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Blood and Transfusion

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by

Bryan McEssy

on 10 November 2014

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Transcript of Blood and Transfusion

Blood Products & Transfusions
So what can be given?
There's a few things actually...
So whats the process?
Alright, all this is going now what?
For our patients that are receiving blood or blood products, careful monitoring should be taking place..... Don't be that guy who misses a transfusion reaction!
Reactions in a Nutshell
Circulatory Volume Overload
Febrile Nonhemolytic Reaction
Allergic Reaction
Transfusion Related Acute Lung InjuryAcute
Hemolytic Immune Mediated Reaction
Bacterial Contamination/Endotoxemia
Got that?

Fairly simple. If there is ever any question, err on the side of the patient's best interest. Don't be afraid to speak up. Always verify what the patient has had, is currently receiving, what the order is, the blood type of the patient and the product, and how the patient is tolerating the transfusion. If you have any doubts, just shut it off....
The Basics of Blood
The patients that need to receive blood will need to be Type and Crossed. This to ensure the patient receives the proper products in order to avoid complications.
What does this mean?
The patients blood is tested to determine the type (
AB
,
A
[AA or AO],
B
[BB or BO], or
O
[OO]). Also tested is whether the blood is
Rh
(An antigen found on the surface of red blood cells, specifically the D antigen)
positive
or
negtive
.
Whole blood
Red Blood Cells
Platelets
Fresh Frozen Plasma (FFP)
Cryoprecipitate
Factor Concentrates
Whole Blood

Description: 500-ML unit contain about 200ml of red blood cells (RBC=s and 300 ml of plasma)
Major Indications: Symptomatic anemia with large volume deficit
Action: Restoration of oxygen carrying capacity, restoration of blood volume
Not Indicated for: Condition to specific component
Special Precautions: Must be ABO-identical; Labile coagulation factors deteriorate within 24 hours after collection
Hazards: Infectious diseases; septic/toxic, allergic, febrile reactions; circulatory overload; GVHD
Rate of Infusion: For massive loss, fast as patient can tolerate
Red Blood Cells

Description: 250 ml, containing red blood cells and some plasma, provides the same hemoglobin as a unit of whole blood.
Major Indications: Symptomatic anemia
Action: Restoration of oxygen-carrying capacity
Not Indicated for: pharmacologically treatable anemia; Coagulation deficiency
Special Precautions: Must be ABO- compatible
Hazards: Infectious diseases; septic/toxic, allergic, febrile reactions; GVHD
Rate of Infusion: As patient can tolerate but less than 4 hours
Platelets

Description: 200-300 ml equal to 6-10 random donor plts.
Major Indications: Bleeding from thrombocytopenia or platelet function abnormality
Action: Improved hemostasis
Not Indicated for: Plasma coagulation deficits and some conditions with rapid platelet destruction (eg, ITP)
Special Precautions: Should not use some microaggregate filters (check manufacturer=s instructions)
Hazards: Infectious diseases; septic/toxic, allergic, febrile reactions; GVHD
Rate of Infusion: Less than 4 hours
Fresh Frozen Plasma (FFP)
Cryoprecipitate
Factor Concentrates for Hemophiliacs....

Description: 200 to 250ml unit of fresh frozen plasma and single donor frozen plasma. Contain coagulation factors, plus 250 mg of fibrinogen
Major Indications: Deficit of labile and stable plasma coagulation factors and TTP
Action: Source of labile and nonlabile plasma factors
Not Indicated for: Condition responsive to volume replacement
Special Precautions: Should be ABO-compatible
Hazards: Infectious disease; allergic reactions; circulatory overload
Rate of Infusion: Less than 4 hours


Description: frozen 20 ml unit contains mostly coagulation factor VIII, plus 250 mg of fibrinogen
Major Indications: Hemophilia A von Willebrands Disease; Hypofibrinogenemia; Factor XIII deficiency
Action: Provides Factor VIII, fibrinogen, vWF, Factor XIII
Not Indicated for: Conditions not deficient in contained factors
Special Precautions: Frequent repeat doses may be necessary
Hazards: Infectious diseases; allergic reactions
Rate of Infusion: Less than 4 hours
When in a pinch, a unit of whole blood can be broken down into other stuff....
One unit of PRBC
One unit of platelets
One unit of FFP
And more
What should we hope to see?
One unit will increase hemoglobin by 1 g/dL
and hematocrit by 3%.
The Down and Dirty of Platelets
Transfusion is usually performed in an ABO-compatible fashion, but is less important than with PRBC’s. (But avoid giving type A platelets to type O, as some platelets may be destroyed. And avoid giving Rh-positive platelets to Rh-negative patients, as sensitization may occur.)

4 units of platelets or a standard apheresis dose increases platelet count by ~25,000

6 units of platelets or a large apheresis dose increases platelet count by ~35,000
Fresh Frozen Plasma Cont...
One unit of FFP contains normal amounts of
all clotting factors from one unit of whole
blood, with no cells.

1 mL/kg raises most clotting factors by 1%
Low purity concentrate from whole
blood containing roughly

100 units Factor VIII
100 units von Willebrand Factor
200 mg fibrinogen
Hemophilia A- Deficiency in factor VIII
Hemophilia B-Deficiency in factor IX
Von Willebrand disease- Most common hereditary coagulation abnormality
Circulatory Volume Overload
1 in 100 transfusions
Dyspnea
Orthopnea
Cough
Tachycardia
Hypertension
Headache
Febrile Nonhemolytic Reaction

1 in 200
1 in 100 with platelets
Develops 1-6 hours after initiating
transfusion
Fever & chills
Allergic Reaction
3 in 1,000
1 in 20,000 are anaphylactic
Urticaria
Pruritis
Flushing
Bronchospasm
Hypotension
Transfusion Related Acute Lung Injury

1 in 5,000
Develops within 1-2 hours after initiating transfusion and is
fully manifest by 6 hours
Pulmonary edema
Hypoxemia
Respiratory failure
Hypotension
Fever
Acute Hemolytic Immune Mediated Reaction

1 in 6,000
1 in 250,000 are fatal
Often within minutes of initiating transfusion. Almost always before unit is transfused.
Fever & chills
Nausea
Hypotension
Back and joint pain
Hemoglobinuria, renal failure, and oliguria
DIC
Bacterial Contamination/Endotoxemia
1 in 31,000
1 in 4,000 for platelets
Fever & chills
Hypothermia
Tachycardia
Hypotension
Altered mental status
Multisystem organ failure
Bryan McEssy
*Mental Note: This is a collection of information gathered in one presentation
from multiple sources. Some I will name and others I can't........
Full transcript