BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

Slides:



Advertisements
Similar presentations
Administration of Blood and Blood Products PN 3 November 2005.
Advertisements

Transfusion A blood transfusion is a safe, common procedure in which you receive blood through an intravenous (IV) line inserted into one of your blood.
Transfusion ComplicationRisk per UNIT Allergic3:100 Febrile (Leuko-reduced Units) 1:100 TACO1:100 TRALI1:5,000 Sepsis1:5,000 Acute hemolytic1:75,000 HBV1:160,000.
بسم رب نور.
Transfusion-Related Acute Lung Injury
Adverse Effects of Blood Transfusion. Adverse Effects of Blood Transfusion ANY unfavorable consequence is considered an adverse effect of blood transfusion.
Components of Blood Formed elements-Cells – Erythrocytes (RBCs) – Leukocytes (WBCs) – Thrombocytes (platelets) Plasma – 90% water – 10% solutes – Proteins,
Hello. Blood Transfusion What is a Blood Transfusion? Blood transfusion is a medical procedure that needs to be ordered by a physician. It is the introduction.
INDICATIONS FOR EMERGENT TRANSFUSIONS Manjushree Matadial DO Saint Joseph Hospital and Medical Center, April 27,2009.
1 Proposed Changes to ICD-9-CM Transfusion Associated Adverse Events September 17th, 2009 ICD-9-CM Coordination and Maintenance Committee Meeting Mikhail.
BLOOD BANKING 1- BLOOD PRODUCTS 2- AUTOLOGOUS TRANSFUSION M. H. Shaheen Maadi Armed Forces Hospital.
BLOOD TRANSFUSION Begashaw M (MD).
Blood Products.  Etiology of bleeding: –Platelet Count and function need to be assessed. –Coagulation factors Glycoproteins that are synthesized in the.
Adult Health Nursing II Block 7.0. Blood Products and Blood Transfusions Adult Health II Block 7.0 University of Southern Nevada Block 7.0 Module 1.3.
Transfusion of Blood Product History: 1920:Sodium citrate anticoagulant(10 days storage) 1958: Plastic bag of transfusion 1656: Initial theory and.
Immunohematology (Blood Bank) CLS 245. What is Immunohematology? It is the study of Antigen-Antibody reaction as they relate to blood disorder.
Risks and Indications for RBCs Transfusions David Stroncek, MD Chief, Laboratory Services Section Department of Transfusion Medicine, Clinical Center,
+ Dr. Megan Rowley Consultant in Transfusion Medicine Blood Transfusion.
Transfusion Emergencies. TRANSFUSION REACTIONS IMMUNOLOGIC NON-IMMUNOLOGIC.
Transfusion Reactions June Objectives  Be able to recognize the more common transfusion reactions  Learn about treatment and prevention of transfusion.
Blood Transfusion Reactions Col.Dr.Mohamed H Khalaf,MD Head, Department of Haematology Maadi A F Medical Compound Blood Transfusion Reactions Col.Dr.Mohamed.
BLOOD TRANSFUSIONS Dr. Tamara Wagenheim.
BLOOD TRANSFUSION AND TRANSFUSION REACTIONS
上海交通大学瑞金临床医学院 外科教研室. Blood Transfusion History Type of Transfusion Indication Transfusion Reactions Autologous transfusion Component Transfusion Blood.
2011. Objectives Identify various blood products available for transfusion Identify possible blood transfusion side effects Identify the various blood.
INCOMPLETE CROSSMATCH
Blood Transfusion Done by : Mrs.Eman Rizk. Definition ( Blood Transfusion ) Is the process of transferring blood or blood-based products from one person.
Transfusion Therapy Principles of IV Therapy BSN336.
BLOOD TRANSFUSION NUR 317. TRANSFUSION Infusion of blood products for the purpose of restoring circulating volume.
Blood Component Therapy
Acute Transfusion Reactions Clinical Symptoms and Laboratory Investigation.
RESULTS FROM THE 2007 SHOT REPORT. SHOT report 2007 (561 cases)
Blood Product Administration Keith Rischer, RN. Erythrocytes  Function  Normal Life span  Norms Hgb –Women: g/dl –Men: n g/dl HCT –Women:
BLOOD ADMINISTRATION NRS 108 ESSEC COUNTY COLLEGE Majuvy L. Sulse MSN, RN,CCRN.
Transfusion Reactions
RESULTS FROM THE 2006 SHOT REPORT. SHOT report 2006.
BLOOD TRANSFUSION Ms.SARITHA MOHAN B.Sc.(N) Nursing Eductor Al-Ahsa Hospital Kingdom of Saudi Arabia.
Faculty of Allied Medical Science Blood Banking (MLBB 201)
Case presentation Present by R1 黃信豪. Brief history (1) This 49 y/o male patient denied any systemic disease except HBV related HCC. Hepatectomy was performed.
Blood 101 Hank Hanna, MD Medical Director American Red Cross Pacific Northwest.
Transfusion Reactions Lloyd O. Cook, M.D. Department of Pathology March 2005.
Lecture 7 blood bank BLOOD TRANSFUSION REACTION Non immunological Dr. Dalia Galal.
Acute Transfusion Reactions
Transfusion Medicine Kristine Krafts, M.D.. Blood groups Introduction ABO system Rh system Other systems Blood transfusion Blood products Indications.
The complications can be broadly classified into two categories: Immune Complications Non-immune Complications.
lecture 10 blood bank Compatibility Testing
SVTM 17.Sept.2005 M. Senn Hemovigilance : Risks of the Blood Transfusion Process Marianne Senn, ART (CSMLS) Head of Hemovigilance Swissmedic / Swiss Agency.
M.Senn, Swissmedlab Okt Hemovigilance in Switzerland Marianne Senn, ART (CSMLS) Head of Hemovigilance Swissmedic / Swiss Agency for Therapeutic Products.
BLOOD TRANSFUSION Ferdi Menda,M.D. Associated Prof of Anesthesiology Yeditepe University.
Blood Transfusion tutorial
Blood Transfusions 1. Blood Administration Blood transfusion includes any of the following : whole blood packed RBC’s plasma platelets Purpose: 1.Increase.
Blood and Blood Products. Whole Blood n Contents –RBC’s –WBC’s –Platelets –Plasma –Clotting factors.
CARE OF THE PATIENT RECEIVING BLOOD/BLOOD COMPONENTS.
Blood Transfusion Reaction in neonates & management
Compatibility Testing
BLOOD TRANSFUSION Blood transfusion is generally the process of receiving blood or blood products into one's circulation intravenously. Transfusions are.
Transfusion Medicine Kristine Krafts, M.D..
TRANSFUSION REACTIONS
Transfusion Medicine: Types, Indications and Complications
د.محمد حارث الساعاتي.
Blood transfusion: When to transfuse and risks involved
BLOOD TRANSFUSION An overview
NUR 422 Blood administration
Transfusion Medicine Kristine Krafts, M.D..
Blood Transfusion Evidence-Based Blood Therapeutics “7 is the NEW 10”
Blood and Blood Product Transfusion Reaction
Recent advances – TRALI
Transfusion Medicine Kristine Krafts, M.D..
Complications of Transfusion
Dr. Kareema Ahmed Hussein
Presentation transcript:

BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015

OVERVIEW The process Blood components Testing Consent Transfusion reactions

DONATION

TESTSPECIFIC AGENTSTESTS Group ABO,Rh Alloantibodies ABO and Rh antigen testing Virus HIV Hep B Hep C HTLV West Nile Antibodies, nucleic acid testing Bacteria Syphilis Bacterial contamination Serology Bacterial Culture (plt only) Parasites Chagas in at risk donors antibody

BLOOD COMPONENTS

CONSENT: HISTORY

CONSENT Time to think of alternatives Describe the product Describe benefits & risks Describe alternatives Answer questions/confirm understanding Complete consent form Document in chart

RISKS Hep B: 1/ 153,000 Hep C: 1/ 2.3 million HIV: 1/ 7.8 million Minor urticaria: 1/100 Febrile non-hemolytic: 1/300 ABO incomp/serious immune: 1/ 40,000 Sepsis: 1/ 10,000 plts, 1/ 500,000 pRBCs

TESTING TEST TIMIN G (min) Group5Patient tested for ABO and Rh antigen Screen45 Patient tested for alloantibodies from prior transfusion/pregnancy Xmatch45 Incubate patient’s blood with donor blood, checks for immune reaction due to alloantibodies Computer Xmatch 2 Computer picks appropriate unit based on patient and donor testing. Blood is not actually mixed. DAT 45 RBCs from patient are washed, and then mixed with Coombs Reagent. If they stick together, it means they have antibodies on their surface (+ for immune transfusion reaction)

TRANSFUSION REACTIONS

56F – POD#3 L hemi-colectomy for diverticulitis Transfusion for low Hb You are called for FEVER

DDX: FEVER Usual post-op fever causes Transfusion specific: Febrile non-hemolytic Hemolytic Septic

FEBRILE TRANSFUSION REACTION During or within 4 hours of transfusion: >38°C Increase by 1°C

MANAGEMENT STOP THE TRANSFUSION Maintain IV access Check patient ID and blood product Notify the blood bank

RED FLAGS T>39°C Hypotension/shock Tachycardia Dyspnea Back/chest pain Oliguria/Hematuria Nausea/vomiting Bleeding from IV sites

NON-HEMOLYTIC

HEMOLYTIC BACTERIAL CONTAMINATION

From: Donor skin/blood Poor handling 10% of transfusion mortality

BACTERIAL CONTAMINATION Cultures Two patient sites Bag/line  lab Antibiotics Pip-tazo Vanco

HEMOLYTIC REACTION ABO incompatibility ½ from proper labeling  wrong patient Others from improper labeling, testing error etc. Non-ABO incompatibility From pregnancy/previous transfusion >50%: No morbidity <10%: Fatal

MANAGEMENT Check labels Call blood bank UA for Hb DAT Fluids Supportive

60F – VAGINAL BLEEDING Transfused 2U pRBC You are called for: SOB  SaO2

DDX: DYSPNEA Usual post-op SOB causes Transfusion specific: TACO TRALI Anaphylaxis

TACO Fluid overload Impaired cardiac function +/- Fast rate of transfusion 1/700 transfusions Management Stop transfusion Oxygen Diurese

TACO Prevention is key Identify at risk patients Diuretics between/after units Slow speed (4 hours/U) Divide products into smaller aliquotes Reduce speed without waste

TRALI Acute onset: Hypoxemia Bilateral lung infiltrates on CXR No cardiac cause No ALI before transfusion, and now ALI present DURING or WITHIN 6 hours of transfusion No other risk factors for ALI ALI

TRALI Etiology Passive transfer of antibodies Neutrophil reaction to biologically active compounds in blood Most common cause of transfusion related death (up to 10% of TRALI) Usually 1-2 hours post (up to 6)

TRALI - MANAGEMENT Supportive care No evidence for steroids or diuretics Reducing risk: No plasma/plasma products from multip females Platelets from males or nullip females Pool platelets in male plasma Testing of & deferral of donors with TRALI hx  2/3 reduction

ANAPHYLAXIS Mechanism unclear Transfusing IgA / IgE Antibodies to serum proteins Transfusion an allergen consumed by donor Rare 1/40,000 3% of transfusion fatalities

URTICARIA 1/100 transfusions Management: Interrupt transfusion Benadryl 25-50mg IV Resume if: Urticaria improving/mild No associated symptoms

72M – DIALYSIS PATIENT Transfused 2U pRBC for chronic support Complaining of palpitations

HYPERKALEMIA Prolonged storage & irradiation  K leakage

62F – LGIB 6U pRBC for massive LGIB in ER C/O: Anxiety Foot and hand “cramping” Peri-oral tingling

CITRATE TOXICITY Rare! Massive transfusion or plex only Replace PO or IV More common: Metabolic alkalosis

SUMMARY Know the risks Know the benefits Know the alternatives Document Have a high suspicion Stop the transfusion and investigate

TO STOP OR NOT? Sick or severe TRALI Hemolysis Lab/clerical error Sepsis Anaphylaxis Urticaria Febrile non-hemolytic TACO

Fever NHTR Sepsis HTR Dyspnea TRALI TACO Anaphylaxis Allergic Urticaria Anaphylaxis Hypotension Sepsis Anaphylaxis HTR

REFERENCES Bloody Easy Rosen’s Up-to-date CMPA TRALI: A clinical review. The Lancet. Sept Vlaar et al.

EXTRA SLIDES

STORAGE