transfusion surgery-1

transfusion surgery-1 - TRANSFUSION OF BLOOD &...

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Unformatted text preview: TRANSFUSION OF BLOOD & BLOOD PRODUCTS PRODUCTS FRESH BLOOD COMPONENTS FRESH WHOLE BLOOD RED BLOOD CELL IN ADDITIVE SOLUTION PLATELETS FRESH FROZEN PLASMA (FFP) CRYOPRECIPITATE PLASMA FRACTION PLASMA HUMAN ALBUMIN PROTHROMBIN COMPLEX CONCENTRATES IMMUNOGLOBULIN PREPARATION (90% Ig G) RED CELL SEROLOGY RED ABO ANTIGENS RHESUS ANTIGENS (Rh) OTHER RED CELL ANTIGENS • • • Kell antigens Duffy antigens Kidd antigens PRETRANFUSION TESTING PRETRANFUSION TYPE AND SCREEN CROSS­ MATCHING EMERGENCY REQUIREMENTS FOR BLOOD ORDERING BLOOD IN AN EMERGENCY EMERGENCY Immediately take samples for cross­matching Inform the blood bank of the emergency,the volume of blood required,and where blood is to be delivered One individual should take responsibility for all communications with the blood bank, and should ensure that it is clear who will be responsible for the blood delivery In cases of exsanguinations use emergency group O Rh(D)­negetive blood. Do not ask for cross­matched blood in an emergency BLOOD ADMINISTRATION BLOOD Before administrating blood 2 staff members (one of whom must be a doctor or trained staff nurse) must check • • • the patient’s full identity the blood pack,compatability label and report form the blood pack for signs of haemolysis or leakage from the pack. Any discrepancies means that the blood must not be transfused and that the laboratory must be informed TRANSFUSION ERRORS TRANSFUSION Almost all deaths from transfusion reaction are due to ABO incompatility Errors in patient identification at the time of blood sampling or administration are the major cause When taking the initial blood sample • check the patient’s identity verbally and on the wrist identification band • label the sample fully before leaving the bedside • make sure that the blood request form is clearly and accurately completed. ADVERSE EFFECTS OF TRANSFUSION TRANSFUSION ACUTE HAEMOLYTIC REACTIONS DELAYED HAEMOLYTIC REACTIONS FEBRILE NON­HAEMOLYTIC REACTION ALLOIMMUNIZATION ALLERGIC REACTIONS CARDIAC FAILURE GRAFT­VERSUS­HOST REACTION TRANSFUSION­ ASSOCIATED LUNG INJURY IMMUNE MODULATION TRANSFUSION­TRANSMITTED INFECTIONS BACTERIAL INFECTIONS AUTOLOGOUS TRANSFUSION AUTOLOGOUS PREOPERATIVE DONATION ISOVOLAEMIC HAEMODILUTION CELL SALVAGE TRANSFUSION REQUIREMENTS IN SPECIAL SURGICAL SETTINGS SPECIAL MASSIVE TRANSFUSION THROMBOCYTOPENIA COAGULATION FACTOR DEFICIENCY HYPOCALACAEMIA HYPERKALEMIA & HYPOKALAMIA HYPOTHERMIA ADULT RESPIARATORY DISTRESS SYNDROME (ARDS) MASSIVE BLOOD TRANSFUSION TRANSFUSION This is defined as the transfusion of the equivalent of the the circulating blood volume within a 24hour period (in practice 10­20 units in an adult) Common identifications for massive blood transfusion are major trauma, gastrointestinal bleeding and obstetrics complications. Major problems associated with massive blood transfusion include • underlying coagulopathy • thrombocytopenia • lack of coagulation factor 5 & 8 • hyperkalaemia • hypothermia METHODS TO REDUCE THE NEED FOR BLOOD TRANSFUSION FOR ACUTE VOLUME REPLACEMENT HYDROXYETHYL STARCH (HES) DEXRAN 70 DEXTRAN40 UREA­BRIDGED GELATIN (HAEMACCEL MECHANISM FOR REDUCED BLOOD USE IN SURGERY BLOOD PREOPERATIVE * Surgery elective – Correct the Haemoglobin level. Stop drugs that interfere Haemostasis INTRAOPERATIVE • Posture • Use of Vasoconstrictors • Use of tourniquets • Use of anti­fibrinolytic drugs eg Aprotinin • Using Fibrin Sealant POST OPERATIVELY • Blood can be salvaged from drains into collection devices that permit reinfusion • Decision to transfuse post operatively should depend * Age of the patient * Ability to tolerate lower levels of anaemia * Rate & amount of continuing blood loss TRANSFUSION OF BLOOD &BLOOD PRODUCTS PRODUCTS Clinical Scenarios A 65 year old man has undergone a left nephrectomy 3 days ago. He required 3 units of packed cells intra­operatively. He looks pale and is dyspnoeic but his vital signs and urinary output are satisfactory. You check his FBP. Hb is 7 PCV 0.28. What would you do? A 34 year old man presents in the resuscitation room of the A/E department. He is anxious, short of breath, sweating and his BP is 80 systolic, Pulse 120. There is a stab wound on the right side of the chest. A chest drain was inserted by the SHO and 1000mls of blood drained immediately. What would you do with respect to his fluid A 57 year old man needs a left hemicolectomy for carcinoma. He declares himself to be a Jehovah’s witness and refuses a blood transfusion under any circumstances. What will you do? ...
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