Blood transfusion for required persons.pptx

It involves giving blood or blood components from one person to another person.
It can be a life-saving process.
Its usually done to replace blood that has been lost because of severe bleeding & also used as treatment of severe anaemia

1. BLOOD & BLOOD PRODUCTS, TRANSFUSION & COMPLICATIONS

2. Blood transfusion It involves giving blood or blood components from one person to another person. It can be a life-saving process. Its usually done to replace blood that has been lost because of severe bleeding & also used as treatment of severe anaemia .

3. 3 Whole blood Red cells Plasma Platelets (Fresh) frozen plasma (FFP) Cryoprecipitate Stored Plasma F lX Immuno- globulins Albumin Fractionated products F Vlla F Vlll Granulocytes

4. BLOOD TYPES Fresh Blood Whole blood or RBC concentrates less than 12-24 hours old from the time of collection are considered as fresh blood . Whole Blood Blood after 24 hours of collection to 35 days are considered as Whole Blood (without platelet and labile clotting factor).

5. WHOLE BLOOD Indications - Acute , active blood loss with hypovolaemia - Exchange transfusion Contraindication - Risk of volume overload : Chronic anaemia Incipient cardiac failure

6. WHOLE BLOOD Administration - Must be ABO and RhD compatible - Never add medication to a unit of blood - Use blood administration set Dosage 1 unit  Hct 3 % or Hb 1 g / d L

7. Blood components IMPORTANCE OF COMPONENT SEPARATION Separation of blood into component allows optimal survival of each constituents Component separation allows transfusion of only specific desired component to the patient Transfusion of only the specific constituent of the blood avoids the use of unnecessary component By using blood components several patient can be treated with the blood from one donor

8. Packed Red Cells (in plasma) Contents RBC’s 20% Plasma Indication Replacement of red cells in anaemic patients Use with crystalloid or colloid solution in acute blood loss Replace O2 carrying capacity with less volume Severe anemia, slow blood loss, CHF Dosage 10 - 15 ml / kg PRC 1 unit  Hct 3 % or Hb 1 g/ dL

9. Packed Red Cells ( in additive solution) Indication - Replacement of red cells in anaemic patients - Use with crystalloid or colloid solution in acute blood loss Contraindication Not advised for exchange transfusion of neonates Dosage same as PRC

10. Washed red cells It is convenient but expensive. Washed RBCs are free of almost all traces of plasma, most WBCs, and platelets. They are generally given to patients who have severe reactions to plasma ( eg , severe allergies, paroxysmal nocturnal hemoglobinuria, or IgA immunization). In IgA-immunized patients, blood collected from IgA-deficient donors may be preferable for transfusion.

11. Platelets Concentrate Random donor Platelets Whole blood 1 unit Platelet Concentrate 1 unit > 5.5 x 10 10 platelets in 50 - 70 ml of plasma Single donor platelets 1 Donor Platelet concentrate > 3 x 10 11 platelets in ~ 3 00 ml of plasma

12. PLATELET CONCENTRATE Contents Platelets WBC’s Plasma Indications Treatment of bleeding due to Thrombocytopenia Platelet Dysfunction Prevention of bleeding Contraindication Prophylaxis of bleeding in surgical patients

13. PLATELET CONCENTRATE Dosage 1 unit of PC / 10 kg B.W . Increment will be less in - Spleenomegaly - DIC - Septicemia 1 unit of PC  Platelet 5000-10,000 / ul

14. Single Donor Platelet Administration same as random PC , but ABO compatible is more important Vol ~ 300 ml Vol ~ 50 – 70 ml

15. Plasma Components Fresh Frozen Plasma Frozen Plasma :- Aged plasma Cryo removed plasma Cryoprecipitate

16. FRESH FROZEN PLASMA Indication Clinically significant deficiency of Factors II, V, X, XI Replacement of multiple coagulation Factor deficiencies :- Liver disease , warfarin treatment, dilutional and consumption coagulopathy Treatment of stable coagulation deficiencies.

17. Fresh frozen plasma (FFP) Contents Clotting factors Fibrinogen Prothrombin Albumin Globulins

18. FRESH FROZEN PLASMA Precaution Acute allergic reaction are common Anaphylactic reaction may occur Hypovolemia alone is not an indication for use. Dosage Initial dose of 15 - 20 ml / kg

19. FRESH FROZEN PLASMA Administration Must be ABO compatible Infuse as soon as possible after thawing(within 6 hrs ). Using standard blood administration set

20. Cryoprecipitate Cryoprecipitate is the cold - insoluble portion of plasma that precipitates when FFP is thawed between 1-6 C

21. CRYOPRECIPITATE Indication Quantitative and Qualitative Fibrinogen deficiency : DIC Von Willebrand Disease Factor XIII deficiency Uremic Coagulopathy Fibrin Glue Factor VIII ( haemophilia A )

22. CRYOPRECIPITATE Administration Dose of Cryo is based on the desired target level of the specific factor to be replaced ABO compatible if possible No compatibility testing required After thawing & pooling, infuse as soon as possible through blood administration set Must be infused within 6 hours of thawing

23. BLOOD DERIVATIVES ARE MANUFACTURED BY FRACTIONATION OF LARGE POOL OF HUMAN PLASMA. Blood Derivatives :- i )Human albumin solutions ii)F VIII concentrate iii)F IX concentrate iv) Prothrombin complex concentrate v) Immunoglobulin

24. Cryoprecipitated anti hemophilic factor ( AHF ) Contents Factors VIII and XIII, Fibrinogen and von Willebrand factor (vWF). It also contains fibronectin Indications Hemophilia A Fibrinogen deficiency Factor XIII deficiency Disseminated intravascular coagulation Rare factor XIII deficiency .

25. Factor VIII Concentrate Commercially prepared, lyophilized powder purified from human FFP Contain also small amounts of fibrinogen & other proteins Can contain blood group Abs Treat patients with hemophilia A

26. Plasma Protein Fraction: Contents 5% Albumin/Globin in saline Indications Expand volume in burns Hemorrhage Hypoproteinemia

27. Albumin : Contents 5% or 25% albumin Indications Replace volume in shock Burns Hypoproteinemia

28. IMMUNOGLOBULINS : Rh immune globulin ( RhIg ), given IM or IV, prevents development of maternal Rh antibodies that can result from fetomaternal hemorrhage. Other immune globulins are available for post exposure prophylaxis for patients exposed to a number of infectious diseases, including cytomegalovirus, hepatitis A and B, measles, rabies, respiratory syncytial virus, rubella, tetanus, smallpox, and varicella.

29. ADVERSE EFFECTS OF TRANSFUSION

30. ADVERSE EFFECTS OF BLOOD TRANSFUSION IMMEDIATE Immunological Non immunological DELAYED Immunological Non immunological

31. IMMEDIATE COMPLICATIONS IMMUNOLOGICAL 1.HEMOLYTIC TRANSFUSION REACTIONS 2.FNHTR 3.ALLERGIC REACTIONS 4.TRANSFUSION ASSOCIATED LUNG INJURY NON IMMUNOLOGICAL CIRCULATORY OVERLOAD BACTERIAL CONTAMINATION

32. DELAYED COMPLICATIONS IMMUNOLOGICAL 1. HEMOLYTIC TRANSFUSION REACTIONS 2. POST TRANSFUSION PURPURA 3. GRAFT vs HOST DISEASE NON IMMUNOLOGICAL TRANSMISSION OF INFECTIOUS ORGANISMS IRON OVERLOAD

33. HEMOLYTIC TRANSFUSION REACTIONS A haemolytic transfusion reaction is the accelerated clearance or lysis of transfused red cells because of immunological incompatibility (incompatible transfusion) Mediated by IgM antibodies

34. HTR are classified based on whether they occur within or after 24 hours of transfusion as- Acute Hemolytic Transfusion Reaction (AHTR) Delayed Hemolytic Transfusion Reaction (DHTR)

35. AHTR Rapid destruction of blood cells within 24 hours or immediately after 24 hours of transfusion. Commonly occurs with ABO incompatibility .

36. Signs and symptoms Fever with or without chills and rigors- mc. Anxiety Chest or back pain Flushing Dyspnoea Tachycardia, hypotension Life threatening complications such as acute renal failure, shock and intravascular coagulation can occur.

37. Antibody ( in recipient serum ) + Antigen ( on donor RBC ) Acute haemolytic transfusion reaction Leads to Complement activation Coagulation pathway activation Cytokine release

38. Major complications of AHTR: Hypotension Vasoconstriction and renal ischemia Activation of platelets and coagulation cascade resulting in DIC.

39. Investigations for AHTR: All records checked for clerical errors. Check post-transfusion sample for hemolysis (pink-red supernatant plasma) Repeat blood grouping of donor and recepient samples Direct antiglobulin test usually positive

40. PREVENTION AND MANAGEMENT Avoid unnecessary blood transfusion, define clear cut indications for blood transfusion. Consider blood substitutes. Use autologous blood if feasible. Use sensitive antibody screening tests. Avoid, trace and correct errors. Implement strict quality control programs.

41. DHTR Transfused red cells are destroyed 2-10 days after transfusion. Usually associated with previous immunisation or pregnancy ( alloantibodies ) Destruction of red cells is predominantly extravascular .( IgG -coated red cells are removed by the reticuloendothelial system.)

42. Has milder clinical manifestations- fever, anaemia, jaundice, hemoglobinuria . Commonly seen with antibodies to Kidd and Rh antigens.

43. Prevention : Perform prophylactic antigen matching of donor RBC with recipient’s complete phenotype Use artificial blood substitutes Use more sensitive antibody screening tests

44. FNHTR Temperature rise of at least 1˚C occurring with or without chills in association with transfusion or shortly thereafter ( up to 4 hours ) that is not attributable to other causes including hemolysis or underlying disease. Commonly associated with transfusion of cellular blood components Longer storage times are associated with higher rates of FNHTR.

45. Diagnosis : Fever and chills develop during or shortly after the transfusion has been completed Rule out other causes of fever-HTR/contamination /TRALI

46. Prevention and management: Immediate discontinuation of blood transfusion. Premedication with anti- pyretics for those with history of FNHTR. Use of leuco -depleted blood. Clinical manifestations resolve with or without treatment.

47. TRALI Transfusion­ related acute lung injury (TRALI) is a rare but potentially fatal complication of blood product transfusion TRALI has been defined as new acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) occurring during or within six hours after blood product administration

48. TRALI occurs at a rate of approximately 0.04 to 0.1 percent of transfused patients or in approximately 1 in 5000 transfused blood components

49. RISK FACTORS Recipient risk factors - Occurs in all age groups and equally in both sexes Blood component risk factors- A ll blood components have been associated with TRALI

50. Recipient risk factors Chronic alcohol /nicotine abuse Shock Higher interleukin (IL)­8 levels Positive fluid balance Liver transplantation surgery

51. Blood component risk factors 1. Donor gender and high­plasma­volume blood components 2. Red blood cell storage duration

52. Treatment and prevention : Supportive treatment. Resolution within 3-5 days of onset. Donor who is ‘implicated’ in a case of TRALI should be deferred. Plasma for transfusions should be prepared from donors who are less likely to be alloimmunised - preferably male donors.

53. ALLERGIC REACTIONS Allergic reaction consisting of localised or diffuse urticaria - most commonly IgE mediated.

54. Pathophysiology : Allergin - Reagin complex ( IgE , IgG) Attaches to mast cells Histamines/ leukotrienes release Allergic reaction ( Urticaria )

55. Treatment : Stop the transfusion Antidotes: anti- histaminics , epinephrine. Prevention : Pre-mediation with antipyretics or anti- histaminics . Avoid plasma containing blood products.

56. TRANSFUSION-ASSOCIATED CIRCULATORY OVERLOAD Rapid/excessive transfusion - more than what the recipient's circulatory system can handle. Recipients with underlying cardiopulmonary compromise, renal failure, chronic anemia, and extremes of age are at an increased risk

57. Signs and symptoms Tachycardia, cough, dyspnea , hypertension, elevated central venous pressure, elevated pulmonary wedge pressure, and widened pulse pressure. Cardiomegaly and pulmonary edema are often seen on chest radiography

58. INFECTIONS

59. POST TRANSFUSION PURPURA PTP is an acute episode of severe thrombocytopenia occurring a week after a blood transfusion. Clinical features: Almost all patients have previous exposure to platelet antigens through pregnancy and/or transfusion.

60. Widespread purpura and bleeding from mucous membranes , GI and urinary tracts. Megakaryocytes in bone marrow are normal or increased.

61. Treatment and prevention: IVIG Plasmapheresis Steroids

62. GVHD It is characterised by attack and destruction of recipient cells by engrafted immune cells. It is defined as fever, rash, liver dysfunction, diarrhoea and pancytopenia occurring 1-6 weeks after transfusion, without other apparent cause .

63. Pathogenesis : Infusion of immunocompetent lymphocytes Patient at risk ( immunocompromised ) Proliferation of donor lymphocytes Attack against patient tissue

64. Clinical manifestations: Fever Erythematous maculopapular rash Liver dysfunction Diarrhoea Pancytopenia Leucopenia and pancytopenia leading to sepsis and multi-organ failure is the primary reason for death.

65. Criteria for diagnosis: Major histocompatibility difference between donor and recipient. Characteristic clinical manifestations

66. Prevention : Patients at risk should be identified and transfused with lymphocyte inactivated products. Lymphocyte inactivation done through gamma irradiation or pathogen inactivation methods (Cs-137 and Co-60)

67. IRON OVERLOAD In patients receiving long term blood transfusion therapy ( thalassemics , sickle cell anemia) Deposition in various organs-heart, liver endocrine organs –organ failure Iron chelating therapy instituted early

68. CONCLUSION Haemoglobin level is not the sole indicator for transfusion Use of appropriate products for the various conditions Transfusion of blood and blood components is life saving procedure. In a few patients, it can result in potentially fatal complications. Thus should be considered if benefits outweigh the risks.

69. Thank you…..