transfusion surgery

8/7/2019 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


16/18

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?


17/18

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?

transfusion surgery

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