Blood transfusion (2).pdf

Physiological Changes during Storage % of Red cells viability; ▪ Decreases gradually % of Platelets viability; ▪ Rapidly drops to zero % of coagulation factor V and XIII; ▪ Markedly drops Potassium content (mmol/L) ▪ Rises leads to hyperkalemia  Blood components Packed red ce...

Physiological Changes during Storage % of Red cells viability; ▪ Decreases gradually % of Platelets viability; ▪ Rapidly drops to zero % of coagulation factor V and XIII; ▪ Markedly drops Potassium content (mmol/L) ▪ Rises leads to hyperkalemia  Blood components Packed red cells: Increase the hemoglobin content without overloading the circulation o Indicated in o Anemic patients ▪ Elderly ▪ Renal patients ▪ Cardiac patients  Platelets concentrates: o Increases number of platelets by 10,000 to 15,000/uL o They should be freshly prepared o Indicated in patients with thrombocytopenia (low platelets) Common Complications Pyrogenic reactions: Most common. Patient develops chills, fever Headache, nausea and vomiting Due to: Minor bacterial contamination Donor's white blood cells or platelets, Pyrogens in the transfusion apparatus. Treatment: Stop the transfusion IV antihistaminics Hydrocortisone Allergic reaction: These range from mild itching and urticaria to a severe reaction (laryngeal edema and collapse). They are due to the recipient's response to allergens in the donor's blood. Common in those patients who received many transfusions in the past Treatment: Stop the transfusion IV antihistaminics & Hydrocortisone Hemolytic reactions: Serious life threatening complication. Due to transfusion of ABO incompatible blood Antibodies in the recipient's blood against one or more of the antigens of the donor's cells. Present after the transfusion of less than 50 ml Symptoms Fever, chills, Chest pain, Dyspnea, Pain in the flanks.  Examination reveals: Tachycardia Hypotension In anaesthetized patients; Sudden tachycardia Hypotension Bleeding tendency. A major hemolytic reaction will lead to: Hemoglobinuria, Jaundice & acute renal failure due to ATN …. Citrate intoxication: Excess citrate Hypocalcaemia Tetany Augments the effects of hyperkalemia on the myocardium. Treatment: Give 10 ml of 10% calcium gluconate for each two units of blood Massive Blood Transfusion Transfusion of more than 4 units of blood in one time or 5000 ml or more over 24 hours Massive Transfusion Protocols Rapid administration of large amounts of blood products in fixed ratios (usually 1:1:1) for the management of hemorrhagic shock At least 6 units of PRBC, FFPs and Platelets 1PRBCs:1FFPs:1Platelets