blood transfusions are to increase oxygen-carrying capacity and circulating volume. 2) Stored blood can be kept for various periods of time - red blood cells for 42 days if stored in CPDA, platelets for 3 days, and plasma can be frozen for long periods. 3) Complications include incompatibility reactions, infections, allergic reactions, and transfusion-related lung injury. Managing complications involves discontinuing the transfusion and providing supportive care. 4) Alternatives to transfusions include accepting lower hemoglobin levels, minimizing

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52 views

Blood Transfusions: Dr. Asoka de Silva

This document discusses blood transfusions, including their purpose, functions, storage, complications, and alternatives. The key points are: 1) The main purposes of blood transfusions are to increase oxygen-carrying capacity and circulating volume. 2) Stored blood can be kept for various periods of time - red blood cells for 42 days if stored in CPDA, platelets for 3 days, and plasma can be frozen for long periods. 3) Complications include incompatibility reactions, infections, allergic reactions, and transfusion-related lung injury. Managing complications involves discontinuing the transfusion and providing supportive care. 4) Alternatives to transfusions include accepting lower hemoglobin levels, minimizing

Uploaded by

anojan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Blood transfusions

Dr. Asoka de silva

Purpose of transfusions
to increase oxygen carrying capacity
to increase circulating volume
other minor reasons
CIRCULATING BLOOD
VOLUME 70ML /KG
ACCEPTABLE BLOOD LOSS
10% OF CIRCULATING VOLUME

Functions
Transport
Oxygen
Carbon dioxide
Ions
Carbohydrates, fats, proteins
Protection
Humoral
Cellular

Stored blood
437 blood and 63 ml of CPD solution
Temp 4 degree centigrade
pH 6.7
k 20 m.equ/l
ACD 21 days
low 2:3 DPG
CPD 35 days
CPDA42 days
RBC 80% viable
Red cells can be kept for 42 days
Platelets for three days
Plasma can be frozen for a long time

Complications
Incompatibility
Infections
Allergic reactions
Over transfusion
Pyrogens
Emboli
Contaminated blood
ARDS

HIV
Hep B
HepC
Syphillis
Cytomegalo virus
Epstein_Barr virus

Incompatibility
Signs and symptoms depends on
Intravascular haemolysis
RE system haemolysis
Chest and flank pain
Chills, fever, flushing
Headache, vomiting, tachypnea
Hypotension, tachycardia
Oozing from the wound
Haemoglobinuria
Later oliguria, jaundice, anaemia

Haemolytic reactions
Due to an error in either
Typing and cross matching
Documentation and labeling
Checking and cross checking
S&S
Chest pain
Backache
Dyspnea
Hypotension
Fever, chills, headache, nausea, vomiting,
burning sensation at the site of the infusion

and a

Management
Discontinue
Oxygen
New tubing, vigorous crystalloids .
Mannitol, diuretic therapy dopamine.
Maintain urine output at 1 to 2 ml/kg/hr.
Anti-histamines, steroids
Samples
blood from patient.
Blood from blood pack
urine for HB

Immediate reactions
Haemolytic reactions
Febrile transfusion reactions
Allergic reactions
Transfusion related lung injury

Delayed reactions
Extra vascular haemolytic reactions
Graft versus host reactions

Blood and cancer surgery


Facts
Pts survive longer if no blood is given
Recurrences are less if no blood is given
Immunosuppression
Graft-versus-host disease

May be due to white


cells that we give

Complications of massive
transfusions (>35ml/kg/hr)
Potassium
Calcium
Citrate
Clotting factors
pH
Platelets
Temperature
2:3 DPG

Measures to reduce
transfusions
Accept lower HB levels
Keep blood loss to a minimum
hypotension
good haemostasis
regional blocks
Auto transfusions
Drugs
desmopressin
antifibrinolitics
Use alternatives

Stored ptblood
Intra op collection
Post op collection

Autotransfusion may be defined as "collection and


reinfusion of the patient's own blood
There is rapid availability
Blood compatibility is not a problem,
There is immediate reinfusion of normothermic blood.
No risk of transmission of infectious diseases
2,3-diphosphoglycerate (2,3-DPG) have been found to be
significantly higher
no direct complications of hypocalcemia or hyperkalemia..
Autotransfusion allows preservation of limited stores of
banked blood,
Autotransfusion lowers the cost of medical care.
It may be acceptable to those patients whose religious
convictions prohibit blood transfusions

Alternatives
Plasma
Crystalloids
Plasma expanders
Dextrans
Polygelatins
Starch preparations
Haemoglobin substitutes
Perflurocarbons
Haemoglobin solutions

Blood banking

Anticoagulation
Storage at 4 degrees
Life span
Changes
ATPase pump
K+ H+
Granulocites
Platelets
Factors V & Vll

Blood typing
Blood that lacks A antigen is Type B
Blood that lacks B antigen is Type A
Blood that lacks both Type O
Blood that has both is type AB

Other tests
Rh typing
Antibody screening
Coombs test

In crisis situations
O+ blood is used
In females O-

Type & cross match


Type specific in 10 minutes
Incomplete cross match in 30
minutes
Full cross match is available in 45
minutes

Packed red cells


1 unit increases Hb by 1 G/100ml
Haematocrit by 3%
Similar increase in children by giving
3ml/Kg
A unit should never be given over more
than 4hours
A unit not refrigerated should be discarded

platelets
Cross matching is not needed
Rh females should receive Rh ve
platelets
1 unit will increase by 5000/mm3
Each unit is about 50-70 ml
Usually 6 units are given

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