Blood transfusion

blood transfusion, indications, complications,

1. BLOOD AND BLOOD PRODUCTS Dr. veeranadha reddy , Assistant professor, Department of general surgery.

2. INTRODUCTION Blood transfusion is the process of transferring compatible blood or blood-based products from one person into the circulatory system of another. TYPES 1.Homologous blood transfusion 2.Autologous blood transfusion

3. History In 1492 , the first historical attempt at blood transfusion was made by Stefano Infessura . Pope Innocent VIII

4. History In 1818, the first successful man to man blood transfusion was recorded by James Blundell In 1901, Karl Landsteiner discovered the human blood groups. In 1940 Dr.Wener discovered the Rh factor

5. INDICATION FOR BLOOD TRANSFUSION Increasing the oxygen carrying capacity is the only real indication for blood transfusion

6. Indications of blood transfusion Acute blood loss following trauma >15% During major surgeries Burns Packed cells in chronic anemia Blood fractions in ITP, Hemophilia

7. There is no “ UNIVERSAL TRIGGER ” Transfusion trigger is the critical point at which decision to transfuse blood is taken GENERAL LOWER LIMIT Hb<7gm/dl Hct <21%

8. DONAR CRITERIA Age - 18 to 60 yrs Hemoglobin shall not be less than 12.5 g/dl. Healthy- free from any disease transmissible by blood transfusion Weight shall not be less than 45 kilograms Interval between blood donations - three months

9. COLLECTION OF BLOOD Blood is collected in a sac containing 75ml of CPD solution and stored in special refrigerators at 4 degree Celsius – 3 weeks. CPDA solution – storage life of blood 5weeks SAG –M increases shelf life to 5weeks in 2-6 degree c

10. In Stored Blood RBC lasts for 3weeks WBC destroyed in 2 days Platelets and clotting factors destroyed within 1-2 days

11. BLOOD FRACTIONS Packed cells Plasma human albumin 4.5% fresh frozen plasma cryoprecipitate fibriniogen factor VIII and IX concentrates Platelet rich plasma Platelet concentrate Prothrombin complex concentrate

12. PACKED CELLS Centrifusing whole blood at 2000-2300 for 15-20min. One unit – 300ml with Hct 70% Raises Hb by 1gm Can be stored for 35days at 1-6 degree c

13. Human albumin 4.5% Repeated fractionations of plasma and is stored for several months in liquid form at 4 degree c

14. FFP Rapidly frozen fresh plasma at -40 degree Contains all clotting factors 1unit FFP- 250ml inc clotting factors by levels 3%. stored for 2 years Uses : . Liver disease with abnormal coagulationnnn . congenital clotting factor deficiency . deficiency following warfarin therapy . Massive transfusion,DIC .maintain PT at normal level (15ml/kg)

15. CRYOPRECIPITATE When fresh frozen plasma is allowed to thaw at 4°C, visible white supernatant layer develops and is called as cryoprecipitate. Rich in Factor VIII and fibrinogen. It is stored at - 40°C and can be kept for 2 years. Uses: To raise fibrinogen level at a dose to make plasma fibrinogen level 150 mg/dl. It is also used in inherited deficiency of Factor VIII, fibrinogen, Factor XIII, von Willebrand’s disease.

16. Fibrinogen obtained by organic liquid fractionation of plasma and is stored in dried form. It is very useful in DIC and afibrinogenaemia . It has risk of transmitting hepatitis . Factor VIII and IX concentrate: They are freeze dried part from a large pooled plasma used in haemoplhilia and von Willebrand’s disease.

17. PLATELET RICH PLASMA Centrifugation of freshly donated blood at 150–200 g for 15–20 minutes. Platelet rich plasma contains 5.5 × 109/L platelets in 50 ml plasma. It can be random donor platelet or single donor platelet. SDP is prepared by plateletapheresis containing 3 × 109/L platelets in 200 ml of plasma. One single donor platelet is equal to 8 units of random donor platelets.

18. PLATELET CONCENTRATE It is prepared by centrifugation of platelet rich plasma at 1200–1500 g for 15–20 minutes. Used in thrombocytopaenia and drug (aspirin, clopidogrel ) induced haemorrhage . Platelet is transfused at a dose of 0.1 unit/kg, when platelet drops below 20,000/or episodes of bleeding.

19. Platelet concentrate Platelets are stored at 4°C should be used within 48 hours; when stored at room temperature can be used up to 5 days. One platelet concentrate can increase up to 10,000 platelet/ cumm in one hour.

20. Prothrombin complex concentrate (PCC) are derived from pooled plasma which contains factors II, IX and X; used in emergency reversal of warfarin therapy in uncontrolled haemorrhage .

21. SAG-M Blood A proportion of donations will have plasma removed and will be replaced by crystalloid solution of SAG-M. S — Sodium chloride. A — Adenine. G — Glucose anhydrate. M — Mannitol .

22. Allows good viability of cells. It is very useful in anaemias . Precautions : For every four units of SAG-M blood, one whole blood has to be given. Later for every two units of SAG-M blood, one unit (400 ml) of 4.5% human albumin has to be given. Coagulation status and platelets count should be checked regularly.

23. complications Congestive cardiac failure ™ Transfusion reactions - Incompatibility: Major and minor reactions with fever, rigors, pain, hypotension - Pyrexial reactions - Allergic reactions ™ Infections TRALI (Transfusion Related Acute Lung Injury) TGVH(Transfusion related Graft vs Host disease)

24. complications ™ Air embolism ™ Thrombophlebitis ™ Coagulation failure Dilutional thrombocytopenia occurs in patients with massive blood transfusion ™ Circulatory overload causing heart failure ™ Haemochromatosis in patients with CRF receiving repeated blood transfusions ™ Citrate intoxication causes bradycardia and hypocalcaemia. ™ Iron overload

25. MASSIVE BLOOD TRANSFUSION One entire blood volume in 24hrs >4 units in one hour 50% of total blood volume in 3hrs >10 units in 24hrs Uses: Severe trauma associated with liver, cardiac pulmonary and pelvic injuries During surgical bleeding of major surgeries

26. Adverse effects of massive transfusion a. Severe electrolyte imbalance b. Coagulopathy c. Citrate toxicity, hyperammonaemia d. Hypothermia e. Poor oxygen delivery—due to reduced 2,3 DPG f. Infections g. Incompatibility and transfusion reactions h. ARDS, DIC, CCF

27. Artificial Red cell substitut es Perfluorocarbon A biotic substitute as synthetic oxygen carrier. Its half life is 7 days. It has got high affinity for O2. It is inert, colourless , odourless , dense, poorly soluble liquid. It is emulsified with albumin or lipids before infusion .

28. Stroma -free haemoglobin . Biomimetic haemoglobin based substitute. . It has more affinity for oxygen as it does not contain 2, 3 DPG but has short half life. It is nephrotoxic . Chelates which reverse bound O2. Intraoperative —salvage of blood: On table blood is collected, washed, filtered and transfused. Used in trauma

29. Artificial Plasma substitutes Human albumin 4.5% There is no risk of transmitting hepatitis. Plasma fractionation is done using organic liquids and heat to extract albumin which is stored at 4°C for many months. It can be used in patients with cirrhosis, burns, nephrotic syndrome, ovarian hyperstimulation syndrome . One gram of albumin binds with 14 ml of water so it increases the blood volume also.

30. Dextrans useful to improve plasma volume. They are polysaccharides of varying molecular weights. This is derived from leuconostoc mesenteroides bacteria after adding yeast. a. Low molecular weight dextran (40,000 mol wt) Dextran 40 is very effective in restoring blood volume immediately. But small molecules are readily excreted in kidney and so effect is transitory. b. High molecular weight dextran ( Dextran 110 and Dextran 70). Less effective but long acting and so useful to have prolonged effect.

31. Precautions 1. Blood samples for blood group and cross-matching should be taken before giving dextrans as it interferes with Rouleaux formation of red cells. 2. Dextrans also interfere with platelet function and so may precipitate abnormal bleeding. 3. Total volume of dextrans should not exceed 1000 ml.

32. Gelatin used as a plasma expander. But it is less effective than dextran After 4 hours of its infusion, only 30% remains intravascular. Hydroxyethystarch : It contains starch, sodium hydroxide, ethylene oxide. It is a good plasma volume expander but lasts only for 6 hours.

33. HES GELATIN

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