Transcript Blood Tranfusion

Blood Transfusion
. Precautions :
. Types :
1- whole blood
2- packed RBCs
3- fresh frozen plasma
4- platelets
5- granulocyte transfusion
6- cryopercipitate transfusion
Fresh Frozen Plasma
. Stored frozen, when thawed to 37oC should be
transfused within 24 hrs
. unit = 200ml increases the level of each clotting
factor 2-3%
. Dose = 10-15 ml\Kg
. Indications : - isolated factor deficiency
- warfarin reversal
- liver disease
- massive blood transfusion
- antithrombin III deficiency when
Heparin is needed
Platelets
. Stored at 20-240 C for 5 days (shelf life) , stored at 370 C
. Unit 50-70 ml, survival only for 1-7 days
. Each unit increase platelet count by 5000-10,000%
. Side effects :
- Rh sensitization
- Anti A, anti B reaction
- HLA typing
- proliferating bacteria
. Indications :
a- thrombocytopenia (DIC, massive transfusion,
prophylactic preop, ITP)
b- thrombasthenia (bleeding, prophylactic preop,)
. Dose : one unit plt. Conc. /(10 KgBW … 4u/m2 )
Complications
- Non-immune comp.
- Immune comp. :
. Non-heamolytic
. Heamolytic:
. Acute (ABOsystem)
. Dealyed (other system)
Destruction of the transfused RBCs by the recipient
antibodies
Heamolysis
Fever
 Rigors
 Hypotension
 Nausea and vomiting
 Headache
 Myalgia (chest pain and flank pain)

Non-heamolytic reactions
sensitization of the recipient to the donor
WBCs, plt or plasma prt.
1- febrile reactions :
. dt WBCs or plt. sensitization
. Inc temp. without heamolysis
. White cell poor RBCs , use of 20-40 micrometer filter
2- urticarial reactions :
. Urticaria with no fever (itching , erythema)
. dt to plasma prt sensitization
. Use of packed RBCs
3- Anaphylactic reaction :
. dt IgA containing blood transfusion in IGA deficient ptn.
. Should be given washed RBCs
. Maybe so severe : epinephrine,fluids,steroids
4- Non-cardiogenic pulmonary edema:
. Dt transfusion of antileucocytic antibodies
. Endothelial damage (WBCs,antiWBCs reaction)
. Supportive therapy : resolve 12-48 hrs
5- Graft versus host reaction :
. dt immune response mediated by blood product
lymphocytes against recepient … so use irradiated
RBCs, granulocytes and plt.
6- Post transfusion Purpura:
. 1 week after
. Formation of allo antibodies, destruction of ptn .own plt.
. Ttt  plasmapharesis
Non-immune Complications
A- Massive blood transfusion:
. Dilutional coagulopathy lab: dec. plt. And coag. Factors
. DIC
. Citrate toxicty (hypocalcemia)
. Hypothermia (VF, dec. citrate met. , plt. dysfunction)
. Hypokalemia, hperkalemia
. Acid-base … metabolic acidosis (PH of stored blood 6.8)
metabolic alkalosis (HCO3 from citrate)
. Impaired Hb function
B- Infection :
. Viruses… Hepatitis, Cytomegalo, AIDS, EBV, HTLVI, II
. Parasites
. bacteria
“OLD BLOOD”
. pH = 6.8
. Temp = 2-60C
. S.K = 5-25 meq/L
. Decrease 2,3 DPG  shift to left
. Platelets  not functioning (10% normal activity)
. Decrease factors V,VIII,IX, 10-20 % of normal
activity
. Microembolization
Alternative strategies for
ordinary Blood Transfusion
1- Preoperatrive donation :
-
-
Donation of 3-4 unit of blood in the 4-5
weeks before surgery (HCT 34%, Hb 11gm%)
Donation of 1-2 units of blood immediately
before surgery (normovolemic
heamodilution)
2- Blood salvage & reinfusion
For cardiac, major reconstruction, vascular %
orthopedic surgery