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PPT ON BLOOD TRANSFUSION BY DR.M.RAVICHANDRA,M.S

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BLOOD TRANSFUSION:

BLOOD TRANSFUSION *Image via Bing

DR.M.RAVICHANDRA,M.S:

DR.M.RAVICHANDRA,M.S ASSISTANT PROFESSOR OF SURGERY RAJIVGANDHI INSTITUTE OF MEDICAL SCIENCES SRIKAKULAM

DEFINITION:

THE PROCESS OF RECEIVING BLOOD/BLOOD PRODUCTS INTO ONE’S CIRCULATION INTRAVENOUSLY DEFINITION

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History Type of Transfusion Indication Transfusion Reactions Autologous transfusion Component Transfusion Blood Transfusion

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History and Significance

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LOWER (1665) First blood transfusion

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Philip (1825) FIRST HUMAN BLOOD TRANSFUSION

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Landsteiner (1900) Discovery of ABO type

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How to store blood longer ? World war I

IMPACT OF WAR:

IMPACT OF WAR 1920-1949 1 ST TO 2 ND WORLD WAR 1920 DR.EDWIN JOHN &DR.CHARLES DREW REVOLUTIONISED STORAGE &DISTRIBUTION OF BLOOD 1922DR.PERCY LANE OLIVER BLOOD DONOR SERVICE (VOLUNTEERS ON 24HRS CALL) 1930 DR.SERGIE YUDINE –CADAVERIC BLOOD TO HUMANS

(CONTD):

1935-ANAESTESIOLOGISTS-STORED CITRATED BLOOD 1936 DR.DURAN JORDO- BARCELONA BLOOD TRANSFUSION SERVICE 1937 DR.BERNARD FANTUS COINED THE TERM BLOOD BANK COOK COUNTY HOSPITAL IN CHICAGO,IL 1940 DR.CHARLES DREW –PLASMA STORAGE VIABLE SUBSTITUTE FOR BLOOD 1957 DR.GIBSON STORED FOR 28 DAYS –ACD&SOD. DEHYDRO PHOSPHATE (CONTD)

INDIA'S FIRST BLOOD BANK:

ESTABLISHED IN SCHOOL OF TROPICAL MEDICINE, KOLKATTA BY SIR. UPENDRANATH BRAHMACHARI CHAIRMAN OF BENGAL RED CROSS SOCIETY INDIA'S FIRST BLOOD BANK

BLOOD BANKING:

BLOOD BANKING Anti coagulation Refrigeration 1 st anti coagulant used sodium citrate OSWARD HOPE ROBARTSON IST blood bank France World war 1 1939 – KARL LANDSTEINER –Rh blood group system W.B.MURPHY 1 st used plastic bag to store blood

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Is there any suitable Blood Substitutes WORLD WAR II

MAJOR BLOOD GROUP SYSTEMS:

MAJOR BLOOD GROUP SYSTEMS A-B-O SYSTEM Rh SYSTEM

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Successful blood transfusion is relatively recent Crossmatching Anticoagulation Plastic storage container Blood Transfusion

OBJECTIVES:

OBJECTIVES ENHANCEMENT OF OXYGEN CARRYING CAPACITY OF BLOOD RESTORATION OF BLOOD VOLUME MAINTAIN HOMEOSTASIS TO SUPPLY PLATELETS COAGULATION FACTORS FRESH BLOOD FFP/APPROPRIATE COMPONEN TS

NEED?:

20% LOSS -- NO NEED 20 TO 30% -- PLASMA SUBSTITUTION >30% LOSS -- BLOOD TRANSFUSION NEED?

BEFORE TRANSFUSION DETERMINE WHAT:

W– WHETHER REQUIRED H –HOW MUCH REQUIRED A –ACTUAL COMPONENT REQUIRED T –TIME OF DURATION &ADMINISTRATION BEFORE TRANSFUSION DETERMINE WHAT

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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 Transfusion

BLOOD GROUPING &RH TYPING:

BLOOD GROUPING &RH TYPING R.B.C MIXED WASHED WITH SALINE ONE PORTION MIXED WITH ANTI A –SERUM WHICH CONTAINS ANTI A-ANTIBODY ONE PORTION MIXED WITH ANTI B-SERUM WHICH CONTAINS ANTI B- ANTI BODY DEPENDING ON AGGLUTINATION BLOOD GROUP IS DETERMINED

AGGLUTINATION OF R.B.C WITH SERA:

R.B.C TYPE ANTI-A ANTI-B O _ + A + _ B _ + AB + + AGGLUTINATION OF R.B.C WITH SERA

AGGLUTINATION PROCESS:

AGGLUTINATION PROCESS

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CROSS MATCHING DONOR’S R.B.C + RECIPIENTS SERUM+ COOMB’S REAGENT

COLLECTION OF BLOOD:

COLLECTION OF BLOOD FIT DONOR SCREENED DONOR COMMERCIALLY AVAILABLE PLASTIC BAGS DONOR ON A COUCH ,RELAXED,B.P CUFF APPLIED TO UPPER ARM 70MM HG/9.3K PA -80/10.6 15G NEEDLE MEDIAN CUBITAL VEIN 410 ML OF BLOOD BAG CONTAINING 75ML OF CPD (CITRATE , POTASSIUM,DEXTROSE)

TYPES OF DONORS:

PROFESSIONALS VOLUNTEERS RELATIVES AUTODONORS ELECTIVE EMERGENCY MOBILE DONORS TYPES OF DONORS

CONTRAINDICATIONS:

TEMPORARY ANAEMIA CERTAIN MEDICATIONS MALARIA PREGNANCY REC EXPOSURE TO HEPATITIS RECENT TATTOO TRANSFUSION PREVIOUS 12 MONT HS AIDS BLEEDING DISORDERS CANCER(NOT TREATABLE) HEPATITIS SEVERE ASTHMA SEVERE HEART DISEASE CONTRAINDICATIONS PERMANENT

BLOOD STORAGE:

SPECIAL REF. 4DEGREES CENTI.+/_2DEG.CEN HIGHER TEMP –MORE THAN 2HRS –INFECTION SHELF LIFE OF CPD BLOOD -3WKS W.B.C RAPIDLY DESTOYED IN STORED BLOOD PLATELETS AT4DEG CEN.AFEW AFTER 24 HRS SEPARATED PLT GOOD SURVIVAL EVEN AFTER 72HRS CLOT. FACTORS 8&5 LABILE BLOOD STORAGE

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*Image via Bing CENTRIFUGE

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*Image via Bing REFRIGERATED CENTRIFUGE

INDICATIONS FOR BLOOD TRANSFUSION:

INDICATIONS FOR BLOOD TRANSFUSION TRAUMA HAEMORRHAGE FROM PATHOLOGICAL LESIONS MAJOR OPERATIVE PROCEDURES SEVERE BURNS POST OPERATIVELY PREOPERATIVELY CH.ANAEMIA APLASTIC ANAEMIA AS APROPHYLACTIC MEASURE PRIOR TO SURGERY IN HAEMORRHAGIC STATES THROMBOCYTOPENIA HAEMOPHILIA LIVER DISEASE

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BLOOD COMPONENTS AND THEIR TRANSFUSION

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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 Cells

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THROMBOCYTOPENIA (< 50,000) PLATELET DYSFUNCTION EACH UNIT INCREASE 5,000 PLTS AFTER 1 H Platelets

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PROFOUNDLY GRANULOCYTOPENIA (<500) SERIOUS INFECTION NOT RESPONSIVE TO ANTIBIOTIC THERAPY Granulocytes

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COAGULATION FACTOR DEFICIENCIES 1 ML INCREASES 1% CLOTTING FACTORS BEING USED AS SOON AS POSSIBLE ALBUMIN, HETASTARCH, CRYSTALLIODS 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)

--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 (H ES ) MORE STABLE CONTAINING ESSENTIAL ELECTROLYTES NO ALLERGIC REACTION -- Volume Expander Plasma Substitutes

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Technique of Transfusion: Approach Route: P eripheral Vein, Center Vein Filtration before Transfusion : Velocity of Transfusion : 5-10ml/min BLOOD TRANSFUSION

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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 TRANSFUSION

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I ncidence : 2% Chills, Fever 39-40 . C Headache, S weatiness Nausea, Vomiting, Flushing 15min-1hr Febrile Reactions : Transfusion Reactions

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Immuno-reaction : Endo-toxins : Contamination or Hemolysis : Analyze possible reasons : Stop Transfusion : General Support : Treatment : Febrile Reactions : TRANSFUSION REACTIONS

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Urticaria Abdominal cramps Dyspnea Vomiting Diarrhea Anaphylactic reactions : TRANSFUSION REACTIONS

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Immuno-reaction : IgE H ereditary I mmunoglobulin : IgA Reason : Administer antihistamines Administer epinephrine, diphenhydramine, and corticosteroids : Support airway and circulation as necessary : Treatment : ANAPHYLACTIC REACTIONS :

HAEMOLYTIC TRANSFUSION REACTION:

HAEMOLYTIC TRANSFUSION REACTION SYMPTOMS SEVERE ACHE IN TRANSFUSION VEIN PAIN LUMBAR&BACK REGIONS DYSPNOEA NAUSEA VOMITING FLUSHING OF FACE CHILLS &RIGORS INC.TEMP ANXIETY RESTLESSNESS FEELING OF CHEST CONSTRICTION

SIGNS OF HTR:

PYREXIA TACHYCARDIA HYPOTENSION UNEXPLAINED BLOOD LOSS SHOCK-DEC.U.O.P-ANURIA-DEATH SIGNS OF HTR

UNDER ANAES. &SEDATION:

SYMPTOMLESS SIGNS BLEEDING FROM WOUND &NEEDLE SITES PERSISTANT HYPOTENSION TACHYCARDIA UNDER ANAES. &SEDATION

INVESTIGATIONS(HTR):

STOP TRANSFUSION 10ML OF BL.SAMPLE IN TEST TUBE 2ML OXALATED URINE SAMPLE-2-5 DAYS MEASURE&EXAMINE BL. FOR GM STAINING &C/S EXCLUDE CLINICAL ERROR INVESTIGATIONS(HTR)

(HTR)LAB INVESTIGATIONS:

REGROUPING RETYPING RECROSSMATCHING POST TRANSFUSION SAMP. FOR AGGL. OF R.B.C SCREEN DONOR SAMPLE AGAIN (HTR)LAB INVESTIGATIONS

HTR-BIOCHEMISTRY:

P T B S FOR FREE HB & BILIRUBIN&COMPARE WITH PRE TRANS. LEVEL URINE FOR FREE HB &R.B.C CASTS SCHUMMS TEST FOR MET HB HTR-BIOCHEMISTRY

HAEMATOLOGICAL&BACT.:

BL. FOR HB&T.C OF R.B.C P.B.F FOR R.B.C MORPHOLOGY DONOR BL.GM STA.&C/S HAEMATOLOGICAL&BACT.

MANAGEMENT OF HTR:

AIM-FLUID &ELECT.BAL,NUTRITION STOPTRANSFUSION KEEP I.V CHANNEL OPEN WITH SALINE & HYDRO CORTISONE MAINTAIN I/O CHART INJ .FRUSEMIDE INJ.HEPARIN FFP/COMP.WHOLE BL. INFUSE MANNITOL IF NODIURISIS PERI.DIALYSIS. MANAGEMENT OF HTR

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ABO incompatibility Rh Incompatibility Non-immune Hemolysis Immune Hemolysis Reasons : Hemolytic Transfusion Reactions

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Double Check name,type and crossmatch Operate carefully and routinely Temperature Monitor Prevention : Hemolytic Transfusion Reactions

D.I.C:

D.I.C SEVERE ACUTE MANIFESTS AS MUCOSAL OOZING,G.I.BLEED,BLEEDING FROM SUR. INCISIONS/SITES OF VENOUS ACCESS DEPOSITION OF THROMBI IN MICRO CIRCULATION- MULTIORGAN FAILURE REN. FAILURE DUE TO HYPOVOLEMIA &FIBRIN DEP. INRENAL VASCULATURE PERIPHERAL VASODILATATION—HYPOTENSION-SHOCK--DEATH

MANAGEMENT:

ELIMINATION OF ETIOLOGICAL FACTORS REPLETION OF COAGULATION FACTORS PLT FFP FR. W B FIBRIN INHIBITION OF CLOTTING FACTORS BY HEPARIN /OTHERS MANAGEMENT

MASSIVE TRANSFUSION:

MASSIVE TRANSFUSION IT IS DEFINED AS TRANSFUSION OR INFUSION OF WHOLE BLOOD EQUAL TO OR EXCEEDING THE PERSONS BLOOD VOLUME WITH IN 24 HRS PERIOD

INDICATIONS:

MEDICAL EMERGENCIES MAJOR SURGERY EXCHANGE TRANSFUSION INDICATIONS

PROBLEMS:

PHYSICAL HYPOTHERMIA CHEMICAL HYPOCALCEMIA ACIDOSIS HYPOKALEMIA WITH MET.ACIDOSIS PHYSIOLOGICAL OXYGEN DIS. CURVE TO LEFT DEPLETION OF LABILE COAG. FACTORS DILUTIONAL THROMBOCYTOPENIA PROBLEMS

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Massive transfusion complications : Volume Overload Congestive Heart Failure Tachycardia Tachypnea Cyanopathy Transfusion Reactions

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Volume Overload Heart Functional Failure Lung Functional Failure Reasons : Stop Transfusion Heart Functional Support Diuresis (Furosemide) Treatment : Massive T ransfusion C omplications :

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Contamination: Fever Shock DIC Bacterial Contamination Reasons : Transfusion Reactions

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Stop Transfusion Bacterial Exam and Culture Antibiotics Treatment : Double Check Operate carefully Prevention : Contamination:

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Hepatitis B , Hepatitis C HIV Cytomegalovirus (CMV) Syphilis Malaria Acquired diseases : Transfusion Reactions

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No risk of infectious disease transmission No transfusion reactions No compatibility testing Reduced demand on blood bank stores An immediate source of autologous blood AUTOTRANSFUSION :

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Red Blood Cells Packed RBC White Blood Cells Pooled Platelets Blood Cell : Component Transfusion :

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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 Transfusion :

MOST COMMON CAUSE OF MISMATCHED TRANSFUSION?:

MOST COMMON CAUSE OF MISMATCHED TRANSFUSION?

CLERICAL ERROR!:

CLERICAL ERROR!

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