USE OF BLOOD AND BLOOD PRODUCTS

Historical perspective
 Role of bloodloss/control of blood loss and others as rate limiting steps  Blood letting as anesthesia  Blood considered determinant of ill-health and wellness- the pope and the boys  Blood considered determinant of temperament  Role of Landsteiner brothers  Role of world war II  Role of HIV  The church forbids blood (Jehovah witness)

 Whole blood  Fresh whole blood transfusion***  Massive bleeder  Massive blood transfusion***  Bloodless field  Bloodless surgery  Autologous transfusion  Transfusion trigger ??(the ian wright , wright, wright rule= the rt bld, rt pxt, rt bld)  GRP & XMCH ( NORMAL, NEONATE, MASSIVE)  GRP & SAVE  How many units to transfuse

Terminologies *** common questions

Blood fractions or products(common exam question)

Packed cells White cell concentrate Platelet concentrate Plasma fresh frozen plasma Human albumin Cryoprecipitate Clotting factor concentrate Immunoglobulin fibrinogen

ABO BLOOD TYPES

OTHER Blood TYPES(antigen)

OTHERS( LESS ANTIGENIC)

DUFF KIDD KELLY

Storage (with reference to whole blood and packed cells mostly)

Media (at 40 +_20) ACD (1-2weeks) CPD (2-3 weeks) CPD-A (4-6 weeks) SAG-M (3-9 mths) Deglycerolized solution (3years)

STORAGE LESIONS
BLOOD CELLS
RED BLOOD CELLS WBC PLATELET

CLOTTING FACTORS SERUM ELECTROLYTES/VASOACTIVE AMINES CYTOKINES (? FEBRILE TXN RXN) ACIDOSIS CLINICAL IMPLICATION
WHY FRESH WHOLE BLOOD WHY WE NEED TO WAIT FOR 2-3DAYS WHY SITUATION MAY WORSEN IN ACUTE O2 DEFICIENCY STATE

DONOR SELECTION
       

AGE WEIGHT PHYSIOLOGIC STATES CHRONIC OR LANTANIC ILLNESSES INFECTION FREE INFESTATION FREE( MALARIA 1MTH) PREVIOUS DONATION (?46MTHS) ADEQUATE HEMOGLOBIN/PCV

INDICATIONS FOR BLOOD TRANSFUSION (common exam question)

T-THROMBOCYTOPENIA / THROMBOCYTOPATHY O-OXYGEN CARRYING DEFICIENCY P-PLASMA EXPANSION I-IMMUNE DEFICIENCY C-COAGULOPATHY

COMPLICATIONS OF BLOOD TRANSFUSION (VERY VERY COMMON QUESTION)

1)BLOOD RELATED
SINGLE UNIT OR MASSIVE TRANSFUSION

2)TECHNICAL OR MECHANICAL

Technical or mechanical
Air embolism Clot/microaggregate embolism Thrombophlebitis Cellulitis bloodloss

Single unit (early and late)

Hemolytic
Acute hemolytic txn reaction Delayed hemolytic txn reaction

Late ( 4Is) Infection Immunosuppression Isoimmunization /Immune sensitization( rhesus, other bld grps) Iron overload

Nonhemolytic
Bacterial txn rxn Pyrogen rxn/febrile rxn Allergic/anaphylactic GVHD (eg TRALI) postTxn purpura (antiplatelet Abs)

Massive transfusion
Circulatory overload Pulmonary oedema Congestive cardiac failure Hypothermia Acidosis (poor liver) Alkalosis (good liver) Citrate toxicity (arrhythmias) Hypocalcemia hyperkalemia Hypokalemia Coagulopathy (from hypocalcemia, clotting factor def, anticoagulant, hypothermia, thrombocytopenia)

BLOOD SUBSTITUTES
CRYSTALLOID ELECTROLYE containing ) COLLOIDS- HMW SUBST( DEXTRAN, GELATIN, HETASTARCH) RBC-SUBSTITUTES- PERFLOROCPD, STROMA FREE RBC

METHODS OF AUTOLOGOUS
PREOP DONATION INTRAOPERATIVE AUTOLOGOUS (ACUTE NORMOVOLEMIC HEMODILUTION, ACUTE HYPERVOLEMIC HEMODILUTION) CELL SALVAGE LEAP-FROG DONATION

ALTERNATIVES TO BLOOD TRANSFUSION

Preop

Correct risk factors for bleeding Microsamples Check drugs, control hpn, infection etc Hematinics EPO

Intraop
All methods including hypothesive anesthesia and controlled hypothemia Blood substitutes Hyperbaric oxygen

SETTING UP TRANSFUSION

TRANSFUSION NOTE
Patient Details required on form Full names Hospital Number ward Blood Group Previous transfusion and obstetric history Transfusion details Reason for request; Present Hb (if known) Location, Date and Time of expected transfusion Date of request Type of blood (Packed cells, whole blood, G&S only); Number of units Time to start and stop.(INCLUDE RATE TO RUN, NEVER MORE THAN 4HRS LONG) Doctor Details Name, Bleep number and Signature of person requesting the blood IN CASE OF TRANSFUSION REACTION SEE BELOW

TRANSFUSION NOTE CONTD: IN CASE OF TXN RXN

STOP TRANFUSION GIVE IV NORMAL SALINE(ANOTHER SET , SAME CANULA) GIVE IV HYDROCORTISONE GIVE IV CHLORPHENIRAMINE CALL ON CALL DOCTOR

Setting up a transfusion
Check Bld Vs Px Particulars (X 2people) Warm The Blood (Tap Water) Set Line (blood giving set) Frusemide (40mg) is often given with each or every other unit (IV or PO) to stop potential fluid overload. Not required when patient is hypovolaemic All patient details MUST be correctly charted AS ABOVE Stay and Transfuse slowly for about 15-30 initially (most rxns will occur by this time).

IF TXN REACTION , TREAT APPROPRIATELY

DEALING WITH JEHOVAH WITNESS

Optimize all the above methods
Early or Delayed surgery to optimize May accept autologous preop donation May accept autologous intra op donation Dealing with the minor ( do they have religion, is it the parents child or the child of the state, hospital policy ) MAKE THEM SIGN APPROPRIATE CONSENT DON T GO AGAINST THEIR WISH, ITS THEIR LIFE /FAITH

Two examples
One died of anemic failure One on present being managed for CAB

THE FISH KNOWS MORE THAN US

NICE DAY