BLOOD TRANSFUSION Ferdi Menda,M.D. Assistant Prof of Anesthesiology Yeditepe University.

Slides:



Advertisements
Similar presentations
Coagulopathy and blood component transfusion in trauma
Advertisements

TREATMENT Coagulopathy of Liver Failure. Fresh Frozen Plasma – Most effective way to correct hemostasis in patients with liver failure – Infusion (5-10mL/kg)
Adverse Effects of Blood Transfusion. Adverse Effects of Blood Transfusion ANY unfavorable consequence is considered an adverse effect of blood transfusion.
Pablo M. Bedano M.D. Community Regional Cancer Care.
Brad Beckham T4. Definitions  Major blood loss Hemoglobin concentration below 6-10 g/dl  Massive transfusion in adults >9 erythrocyte units within 24h.
Massive transfusion: New Protocol
Transfusion Management of massive haemorrhage in children Ongoing severe bleeding (overt / covert) and received 20ml/kg of red cells or 40ml/kg of any.
By Dr. Ahmed Mostafa Assist. Prof. of anesthesia & I.C.U.
Heparin in CRRT Benan Bayrakci, McLean Antitrombin 3 Inactive Thrombin (IIa) V, VIII, XIII, Fibrinogen Inactive Factor Xa Common Pathway Inactive.
INDICATIONS FOR EMERGENT TRANSFUSIONS Manjushree Matadial DO Saint Joseph Hospital and Medical Center, April 27,2009.
Massive Transfusion Mary Jo Drew, MD, MHSA Chief Medical Officer Pacific Northwest Blood Services Region.
Transfusion Quiz “Their Lives in Your Hands” Doctors.
Cristy M. Thomas FNP-BC University of Nevada School of Medicine University Medical Center, Las Vegas NV Nevada’s Only Level 1 Adult Trauma, Level 2 Pediatric.
Transfusion Trends In Surgical Patients
Transfusing tiny soldiers Ramsey C. Tate, MD. Applying combat-derived massive transfusion protocols to pediatric trauma patients.
Definition of Massive Transfusion Replacement of a blood volume equivalent within 24hr Transfusion>10 unit within 24 hr Transfusion > 4 units in 1 hr.
MTP Octaplex rFVIIa Calgary. Massive Transfusion Protocol.
1 Massive Blood Transfusion Massive transfusion, defined as the replacement by transfusion of more than 50 percent of a patient's blood volume in 12 to.
4th year medical students Blood Component Therapy Salwa I Hindawi MSc FRCPath CTM Director of Blood Transfusion Services KAUH. Jeddah.
BLOOD TRANSFUSION Begashaw M (MD).
Senior clinician Request: a o 4 units RBC o 2 units FFP Consider: a o 1 adult therapeutic dose platelets o tranexamic acid in trauma patients Include:
Massive blood transfusion
Transfusion of Blood Product History: 1920:Sodium citrate anticoagulant(10 days storage) 1958: Plastic bag of transfusion 1656: Initial theory and.
TRANSFUSION MEDICINE MBBS,MCPS,FCPS. Professor of Pathology
Risks and Indications for RBCs Transfusions David Stroncek, MD Chief, Laboratory Services Section Department of Transfusion Medicine, Clinical Center,
ANTICOAGULATION IN CONTINUOUS RENAL REPLACEMENT THERAPY Dawn M Eding RN BSN CCRN Pediatric Critical Care Helen DeVos Children's Hospital.
BLOOD COMPONENT THERAPY FOR THE NEONATE
Fluids and blood products in trauma
Faculty of Allied Medical Science Blood Banking (MLBB 201)
Lactated Ringer’s is Superior to Normal Saline in the Resuscitation of Uncontrolled Hemorrhagic Shock Presented by intern 陳姝蓉 S. Rob Todd, MD et al, Journal.
BLOOD TRANSFUSIONS Dr. Tamara Wagenheim.
BLOOD TRANSFUSION NUR 317. TRANSFUSION Infusion of blood products for the purpose of restoring circulating volume.
Blood Banking (MLBB 201). Changes that occur in Stored Blood Prof. Dr. Nadia Aly Sadek Prof. in Haematology and Director of Blood Bank Centre, Medical.
Blood Component Therapy
Transfusion Management of Massive Haemorrhage in Adults Patient bleeding / collapses Ongoing severe bleeding eg: 150 mls/min and Clinical shock Administer.
Role of Factor Concentrates in Perioperative Coagulopathies Dr Neville Gibbs Department of Anaesthesia Sir Charles Gairdner Hospital.
Monthly Journal article review: Vimmi Kang PGY 2
Anticoagulation in CRRT
BLOOD ADMINISTRATION NRS 108 ESSEC COUNTY COLLEGE Majuvy L. Sulse MSN, RN,CCRN.
Blood component therapy This is the seperation of whole blood into its individual components to optimize individual therapeutic potency based on sound.
The Massive Transfusion Protocol An Aide Memoire 1.
Preparation of blood components
Carl P. Walther*, Amber S. Podoll*, Kevin W. Finkel* *The University of Texas Health Science Center at Houston Citrate Toxicity During CRRT After Massive.
Regulation of Potassium K+
Blood Transfusion Safe Practice.
The complications can be broadly classified into two categories: Immune Complications Non-immune Complications.
Patient Blood Management Guidelines: Module 6 Neonatal and Paediatrics Roles Senior clinician Coordinate team and allocate roles Determine volume and type.
BLOOD TRANSFUSION Ferdi Menda,M.D. Associated Prof of Anesthesiology Yeditepe University.
The Clinical Approach to Acid- Base Disorders Mazen Kherallah, MD, FCCP Internal Medicine, Infectious Diseases and Critical Care Medicine.
Blood and Blood Products. Whole Blood n Contents –RBC’s –WBC’s –Platelets –Plasma –Clotting factors.
Plasma and plasma components in the management of disseminated intravascular coagulation Marcel Levi* Academic Medical Center, University of Amsterdam,
Chapter 23. Bleeding disorders associated with coagulopathy
Systemic anticoagulation during ECMO is intended to control thrombin generation and limit the risk for thrombotic and hemorrhagic complications.
Obada Al-Eisa Saud Bashtawy Emad Mansour.  It is an acquired condition characterized by massive activation of the coagulation system.  It is always.
K A U H Blood bank Wesaam Al-Sheyyab.
TRANSFUSION REACTIONS
د.محمد حارث الساعاتي.
BLOOD GROUPS Blood groups are classified according to antigens on the membrane of RBCs called “Agglutinogen”, which are glycoprotein. The plasma may contain.
محاسبه حجم خون ازدست رفته در اطفال
BLOOD TRANSFUSION Ferdi Menda,M.D. Assistant Prof of Anesthesiology
In The name of God ●.
Dr.Mitra Azarasa Fellowship Of Cardiac Anesthesia
Blood Transfusion Evidence-Based Blood Therapeutics “7 is the NEW 10”
Coagulation Disorders Importance in surgical practice
Monthly Journal article review: Vimmi Kang PGY 2
Blood ,its products and transfusion
Coagulopathy and blood component transfusion in trauma
INTRAVENOUS FLUIDS Batool Luay Basyouni
Blood Components Dosage And Their Administration
Presentation transcript:

BLOOD TRANSFUSION Ferdi Menda,M.D. Assistant Prof of Anesthesiology Yeditepe University

Today’sTopics AvailableBloodProducts CurrentEstimatesofTransfusionRisks FatalTransfusionReactions TransfusionReactions IndicationsforAdultBloodTransfusions

IndicationsforTransfusion(Adults)

Defining Quality Administeringthe  Right  Rightquantity component way time patient  Right  Right  Right  Right  Right  Right  Right  Rightreason withinformedconsentandadequate documentationofprocess&outcomes  Right

PackedRedBloodCells SymptomaticAnemia: AnginaClaudicationDiaphoresis DyspneaFatigueTIA SyncopeTachycardiaPosturalHypotension AsymptomaticanemiawithHgb<7g/dl Pre-orPost-operativeHgb<10g/dlorHct<30% Acutebloodloss>15%ofestimatedbloodvolumeor estimatedbloodlossof750ml Acutebloodlosswithevidenceofinadequateoxygen delivery Hgb<9g/dlinpatientonachronictransfusionregimen

Study compared “ restrictive ” (Hgb<7) to “ liberal ” (Hgb<10) transfusion strategies among critically ill patients. The “ restrictive ” strategy was as effective and superior to the “ liberal ” transfusion strategy among patients less than 55 and without cardiac disease. Patients had an overall greater decrease in mortality and less complications. They concluded that a transfusion threshold of 7 g/dl is safe in critically ill patients, including those with minimal cardiopulmonary disease.

Platelets >100,000/mm 3 Bleedingwithfunctional plateletdefect Neonates ,000/mmabovebaseline 3 Bleedingpatient>50,000/mm 3 >100,000/mm 3 Neurosurgicalor ophthalmologicprocedure Invasiveprocedure>50,000/mm 3 Marrowfailure>10-20,000/mm 3 Patient…Maintainplateletct.above…

FreshFrozenPlasma PTT>50secorINR>1.5(PT>20sec) Diffusemicrovascularbleedinginmassive transfusion(>1bloodvolume)withabnormal parameters EmergencyreversalofWarfarin(Coumadin) anticoagulationwhenevidenceofbleeding presentoremergencysurgeryrequired Deficiencyofspecificfactorsofthe coagulationsystemwhenvirus-inactivated concentratesnotavailable

Cryoprecipitate Fibrinogen<100mg/dl FactorXIIIdeficiency Diffusemicrovascularbleedingandfibrinogen <120mg/dl VonWillebrand’sdiseaseorhemophilia unresponsivetoDDAVPandnoappropriate factorconcentratesavailable Uremicbleeding(ifDDAVPisineffective)

RisksofTransfusion

Thesafesttransfusionistheonenotgiven Medicine

TransfusionRisks:Infectious CurrentRisksofInfectionfrom“TestNegative” BloodComponents(USA) AgentRisk HIV-1/21in2.1million HCV1in1.9million HBV1in205, ,000 WNV1in12million Bacteria(culturedapheresis1in75,000 platelets, ARC)

TransfusionRisks:Non-Infectious,EarlyOnset PublishedRates Febrile,nonhemolyticnonsepticreactionRBC:1per units Platelets:1-1.5% Circulatoryoverload(TACO)1per100-2,000units HemolysisofincompatibleRBCs1per13, ,000 1per million(fatal) Hemolysisfromincompatibleplasma1per46,000(21%plasma incompatible) TRALI1per1,000-5,000 Allergicreaction,mild1per4,000RBC,3-5%plts Allergicreaction,severe;anaphylactic1per25,000(RBC), 1per2,000plts Risk NoninfectiousRisksofTransfusion,EarlyOnset(withinhrs)

TransfusionRisks,LateOnset RiskPublishedRates Formationredcellantibody(s)1per200RBCunits(9%pts) Delayedhemolyticreaction1per5,000-10,000 IronoverloadEssentiallyallchronically transfusedpatients ImmunesuppressionAllshowvariablesuppression FormationofHLAantibodies7-15%ifmultiplytransfused Formationofanti-plateletAb0.85%ofpatients Graft-versus-hostdisease<1per1million NoninfectiousRisksofTransfusion,LateOnset (daystomonths)

TransfusionReactions

Transfusionreactions Timing:acuteversusdelayedreaction Severity:fatalversusnon-fatal Cause:immunologic,infectious, cardiovascularoverload Allreactionsmustbereportedtothe labforinvestigationanddocumentation

TransfusionReactions-Common Febrile Allergic CardiovascularOverload

TransfusionReactions-Serious TRALI(transfusion-relatedacutelunginjury) Hemolytic Bacterialcontamination Anaphylactic Graftvs.hostdisease

LeadingCausesofFatalReactions: CasesReportedtoFDA,FY07-08 TRALI(51%) Incompatibleblood(23%) Patientmis-identification:50-75% Clericalerrors:10-15% Technicalerrors:10-15% Bacterialcontamination(13%) Anaphylaxis(5%)

TransfusionFatalityUpdate Transfusion-RelatedFatalitiesReportedinFY2005thruFY2008 Source:FatalitiesReportedtoFDAFollowingBloodCollectionand Transfusion,AnnualSummaryforFiscalYear2008,March2009

TransfusionFatalityUpdate Transfusion-RelatedFatalitiesReportedinFY2005thruFY2008 Source:FatalitiesReportedtoFDAFollowingBloodCollectionand Transfusion,AnnualSummaryforFiscalYear2008,March2009

AllergicReaction Frequency: RBCs:1per4,000,Platelets:3-5% Hivesorrash Few/localized–slowinfusionrate,antihistaminesRx GeneralizedorcardiorespiratoryS/Sx–D/Cinfusion Triggeredbydonorproteinsormedications Candevelopbronchospasm,GIsymptoms Rx:antihistamines;steroids(severerxns)

Volumeoverload Frequency: 1per100-2,000units Toorapidortoolargeavolumetransfused Usuallypre-existinghistoryofheartorlung disease Rx:slowinfusionrate,diuretics Mayneedto“split”aunitofbloodiftransfusion timewillexceed4hours

HemolyticReactions,Acute Frequency RBCs:1per13, ,000 1per million(fatal) ABOincompatibility(usually) Misidentifiedpatientorclericalerror Rx:Supportive(treatshock,DIC)

HemolyticReactions,Delayed Frequency– 1per5,000-10,000RBCs PatienthasRBCantibodies Chronicallytransfusedpatients(10-40%) Multiparousfemales UnexplaineddropinHgb3-10days aftertransfusion Rx:Antigennegativeblood

SepticTransfusionReaction Bacterialcontaminationofbloodproduct Frequency–1in75,000 Platelettransfusionsmostcommoncause Roomtemperaturestorage Contaminationduringbloodcollection,processingor pooling StrepandStaph;gramnegativebacteria PlateletproductsculturedbeforereleasebySBB Rx:Supportive,antibiotics

AnaphylacticReaction(SevereAllergic) Frequency RBCs:1per25,000,Platelets:1per2,000 IgAdeficientpatientwithanti-IgA antibodies Symptomsareimmediate(1-2ml) Hypotension,shock,bronchospasm Rx:Supportive;washedRBCs/platelets

TRALI: Transfusion-RelatedAcuteLungInjury Donororpatienthascytotoxicwhitecell antibodies(HLAorHNA) Patientordonorhascognantantigen Symptomswithin6hoursoftransfusion Acuteinjurytocapillary-alveolarmembraneof lungs Protein-richfluidleaksintoalveolarairspaces Hypoxemia,fever,pulmonaryedema AllrequireO2therapy,mayrequiremechanical ventilation Chestx-ray:pulmonaryedemafluidwithoutCHF changes

TRALI:Treatment&Diagnosis Supportivecare: O 2 AVOIDdiuretics,steroids? Diagnosis:,mechanicalventilation,inotropicagents DemonstrateHLAand/orHNAantibodiesand matchingantigeninpatientanddonor DifferentialDiagnosis: congestiveheartfailure,acuteleftventricularfailure acutecirculatory(volume)overload pulmonaryembolism rapidlyprogressivepneumonia acuterespiratorydistresssyndrome(ARDS)

TRALIPrevention FrequencyofTRALIrelatedtoamountofplasmain bloodproduct PlateletsandFFP>RBC Donorswithhistoryofpriorpregnancies,transfusion, tissuetransplantathigherriskforHLA/HNAantibodies Bloodsupplier(SBB)providesmale-onlyFFP beprovidedifemergencyFFP FemaleABFFPmay inventoryshortage Bloodprovidersconsideringscreeningofplateletand FFPdonors Historyofpriorpregnancies,transfusion,tissue transplants HLA/HNAantibodies

TRALIandBloodProducts Source:FatalitiesReportedtoFDAFollowingBloodCollectionand Transfusion,AnnualSummaryfor2006,March2009

TRALIEdemaFluid

TRALIChestX-Ray

SuspectedTransfusionReaction STOPtransfusion;KeepIVopenwithNS PromptlynotifylaboratoryandattendingMD Verifyclericalinformation; PatientID,bagtagandlabel Completetransfusionreactionreport OrdertransfusionreactionworkupinCareCast Sendreportwithbag(tubingattached)tolab Labwilldeterminewhatsamplesneedtobe collectedandcontactpathologiston-call

Massive Blood Transfusion

Replacement by transfusion of more than 50 % of a patient's blood volume in hours

Hypothermia, acidosis, coagulopathy, usually occurs after uncontrolled bleeding often at 16 units. It exemplifies the issues associated with massive bleeding and volume and blood product replacement

Reduces the enzymatic activity of plasma coagulation proteins Has a greater effect by preventing the activation of platelets via traction on the glycoprotein Ib/IX/V complex by von Willebrand factor. In tests of shear-dependent platelet activation, this pathway stops functioning in 50 percent of individuals at 30 º C, and is markedly diminished in most of the rest.

Interferes with the assembly of coagulation factor complexes involving calcium and negatively- charged phospholipids. The activity of the factor Xa/Va/prothrombinase complex is reduced by 50, 70, and 90 percent at a pH of 7.2, 7.0, and 6.8, respectively.

Large amounts of citrate are given with massive blood transfusion, since blood is anticoagulated with sodium citrate and citric acid. Metabolic alkalosis Decline in the plasma free calcium concentration

Citrate binding of ionized calcium can lead to a clinically significant fall in the plasma free calcium concentration. This change can lead to paresthesias and/or cardiac arrhythmias in some patients

Maintain Hb >8 g/dl Maintain platelet count >75 · 10 9 /LMaintain platelet count >75 · 10 9 /L Maintain PT & APTT < 1.5 · mean controlMaintain PT & APTT < 1.5 · mean control Maintain Fibrinogen > 1.0 g/L

The coagulation system should be frequently monitored with measurements of the PT, aPTT and platelet count, preferably after each 5 units of blood replaced. If the PT and PTT exceed 1.5 times the control value, the patient should be transfused with 2 units of fresh frozen plasma. If the platelet count falls below 50,000/microL, 6 units of platelets should be given.

A blood warmer should be used whenever more than three units are transfused. Hypothermia should be either avoided or minimized. Acid – base balance and the plasma ionized calcium and potassium levels should be periodically monitored, particularly in patients with coexistent liver or renal disease or in those with massive hemorrhage and low cardiac output