blood transfusion Flashcards
Concepts in blood safety
Selection of appropriate, low risk donors
Screening tests for relevant markers of infection
Removal of any pathogens from final blood product
Optimizing blood usage
Rational blood usage policies
Alternatives to blood used
Bloodless surgery
Cardinal priciple in rational blood usage
Determine cause of anemia and take appropriate action
Rational for deficiency anemias
hematinics
Under rational; when do you transfuse
only when necessary
symptomatic esp in signs of cerebral anoxia, cardiac failure
In rational ; 3rd stage of labor is managed by
Giving medication to cause contraction and to reduce amount of blood being lost and hence no transfusion
Alternatives to blood
Crystalloids i.e normal saline
Colloids i.e dextran 70
Perfluorocarbons
Hb base substitutes
If blood loss less than 20%
Do nothing
If blood loss 21-30%
Give crystalloids or colloids
If blood loss greater than 30%
Transfuse blood
Types of autologous blood transfusion
Preoperative deposit- patient going to be operated on donates blood to be given back to him in case of an emergency in operation
Haemodilution- Intentionally removing RBC to lower hematocrit
Intra op blood salvage- Recovering blood lost during surgery and infusing into patient
In bloodless surgery
The surgeon has to be meticulous
Use of torniquets
Diathermy
Who is the best donor
Voluntary repeated donor
Types of blood donors
Voluntary non renumerated donors
Family replacement donors
commercial donors
autologous donors
Types of blood donors to avoid
Family replacement donors
Commercial donors
classifications of transfusion risks
immunologic
non immunologic
Immunologic classification of transfusion
- immune hemolytic rxns- red blood cells transfused are destroyed by persons immune system
- Febrile non hemolytic reactions - cytokines in transfused RBC causing fever,chills, etc
- Anaphylactic reactions - transfusion releases flood of chemicals that can cause shock
- urticarial reactions ; sin rash
- Post transfusional purpura ; thrombocytopenia after blood transfusion causing bleeding
- Graft vs host dx
- Transfusion related acute lung injury
Non immunologic transfusion risk
Transfusion transmitted infections
Acute hypotensive reactions
Physical, thermal
Chemical i.e k, Ca, citrate, iron toxicity
Adverse effects may be
Acute- up to 4 hrs after transfusion
Delayed- > 24hrs-2wks after transfusion
Late - 2wks to 30 yrs
Life threatening acute transfusion rxns
acute hemolytic reactions Acute anaphylactic reaction Transfusion related sepsis TRALI Acute hyperkalemia and hypocalcemia Acute hypervoliemia
Non life threatening acute transfusion reactions
Febrile non hemolytic transfusion rxns
Urticaria
Why does acute hemolysis occur
Due to pre existing antibodies in recipients serum, it hemolyzes any foreign antigen in transfused blood
Most common transfusion rxn
Acute hemolytic transfusion rxn
Signs and symptoms of acute hemolytic transfusion rxn
Occurs within minutes
Heat and pain in vein Throbbing headache Fever Chest tightness Dyspnea Myalgia- pain in muscle Loin pain Hypotension ; masked in anesthetised patients
What immunoglobulin mediates AHTR
It is an IgM mediated complement activation—->intravascular hemolysis—>activation of coagulation cascade
Complications of AHTR
Shock
DIC
Acute tubular necrosis–> Acute renal failure
Management of AHTR
- Stop transfusion, alert blood bank immediately
- In case of hypotension maintain BP and diuresis
- Clerical checks
- Cardiac monitoring cos patient can have hyperkalemia due to excessive hemolysis
- FBC
- Coagulation test - PT,APTT
- LIVER FXN AND KIDNEY FXN TEST
- Urinalysis
Prevention of AHTR
Meticulous compatibility testing
Proper patient identification- this is the correct person im supposed to give the blood to
Acute anaphylatic reaction symptoms
Fever
Chills
Urticaria
Hypotension
Management
Stop transfusuion
Supportive care— airway, breathing, cardiovascular
Antihistamines, steroids, epinephrine
TRansfusion related sepsis occurs because of
Asymptomatic bacterimic donors
Venipuncture
Common organisms that cause transfusion related sepsis
Yersinia E. coli Pseudomonas Staphylococcus Streptococcus
Complications of transfusion related sepsis
hypotension DIC Shock High fever Complement activation
Management of transfusion related sepsis
Stop transfusion
Aggressive IV antibiotics- broad spectrum
Blood culture
Transfusion related acute lung injury is a form of
Non cardiogenic pulmonary edema
TRILA may progress to
Acute respiratory distress syndrome
How does it progress to ARDS
HLA antibodies of donor reacts with recipient neutrophil antigens—> complement activation and alveolitis–> pulmonary edema
Symptoms of TRILA start
An hour to transfusion
Symptoms of TRILA include
Dyspnea
tachypnea
Tachycardia
hypotension
Chest XRAY of TRILA
Patchy alveolar infiltrates
Management of TRILA
Supportivee-ABC
Mechanical ventilation
NO DIURETICS
TRILA resolves
IN a few days
When does hyperkalimea occur
Massive red cell transfusion
Exchange transfusuion in infants
Renal failure
Irradiated blood
Hyperkalimea can result in
cardiac arrest
Stabilise cardiac myocytes with calcium gluconate, ECG monitoring, insulin?glucose
Hypocalcemia is caused by
Massive transfusion of plasma products i.e FFP
Symptoms of hypocalcemia
Tetany
Convulsions
Hypotension
Acute hypervolimea caused by
circulatory overload
Acute hypervolimea occurs mostly in
Patients with poor cardiac status
Elderly patients with decompensation- heart cant maintain circulation
Symptoms of acute hypervolimea
Shortness of breath
crepitations at lung base
Management of acute hypervolimea
furosemide
Acute hypervolimea also called
Transfusion associated circulatory overload
Febrile non hemolytic rxns characteristics
Mild
Asymptomatic
Lasts less than an hour
No sequale
Pathophysiolofy of FNHR
HLA antibodies against contaminating white cells and inflammatory cytokines in transfused blood
FNHR similar to
AHTR
Management of FNHR
Discontinue transfusion
exclude AHTR
Coombs test
Symptomatic treatment of FNHR
acitamenophen
Prevent FNHR with
Leukodepletion
Urticarial reactions caused by
Activation of IgE Leading to histamine release from mast cells and basophils
Manage urticarial rxns by
Giving antihistamines
recommencing of transfusion slowly
Acute transfusion rxns are
the commonest transfusion rxn
Delayed transfusion reactions include
Delayed hemolytic transfususion rxn
Transfusion associated graft vs host dx
Post transfusion purpura
Transfusion transmitted purpura
Causes of delayed HTR
Previous transfusion
pregnancy
Clinical features of AHTR
Failure to achieve rise in Hb
Hyperbilirubinemia
rare intravascular hemolysis
Post transfusion purpura
Due to antibodies produced against HPA1 alpha
PTP clinical manifestation
low platelets
mucocutaneous bleeding
PTP occurs in how many days
8-14
PTP common in this condition
cardiac bypass surgery
Management of PTP
IV immunoglobulins
Steroids
Plasma exchange
What to avoid doing in PTP
Transfusion of platelets
Transmission transmitted protozoa caused by these organisms
plasmodium
Babesia
Symptoms of TTP
Malaria
Transfusion associated GVHD is usually seen in
immunocompromised,
organ transplant patients
chemotherapy patients
HIV patients
How does transfusion associated GVHD occur
donor lymphocytes attack recipient tissue
Symptoms of transfusion GVHD
skin
liver
git symptoms
Transfusion GVHD CAUSES
BONE MA RROW APLASIA- PRIMARY CAUSE OF DEATH
Prevention of transfusion GVHD
gamma irradiation
leucodepletion
Late complications of transfusion
Transfusion haemosiderosis
Transfusion transmitted infections
Alloimmunization
iron overload after
transfusing 10 units of blood
organ damage after 20 units
Transfusion hemosiderosis occurs in
patients who require high transfusion
AA
Thallasemia major
Refractory anemia
Prevent transfusion hemosiderosis by
iron chelation– deferroxamine, deferipone
Risks of transfusion hemosiderosis
cardiomyopathy
cirrhosis
endocrine dysfunction
hyperpigmentation of skin
Alloimmunization
Development of antibodies to red cells within weeks of transfusion
silent
Dangers of alloimmunization
transfusion reaction in future
risk of HDN
limit availability of compatible blood
