Blood Product Transfusion PDF

Blood product transfusion Prepared by: Sazan Salih Pirjeen mohammed Ali Supervised by: Dr.Salah Definition Blood transfusion : is a routine medical procedure in which donated blood is provided to a recipient through a narrow tube placed within a vein. Purpose...

Blood product transfusion Prepared by: Sazan Salih Pirjeen mohammed Ali Supervised by: Dr.Salah Definition Blood transfusion : is a routine medical procedure in which donated blood is provided to a recipient through a narrow tube placed within a vein. Purpose of blood transfusion A blood transfusion provides blood or blood components when: You’ve lost blood due to an injury or during surgery You have a certain medical condition that affects blood or its components.  Whole blood Composition: Red Blood Cells White Blood Cells Plasma Platelets Clotting Factors Indications : Significant blood loss Exchange transfusion  Packed RBCs Composition: RBCs with little plasma Some platelets and WBCs Indications: Symptomatic and chronic anemia Blood loss due to injury or surgery WBCs Composition: WBCs (leukocytes) suspended in 20% of the plasma Indications: NOT usually used Sepsis in neutropenic patient not responding to antibiotic Persistent fever Granulocytopenia Platelets Composition: Platelets Plasma Indications: Thrombocytopenia Platelet dysfunction Aplastic anemia Prophylactic transfusion  Plasma component: Fresh frozen plasma Composition: Plasma All coagulation factors Indications: Bleeding in patients with coagulation factor deficiencies Vit. K deficiency Liver failure DIC  Plasma component: Cryoprecipitate Separated by freezing FFP, allowing it to thaw to 1-6ºC Centrifuge Re-frozen & stored at –30ºC Enriched with FVIII, vWF and fibrinogen Indications: Fibrinogen deficiency VWD Hemophilia A DIC Pre transfusion tests 1. ABO grouping 2. Rh typing 3. Antibody screening and identification 4. Cross-matching 5. Transmissible disease testing : HIV, HBV, HCV, Syphilis Preparation Prepare the patient : Ask about previous history of blood transfusion/adverse reactions Explain the procedure to the patient Inform the patient about (indications ,benefits , risks) Instruct the patient to report any sudden (chills, nausea, itching, rash, dyspnea, back pain or unusual symptoms)  Equipment Blood product Blood administration set 250ml NS for infusion and IV pole Venipuncture set Alcohol swab Clean gloves Gauze , syringe Medications as acetamenophen and diphynhydramine Blood warmer (if needed) Vital signs material  cont. Obtain blood product from the blood bank promptly Perform venipuncture using #18 ,#20 cannula Observe the patient for the first 15 minutes Monitor the patient Document the relevant data Transfusion must be done slowly Blood transfusion takes 1-4 hours depending on how much blood is given and what blood product is given Stop the blood transfusion and clamp the tube Continue the primary IV solution to flush the maintenance line with NS Take vital signs after blood transfusion  What to do if blood transfusion reactions happen Stop the transfusion immediately Support the airways and circulation Check and monitor the vital signs Maintain intravenous access ( do not flush existing line and use a new IV line if require ) Administer epinephrine, diphenylhydramine, corticosteroid Check if the right pack has been given to the right patient Notify your medical officer and transfusion service provider Acute hemolytic reaction : incompatible blood can be fatal Thank You PERFORMING & INTERPRETING ECG PREPARED BY SARA AHMED , ZAINAB ASMAAT WHAT IS AN ECG? ECG(Electrocardiography): is a simple, noninvasive procedure that measures the electrical activity of the heart. There are 3 main types of ECG: A resting ECG A stress or exercise ECG An ambulatory ECG (holter) A standard ECG complex consists of three main components: 1. P wave: depolarization of Atria 2. QRS complex: depolarization of the ventricles 3. T wave: repolarization of the ventricles HOW AN ECG IS CARRIED OUT? There are several different ways an ECG can be carried out. Generally, the test involves attaching anumber of small, sticky sensors called electrodes to your arms, legs and chest. These are connected bywires to an ECG recording machine. ECG LEADS Limb leads The four limb electrodes are used by the ECG machine to create the six limb viewpoints (Leads I, Il. III, aVR, aVL & aVF) Chest leads The six chest electrodes are used by the ECG machine to create the six chest leads (V1, V2, V3, V4, VS, V6). CHEST LEADS:V1,V2,V3,V4,V5 & V6 LIMB LEADS:I, IL, III, AVR, AVL & AVF.  Common Indications for paediatric electrocardiography: Syncope, seizures and “funny turns” Cyanotic episodes Diagnosis and management of rheumatic fever, Kawasaki’s disease, pericarditis, myocarditis Diagnosis and management of congenital heart disease and arrhythmia. Electrolyte abnormalities. ECG INTERPRETATION HOW TO INTERPRET? I. Calibration II. Rhythm III. Rate IV. Cardiac axis V. Segments & intervals P wave PR interval Q wave QRS complex ST segment T wave QT interval CALIBRATION Height 10mm = 1 mV Look for a reference pulse which should be the rectangular looking wave somewhere near the left of the paper. Paper speed 25mm/s  Then look to aVR lead ,normally the deflection is downward. P-is usually upward in leads I and II. RHYTHM NORMAL rhythm must have a P wave before each QRS complex. How to check? 1) mark off on the paper the positions of 3 or 4 R wave tips. 2) Move the paper along the rhythm strip so that your first mark lines up with another R wave tip. 3) See if the subsequent R wave tips line up with the subsequent marks on your paper 4) If they do line up, the rhythm is REGULAR, if not, the rhythm is IRREGULAR. HEART RATE Regular rhythms: 300/number of large squares in between two consecutive R waves. Irregular rhythm: (no. of R waves in 15 large squares x 20) Resting heart rate varies with age: Newborn: 110 – 150 bpm 2 years: 85 – 125 bpm 4 years: 75 – 115 bpm 6 years+: 60 – 100 bpm CARDIAC AXIS The axis is the overall direction of the cardiac impulse or wave of depolarization of the heart. Normal cardiac axis is between (-30) – (+90) Classification of abnormal heart axis: Left axis deviation= (-30) – (-90) Right axis deviation= (+90) – (+180) Indeterminate= (+180) – (-190) To determine the axis, look for L1 and AvF: I. If L1 & AvF positively deflected = normal axis II. If L1 positive & AvF negative = left axis deviation III. If L1 negative & AvF positive = right axis deviation IV. If both negative = indeterminate axis P WAVE o P wave reflect the depolarization of the atria o Normally its 2.5 mm wide and 2.5 mm high o Tall P wave indicate RA enlargement o Wide P wave indicate LA enlargement PR INTERVAL Normal interval= 3-5 small square (0.12-0.20 s) SHORT PR interval (less than 3 small square) Wolf parkinson white syndrome Glycogen storage disease LONG PR interval ( more than 5 small square) Heart block 1st,2nd, and 3rd degree Viral or rheumatic myocarditis and other myocardial dysfunctions Digitalis toxicity Q WAVE o Changes in 2 leads are pathological o Q wave more than quarter of R wave is pathological o Q wave less than quarter of R wave is physiological QRS COMPLEX Normal duration 0.08-0.10s ( 3 or less than 3 small square. PROLONGED QRS complex: WPWS Bundle branch block WOLF PARKINSON WHITE SYNDROME QRS AMPLITUDE High QRS amplitudes are found in: Ventricular hypertrophy Ventricular conduction disturbances eg BBB’s, WPW Low QRS amplitudes are seen in: Pericarditis Myocarditis Hypothyroidism Normal newborns ST SEGMENT the ST segment is the flat, isoelectric section of the ECG between the end of the S wave and the beginning of the T wave. Should be more than 1mm up or down to be considered significant in the limb lead, and more than 2mm in chest lead ST segment depression: Electrolyte imbalance Ischemic disease ST segment elevation: MI Cardiomyopathy Pericarditis Myocarditis T WAVE T wave represents the repolarization of the ventricles. Upright in all leads except AvR and V1. Peaked T wave: Hyperkalemia Inverted T wave: normal finding in children Hypokalemia myocarditis QT INTERVAL The QT interval is measured from beginning of the QRS complex to the end of the T wave. Normal= 0.36-0.44s PROLONGED QT interval: hypokalemia Hypocalcemia CAD THANK YOU Bone marrow aspiration Prepared by: Hallat Khudhir Habeeb Jamshidi needle (named after khosrow jamshidi)