Transfusion: indications, methods and complications

Transfusion: indications, methods and complications

Take-home points

• Every blood compound : different conservation conditions + different indications

• Following the protocol- no transfusion reactions
• Transfusion: ONLY when the benefits outweigh the risks and there are no appropriate alternatives!!
• Clinical assessment, rather than laboratory test results: most important factor in the decision to transfuse

www.gizmodo.com/inside-the-blood-factory-that-keeps-track-of-the-worlds-1659939881

• Reactions after blood transfusion :very frequent (several types). It is important to know how to recognize them in order to treat them

What can we administer?

Bibliography:

Whole blood

1.Bohus Gabriela Monica. Utilizarea terapeutica a sângelui si a componentelor sanguine( online).

2. Hagau Natalia. Curs de Anestezie Terapie Intensiva si Caiet de demonstratii practice pentru studentii anului IV, medicina generala. 2008

3. McEvoy Michael T., Shander Aryeh. Anemia, Bleeding, and Blood Transfusion in the Intensive Care Unit: Causes, Risks, Costs, and New Strategies. Am J Crit Care. November 2013 .

4. Norfolk Derek . 5th Handbook of Transfusion Medicine. United Kingdom Blood Services. 5th edition. 2013

5. SHOT Annual Report 2013

6. Terapia lichidiana. <<www.atimures.ro>>

• 1 Unit= 450 ml of blood + 60-70 ml anticoagulant CDPA
• conserved at 2-6 °C

Indications:

1. acute bleeding

2. to obtain derivatives

Red blood cells

www.learn.fi.edu/learn/heart/blood/images/red-blood-cells.jpg

Thank you!

!!!! It's a must to mantain the compatibility

• prepared by centrifugation then resuspended in SAG-M
• 1 Unit adult - 60 g Hb with Ht = 70%
• 1 Unit increases Hb with approx. 1 G

Do NOT adm. in any type of anaemia which can be corrected by other means (Fe, Folic acid, B12, erythropoietin) !!

Harvesting and conservation

Indications:

1. anaemia without hypovolemia

2. Haemorrhagic shock and crystalloid fluid

3. in emergency, when there is not isogroup blood: RBC 0 (I) - for women , RBC 0 (I) + for men (not previously transfused)

Transfusion represents the administration in intravascular space of blood or blood products from individuals of the same biological species.

www.metrouk2.files.wordpress.com/2012/04/article-1335444948628-12c3bb1b000005dc-814078_466x412.jpg

www.daviddarling.info/images/blood_transfusion.jpg

• Solution for conservation: CDP-A (citrate, phosphate, dextrose, adenine)

- phosphate, dextrose and adenine are for energy -35 days

- citrate is an anticoagulant , easily methabolized by the liver

• Solution for resuspension: SAG-M

(serum, adenine, glucose, mannitol)

-increases the duration of storage for red blood cells from 35 to 42 days

Platelets

Harvested blood :

• whole blood
• red blood cells
• plasma
• cryoprecipitate
• platelets

• from 1 U of blood- 1 U of platelets
• 1 U increases the no. of thrombocytes with 5,000-10,000/mm3

Tested for:

• Human T-Lymphotropic Virus
• malaria
• syphilis
• hepatitis B
• HIV virus
• cytomegalovirus (only on immunocompromised people)

Contents

www.nzblood.co.nz/assets/Give-Blood/Images-blood-bags-machines/Platelet-bags-medium.jpg

Indications:

1. thrombocytopenia

2. congenital or acquired platelet dysfunction

3. pre-operative blood transfusion in thrombocytopenic patients

4. disseminated intravascular coagulation (DIC)

5. prophylactic transfusion when platelets < 10,000 - 20,000 / mm3 due to the risk of spontaneous bleeding

Aspirin therapy cannot be considered an indication for platelet transfusion !!!

!!Freezing

1. Blood groups

2. Principles of harvest and conservation

3. Preparations of blood and substitutes

4. Transfusion indications

5. Complications

Fresh frozen plasma

www.upload.wikimedia.org/wikipedia/190px-Plasma_donation_compatibility_path.svg.png

• contains normal c% of coagulation factors, albumin, immunoglobulin, fibrinogen, enzymes; cholinesterase source
• risk of allergic reactions , anaphylaxis

www.transfusionguidelines.org.uk/public/transfusion-handbook/figure-3.1.png

Indications:

1. coagulation defects correction

2. antithrombin III deficiency

3. cholinesterase deficiency

4. urgent reversal of oral anticoagulants (5-8 ml / kg) , in case of surgical intervention with major bleeding*

*Circulation.2012; 125: 2944-2947

Treatment of the complications

Transfusion complications

1. IMMEDIATE REACTIONS: the first 2-3 hours after the transfusion

eg. Acute intravascular haemolysis

- Causes: incompatibility AB0

2. LATE REACTIONS: days, weeks or months

• immediate ending of transfusion with trasnfusion kit change
• hemodynamic and respiratory stabilization of the patient
• oxygenotherapy
• adrenaline administration
• antihistamines
• hydrocortisone
• checking the compatibility tests
• monitoring the urine output
• administration of colloids
• increasing urine pH

www.shotuk.org/wp-content/uploads/74280-SHOT-2014-Annual-Report-V12-WEB.pdf

Stages of a CORRECT transfusion (1)

3. Sampling for compatibility

-2 samples : blood-grouping

compatibility testing

1. The indication for a transfusion: ALWAYS made by a doctor

2. Inform the patient

Jehovah's Witnesses

Blood Groups

http://image.slidesharecdn.com/bloodtransfusionpart1-140512071127-phpapp01/95/blood-transfusion-part-1-23-638.jpg?cb=1399898541

Antigens:

Antibodies:

- presented at the surface of red cells, in secretions, endothelial cells

-synthesized from the third month of intrauterine life

Stages of a CORRECT transfusion (2)

-located in serum

-2 types:

a. naturals

- synthesized in the first year

of life (IgM)

- TOLERANCE TO SELF!!!

b. earned

-hemolitic action

- Eg. D antibodies (IgG)

www.shotuk.org/wp-content/uploads/74280-SHOT-2014-Annual-Report-V12-WEB.pdf

www.siasat.pk/forum/showthread.php?108715-If-Your-Blood-type-is

4. Order of blood or blood components

5. Preparing the components for administration - blood heating

6. Last bedside control

7. Administration

- filters for clots

- ritm: 60-100 drops/min

8. Transfused patient care and monitoring

- for complications or abnormal reactions

Indications for transfusion

Major conditions with general indications for transfusion:

1. haemorrhagic shock

2. traumatic shock*

3. renal dialysis

4. clotting disorders

5. liver transplant

6. exchange transfusion in newborns

7. acute or chronic bleeding

8. severe anaemia

9. plasma exchanges

10. extensive burns

11. severe infections

Nemtanu Teona

MG II

UMF Iuliu Hatieganu

*Fabiano G1, Pezzolla A, Filograna MA, Ferrarese F. [Traumatic shock--physiopathologic aspects]. G Chir. 2008 Jan-Feb;29(1-2):51-7.