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Rh system
The Rh system classifies blood as Rh-positive or Rh-negative, based on the presence or
absence of Rh antibodies in the blood. People with Rh-positive blood can receive Rhnegative blood, but people with Rh-negative blood will have a transfusion reaction if they
receive Rh-positive blood. Transfusion reactions caused by mismatched Rh blood types can
be serious.
Phenotype
Genotype
AA or AO
BB or BO
AB
AB
OO
Blood group AB individuals have both A and B antigens on the surface of their
RBCs, and their blood plasma does not contain any antibodies against either A or B
antigen. Therefore, an individual with type AB blood can receive blood from any but
cannot donate blood to any group other than AB. They are known as universal
recipients.
Blood group A individuals have the A antigen on the surface of their RBCs, and
blood serum containing IgM antibodies against the B antigen. Therefore, a group A
individual can receive blood only from individuals of groups A or O (with A being
preferable), and can donate blood to individuals with type A or AB.
Blood group B individuals have the B antigen on the surface of their RBCs, and
blood serum containing IgM antibodies against the A antigen. Therefore, a group B
individual can receive blood only from individuals of groups B or O (with B being
preferable), and can donate blood to individuals with type B or AB
Blood group O individuals do not have either A or B antigens on the surface of their RBCs, and
their blood serum contains IgM anti-A and anti-B antibodies. Therefore, a group O individual can
receive blood only from a group O individual, but can donate blood to individuals of any ABO blood
group.They are called universal donors.
This happens when a rh negative baby develops in the womb of rh positive mother.Usually
first babies are not affected by this disease.Second babies are more prone to this disease.
2.BLOOD TRANSFUSION
Blood transfusion is generally the process of receiving blood or blood products into
one's circulation intravenously. Transfusions are used for various medical conditions to
replace lost components of the blood. Early transfusions used whole blood, but modern
medical practice commonly uses only components of the blood, such as red blood cells, white
blood cells, plasma, clotting factors, and platelets.
Blood transfusions typically use sources of blood: one's own (autologoustransfusion), or
someone else's (allogeneic or homologous transfusion). The latter is much more common
than the former. Using another's blood must first start with donation of blood. Blood is most
commonly donated as whole blood intravenously and collecting it with an anticoagulant. In
developed countries, donations are usually anonymous to the recipient, but products in
a blood bank are always individually traceable through the whole cycle of donation, testing,
separation into components, storage, and administration to the recipient. This enables
management and investigation of any suspected transfusion related disease transmission
or transfusion reaction. In developing countries the donor is sometimes specifically recruited
by or for the recipient, typically a family member, and the donation occurs immediately
before the transfusion.
Why a blood transfusion is necessary
There are several different types of blood transfusion. Whether you need one depends on a
number of factors.
These include:
your health
An average-sized adult has about five litres of blood in total. Small amounts of blood loss (up
to 1.5 litres) can be replaced with a salt solution, which your body replaces with new red
blood cells over the following weeks.
The different types of blood transfusions are described below.
Massive transfusion
A massive blood transfusion is defined as the replacement of a patient's total blood volume in
<24 h.2 The abnormalities which result include effects upon coagulation status, serum
biochemistry, acidbase balance and temperature homeostasis.
Coagulation
A massive transfusion of red blood cells (RBCs) may lead to a dilutional coagulopathy, as
plasma-reduced RBCs contain neither coagulation factors nor platelets. Secondly,
haemorrhage, as a consequence of delayed or inadequate perfusion, can result in disseminated
intravascular coagulation. This causes consumption of platelets and coagulation factors and
may account for the numerical distortion of clotting studies appearing out of proportion to the
volume of blood transfused. Aggressive, expectant replacement of clotting factors with fresh
frozen plasma (FFP), platelets and cryoprecipitate transfusions are required to prevent this
coagulopathy becoming severe enough to make haemorrhage worse
Hypothermia
RBCs are stored at 4C. Rapid transfusion at this temperature will quickly lower the
recipient's core temperature and further impair haemostasis. Hypothermia reduces the
metabolism of citrate and lactate and increases the likelihood of hypocalcaemia, metabolic
acidosis and cardiac arrhythmias. A decrease in core temperature shifts the oxyhaemoglobin
dissociation curve to the left, reducing tissue oxygen delivery at a time when it should be
optimized. This reduction in temperature can be minimized by warming all i.v. fluids and by
the use of forced air convection warming blankets to reduce radiant heat loss
PRECAUTIONS TO PREVENT COMPLICATIONS
To minimize the chance of an adverse reaction during a transfusion, health care practitioners
take several precautions. Before starting the transfusion, usually a few hours or even a few
days beforehand, a technician mixes a drop of the donor's blood with the recipient's to make
sure they are compatible. This procedure is called cross-matching.
After double-checking labels on the bags of blood that are about to be given to ensure the
units are intended for that recipient, the health care practitioner gives the blood to the
recipient slowly, generally over 1 to 2 hours for each unit of blood. Because most adverse
reactions occur during the first 15 minutes of the transfusion, the recipient is closely observed
at first.
Most transfusions are safe and successful. However, mild reactions occur occasionally, and,
rarely, severe and even fatal reactions may occur.
The most common reactions, which occur in 1 to 2% of transfusions, are
Fever
Allergic reactions
Fluid overload
Lung injury
3.IMMUNISATION SCHEDULE
Immunisation protects children (and adults) against harmful infections before they come
into contact with them in the community.
Immunisation uses the bodys natural defence mechanism - the immune response - to
build resistance to specific infections. Nine diseases can be prevented by routine
childhood immunisation - diphtheria, tetanus, whooping cough, poliomyelitis (polio),
measles, mumps, rubella, Haemophilus influenzae type b (Hib) and hepatitis B. All of
these diseases can cause serious complications and sometimes death.
Immunisation is given as an injection or, in the case of polio vaccine, taken as drops by
mouth. Immunisation helps children stay healthy by preventing serious infections.
What is in vaccines?
Some vaccines contain a very small dose of a live, but weakened form of a virus. Some
vaccines contain a very small dose of killed bacteria or small parts of bacteria, and other
vaccines contain a small dose of a modified toxin produced by bacteria. Vaccines may
also contain either a small amount of preservative or a small amount of an antibiotic to
preserve the vaccine. Some vaccines may also contain a small amount of an aluminium
salt which helps produce a better immune response
Interval
Betwee
n Dose
4 and
Dose 5
4
weeks
6
months
(Booste
r 1)
3 years
(Booste
r 2)
4
weeks
6
months
(Booste
r 1)
4 weeks
4
weeks
6
months
(Booste
r 1)
6 weeks
4 weeks
4
weeks
9
months
15
months
(Booste
r 1)
Vaccine
Prevents
Minimu
m Age
for
Dose 1
BCG
TB &
bladder
cancer
Birth
HepB
Hepatitis
B
Birth
Polioviru
s
Polio
DTP
Diphtheria
, Tetanus
&
Pertussis
Hib
Infections
caused by
Bacteria
S.N
o
PCV
Pneumonia
RV
Severe
Diarrheal
Disease
Typhoid
Typhoid
Fever,
Diarrhea
Birth
6 weeks
6 weeks
6 weeks
Interva
l
Betwee
n Dose
1 and
Dose 2
Interva
l
Betwee
n Dose
2 and
Dose 3
4 weeks
8
weeks
4 weeks
4
weeks
4 weeks
4 weeks
MMR
Measles,
Mumps &
Rubella
10
Varicella
Chickenpo
x
1 year
3
months
11
HepA
Liver
disease
1 year
6
months
Tdap
Diphtheria
, Tetanus
&
Pertussis
7 years
12
13
HPV
Some
Cancers &
Warts
9
months
6
months
9 years
For
Child
aged 914
years: 6
months.
For
For
Child
Child aged 15
aged 15
or
or
more: 5
more: 1 months
month