Blood transfusion.pdf

Storage of blood  Use blood that has been screened and found negative for transfusion-transmissible infections.  Do not use blood that has passed its expiry date or has been out of the refrigerator for more than 2 hours.  Rapid transfusion at a rate >15 ml/kg/hour of blood stored at 4...

Storage of blood  Use blood that has been screened and found negative for transfusion-transmissible infections.  Do not use blood that has passed its expiry date or has been out of the refrigerator for more than 2 hours.  Rapid transfusion at a rate >15 ml/kg/hour of blood stored at 4'C may cause hypothermia, especially in small babies. Blood transfusion By Dr/ AHMED ELABD Problems with blood transfusion  Blood can be the vehicle for transmitting infections (e.g. malaria, syphilis, hepatitis B and C. HIV). Therefore, screen donors for as many of these infections as possible.  To minimize the risk, only give blood transfusion when essential. Blood transfusion By Dr/ AHMED ELABD Indications for blood transfusion There are five general indications for blood transfusion:  Acute blood loss, when 20-30% of the total blood volume has been lost and bleeding is continuing.  Severe anaemia.  Septic shock (if IV fluids are insufficient to maintain adequate circulation and in addition to antibiotic therapy).  To provide plasma and platelets for clotting factors, if specific blood components are not available.  Exchange transfusion in neonates with severe jaundice. Blood transfusion By Dr/ AHMED ELABD Giving a blood transfusion Before transfusion check the following:  The blood is the correct group and the patient’s name and number are on both the label and the form (in an emergency, reduce the risk of incompatibility or transfusion reactions by crossmatching group-specific blood or giving O-negative blood if available).  The blood transfusion bag has no leaks.  The blood pack has not been out of the refrigerator for more than 2 hours, the plasma is not pink or has large clots, and the red cells do not look purple or black.  Do a baseline recording of the child: temperature, respiratory rate and pulse rate.  The volume transfused should initially be 20 ml/kg body weight of whole blood, given over 4 hours.  If signs of heart failure present, give 1 mg/kg of furosemide IV at the start of the transfusion in children whose circulating blood volume is normal.  Do not inject into the blood pack. Blood transfusion By Dr/ AHMED ELABD During transfusion:  An infusion device is used to control the rate of the transfusion.  Check that the blood is flowing at the correct speed.  Look for signs of a transfusion reaction, particularly carefully in the first 15 minutes of the transfusion.  Record the child's general appearance, temperature, pulse and respiratory rate every 30 minutes.  Record the time the transfusion was started and ended, the volume of blood transfused, and the presence of any reactions. After transfusion:  Reassess the child: if more blood is needed, a similar quantity should be transfused and the dose of furosemide (if given) repeated. Blood transfusion By Dr/ AHMED ELABD Transfusion reactions  If a transfusion reaction occurs, first check the blood pack labels and patient's identity.  If there is any discrepancy, stop the transfusion immediately and notify the blood bank.  Mild reaction: due to mild hypersensitivity. Blood transfusion By Dr/ AHMED ELABD Mild reaction: due to mild hypersensitivity. Signs and symptoms:  Itchy rash Management  Slow the transfusion  Give chlorpheniramine 0.1 mg/kg IM, if available.  Continue the transfusion at the normal rate if there is no progression if symptoms after 30 minutes.  If symptoms persist, treat as moderate reaction. Blood transfusion By Dr/ AHMED ELABD Moderate severe reaction due to moderate hypersensitivity, non-haemolytic reactions, pyrogens or bacterial contamination. Signs and symptoms:  Severe itchy rash (urticaria)  Flushing  Fever > 38 ' C (note: fever may have been present before the transfusion)  Rigors  Restlessness  Raised heart rate. Management:  Stop the transfusion, but keep the IV line open with normal saline.  Give IV 200 mg hydrocortisone, or chlophenamine 0.25 mg/kg IM, if available.  Give bronchodilator, if wheezing occurs.  Send the following to the blood bank: the blood-giving set that was used, blood sample from another site, and urine samples collected over 24 hours.  If there is improvement, restart the transfusion slowly with new blood and observe carefully.  If no improvement in 15 minutes, treat as life-threatening reaction andBlood transfusion reportBy to doctor in charge and to the blood bank. Dr/ AHMED ELABD Life-threatening reactions: due to haemolysis, bacterial contamination and septic shock, fluid overload or anaphylaxis. Signs and symptoms  Fever> 38' C (note: fever may have been present before the transfusion).  Rigors.  Restlessness.  Raised heart rate.  Fast breathing  Black or dark red urine (haemoglobinuria)  Unexplained bleeding.  Confusion.  Collapse.  Note that in an unconscious child, uncontrolled bleeding or shock may be the only signs of a life-threatening reaction. Blood transfusion By Dr/ AHMED ELABD Management  Stop the transfusion, but keep thl IV line open with normal saline.  Maintain airway and give oxygen.  Give epinephrine (adrenaline) 0.01 mg/kg body weight (equal to 0.1 ml of 1 in 10 000 solution.  Give IV 200 mg hydrocortisone, or chlorpheniramine 0.1 mg/kg IM, if available.  Give a bronchodilator, if wheezing occurs.  Report to doctor in charge and to blood laboratory as soon as possible.  Maintain renal blood flow with IV furosemide in a dose of 1 mg/kg.  Give antibiotic for septicemia. Blood transfusion By Dr/ AHMED ELABD