Академический Документы
Профессиональный Документы
Культура Документы
Introduction
Blood transfusion :
Transfer of Blood/ Blood component from
donors blood to receivers circulation
Goals :
- Improve circulation volume
- Improve Hb level
- Improve coagulation mechanism
Cautions :
- Appropriate indications
- Appropriate techniques
- Observations of sign of complications
- Prevention and therapy for complications
1. Whole Blood
* Fresh Blood, storing time 4-6 hours
advantages :
- complete caogulation factors
- good blood cell functions
disanvantages :
- impractical supply
- risk of infections transmission i.e lues, CMV
3. Thrombocyt
given to patients with thrombocyt deficits due to primary disease
or secondary due to bleeding.
Type of thrombocyt :
1. Platelet Rich Plasma (PRP)
PRP made by separating plasma from fresh blood
2. Platelets Concentrate
Made by centrifuging PRP and separating its thrombocyt
concentrate
Storing :
a. In 40 Celcius - good haemostatic, short life span
b. In 180 Celcius - poor hemostatic, better life span
Storing time 48 72 hours
4. Plasma
a. restore blood volume and circulation
b. replace and enhance blood proteins
c. replace and improve spesific plasma factor
* Liquid plasma
made by separating plasma from whole blood on packed red cell
preparation process
* Dry plasma
made by drying liquid plasma
Advantages :
- long storing time (3 years)
- easy transport
- room temperature storage
- no risk of lues infections
- independent of blood group
Disadvantages :
- higher risk of hepatitis infection due to collected from various donors.
* Cryoprecipitate
made by freezing fresh frozen plasma at minus 600 C
and liquified at 4-6 C
advantages :
contains much amount of factor VIII and factor I
(fibrinogen). A bag of cryoprecipitate contains 130
units of Anti Hemophylic Factor (AHF)
Complications of Transfusion
1. Hemolytic Reaction
Red blood cell destructions occur producing free Hb in
plasma due to blood group incompatibility. If free Hb
level more than 25 %, Hb uria occur.
Acute :
-occur immediately when transfusion.
50 cc of incompatible blood enough to precipitate the
reactions
sign :
- hot sensation along the veins
- specific lumbal pain
- depressed chest feeling, dyspneu
- headache, flushing face
- raised body temp., nausea & vomitting
- during anesthesia :
tachypneu, hypotension, small pulse pressure, shock.
Diffuse bleeding from operative wound.
Laboratory :
- Hb-uria
- Peripheral blood preparate hemolytic sign
- Blood bilirubine
- Free Hb in plasma
- methemoglobine
Delayed :
Occur on patients who recieved frequent transfusion
or women who previously had delivered baby.
Reactions occur after several hours or days after
transfusion and commonly after transfusion of
second bag or more.
Therapy :
-
2. Pyrogen reactions
sign :
- febrile (38-400 C)
- shivering, headache, pain on the whole body, restless untill
convulsions
could
occur
during
blood
Sign :
- febrile, headache, shivering, vomitting, stomachache,
diarrhea to shock.
These sign occur during or immediately after transfusion
Therapy :
- stop transfusion
- treat shock (plasma expander, vasopressor, oxygen etc)
4. Overload
occur due to transfusion of relatively too high
volume in a short period.
For these reason, whole blood should be given
cautiously on some circumstances :
- anemia
- decreased cardiac reserve
- renal disease
- oedema
sign :
- headache, precardial pain, coughing, dyspneu,
heavy feeling on both arms, pulmonary rhales and
elevated neck veins
therapy :
For patients with overloading tendency :
- Infusion drips as slow as possible
(adult 12-30 drips/min, children 6-8 drips/min)
- diuretics before transfusion
- only blood component is given
- close observation during transfusion
6. Acidosis
On patients with acidosis tendency (i.e. renal
failure, ileus, septic conditions) administering
stored blood will worsening those condition, so
did massive transfusion.
Therapy :
-correction of acidosis with sodium bicarbonate
7. Kalium toxicity
due to elevated K+ level in blood which stored more than
10 days
sign:
- ECG changes
- Cardiac arrest danger
Prevention :
- administer fresh blood
therapy :
- enforce diuresis
- Glucose 5 % infusion + regular insuline 8-12 units
8. Citrate toxicity
especially on massive transfusion (>2 liters) on patients with
poor hepatic function, where citrate will bound to Ca ++ ion.
Sign :
- tetany, tremor, ECG disturbances to cardiac arrest
therapy :
- Ca gluconate i.v or CaCl2 1 gram every 1000 ml of blood
transfused
9. Coagulation disorder
especially on massive transfusion with stored
blood, due to reduced thrombocyt and other
coagulation factors.
Therapy :
- administering 1 unit of FFP or
cryoprecipitate for every 5 unit of whole
blood.
10. Hyperammonium
- amonium blood level increase after 5-7 days and
reach maximal level after 3 weeks of storage
therapy :
- administering fresh blood.
* Malaria
sign appear after 1-10 days afer transfusion
prevention :
Donor is not accepted under 2 years from last attack.
therapy :
- antimalarial drugs
* Syphylis
sign appear 9-10 weeks post transfusion and manifest
as stage II skin lesions.
Transfusion techniques
1. Infusion set preparation
Infus set must be equipped with filter
Infusion needle gauge should be appropriate to
intended rate of transfusion
a. easily damage venous wall, causing swollen tissue
b. commonly use on babies,easy fixation
c. plastic catheter with stylet inside, if already
inserted, will not damage the vein easily
4. On transfusing blood
a. Note! Blood pressure, heart rate, respiration
and patinets temperature
b. Before transfusing blood, give NaCl infusion
c. If blood drips stagnant, change transfusion set
d. During first 15 minutes, patients should be
carefully monitored
e. During transfusion, blood pressure &
respiration must be monitored
5. Rate of transfusion
a. On massive bleeding, administer blood as fast
as possible (1500 ml in 15 minutes)
b. On normovolemic patients :
adult : 500 ml / 5-6 hours
children : depend on body weight and age