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![Rhesus system
The Rhesus D [Rh(D)] antigen is strongly antigenic
present in approximately 85% of the population
Antibodies to the D antigen are not naturally present in the serum of the remaining 15%
of individuals
Their formation may be stimulated by:
the transfusion of Rh-positive red cells or
they may be acquired during delivery of a Rh(D)-positive baby](https://image.slidesharecdn.com/bldtransfusion-250628103332-3ce06759/75/Blood-transfusion-indications-and-complications-pptx-18-2048.jpg)
![Blood Transfusions ED Powerpoint 12-03-13[1].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/bloodtransfusionsedpowerpoint12-03-131-250306225306-4d317c5e-thumbnail.jpg?width=640&height=640&fit=bounds)
Blood transfusion indications and complications .pptx
- 1.
- 2. Blood Transfusion Definition Itis the transfer of blood or its components from one person (donor) into the blood stream of another person (recipient) Though generally safe and simple, the procedure of blood transfusion is not free of complications. So, It should be administrated in its proper indication.
- 3. Collection and storageof the blood: ➢For standard transfusion blood is collected into a blood collection bag that contains: ▪ Citrate anticoagulant solution ▪ Dextrose to preserve the viability of RBC's ➢ One blood unit (bag) contains : ▪ 70-100 ml of citrate as anticoagulant ▪ 400-450 ml of blood. ➢ Stored at 2-6 oC in a blood bank.
- 4. In storageperiod, RBCs lose their ability to release oxygen in 7 days even though RBCs last for 3 weeks; so blood should be transfused within 7 days ideally. WBCs are destroyed in 2 days. Platelets and clotting factors are destroyed very early in 1–2 days.
- 5. Indications Acute bloodloss following trauma, >15% of total body volume in otherwise healthy individuals (liver, spleen, kidney, GIT injuries, fractures, haemothorax, perineal injuries). During major surgeries—abdominoperineal surgery, thoracic surgery, hepatobiliary surgery. Following burns. In septicaemia. perioperative anaemia, to ensure adequate oxygen delivery during the perioperative phase; symptomatic chronic anaemia without haemorrhage or impending surgery
- 6. Transfusion Trigger Historically, patientswere transfused to achieve a hemoglobin level of > 10 g dl–1. This has now been shown to be not only unnecessary but also associated with increased morbidity and mortality compared with lower target values. A hemoglobin level of 6 g dl–1 is acceptable in patients who are not bleeding, not about to undergo major surgery and not symptomatic
- 7. Screening to Donorblood Blood is collected from donors who have been previously screened to prevent any possible harm to the recipient. Each unit is tested for evidence of hepatitis B, hepatitis C, human immunodeficiency virus (HIV), syphilis.
- 8. Blood components: Bloodcan be separated to its individual components, So that each component can be given according to the specific needs of patients.
- 9. ❖ Components usedin practice are 1. Packed red cells 2. Fresh plasma 3. Fresh frozen plasma 4. Platelets concentrates 5. Cryoprecipitate
- 10. 1. Packed redcells: ➢ useful in: • Anemic patients • In the elderly • In renal patients • Cardiac patients ➢ Increase hemoglobin content without overloading the circulation
- 11. 2. Fresh plasma: ➢ Component of blood remaining after packed RBCs are separated. ➢ Rich in platelets and coagulation factors.
- 12. 3. Fresh frozenplasma: ➢ Stored at -40°C. ➢ Good source of all the coagulation factors. ➢ useful to correct the coagulation disorders e.g. Hemophilia & liver cell failure
- 13. Platelets concentrates: ➢Amount from 1 unit of blood, increase number of platelets by 10,000 to 15,000/uL . ➢ They should be freshly prepared. ➢ Very useful in patients with thrombocytopenia.
- 14. 5. Cryoprecipitate: ➢Prepared from fresh frozen plasma. ➢ Very rich in factor VIII and fibrinogen. Stored at -40°C
- 15. Autologous blood It ispossible for patients undergoing elective surgery to predonate their own blood up to 3 weeks before surgery for retransfusion during the operation. Similarly, during surgery blood can be collected in a cell saver; this washes and collects red blood cells, which can then be returned to the patient
- 16. Blood groups andcross-matching Human red blood cells have many different antigens on their cell surface. Two groups of antigens are of major importance in surgical practice : ABO system Rhesus systems
- 17. ABO system Theseare strongly antigenic and are associated with naturally occurring antibodies in the serum. The system consists of three allelic genes – A, B and O – Naturally occurring antibodies are found in the serum of those lacking the corresponding antigen Blood group O is the universal donor type as it contains no antigens to provoke a reaction Blood group AB individuals are ‘universal recipients’ and can receive any ABO blood type as they have no circulating antibodies.
- 18. Rhesus system TheRhesus D [Rh(D)] antigen is strongly antigenic present in approximately 85% of the population Antibodies to the D antigen are not naturally present in the serum of the remaining 15% of individuals Their formation may be stimulated by: the transfusion of Rh-positive red cells or they may be acquired during delivery of a Rh(D)-positive baby
- 19. N.b Acquiredantibodies are capable of crossing the placenta during pregnancy and, if present in a Rh(D)-negative mother, they may cause severe haemolytic anaemia and even death (hydrops fetalis) in a Rh(D)-positive fetus in utero N.b The other minor blood group antigens may be associated with naturally occurring antibodies or they may stimulate the formation of antibodies on relatively rare occasions
- 20. Complications of BloodTransfusion 1. Pyrogenic reactions: 2. Allergic reaction: 3-Congestive cardiac failure 4- Hemolytic reactions 5. Transmission of infection 6. Hyperkalemia 7. Citrate intoxication: 8- Air embolism
- 21. 1. Pyrogenic reactions ➢ Most common. ➢ Patient develops chills, fever, Headache, nausea and vomiting due to minor bacterial contamination. Treatment ➢ Stop the transfusion + IV antihistaminic & Hydrocortisone.
- 22. 2. Allergic reaction: ➢ These range from mild itching and urticaria to a severe reaction (laryngeal edema and collapse). ➢ They are due to the recipient's response to allergens in the donor's blood. ➢ Stop the transfusion + IV antihistaminics & Hydrocortisone.
- 23. 3. Congestive cardiacfailure: ➢ Liable to occur in elderly persons & also in cardiac & renal pts. ➢ Occurs if a large volume of blood is administered too rapidly. ➢ Transfuse packed RBCs rather than whole blood to correct anemia. ➢ Give diuretics stop the transfusion
- 24. 4. Hemolytic reactions ➢ Serious life threatening complication ➢ Due to transfusion of ABO incompatible blood ➢ Antibodies in the recipient's blood against one or more of the antigens of the donor's cells. ➢ Present after the transfusion of less than 50 ml by: • Fever, chills, • Chest pain, • Dyspnea and pain in the flanks
- 25. ➢ Examinationreveals: • Tachycardia • Hypotension. ➢ In anaesthetized patients; • Sudden tachycardia, • Hypotension • Bleeding tendency
- 26. A majorhemolytic reaction will lead to: • Hemoglobinuria, • Jaundice and acute renal failure due to acute tubular necrosis
- 27. Management: • Stopthe infusion immediately. • Send the donor's blood and of the patient's blood for repeat typing. • Correct shock by infusion of crystalloid solution and corticosteroids. • Foley's catheter; check urine output. • An osmotic diuretic as mannitol may be needed. • Acute renal failure; appropriate treatment
- 28. 5. Transmission ofinfection: ➢ Viral hepatitis (HBV or HCV). It is therefore obligatory to test the donor for hepatitis viruses. ➢ AIDS. HIV infection ➢ Syphilis. This is now rare. ➢ Septicemia: if the blood is allowed to warm, bacteria can grow and multiply
- 29. 6. Hyperkalemia: ➢With prolonged storage of blood ➢ Progressive loss of potassium from erythrocytes into the plasma. ➢ May produce cardiac arrhythmias or even arrest
- 30. 7. Citrate intoxication: ➢ Excess citrate leads to hypocalcaemia which leads to tetany ➢ Augments the effects of hyperkalemia on the myocardium. ➢ Give 10 ml of 10% calcium gluconate for each two units of blood 8. Air embolism: Escape of air into the circulation
- 31. Complications of massiveblood transfusion: Massive blood transfusion means: Transfusion of 2500 ml of blood in one time or 5000 ml or more over 24 hours. Indications severe trauma associated with liver, vessel, cardiac, pulmonary, pelvic injuries. During surgical bleeding (primary haemorrhage on table) of major surgeries
- 32. ii. Complications are: ➢ Hypothermia: • With reduced cardiac, hepatic and renal functions, • Difficult O2 delivery • impaired blood coagulation ➢ Citrate toxicity leads to Hypocalcemia Severe electrolyte imbalance (hypocalcaemia, hyperkalaemia, acidosis)
- 33. ➢ Volumeoverload ➢ Deficient oxygen transport. ➢ Thrombocytopenia and Coagulation failure ➢ Infections ➢ Incompatibility and transfusion reactions ➢ Adult Respiratory Distress Syndrome ( ARDS)