Download - transfusion surgery
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TRANSFUSION OFTRANSFUSION OF
BLOOD & BLOODBLOOD & BLOOD
PRODUCTSPRODUCTS
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FRESH BLOOD COMPONENTSFRESH BLOOD COMPONENTS
WHOLE BLOODWHOLE BLOOD
RED BLOOD CELL IN ADDITIVERED BLOOD CELL IN ADDITIVE
SOLUTIONSOLUTION PLATELETSPLATELETS
FRESH FROZEN PLASMA (FFP)FRESH FROZEN PLASMA (FFP)
CRYOPRECIPITATECRYOPRECIPITATE
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PLASMA FRACTIONPLASMA FRACTION
HUMAN ALBUMINHUMAN ALBUMIN
PROTHROMBIN COMPLEXPROTHROMBIN COMPLEX
CONCENTRATESCONCENTRATES IMMUNOGLOBULIN PREPARATIONIMMUNOGLOBULIN PREPARATION
(90% Ig G)(90% Ig G)
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RED CELL SEROLOGYRED CELL SEROLOGY
ABO ANTIGENSABO ANTIGENS
RHESUS ANTIGENS (Rh)RHESUS ANTIGENS (Rh)
OTHER RED CELL ANTIGENSOTHER RED CELL ANTIGENS Kell antigensKell antigens
Duffy antigensDuffy antigens
Kidd antigensKidd antigens
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PRETRANFUSION TESTINGPRETRANFUSION TESTING
TYPE AND SCREENTYPE AND SCREEN
CROSSCROSS-- MATCHINGMATCHING
EMERGENCY REQUIREMENTS FOREMERGENCY REQUIREMENTS FORBLOODBLOOD
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ORDERING BLOOD IN ANORDERING BLOOD IN AN
EMERGENCYEMERGENCY
Immediately take samples for crossImmediately take samples for cross--matchingmatching
Inform the blood bank of theInform the blood bank of theemergency,the volume of bloodemergency,the volume of bloodrequired,and where blood is to be deliveredrequired,and where blood is to be delivered
One individual should take responsibility forOne individual should take responsibility forall communications with the blood bank,all communications with the blood bank,and should ensure that it is clear who willand should ensure that it is clear who willbe responsible for the blood deliverybe responsible for the blood delivery
In cases of exsanguinations use emergencyIn cases of exsanguinations use emergencygroup O Rh(D)group O Rh(D)--negetive blood.negetive blood.
Do not ask for crossDo not ask for cross--matched blood in anmatched blood in anemergencyemergency
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BLOOD ADMINISTRATIONBLOOD ADMINISTRATION
Before administrating blood 2 staffBefore administrating blood 2 staffmembers (one of whom must be a doctormembers (one of whom must be a doctoror trained staff nurse) must checkor trained staff nurse) must check
the patients full identitythe patients full identity
the blood pack,compatability label and reportthe blood pack,compatability label and reportformform
the blood pack for signs of haemolysis orthe blood pack for signs of haemolysis or
leakage from the pack.leakage from the pack.
Any discrepancies means that the bloodAny discrepancies means that the bloodmust not be transfused and that themust not be transfused and that thelaboratory must be informedlaboratory must be informed
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TRANSFUSION ERRORSTRANSFUSION ERRORS
Almost all deaths from transfusionAlmost all deaths from transfusionreaction are due to ABO incompatilityreaction are due to ABO incompatility
Errors in patient identification at the timeErrors in patient identification at the time
of blood sampling or administration areof blood sampling or administration arethe major causethe major cause
When taking the initial blood sampleWhen taking the initial blood sample check the patients identity verbally and on thecheck the patients identity verbally and on the
wrist identification bandwrist identification band label the sample fully before leaving thelabel the sample fully before leaving the
bedsidebedside
make sure that the blood request form ismake sure that the blood request form isclearly and accurately completed.clearly and accurately completed.
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ADVERSE EFFECTS OFADVERSE EFFECTS OF
TRANSFUSIONTRANSFUSION
ACUTE HAEMOLYTIC REACTIONSACUTE HAEMOLYTIC REACTIONS
DELAYED HAEMOLYTIC REACTIONSDELAYED HAEMOLYTIC REACTIONS
FEBRILE NONFEBRILE NON--HAEMOLYTIC REACTIONHAEMOLYTIC REACTION
ALLOIMMUNIZATIONALLOIMMUNIZATION ALLERGIC REACTIONSALLERGIC REACTIONS
CARDIAC FAILURECARDIAC FAILURE
GRAFTGRAFT--VERSUSVERSUS--HOST REACTIONHOST REACTION
TRANSFUSIONTRANSFUSION-- ASSOCIATED LUNG INJURYASSOCIATED LUNG INJURY
IMMUNE MODULATIONIMMUNE MODULATION
TRANSFUSIONTRANSFUSION--TRANSMITTED INFECTIONSTRANSMITTED INFECTIONS
BACTERIAL INFECTIONSBACTERIAL INFECTIONS
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AUTOLOGOUS TRANSFUSIONAUTOLOGOUS TRANSFUSION
PREOPERATIVE DONATIONPREOPERATIVE DONATION
ISOVOLAEMIC HAEMODILUTIONISOVOLAEMIC HAEMODILUTION
CELL SALVAGECELL SALVAGE
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TRANSFUSION REQUIREMENTS INTRANSFUSION REQUIREMENTS IN
SPECIAL SURGICAL SETTINGSSPECIAL SURGICAL SETTINGS
MASSIVE TRANSFUSIONMASSIVE TRANSFUSION
THROMBOCYTOPENIATHROMBOCYTOPENIA
COAGULATION FACTOR DEFICIENCYCOAGULATION FACTOR DEFICIENCY HYPOCALACAEMIAHYPOCALACAEMIA
HYPERKALEMIA & HYPOKALAMIAHYPERKALEMIA & HYPOKALAMIA
HYPOTHERMIAHYPOTHERMIA
ADULT RESPIARATORY DISTRESSADULT RESPIARATORY DISTRESSSYNDROME (ARDS)SYNDROME (ARDS)
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MASSIVE BLOODMASSIVE BLOOD
TRANSFUSIONTRANSFUSION
This is defined as the transfusion of the equivalentThis is defined as the transfusion of the equivalentof the the circulating blood volume within a 24hourof the the circulating blood volume within a 24hourperiod (in practice 10period (in practice 10--20 units in an adult)20 units in an adult)
Common identifications for massive bloodCommon identifications for massive blood
transfusion are major trauma, gastrointestinaltransfusion are major trauma, gastrointestinalbleeding and obstetrics complications.bleeding and obstetrics complications. Major problems associated with massive bloodMajor problems associated with massive blood
transfusion includetransfusion include underlying coagulopathyunderlying coagulopathy thrombocytopeniathrombocytopenia
lack of coagulation factor 5 & 8lack of coagulation factor 5 & 8 hyperkalaemiahyperkalaemia hypothermiahypothermia
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METHODS TO REDUCE THE NEEDMETHODS TO REDUCE THE NEED
FOR BLOOD TRANSFUSIONFOR BLOOD TRANSFUSION
ACUTE VOLUME REPLACEMENTACUTE VOLUME REPLACEMENT
HYDROXYETHYL STARCH (HES)HYDROXYETHYL STARCH (HES)
DEXRAN 70DEXRAN 70 DEXTRAN40DEXTRAN40
UREAUREA--BRIDGED GELATINBRIDGED GELATIN
(HAEMACCEL(HAEMACCEL
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MECHANISM FOR REDUCEDMECHANISM FOR REDUCED
BLOOD USE IN SURGERYBLOOD USE IN SURGERY PREOPERATIVEPREOPERATIVE * Surgery elective* Surgery elective Correct the Haemoglobin level.Correct the Haemoglobin level. Stop drugs that interfere HaemostasisStop drugs that interfere Haemostasis INTRAOPERATIVEINTRAOPERATIVE
PosturePosture Use of VasoconstrictorsUse of Vasoconstrictors Use of tourniquetsUse of tourniquets Use of antiUse of anti--fibrinolytic drugs eg Aprotininfibrinolytic drugs eg Aprotinin Using Fibrin SealantUsing Fibrin Sealant
POST OPERATIVELYPOST OPERATIVELY Blood can be salvaged from drains into collection devices that permit reinfusionBlood can be salvaged from drains into collection devices that permit reinfusion Decision to transfuse post operatively should dependDecision to transfuse post operatively should depend
* Age of the patient* Age of the patient * Ability to tolerate lower levels of anaemia* Ability to tolerate lower levels of anaemia
* Rate & amount of continuing blood loss* Rate & amount of continuing blood loss
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TRANSFUSION OFTRANSFUSION OFBLOOD &BLOODBLOOD &BLOOD
PRODUCTSPRODUCTS
Clinical ScenariosClinical Scenarios
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A 65 year old man has undergone aA 65 year old man has undergone aleft nephrectomy 3 days ago. Heleft nephrectomy 3 days ago. Herequired 3 units of packed cells intrarequired 3 units of packed cells intra--
operatively. He looks pale and isoperatively. He looks pale and isdyspnoeic but his vital signs anddyspnoeic but his vital signs andurinary output are satisfactory. Youurinary output are satisfactory. Youcheck his FBP. Hb is 7 PCV 0.28.check his FBP. Hb is 7 PCV 0.28.
What would you do?What would you do?
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A 34 year old man presents in theA 34 year old man presents in theresuscitation room of the A/E department.resuscitation room of the A/E department.He is anxious, short of breath, sweatingHe is anxious, short of breath, sweating
and his BP is 80 systolic, Pulse 120. Thereand his BP is 80 systolic, Pulse 120. Thereis a stab wound on the right side of theis a stab wound on the right side of thechest. A chest drain was inserted by thechest. A chest drain was inserted by theSHO and 1000mls of blood drainedSHO and 1000mls of blood drainedimmediately.immediately.
What would you do with respect to hisWhat would you do with respect to hisfluidfluid
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A 57 year old man needs a leftA 57 year old man needs a lefthemicolectomy for carcinoma. Hehemicolectomy for carcinoma. Hedeclares himself to be adeclares himself to be aJehovahs witness and refuses aJehovahs witness and refuses ablood transfusion under anyblood transfusion under anycircumstances.circumstances.
What will you do?What will you do?