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Sheilla Khonada
(406162056)
Pembimbing:
dr. Erniody, Sp.An, KIC, M.Kes
Clinical
medication) immediately & the need for transfusion is
estimated thereafter.
Transfusion
• The patient’s hemoglobin (Hb) value, although important,
should NOT be the sole deciding factor in the decision to
transfuse blood should be supported by the need to
Practice relieve clinical S&S and to prevent significant
morbidity/mortality.
• Clinicians should be aware of the risk of transfusion
transmissible infections.
• Transfusion should be prescribed only when the benefits
are likely to outweigh the risks.
• Clinicians should clearly record the REASON for ordering a
transfusion (clinical diagnosis).
• Trained staff should monitor a patient undergoing
transfusion and respond immediately there are signs of an
adverse effect.
Welsby IJ, Hathaway JA. Blood and Blood Component Therapy. In:
Longnecker DE, Brown DL, Newman MF, et al. Anesthesiology. 2nd Ed. New
York: McGraw-Hill Companies; 2012: 1438-53.
Indications
• To increase the oxygen capacity of blood by giving red cells.
• To restore the blood volume to maintain effective tissue
for Blood
perfusion.
• To replace platelets, coagulation factors and other plasma
Transfusion
proteins.
(Adults)
undergoing cardiovascular surgery, orthopedics and
acute GI bleeding.
• Chronic anemia: 7g/dL in adults (target of 7-9 g/dL)
• Acute blood loss: 30% of volume of blood.
Nelson’s Textbook of Pediatrics, 26th Ed, Chapter 470: Red Blood Cell
Transfusions and Erythropoietin Therapy
Red Cell The laboratory performs:
Signs of Deterioration • Any sign of hemolysis in the plasma indicating that the blood has
been contaminated, allowed to freeze or to warm.
in Blood and Plasma • Any sign of hemolysis on the line between the red cells and
plasma during storage.
• Any sign of contamination, such as a change of color in the red
cells, which often look darker/purple/ black when contaminated.
• Any clot, which may mean that the blood was not mixed
properly with the anticoagulant when it was collected or might
also indicate bacterial contamination due to the utilization of
citrate by proliferating bacteria.
• Any sign that there is a leak in the bag or that it has already been
opened.
The blood unit must be discarded if:
• It has been out of the refrigerator for longer than 30 minutes, or
• The seal is broken, or
• There is any sign of hemolysis, clotting or contamination.
Clinical Transfusion Practice (World Health Organization)
ABO Compatibility of Blood Products
Anti-A and
O O O A, B, AB, or O Any Any
anti-B
Welsby IJ, Hathaway JA. Blood and Blood Component Therapy. In:
Longnecker DE, Brown DL, Newman MF, et al. Anesthesiology. 2nd Ed. New
York: McGraw-Hill Companies; 2012: 1438-53.
Whole Blood Red Cell Platelet Fresh Frozen
Concentrates Concentrates Plasma (FFP)
1 (PRBC) (PC)
2 3 4
Cryoprecipitated
anti-haemophilic
factor (Cryo-AHF)
Wang D, Sun J, Solomon SB. Transfusion of older stored blood and risk of
death: a meta-analysis. Transfusion. 2012 Jun; 52(6): 10.
Content
WB PRBC Platelet FFP Cryoprecipitate
450 mL WB in 63 mL 150‐200 mL red blood Prepared from units Plasma prepared from WB, Prepared from FFP by
anticoagulant‐preservati cells from which most of whole blood that from the primary centrifugation collecting the precipitate
ve solution (7:1) of the plasma has have not been of WB into PRBC and plasma, or formed during
been removed (250 allowed to cool from a secondary centrifugation controlled thawing at
mL). below +20°C. of platelet rich plasma. +4°C & re‐suspending in
10‐20 mL plasma. It’s
stored at –25°C or colder
for up to 1 year after the
date of phlebotomy.
Hb will be approximately Hb concentration will A single donor unit The plasma is rapidly frozen to – Cryo‐AHF contains
1.2 g/dL and be approximately 20 consists of 50‐60 25°C or colder within 8 hours of about half the Factor VIII
haematocrit (Hct) g/100 mL (not less mL plasma that collection contains normal and fibrinogen as a pack
35‐45% with no than 45 g per unit) and should contain ≥55 plasma levels of stable clotting of fresh WB: e.g. Factor
functional platelets or Hct 55‐75%. x 109 platelets. factors, albumin, Ig & Factor VIII VIII: 80‐100 IU/ pack;
labile coagulation at level of at least 70% of fibrinogen: 150‐300 mg/
factors (V and VIII) when normal fresh plasma. pack.
stored at +2°C to +6°C.
NOTE:
In dengue fever thrombocytopenia, platelet transfusion
refers to management of dengue fever guideline.
Avoid thrombocyte transfusion in: 1) thrombotic
thrombocytopenic purpura (TTP), 2) idiopathic
thrombocytopenic purpura (ITP), and 3) heparin-induced
thrombocytopenia.
Setyohadi B, Arsana PM, Suryanto A, et al. EIMED PAPDI:
Kegawatdaruratan Penyakit Dalam (Emergency in Internal
Medicine). Jakarta: Interna Publlishing ; 2011: 146-9.
Nelson’s Textbook of Pediatrics, 26th Ed, Chapter 470: Red Blood Cell
Transfusions and Erythropoietin Therapy
4 Fresh Frozen Plasma (FFP) Conditional indications:
• Massive blood transfusion.
• Acute DIC if there are coagulation
Definite indications: abnormalities (PT or aPTT > 1.5x normal
• Replacement of a single coagulation factor deficiency, values) and patient is bleeding.
where a specific or combined factor concentrate is • Liver disease, with abnormal coagulation
unavailable or contraindicated. and bleeding - prophylactic use to reduce
• Immediate reversal of warfarin effect where prothrombin time (PT) to 1.6‐1.8 x normal
prothrombin complex concentrate is unavailable. for liver biopsy.
– Time the transfusion was completed. • Identify and respond immediately to any adverse
– Volume and type of blood products transfused. effect, by stopping the transfusion. Severe
– Unique donation number of all products transfused.
reactions most commonly present during the first 15
minutes of a transfusion.
– Any adverse effect.
Anaphylactic Delayed
TRALI
reaction complications
and septic shock – Bacteria from donor’s skin entering blood unit during collection
(usually staphylococci)
– Bacteremia present in blood donor during collection (Yersinia)
– Improper handling during blood processing
– Defect or damage to the blood bag
– Thawing FFP or cryoprecipitate in water-bath (often contaminated)
• Contaminants:
– Pseudomonas grows at +2oC to +6oC & can survive/multiply in
refrigerated red cell units
– Staphylococci grow in warmer conditions & able to proliferate in PCs
stored at +20oC to +24oC
• Signs/symptoms appear rapidly after commencement, but
may delayed for a few hours. Severe reaction sudden onset of
high fever, rigors, and hypotension
• Tx: Urgent supportive care + high dose IV AB
Clinical Transfusion Practice (World Health Organization)
3. Transfusion • Is acute pulmonary edema caused by left atrial
Associated
hypertension or volume overload occuring within 6
hours following a blood transfusion.
Circulatory • May occur when:
Overload (TACO) – Too much fluid is transfused
– Transfusion is given too rapidly
– Renal function is impaired
• Particularly likely to happen in patients with:
– Chronic severe anemia
– Underlying cardiovascular disease
transfusion – Fever
– Anemia
– Jaundice
– (Occasionally) hemoglobinuria
Severe life-threatening delayed hemolytic transfusion
reactions with shock, renal failure, and DIC are rare.
complications of
infections
• Infections of:
transfusion
– HIV, Hep B and C, syphilis (Treponema pallidum), malaria
– Cytomegalovirus (CMV)
– Other TTIs: Human parvovirus B19, brucellosis, Epstein-
Barr virus, toxoplasmosis, Chagas disease, infectious
mononucleosis, Lyme’s disease
• May occur days, weeks/months after transfusion it’s
essential to record all transfusions accurately in
patient’s case notes & consider transfusion in the DD.
• Stop the transfusion and keep IV line open with normal saline in another site.
• Return the blood unit with transfusion administration set, freshly collected urine and new blood
samples (1 clotted and 1 anticoagulated), drawn from a vein opposite to the transfusion site, to the
blood transfusion center for laboratory investigations.
• Administer antihistamine IM and oral or rectal antipyretic. Avoid aspirin in thrombocytopenic patients.
• Give IV corticosteroids and bronchodilators if there are anaphylactoid features (e.g. bronchospasm,
stridor).
• If clinical improvement occurs, restart transfusion slowly with new blood unit and observe carefully.
• If no clinical improvement within 15 minutes or if signs and symptoms worsen, treat as Category 3.
• Collect urine for next 24 hours for evidence of hemolysis and send for laboratory investigations