Download Blood transfusion

21/4/2015
GS sheet 10
Reem dawood
Blood transfusion
During major surgeries the blood unit that suits the patient should always
be near the operation room because you never know what will face you,
this will improve the patient outcome for sure.
A surgeon should always sticks to the blood transfusion rules.
We already know a lot about blood groups so the doctor mentioned them
briefly.
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21/4/2015
GS sheet 10
Reem dawood
Blood donation:
We should always encourage people to donate by campaigns.
Whole blood is collected from healthy donors who are required to meet
strict criteria concerning:
1. Age: they should not be older than 55 or 60 years old.
2. Medical and physical health: no recent upper respiratory tract infection or bacteremia.
3. Travel to areas of endemic disease (malaria).
They only check the CBC level, if it was more than 35-40% than they are
safe to donate. Hgb level (13-14 gm/dL)
You can donate blood every 2 months.
450ml is the amount of blood that is taking from the donor each time.
(Less than 10% of your blood).
Blood testing:
Donated blood is tested by many methods, but the core tests
recommended by the World Health Organization are these four:
•
Hepatitis B Surface Antigen
•
Antibody to Hepatitis C
•
Antibody to HIV, usually subtypes 1 and 2
•
Serologic test for Syphilis
Homologous donation: intravenous infusion of blood that has been donated by
another person.
Alternatives to homologous transfusion:

Autologous Predonations: occurs when a person donates his or her own
blood for personal use. This will save the patient from the infection or the
antibodies that the donor blood might carries. 1 month before the major surgery
we take 2 units of blood from the patient and return it to him during the surgery.
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21/4/2015
GS sheet 10
Reem dawood
How can we increase the patient HB level?
We give him erythropoietin (transferrin IV) and this will increase the bone
marrow activity.

Isovolemic Hemodilution: the patient's blood is collected prior to surgery
and replaced with a plasma expander. The theory is that any bleeding during
surgery will lose fewer RBC's. Then the previously collected, higher hematocrit
blood can be given back. (usually done in open heart surgeries)

Intraoperative autotransfusion (Cell Saver): to collect blood in the
operative field during surgery, wash it, and return it to the patient. This will work
as long as the operative field is not contaminated with bacteria or with malignant
cells. (usually done in liver, spine, orthopedics, open heart procedures when 2L
of blood is lost)

Wound drainage: blood is collected from cavities (such as a joint space into
which bleeding has occurred) and returned through a filter. (should be given
within 4 hours after surgeries)
When we give the patient blood we actually give him blood products: RBCs,
WBCs, Platelets, Proteins in plasma, antibodies, and coagulation factors.
The blood bank has a processor that will take the RBCs and plasma only
and get rid of WBCs by filtration.
Why WBCs (leukocytes) are unwanted? They are antibodies receptors.
Types of transfusion:
1.
2.
3.
4.
RBCs transfusion
Platelet transfusion
Fresh Frozen plasma
Whole blood
Now a day we give the patient RBCs alone:




Compact RBCs
Lymphocyte deleted RBCs
Frozen RBCs
Synthetic RBCs (only HgB)
(The last two are used in military a lot)
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21/4/2015
GS sheet 10
Reem dawood
When do we give blood?
Anemia, major surgeries, severe trauma, and hemorrhage.
Hgb level 7 is the trigger of blood transfusion.
Sometimes in open heart surgeries even if the Hgb level reaches 7 we
don’t give blood. But in other surgeries we must . Ischemic heart diseases
patients are given blood when their Hgb level reaches 9 because they can’t
tolerate anemia.
Every blood unit increases Hgb level by 1mg (3% ccv)
We never give a patient blood until his Hgb level reaches 15, we always
reach the save limit 9 and let the bone marrow compensate+ we give him
supplement if needed (B12 or folate)
The main goal in blood transfusion is to minimize the given blood units.
When we decide that this patient for example needs 2 blood units, the next
step will be:
Blood typing and cross-match:
 BLOOD TYPING tests the recipient’s RBCs for antigens and SCREENS the
recipient's serum for antibodies.

CROSS MATCHING done by mixing the recipient’s serum with the donor's
RBCs to check for performed antibodies.
 Type O/RH negative is a universal donor.
The blood that is taken from the donor can be kept in the blood bank for 5
to 6 weeks. How?
1.




By adding supplement: (CPDA)
2.
Refrigerator: 4 degrees Celsius centigrade
C: citrate (anticoagulant)
P: phosphate (for ATP)
D: dextrose (nutrient supply)
A: adenine (amino acid)
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21/4/2015
GS sheet 10
Reem dawood
What are blood transfusion complications?

Disaster: A group patient that is given b group blood. It might kill the patient
by a septic shock.
What will happen if you gave an a blood patient b type blood?
You should never leave the patient before 15-30 min during blood transfusion.
Because the reaction might happen by the first drop contact or first 5min or first
10 min
painbronco spasmtachycardiadiaphoresisstridor and wheeze
urticariaanaphylactic shock.
When we see symptoms of anaphylactic shock we should remove the blood unit
and do re-testing and re-matching, and manage the patient as an anaphylactic
patient (cortisone)
This is known as ABO incompatibility.
That doesn’t mean that each reaction happens is ABO incompatibility, it might be
minor antibodies lead to etching and urtecaria, if it was not anaphylactic shock
symptoms we can keep the blood.
Some of the patients will have fever because some of the leukocytes are still
present, if the increase was by 1 degree it is save to continue but if it increases
more we should stop and think of something else.
Miss labeling that will leads to ABO incompatibility.
 Acute lung injury (ARDS: acute respiratory Distress syndrome) Remnants of

WBCs that will go to the lung and injure alveolar capillary membrane of the lung.
Like the pulmonary edema but the heart function is normal. Mechanical ventilator
is used to save the patient, the mortality rate is 40% but if he survived he will
have alveolar capillary membrane fibrosis. Cause? There will be some enzymes
that activate the inflammatory cascade

Elderly: we get afraid of overload that’s why we give diuretics.
Massive transfusion:
We give the whole blood volume within 24 hours, he must complain of
multiple systems problems to be given 5L within 24 hours
(Other definition) more than the half volume in a single transfusion order
The more you give blood, the more the allergies and complications will
appear.
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21/4/2015
GS sheet 10
Reem dawood
Complications:




Coagulopathy: Citrate level increase
Hypothermia: mainly in traumatic patient. Treatment RBCs + blood warmer (32
degree)
Citrate toxicity
Electrolyte abnormalities:
Hypocalcaemia: most common because citrate binds to calcium
Hyperkalemia because of RBCs breaking down
Acidosis
How can donated blood get infected by bacteria?
Platelets are stored in rotators at room temperature, a temperature which bacteria can
live in. so usually infection happens in platelets transfusion
Platelet transfusion:
Thrombocytopenia (bacterial contamination)
Bleeding secondary dysfunction
If Platelets level is 50,000-100,000 platelets per micro liter you can do major surgery
150,000-450,000 p/microL is the normal level.
Less than 10,000 p/microL spontaneous bleeding
If it is below 50,000 p/microL we give platelets transfusion
Every blood unit increase 5000 p/microL, for every 10kilograms we give 1 unit until we
reach 50,000 p/micoL.
Every unit you give the patient should be from a different patient (multidonor)
(increase complications) (usually we do that)
But (single
(freshly)
donor) must be done if the donor was a brother we take units from him
FFB: fresh frozen plasma: (contain coagulant factors)
If a patient is taking warfarin (anticoagulant) and he needs blood you must give him fresh
plasma to reverse the warfarin action within 2 hours.
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