Blood Transfusion Mei2008

7/25/2019 Blood Transfusion Mei2008

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BLOOD TRANSFUSION

HEMATO - ONCOLOGY DIVISION

DEPARTEMENT OF CHILD HEALTH

MEDICAL SCHOOL

UNIVERSITY OF SUMATERA UTARA



2

TRANSFUSION

The decision to transfuse should not be based the haemoglobin

level alone, but also on a assesment of the child’s clinical

condition.

Indication for transfusion :

Hb concentration of 4 g/dl or less

Hb concentration 4 -6 g/dl, if any of the clinical features ofhyo!ia "acidosis, imaired conciousness#,

hyerarasitemia "$%&'#.



3

TRANFUSION PROCEDURES

(. If transfusion is needed, give sufficient blood the child

clinically stable.

%. ) ml/*g of red cells or (& ml/*g +hole blood increase Hb

concentration %- g/dl unless there is continued bleeding or

haemolysis.

. here ossible, use a aediatric blood ac* device to

control rate volume of transfusion.

4. Transfusion should be given slo+ly e.g. ) ml/*g of red cells

over ( hour.

). 0ive furosemide ( mg/*g orally or &.) mg/*g Iv to ma!. dose

%& mg.*g cardiac failure ulmonary oedema.



4

TRANFUSION PROCEDURES

6. 1onitor for signs of "cardiac failure, fever, resiratory disterss,

tachynoea, hyotension, acute transfusion reaction, shoc*,

haemolysis, 2I3#.

. 5e-evaluate the atient’s Hb or Ht clinical condition aftertransfusion.

. If still anemia, give a second transfusion of ) 7 (& ml/*g of red

cells or (& 7 () ml/*g of +hole blood.

8. 3ontinue treatment of anemia to hel haematological recovery.



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APPROPRIATE & INAPPRORIATE TRANSFUSION

The safety effectiveness of transfusion deend ont+o *ey factors :

9 suly of blood blood roducts that are safe.

The aroriate clinical use of blood blood roducts.



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T59;<=;I> I; ><T? =?33?;;95@

<>5 TH? <>AA>I0 5?9;>; :

The need for transfusion can often be avoided by the

revention or early diagnosis treatment of anemia.

Blood is often unneccessarily given to raise a atient’s Hblevel before surgery or to allo+ earlier discharge from

hosital.

Catient’s transfusion reDuirment can often be minimiEed by

good anaesthetic surgical management. If blood is given +hen is not needed.

Bllos is e!ansive, scarce resource.



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TH? 5I;F >< T59;<=;I> :

5ed cell transfusion : The transfusion of red cell roducts carries a ris* of

serious haemolityc transfusion reaction. Blood roducts can transmit infection agents " HIG,

heattis B, heatitis 3, syhillis, malaria 3hagasdiseases to the reciient#.

9ny blood roduct can become contaminated +ith bacteria.

Clasma transfusion : Clasma can transmit most of the infection resent in

+hole blood. Clasma can also cause transfusion reactions.



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BA>>2 ;9<?T@

The Duality safety of all blood blood roducts the

rocess from selection of blood donors to administration

atients, the reDuires :

The establishement of a +ell-organiEed blood transfusion

service.

The collection of bloood only from voluntary non-remunerated

donors.

The screening of all donated for transfusion 7 transmissible

infections.

0ood laboratory ractice in all asects of blood grouing,comatibility testing, comonents rearation storage of

blood blood roducts.

9 reduction in unneccesary transfusions.



9

BLOOD PRODUCTS

Blood roduct : 9ny theraeutic substance reared from human blood.

hole blood : =nsearated blood collected into an arovedcontainer containing an anticoagulant-reservative solution.

Blood comonent :

(. 9 constituent of blood, searated from +hole blood, such as :

7 5ed cell consentrate

7 5ed cell susension

7 Clasma

7 Clatelet concentrates



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%. Clasma or latelets collected by aheresis. 3ryoreciitate, reard from fresh froEen

lasma "<actor GIII fibrinogen#.

Clasma derivate : Human lasma roteins rearedunder harmaceutical manufacturing conditions,such as :

9lbumin

3oagulation factor concentrates

Immunoglobulins



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WHOLE BLOOD

4)& ml B donation contains : 4)& ml donor blood

6 ml anticoagulant

o functional latelets

o labile coagulation factors "G GIII#

Infection ris* : HIG(, HIG %, heatitis, syhillis, malaria

3hagas diseases.

Indications : 5ed cells relacement in acute blood loss +ith

hyovolemia, e!change transfusion.

;torage : % 6 &3 in blood ban*, transfusion should be

started +ithin & minutes of removal from refrigerator.

3omlete transfusion +ithin 4 hrs of commencement.



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PACKED RED CELLS

Infection ris* : HIG(, HIG %, heatitis, syhillis, malaria

3hagas diseases.

Indications : 5ed cells relacement in anemia, use crystalloid

relacement fluids or colloid solution in acute blood loss.

;torage : % 6 &3 in blood ban*, transfusion should be

started +ithin & minutes of removal from refrigerator.




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0uidelines for Cediatric 5B3 Transfusions

Children and Adolescen

9cute loss $%)' circulating blood volume Hemoglobin .& g/dAJ in erioerative eriod Hemoglobin (.& g/dA and severe cardioulmonary disease Hemoglobin .& g/dA and symtomatic chronic anemia Hemoglobin .& g/dA and marro+ failure

In!ans Wihin Firs " #o o! Li!e

Hemoglobin (.& g/dA and severe ulmonary disease Hemoglobin (&.& g/dA and moderate ulmonary disease Hemoglobin (.& g/dA and severe cardiac disease Hemoglobin (&.& g/dA and maKor surgery Hemoglobin .& g/dA and symtomatic anemia

J Hematocrit estimated by Hb g/dL x 3

;trauss 50. Blood and blood comonent transfusion. In: Behrman 5?, Fliegman 51, Lenson HB, editors. elsonTe!tboo* of Cediatrics. (6th ed. Chiladelia. B ;aunders 3omany, %&&&..(488-()&



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PLATELETS CONCENTRATES

;ingle donor unit in a volume )& 7 6& ml

of lasma.

Infection ris* : HIG(, HIG %, heatitis, syhillis

malaria 3hagas diseases, bacterial contamination.

Indications : Trhrombocytoenia, latelets function defects.

;torage : = to % hours at %& - %4 &3 +ith agitation, do not

store at % 7 6 &3.




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0uidelines for Cediatric Clatelet Transfusions

Children and Adolescen

CATs )& ! (&8/A and bleeding CATs )& ! (&8/A and invasive rocedure CATs %& ! (&8/A and marro+ failure +ith additional

hemorrhagic ris* factors CATs normal +ith Dualitative CAT defect and bleeding or

invasive rocedure

In!ans Wihin Firs " #o o! Li!e

CATs (&& ! (&8/A and bleeding

CATs )& ! (&8

/A and invasive rocedure CATs %& ! (&8/A and clinically stable CATs (&& ! (&8/A and clinically unstable

PLTs = platelets

;trauss 50. Blood and blood comonent transfusion. In: Behrman 5?, Fliegman 51, Lenson HB, editors. elsonTe!tboo* of Cediatrics. (6th ed. Chiladel ia. B ;aunders 3om an %&&&. .(488-()&



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FRESH FRO$EN PLAS#A

3ontains normal lasma levels of stable clotting factors,albumin , immunoglobulin, factors GIII and searated from

one +hole blood .

=sual volume of ac* %&& 7 && ml.

Infection ris* : same as +hole blood

Indications : Aiver diseases, +arfarin overdose, deletion od

coagulant factors, 2I3, TTC.

Before use, should be tha+ed in blood ban* in +ater is &-&3. transfusion should be started +ithin & minutes of removal

from refrigerator.

3omlete transfusion +ithin 4 hrs of commencement. Initial

dose () ml/*g.



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0uidelines for Cediatric <<C TransfusionsIn!ans% Children and Adolescen

;evere clotting factor deficiency and bleeding ;evere clotting factor deficiency and invasive rocedure

?mergency reversal of +arfarin effects 2ilutional coaguloathy and bleeding 9nticoagulant rotein "9T-III#, rotein 3 and ;# relacement Clasma e!change relacement fluid for thrombotic

thrombocytoenic urura

AT-IIII = Antithrombin III

;trauss 50. Blood and blood comonent transfusion. In: Behrman 5?, Fliegman 51, Lenson HB, editors. elsonTe!tboo* of Cediatrics. (6th ed. Chiladelia. B ;aunders 3omany, %&&&..(488-()&



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CROPRECIPITATE

3ontains : The factors GIII &-(&& iu/ac*,

fibrinogen ()&-&& mg/ac*.

Infection ris* : as for lasma.

Indications : Gon +illebrand factor, factor GIII,

factors MIII, 2I3.



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ALBU#IN

Crearation : )' : )&mg/ml N

%&' : %&&mg/mlN %)' : %)&mg/ml.

=sual volume of ac* %&& 7 && ml. Infection ris* : o ris* of transmission viral infection.

Indications : 5elacement fluid in theraeutic lasma

e!change, edema in nehrotic syndrome, ascites,

hyoalbuminemia. Crecaution : administration of %&' albumin may cause

ulmonary edema



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ORDERIN' BLOOD

Assess patient’s

need for transfusion

Emergency

Blood need

within 1 hr or less

Definite need

for bloode.g elective surgery

Possible need

for bloode.g. obstetrics,

elective surgery

rgently re!uest AB"

# $hD campatible units.

Blood ban% may

select group "

$e!uest AB" #

$hD compatible units

&o be available

at stated time

$e!uest group,

antibody screen

# hold



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#ONITORIN' THE TRANSFUSED PATIENT

(. <or each unit of blood transfused, monitor the atient :

Before starting the transfusion

9s soon as the transfusion is started

() minutes after starting the transfusion

9t least every hours during transfusion

>n comletion of the transfusion

4 hours after comleting the transfusion



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%. 9t each of the stages, record the follo+ing information on the atient’s chart :

Catient’s general aearance Temerature

Culse

Blood ressure

5esiratory rate

<luid balance "oral IG fluid inta*e N =rinary outut#

. 5ecord :

Time the transfusion is started

Time tha transfusion is comleted

Golume and tye of all roducts transfused

=niDue donation numbers of all roducts transfusion

9ny adverse effects



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AD(ERSE EFFECTS OF TRANSFUSION

Category Signs Symptoms Possible cause

MILD REACTION rticaria, rash Pruritus 'ypersensitivity (mild)

MODERATELY

SEERE REACTION

*lushing,

urticaria, rigors,fever,

restlessness,tachycardia

An+iety, pruritus,

palpitations, milddyspnoe, headache

'ypersensitivy, febrile non

haemolytic transfusionreaction. -ontamination

with pyrogens or bacteria

LI!E T"REATENIN#

REACTIONS

$igors, fever,

restlessness,hypotension,tachycardia,'buria,D/-

An+iety, chest pain,

pain near infusionsite, respiratory

distress, bac% pain,headache, dyspnoe

Acute intravascular

haemolysis, bacterialcontamination # septicshoc%, fluid overload,

anaphyla+is, transfusionassociated acute lung in0ury

Ac)e co*+licaions o! rans!)sion



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Category Managements

MILD

REACTION1.

low the transfusion2. Administer antihistamine /3 (-&3 o.1 mg%g or e!uiv!lent)

4. /f no clinical improvement within 45 minutes or if signs # symptom worsen,treat as category 2.

MODERATELY

SEEREREACTION

1. top the transfusion, replace the infusion set # %eep /6 line open with normal

saline

2. 7otify the doctor responsible for the patients # the blood blan% immediately

4. end blood unit with infusionset, freshly collected urine # new blood samples

8. Administer antihistamine /3 # oral or recta anipyretic.

9. :ive /6 corticosteroid # bronchodilator if there are anaphylactoid features.;. -ollect urine for ne+t 28 hrs

<. /f clinical improvement, restart transfusionslowly with new blood unit

=. /n no clinical improvement within 19 minutes or if signs # symptoms worsen,treat as category 4.

I**ediae *ana,e*en !or rans!)sion reacion



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Category Managements

LI!E

T"REATENIN#REACTIONS

1. top the transfusion, replace the infusion set # %eep /6 line open with normal saline

2. /nfuse 7 (initially 2545 ml%g) to maintain systolic BP if hypotensions.

4. 3aintain airway # give high flow o+ygen by mas%

8. :ive adrenalin 5.51 mg%g /3 (as 1> 1555 solution)

9. :ive /6 corticosteroid # bronchodilator if there are anaphylactoid features.

;. :ive diuretic (furosemide 1 mg%g /6)

<. 7otify the doctor responsible for the patients # the blood blan% immediately

=. end blood unit with infusionset, freshly collected urine # new blood samples

?. -hec% fresh urine specimen vissually for signs of 'buria

15. tart a 28 hrs urine collection # fluid balance

11. Assess for bleeding from puncture site or wounds

12. $eassess, if hypotension > (give further 7 254 ml%g over 9 minuts@ give inotrpe, ifavailable)

14. /f "P fallinf or alboratory evidence of acute renal failure > (3aintain fluid balance,give furosemide, consider dopamine infusion, dialysis)

18. /f bacterenia is suspected , start broad spectrum antibiotics /6.

I**ediae *ana,e*en !or rans!)sion reacion



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AD(ERSE EFFECTS OF TRANSFUSION

Complications Signs $ symptom Presentation Treatment

Delaye% &aemolyticreaction

*ever, anemia, 0aundice,

occasionally 'buria

915 days posttransfusion

ssually not treatment@ ifhypotension # oliguria, treat asacute intravascular haemolysis

Post'trans(usion

purpura

/ncreased bleeding

tedency,thrombocytopenia

915 days post

transfusion

'igh dose steroid, /v

imunoglobulin, Plasma e+change

#ra(t ) *s &ost%iseases

*ever, s%in rash,des!uamation,

diarrhoea, hepatits,pancytopenia

1512 days posttransfusion

sually fatal, supportive care, nospecific therapy

Iron o*erloa% -ardiac # liverfailure in transfusion

depents patients

Prevent with ironbindingagents(desfero+amine)

Trans(usiontransmitte% in(ections

'/6 1, '/6 2, 'epatitis B, -@ yphillis, -hagas diseases, 3alaria,cytomegalovirus, brucellosis, etc.

Dela-ed co*+licaions o! rans!)sion



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FACTORS DETER#ININ' FOR TRANSFUSION

Blood loss

?!ternal bleeding

Internal bleeding 7 non traumatic "etic ulcer, varices,ectoic regnancy, anteartum hemorrhage, rutureduterus#

Internal bleeding traumatic "chest, sleen, elvis, femur# Haemolysis

1alaria

;esis

2I3

3ardioresiratory state tissue o!ygenation

9nemia

9nticiated need for blood "surgery anaesthesia#



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Blood Transfusion Mei2008

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