blood products Flashcards
indictations of blood products
only if strictly necessary and NO alternative - outcomes worse after inappropriate transfusion
group and save requests
know guidelines
having crossmatched blood might nopt be necessary if blood sample already in lab, with group determined, without atypical AB
ie a G&S
whole blood
rarely used now
red cells
packed to make haematocrit 70%
use to correct anaemia or blood loss
1U increases Hb by 10-15g/L
in anaemia transfuse until Hb 80g/L
platelets
usually only needed of bleeding or count <20x10(9)/L
1U increase platelet count by >20x10(9)/L
if this fails - suggests a refractory cause
if surgery planned, get advice if count <100x10(9)/L
Fresh frozen plasma
correct clotting defects eg DIC, warfarin OD where vit K would be too slow, liver disease, thrombotic thrombocytopenic purpura
expensive, carries all risk of blood transfusion - dont use as simple vol expander
human albumin soln
produced at 4.5% or 20% protein soln
used to replace protein
20% can be used temporarily in hypoproteinaemic pt (eg liver disease, nephrosis) who is fluid overloaded w/o giving an excessive salt load
also used as replacement in abdo paracentesis
cyroprecipitate
source of fibrinogen
coagulation concentrates
self injected in haemophilia
early complications of transfusion
- acute haemolytic reactions - ABO or Rh incompatability
- anaphylaxis
- bacterial contamination
- febrile reactions eg from HLA Ab
- allergic reactions - itch, urticaria, mild fever
- fluid overload
- transfusion related acute lung injury ie ARDS due to antileukocyte Ab in donor plasma
delayed complications of transfusion
- infections -viruses (hep B/C, HIV, bacteria, protazoa, prions
- iron overload
- GVHD
- post-transfusion purpura - potentially lethal if platelet count 5-7days post transfusion requiring specialist treatment
massive blood transfusion
replacement of an individual’s entire blood vol (>10U) within 24hrs
complications of massive blood transfusion
low platelets
low ca
low clotting factors
high K
hypothermia
Transfusing patients with heart failure
If Hb <50g/L with heart failure, transfusion with packed red cells is vital to restore Hb to a safe level, eg 60–80g/L,
must be done with care.
Give each unit over 4h with furosemide (eg 40mg slow IV/PO; don’t mix with blood) with alternate units.
Check for raised JVP and basal lung crackles; consider CVP line.
autologous transfusion
pts have own blood stored pre-op for later use
erythropoetin can increase yield of autologoud blood in normal people
Intraoperative cell salvage with retransfusion is also being used more often, especially in cardiac, vascular, and emergency surgery
