上海交通大学瑞金临床医学院 外科教研室. blood transfusion history type of...
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• History
• Type of Transfusion
• Indication
• Transfusion Reactions
• Autologous transfusion
• Component Transfusion
Blood TransfusionBlood Transfusion
Successful blood transfusion is relatively recent
• Crossmatching
• Anticoagulation
• Plastic storage container
Blood TransfusionBlood Transfusion
Type of Transfusion: Whole Blood;
Blood Component;
RBC PLT FFP Leukocyte concentrate
Plasma Substitutes;Use of whole blood is considered to be a waste of
resources
Blood TransfusionBlood Transfusion
• Symptomatic anemia (providing
oxygen-carrying capacity)
• Transfusion trigger
(HCT<30% ; HB<10g/dl)
• 1 Unit increases 3% HCT or 1g/dl
• Shelf life =42 d (1-6 )℃
Red Blood CellsRed Blood Cells
• Thrombocytopenia
(< 50,000)
• Platelet dysfunction
• Each unit increase 5,000
PLTs after 1 H
PlateletsPlatelets
• Profoundly granulocytopenia (<500)
• Serious infection not responsive to antibiotic thera
py
GranulocytesGranulocytes
• Coagulation factor deficiencies
• 1 ml increases 1% clotting fact
ors• Being used as soon as possible• Albumin, hetastarch, crystallio
ds are equally effective volume expander but safer than FFP
• After use of 5 U of RBCs, matching 2 U of FFP
Fresh Frozen Plasma (FFP)Fresh Frozen Plasma (FFP)
--Volume Expander
Dextran• Most widely used• Low/Middle M.W. (40,000-70,000)• Massive transfusion could impair coagulation• Occasional ALLERGIC reaction
Hydroxyethyl Starch Formulation (HES)• More stable• Containing essential electrolytes• No allergic reaction
Plasma SubstitutesPlasma Substitutes
Indication:
Acute massive blood loss;
Anaemia and hypoalbuminemia;
Overwhelming Infection;
Dysfunction of Coagulation;
Blood TransfusionBlood Transfusion
Technique of Transfusion:
Approach Route:
Peripheral Vein, Center Vein
Filtration before Transfusion:
Velocity of Transfusion:5-10ml/min
Blood TransfusionBlood Transfusion
Double Check: Name, Type and Crossmatch
Storage Time: Citrate Phoshate Detrose
Acidic Citrate Detrose
21D, 35D
Pre-heat: No any other Medication: Observation during / after Transfusion:
Attention:
Blood TransfusionBlood Transfusion
Incidence: 2%
Chills, Fever 39-40.C
Headache, Sweatiness
Nausea, Vomiting, Flushing
15min-1hr
Febrile Reactions :
Transfusion ReactionsTransfusion Reactions
Immuno-reaction :
Endo-toxins:
Contamination or Hemolysis:
Analyze possible reasons:
Stop Transfusion :
General Support:
Treatment:
Febrile Reactions :
Transfusion ReactionsTransfusion Reactions
Urticaria
Abdominal cramps
Dyspnea
Vomiting
Diarrhea
Anaphylactic reactions:
Transfusion ReactionsTransfusion Reactions
Immuno-reaction : IgE
Hereditary Immunoglobulin : IgA
Reason:
Administer antihistamines
Administer epinephrine, diphenhydramine,
and corticosteroids:
Support airway and circulation as necessary
:
Treatment:
Anaphylactic reactions:
Burning at the intravenous (IV) line site
Fever, Chills, Dyspnea
Shock
Cardiovascular Collapse
Hemoglobinuria, Hemoglobinemia
Renal Failure
DIC
Hemolytic transfusion reactions
Transfusion ReactionsTransfusion Reactions
ABO incompatibility
Rh Incompatibility
Non-immune Hemolysis
Immune Hemolysis
Reasons:
Hemolytic Transfusion Reactions
Stop Transfusion as soon as reaction is suspected
Check the name, type and crossmatch
Urine Exam
Renal Protection
(Aggressive Fluid Resuscitation, Furosemide)
DIC Monitor
Treatment:
Hemolytic Transfusion Reactions
Double Check name,type and crossmatch
Operate carefully and routinely
Temperature Monitor
Prevention:
Hemolytic Transfusion Reactions
Massive transfusion complications:
Volume Overload
Congestive Heart Failure
Tachycardia
Tachypnea
Cyanopathy
Transfusion ReactionsTransfusion Reactions
Volume Overload
Heart Functional Failure
Lung Functional Failure
Reasons:
Stop Transfusion
Heart Functional Support
Diuresis (Furosemide)
Treatment:
Massive Transfusion Complications:
Contamination:
Fever
Shock
DIC
Bacterial Contamination
Reasons:
Transfusion ReactionsTransfusion Reactions
Stop Transfusion
Bacterial Exam and Culture
Antibiotics
Treatment:
Double Check
Operate carefully
Prevention:
Contamination:
Hepatitis B, Hepatitis C
HIV
Cytomegalovirus (CMV)
Syphilis
Malaria
Acquired diseases :
Transfusion ReactionsTransfusion Reactions
No risk of infectious disease transmission
No transfusion reactions
No compatibility testing
Reduced demand on blood bank stores
An immediate source of autologous blood
AutotransfusionAutotransfusion ::
Red Blood Cells
Packed RBC
White Blood Cells
Pooled Platelets
Blood Cell:
Component TransfusionComponent Transfusion ::
• Saving blood source
• Less likely carrier of transmitted diseases
• Shortage of quality blood
• Greater shelf life than whole blood
• Helping to make blood safer by filtration
• Infusing regardless of ABO type in some blood
products
giving only essential/desired blood component
Component TransfusionComponent Transfusion ::