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    Add as FriendCOMPLICATIONS OF BLOOD TRANSFUSION BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPORE KASHMIR

    by: DR BASHIR AHMED

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    1 : BLOOD & BLOOD PRODUCTS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE CHINKIPORA SOPORE KASHMIR EMAIL---drbashir123@gmail.com
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    11 : BLOOD PRODUCTS Cellular Components- Red Cells Platelets Granulocytes Plasma Components- Fresh Frozen plasma Cryoprecipitate Cryopoor plasma Stored plasma Plasma Derivatives- Albumin Immunoglobulin Coagulation Factors
    12 : Whole Blood (WB) 1 Unit-450ml No functional platelets No labile coagulation factors Whole blood is now rarely used for transfusion. Rate of Blood Transfusion-3ml/kg/hr
    13 : Red Cell Concentrates Also called Packed Red Cells Platelets and plasma are removed I Unit- 200- 250ml Rate of Blood Transfusion -3ml/kg/hr
    14 : Leucoreduced Red Blood Cells Most plasma & 70-80% WBC (buffy coat) are Removed from whole blood.
    15 : Leucoreduced Red Blood Cells Suitable for patients requiring repeated transfusions. Prevent febrile non haemolytic reactions. Rate of Blood Transfusion -3ml/kg/hr
    16 : Washed Red Blood Cells RBC washed with 1-2 L Normal Saline Washing removes plasma & other plasma constituents like plasma proteins , microaggregates, cytokines, and unwanted antibodies. Most important eliminates antibodies Prevent febrile non hemolytic reactions.
    17 : Washed Red Blood Cells Indications Multitransfused patients with recurrent febrile reactions Urticarial reactions Anaphylactic reactions IgA deficiency with IgA antibodies Paroxysmal nocturnul hemoglobinuria Patients with T activated cells by infections who require transfusion
    18 : Platelets Concentrate The average lifespan of a platelet is normally just 5 to 9 days. If the number of platelets is too low, excessive bleeding can occur and too high leads to thrombosis-stroke, myocardial infarction, pulmonary embolism. etc
    19 : Platelets Concentrate The unit of whole blood is centrifuged using settings that cause the platelets to become suspended in the "buffy coat" layer, which includes the platelets and the white blood cells.
    20 : Platelets Concentrate The "buffy coat" is isolated in a sterile bag, then centrifuged again to separate the platelets and plasma from the red and white blood cells.
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    22 : Platelets Concentrate Platelets are not cross-matched unless they contain a significant amount of red blood cells (RBCs), which results in a reddish-orange color to the product.
    23 : Platelets Concentrate Types of Platelets Recovered platelets(Random donor platelets) Apheresis platelets(single donor platelets)
    24 : Platelets Concentrate Indications All types of thrombocytopenia except TP(Thrombotic Thrombocytopenic Purpura) HIT(Heparin Induced Thrombocytopenia)
    25 : Granulocytes (neutrophilis) Granulocyte concentrate Buffy coat
    26 : Buffy Coat Layer between red cells & plasma also buffy coat contains platelets
    27 : Granulocytes Some clinicians believe that some patients with very low neutrophil counts can benefit from infusion of granulocyte concentrates. Clinical trials have not so far established effectiveness of the treatment
    28 : Granulocytes However granulocytes should still be considered for patients with severe neutropenia (<200/µl) and a documented life-threatening bacterial or fungal infection not responsive to appropriate antibiotic therapy.
    29 : Irradiated blood products Irradiated Blood products are exposed to approximately 2500 rads of Gamma radiation to destroy the lymphocyte’s ability to divide.
    30 : Irradiated blood products Donor lymphocytes proliferate and damage target organs, especially bone marrow, skin, liver, and gastrointestinal tract, as well as grafts or transplanted organs which ultimately can be fatal.
    31 : Irradiated blood products Transfusion-associated graft-versus-host disease (TA-GVHD) has not been reported from transfusion of cryoprecipitate or fresh frozen plasma (FFP), thus these components do not require irradiation.
    32 : Irradiated blood products Fresh plasma (not frozen) for transfusion should be irradiated if the patient is at risk for TA-GVHD.
    33 : Irradiated blood products Absolute Indications Bone marrow/ stem cell transplant Intrauterine transfusions Congenital immunodeficiency syndrome Premature newborn Neonatal exchange transfusion
    34 : Irradiated blood products Appropriate Indication Hematologic malignancies (leukemias) Hodgkin’s Disease Non-Hodgkin’s Lymphoma
    35 : Irradiated blood products
    36 : Blood warming Warming is not necessary for routine transfusions. Warming of blood increase red cell metabolism & bacterial growth. Warm by electric warmer Indication Exchange transfusion in neonates Presence of cold agglutinins Rapid infusion through CVP lines
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    38 : Blood warming As blood flows drop by drop it attains body temperature. Don’t use hot water to warm.
    39 : PLASMA INFUSION Plasma infusion contains all coagulation factors but has disadvantage that it contains along with it more and more plasma fluid which is often not desirable since it can cause volume expansion There fore one can use FFP which has more coagulation factors and very less plasma fluid.
    40 : PLASMA INFUSION Or one can use still better the cryoprecipitate which has more and more concentrated form of coagulation factors and minimal or no plasma at all. And still more one can give specific factors without any mixture
    41 : Plasma components Based on these observations we have now Stored plasma without being frozen Fresh Frozen plasma Cryoprecipitate Cryopoor plasma
    42 : PLASMA INFUSION Since plasma infusion contains all coagulation factors it can therefore be indicated in patients with documented coagulation factor deficiencies and active bleeding.
    43 : PLASMA INFUSION Deficiencies may be congenital like hemophilia or acquired secondary to liver disease, Warfarin anticoagulation, disseminated intravascular coagulation, or massive replacement with red blood cells and crystalloid/colloid solutions.
    44 : PLASMA INFUSION Plasma infusion therefore was used to treat haemophilia before more concentrated forms like FFP & cryoprecipitate came into practice latest came specific concentrates like factor VIII itself & IX.
    45 : Fresh Frozen Plasma(FFP) The liquid portion of whole blood is centrifuged and separated from red blood cells, while blood cells and platelets and is called plasma.
    46 : Fresh Frozen Plasma(FFP) When plasma is still fresh, it is immediately frozen within eight hours of collection at – 18°C or -0 °Fahrenheit. A single unit of fresh and frozen plasma separated from single unit of whole blood is also called “thawed plasma” and it contains all coagulation factors (thickened mass) in normal concentrations.
    47 : Fresh Frozen Plasma(FFP) FFP contains the labile as well as stable components of the coagulation, fibrinolytic and complement systems; the proteins that maintain oncotic pressure and modulate immunity; and other proteins that have diverse activities.
    48 : Fresh Frozen Plasma(FFP) In addition, fats, carbohydrates and minerals are present in concentrations similar to those in circulation. Used for single or multiple coagulation factor deficiencies
    49 : Fresh Frozen Plasma(FFP) FFP is efficacious for treatment of deficiencies of factors II, V, VII, IX, X, and XI when specific component therapy is neither available nor appropriate.
    50 : Fresh Frozen Plasma(FFP) FFP is useful in infants with secondary immunodeficiency associated with severe protein-losing enteropathy and in whom total parenteral nutrition is ineffectual.
    51 : Fresh Frozen Plasma(FFP) FFP also can be used as a source of immunoglobulin for children and adults with humoral immunodeficiency. However, the development of a purified immune globulin for intravenous use largely has replaced FFP.
    52 : FRESH FROZEN PLASMA FFP should not be used for Hemophilia A (facor VIII) or B (Factor IX) deficiency unless Factor VIII OR IX concentrate is not available.
    53 : Fresh frozen plasma Indications therefore are (summary) Single clotting factor deficiency Multiple clotting factors deficiencies-DIC Massive transfusions Warfarine overdose Haemorrhagic disease of neonates thrombotic thrombocytopenic purpura (TTP). Use in antithrombin III deficiency Not recommended As Plasma volume expansion
    54 : Fresh frozen plasma DOSAGE 12-15ml/kg (1unit – 200-250ml) Must be ABO compatible Storage temperature: <-300c
    55 : CRYOPRECIPITATE Any precipitate formed on cooling of a solution is called cryoprecipitate.
    56 : CRYOPRECIPITATE Cryoprecipitate is a highly concentrated form of plasma proteins that settles down at bottom as a precipitate when frozen plasma is slowly thawed at 1-6°C. This precipitate can again be separated and refrozen for use. Frozen cryoprecipitate is stable for one year at -30.One unit of whole blood forms about 15 ml of cryoprecipitate.
    57 : CRYOPRECIPITATE Cryoprecipitate was originally known as "Cryoprecipitate AHF"(Anti-haemophiliac factor." AHF).AHF is now known as Factor VIII.
    58 : CRYOPRECIPITATE Cryoprecipitate contains most of the factor VIII (the protein missing in patients with Haemophilia A), fibrinogen, factor XIII, von Willebrand's factor (helps in getting the platelets to stick together) and fibronectin from some fresh frozen plasma.
    59 : CRYOPRECIPITATE However do not use cryoprecipitate for the treatment of haemophilia, von Willebrand’s disease or deficiencies of factor XIII or fibronectin unless alternative therapies are unavailable. Because many uses of the cryoprecipitate have been replaced by factor concentrates.
    60 : CRYOPRECIPITATE Cryoprecipitate is indicated for the treatment of fibrinogen deficiency or dysfibrinogenaemia when there is clinical bleeding, an invasive procedure, trauma or disseminated intravascular coagulation (DIC).
    61 : CRYOPRECIPITATE Conversion of fibrinogen into fibrin is the last stage of the coagulation sequence. Fibrinogen plays an important role in fibrin clot formation and platelet aggregation. If fibrinogen is decreased, bleeding may ensue.
    62 : DOSE OF CRYOPRECIPITATE Dosage Depends on clinical situation and laboratory tests. Cryoprecipitate should be given when the fibrinogen level falls below 100 mg/dL, which is the minimal level needed for hemostasis.
    63 : DOSE OF CRYOPRECIPITATE Each bag of cryoprecipitate contains 200 to 250 mg of fibrinogen and will increase the plasma fibrinogen level of a 70-kg adult by 6 to 8 mg/dL. Generally, 10 bags of cryoprecipitate are given if the fibrinogen level is between 50 and 100 mg/dL and 20 bags are given if it is less than 50 mg/dL.
    64 : DOSE OF CRYOPRECIPITATE A common dose for fibrinogen replacement is 10 – 20ml/kg at a rate of 4 to 10 mL/minute. At this rate, a pool of 10 bags can be infused in approximately 30 minutes. The usual adult dose is a pool of 6 - 12 bags. The dose should be repeated every 8 to 12 hours till fibrogen levels become towards normal.
    65 : DOSE OF CRYOPRECIPITATE A fibrinogen level should be measured at 30 to 60 minutes after completion of the transfusion to determine if additional doses are needed. The therapeutic goal is to keep the plasma fibrinogen level above 100 mg/dL.A dose must not exceed an infusion time of greater than 4 hours.
    66 : DOSE OF CRYOPRECIPITATE Cryoprecipitate is sometimes useful if platelet dysfunction associated with renal failure who does not respond to dialysis.
    67 : DOSE OF CRYOPRECIPITATE I unit Contains VIII, XIII, vWF, Fibrinogen I unit =15 ml Stored at -300c
    68 : Plasma derivatives Factor VIII Factor IX Factor VIII- vWF concentrates 1.Factor VIII Indication- Hemophilia A Necessary before invasive procedures, tooth extraction, surgery.
    69 : Plasma derivatives 2.Factor IX Indication- Hemophilia B
    70 : Plasma derivatives 3.Factor VIII- vWF concentrates Indications- Type IIB & severe type III Von Willebrand’s disease
    71 : Plasma derivatives Albumin 2 preparations Human albumin solution4.5%(plasma protein fraction) Human albumin solution20%(salt poor albumin) Indications Nephrotic syndrome Liver disease with fluid overload
    72 : Plasma derivatives Immunoglobulin Normal immunoglobulin Prepared from normal plasma contain usually IgG Indications Hypogammaglobulinaemia Infections Immune thrombocytopenic purpura Specific immunoglobulin's Obtained from donors with high titers of antibodies E.g- anti-D, anti-hepatitis B& anti-Varicella zoster
    73 : Fresh Blood Blood < 5 days Source of coagulation factors, platelets & WBC
    74 :
    75 : Blood Transfusion Usually 2-4 units can be given for anaemic patients. If you need several units of blood you may need to stay in hospital overnight. However, a transfusion of only 1-2 units of blood can usually be given to you as a day patient or outpatient.
    76 : Blood Transfusion When more than ten units of packed red blood cells or whole blood is infused in 24 hours it is then called massive transfusion.
    77 : Blood Transfusion This is only likely if you have had at least 20 transfusions. Iron overload can happen because the red blood cells in each unit of blood contain a small amount of iron that builds up in the body.
    78 : Blood Transfusion The following are examples of how blood donations are put to good use: An Organ Transplant typically requires: •40 units of blood •30 units of platelets •25 units of fresh frozen plasma •20 units of cryoprecipitate
    79 : Blood Transfusion A Bone Marrow Transplant typically requires: •20 units of blood •120 units of platelets
    80 : Blood Transfusion Heart Surgery Typically requires: •6 units of blood A Burn Victim typically requires: •20 units of platelets
    81 : Blood Transfusion Someone injured in an Automobile Accident may need: •50 units or more of blood
    82 : BLOOD TRANSFUSION Blood that you receive in a transfusion must be compatible. Being compatible means that your body will not form antibodies against the blood you receive.
    83 : BLOOD TRANSFUSION Blood transfusion between compatible groups (such as O+ to O+) usually causes no problem.
    84 : BLOOD TRANSFUSION Blood transfusion between incompatible groups (such as A+ to O-) causes an immune response. This can lead to a very serious transfusion reaction. The immune system attacks the donated blood cells, causing them to burst.
    85 : BLOOD TRANSFUSION Today, all blood is carefully screened. Modern lab methods and many checks have helped make these transfusion reactions very rare.
    86 : BLOOD TRANSFUSION Symptoms of transfusion reaction usually appear during or right after the transfusion. Sometimes, they may develop after several days (delayed reaction).
    87 : DISEASES & CHOICE OF TRANSFUSION Anemia CHOICE IS PACKED RED CELLS 2ND CHOICE WHOLE BLOOD
    88 : DISEASES & CHOICE OF TRANSFUSION BLOOD LOSS IST CHOICE PACKED RED CELLS 2ND CHOICE FRESH WHOLE BLOOD
    89 : DISEASES & CHOICE OF TRANSFUSION DIC IST CHOICE CRYOPRECIPITATE 2ND CHOICE FFP
    90 : DISEASES & CHOICE OF TRANSFUSION HYPOFIBRINOGENEMIA IST CHOICE CRYOPRECIPITATE 2ND CHOICE FFP
    91 : DISEASES & CHOICE OF TRANSFUSION FACTOR VII & FACTOR X IST CHOICE PLASMA 2ND CHOICE FFP
    92 : DISEASES & CHOICE OF TRANSFUSION MASSIVE HAEMORRHAGE IST CHOICE FRESH WHOLE BLOOD 2ND CHOICE FFP
    93 : DISEASES & CHOICE OF TRANSFUSION HYPO-PROTENEMIA DUE TO RENAL DISEASE. MALNUTRITION, LIVER DISEASE IST CHOICE IV COLLOID 2ND CHOICE PLASMA
    94 : DISEASES & CHOICE OF TRANSFUSION PROTHROMBIN DEFICIENCY IST CHOICE CRYOPRECIPITATE 2ND CHOICE FFP
    95 : Complications of blood transfusion The complications can be broadly classified into two categories: Immune Complications Non-immune Complications
    96 : Complications of blood transfusion Immune complications can further be classified into two categories: Hemolytic (acute and delayed) Non-Hemolytic (includes febrile, urticarial, anaphylactic, purpura, etc.)
    97 : Complications of blood transfusion Hemolytic reactions usually involve the destruction of transfused blood cells by the recipient's antibodies. Less commonly, the transfused antibodies can cause hemolysis of the recipient's blood cells.
    98 : Complications of blood transfusion There are acute (also known as intravascular) hemolytic reactions and delayed (also known as extra vascular) hemolytic reactions.
    99 : Complications of blood transfusion Acute hemolytic reactions are usually due to ABO blood type incompatibility - in other words, human error plays a large part in these reactions.The severity of the reaction often depends upon the amount of blood given.
    100 : Complications of blood transfusion Symptoms of acute hemolytic reactions include Chills, fever, nausea, chest pain and flank pain in awake patients.
    101 : Complications of blood transfusion In anesthetized patients, you should look for rise in temperature, unexplained tachycardia, hypotension, hemoglobinuria, oozing in the surgical field, DIC, shock and renal shutdown.
    102 : Complications of blood transfusion Management of acute hemolytic reactions mandates that the transfusion be stopped immediately. The unit should be re-checked. Blood from the recipient patient should be drawn to test for hemoglobin in plasma, repeat compatibility testing and coagulation tests.
    103 : Complications of blood transfusion A foley catheter should be placed to check for hemoglobin in the urine. Osmotic diuresis with mannitol and fluids should be utilized (low-dose dopamine may help renal function and support blood pressure).
    104 : Complications of blood transfusion With rapid blood loss, platelets and fresh frozen plasma may be indicated.
    105 : Complications of blood transfusion Delayed hemolytic reactions are generally mild in comparison. These are caused by antibodies to non-D antigens of the Rh system or to foreign alleles in other systems such as the Kell, Duffy or Kidd antigens.
    106 : Complications of blood transfusion This takes weeks or months to happen - and by that time, the original transfused cells have already been cleared.
    107 : Complications of blood transfusion Re-exposure to the same foreign antigen can then cause an immune response. Thus the reaction is typically delayed from two to twenty-one days after transfusion.
    108 : Complications of blood transfusion Symptoms are generally mild and include malaise, jaundice, fever, a fall in hematocrit despite transfusion, and an increase in unconjugated bilirubin. Diagnosis may be facilitated by the direct Coombs test which can detect the presence of antibodies on the membranes of red cells.
    109 : Complications of blood transfusion Treatment is generally supportive. These reactions occur in approximately 1 in 2,500 transfusions and most often in females with previous exposure secondary to pregnancy.
    110 : Complications of blood transfusion Non hemolytic febrile reactions occur due to antibodies in recipients plasma acting against donor WBCs or platelets. In which cytokines are released by donor leukocytes.
    111 : Complications of blood transfusion The cytokines released include interleukin 1 b (IL-1 b), interleukin 6 (IL-6), and tumor necrosis factor (TNF).
    112 : Complications of blood transfusion Another theory is antigen-antibody reaction may activate complement, thus stimulating the recipient's macrophages to produce and release cytokines. Or probably cytokines released by platelets /WBC have accumulated long before in the product during storage
    113 : Complications of blood transfusion Rarely these febrile reactions are caused by bacterial contaminations of blood. The reactions include: Fever and chills within 30 minutes of starting transfusion. Urticarial Anaphylactic Pulmonary Edema (non-cardiogenic) Graft vs. Host Purpura Immune Suppression
    114 : Complications of blood transfusion Patients with a history of this reaction that require additional transfusions should receive leukocyte poor transfusions.
    115 : Complications of blood transfusion Urticarial reactions are characterized by erythema, hives and itching without fever. Again, this is a relatively common reaction and occurs in about 1% of all transfusions.
    116 : Complications of blood transfusion The use of packed red blood cells rather than whole blood has decreased the likelihood of this problem. Treatment is with antihistamines for symptomatic relief.
    117 : Complications of blood transfusion Anaphylactic reactions are rare and occur in about 1 of 150,000 transfusions. These are severe reactions that can occur with very small amounts of blood (a few milliliters).
    118 : Complications of blood transfusion Typically, these reactions occur in IgA-deficient patients with anti-IgA antibodies. These antibodies react to transfusions containing IgA. Treatment is with epinephrine, fluids, corticosteroids and supportive measures.
    119 : Complications of blood transfusion Patients with known IgA deficiency should receive thoroughly washed packed red blood cells, deglycerolized frozen red cells or IgA free blood units.
    120 : Complications of blood transfusion Some patients can develop pulmonary edema and present with a picture that looks like adult respiratory distress syndrome (ARDS). This is a rare but serious complication that is thought to be due to the transfusion of antileukocyte antibodies that interact with the patient's white blood cells causing them to aggregate in the pulmonary circulation.
    121 : Complications of blood transfusion Treatment involves respiratory support as needed.
    122 : Complications of blood transfusion Graft versus Host disease is seen exclusively in immunocompromised patients where cellular blood products containing lymphocytes are given. These lymphocytes can mount an immune response against the compromised recipient.
    123 : Complications of blood transfusion Irradiation of transfusions can be utilized to inactivate the lymphocytes prior to transfusion.
    124 : Complications of blood transfusion Post-transfusion purpura is common with the development of platelet antibodies. leading to profound thrombocytopenia which usually occurs about one week post transfusion. Plasmapheresis is the recommended treatment.
    125 : Complications of blood transfusion Immune suppression is a debatable complication. The transfusion of leukocyte-containing blood products appears to be immunosuppressive causing a decrease in Natural Killer cell function, decreased phagocytosis and decreased helper to suppressor cell ratios. The reason for this is unclear.
    126 : Non-Immune Complications The non-immune complications can also be classified into two broad categories: Non immune complications usually occurs with massive Transfusion. Infectious complications
    127 : Non-Immune Complications of blood transfusion Massive Transfusion is usually defined as the need to transfuse from one to two times the patient's normal blood volume. In a "normal" adult, this is the equivalent to more than 10 units.
    128 : Non-Immune Complications of blood transfusion Potential complications from this include coagulopathy, citrate toxicity, hypothermia, acid-base disturbances and changes in serum potassium concentration.
    129 : Non-Immune Complications of blood transfusion The most common cause of bleeding following a large volume transfusion is dilutional thrombocytopenia. This should be suspected and treated first before moving on to factor deficiencies.
    130 : Non-Immune Complications of blood transfusion Citrate toxicity results when the citrate in the transfused blood begins to bind calcium in the patient's body. Clinically significant hypocalcemia does not usually occur unless the rate of transfusion exceeds one unit every five minutes or so.
    131 : Non-Immune Complications of blood transfusion Citrate metabolism is primarily hepatic - so hepatic disease or dysfunction can cause this effect to be more pronounced. Treatment is with intravenous calcium administration .
    132 : Non-Immune Complications of blood transfusion Hypothermia should not occur on a regular basis. Massive transfusion is an absolute indication for the warming of all blood and fluid to body temperature as it is being given.
    133 : Non-Immune Complications of blood transfusion Acid-Base balance can be seen after massive transfusion. The most common abnormality is a metabolic alkalosis.
    134 : Non-Immune Complications of blood transfusion Patients may initially be acidotic because the blood load itself is acidic and there may be a prevailing lactic acidosis from hypoperfusion.
    135 : Non-Immune Complications of blood transfusion However, once normal perfusion is restored, any metabolic acidosis resolves and the citrate and lactate are then converted to bicarbonate in the liver.
    136 : Non-Immune Complications of blood transfusion Serum potassium can rise as blood is given. The potassium concentration in stored blood increases steadily with time.
    137 : Non-Immune Complications of blood transfusion The amount of potassium is typically less than 4 milliequivalents per unit - so you can see that large amounts of blood at a high rate of delivery is required to raise serum levels of potassium.
    138 : Non-Immune Complications of blood transfusion Infectious Agents can be passed along with blood transfusion as well. Hepatitis AIDS Other viral agents (CMV, EBV, HTLV) Parasites and bacteria
    139 : Non-Immune Complications of blood transfusion The incidence of hepatitis following transfusion was as high in the past and overwhelming majority of these infections was caused by hepatitis C.Now that this virus is identified and tested for, the risk is decreased now.
    140 : Non-Immune Complications of blood transfusion AIDS is a feared disease but the actual risk is quite low. All blood is tested for the anti-HIV-1 antibody which is a marker for infectivity.
    141 : Non-Immune Complications of blood transfusion Unfortunately, there is a 6-8 week period required for a person to develop the antibody after they are infected with HIV and therefore infectious units can go undetected.
    142 : Non-Immune Complications of blood transfusion CMV and EBV are usually the cause of only asymptomatic infection or mild systemic illness.
    143 : Non-Immune Complications of blood transfusion Unfortunately, some of these people become asymptomatic carriers of the viruses and the white blood cells in blood units are capable of transmitting either virus.
    144 : Non-Immune Complications of blood transfusion Immunocompromised and immunosuppressed patients are particularly susceptible to CMV and should receive CMV negative units only.
    145 : Non-Immune Complications of blood transfusion Human T cell Lymphocytic Viruses (HTLV-1 responsible for tropical spastic paresis and HTLV-II) are leukemia and lymphoma retro-viruses that have been reported to be transmitted via transfusion.
    146 : Non-Immune Complications of blood transfusion Screening is done for these, but again those in the window before antibodies are made can be missed.
    147 : Non-Immune Complications of blood transfusion Parvovirus B19 has been reported to be transmitted by factor concentrates. It is associated with aplastic anemia and liver failure, especially in immunologically compromised children.
    148 : Non-Immune Complications of blood transfusion Parasitic diseases reported to be transmitted via blood transfusion include malaria, toxoplasmosis, and Chagas' disease.
    149 : Non-Immune Complications of blood transfusion Fortunately, such cases are rare and the prevalence of these diseases is very low in the United States. Therefore, these are of very little concern in this country.
    150 : Non-Immune Complications of blood transfusion Both gram-positive and gram-negative bacteria can rarely contaminate blood transfusions. To avoid the possibility of significant bacterial contamination, blood should be administered over a period of shorter than four hours.
    151 : Exams and Tests to be done in case of blood transfusion reaction Bilirubin CBC Coombs' test, direct Coombs' test, indirect Fibrin degradation products Haptoglobin Hematocrit Hemoglobin
    152 : Exams and Tests to be done in case of blood transfusion reaction RBC count Serum creatinine Serum hemoglobin Urinalysis for any haemoglobinuria
    153 : GENERAL MEASURES TO PREVENT AND TREAT REACTIONS MONITORING THE TRANSFUSED PATIENT For each unit of blood transfused, monitor the patient: Before starting the transfusion As soon as the transfusion is started 15 minutes after starting the transfusion At least every hour during transfusion On completion of the transfusion 4 hours after completing the transfusion.
    154 : GENERAL MEASURES TO PREVENT AND TREAT REACTIONS At each of these stages, record the following information on the patient’s chart Patient’s general appearance Temperature Pulse Blood pressure Respiratory rate . Fluid balance: — Oral and IV fluid intake — Urinary output
    155 : GENERAL MEASURES TO PREVENT AND TREAT REACTIONS Record: Time the transfusion is started Time the transfusion is completed Volume and type of all products transfused Unique donation numbers of all products transfused Any adverse effects.
    156 : GENERAL MEASURES TO PREVENT AND TREAT REACTIONS Severe reactions most commonly present during the first 15 minutes of a transfusion. All patients and, in particular, unconscious patients should be monitored during this period and for the first 15 minutes of each subsequent UNIT
    157 : GENERAL MEASURES TO PREVENT AND TREAT REACTIONS Acute transfusion reactions occur during or shortly after (within 24 hours) the transfusion.
    158 : TREATMENT -CATEGORY 1: MILD REACTIONS Immediate management 1 Slow the transfusion. 2 Administer antihistamine IM (e.g. chlorpheniramine 0.1 mg/kg or equivalent). 3 If no clinical improvement within 30 minutes or if signs and symptoms worsen, treat as Category 2.
    159 : TREATMENT CATEGORY 2: MODERATELY SEVERE REACTIONS Immediate management 1 Stop the transfusion. Replace the infusion set and keep IV line open with normal saline. 2 Notify the doctor responsible for the patient and the blood bank immediately.
    160 : TREATMENT CATEGORY 2: MODERATELY SEVERE REACTIONS 3 Send blood unit with infusion set, freshly collected urine and new blood samples (1 clotted and 1 anticoagulated) from vein opposite infusion site with appropriate request form to blood bank for laboratory investigations.
    161 : TREATMENT CATEGORY 2: MODERATELY SEVERE REACTIONS 4 Administer antihistamine IM (e.g. chlorpheniramine 0.1 mg/kg or equivalent) and oral or rectal antipyretic (e.g. paracetamol 10 mg/kg: 500 mg – 1 g in adults). Avoid aspirin in thrombocytopenic patients.
    162 : TREATMENT CATEGORY 2: MODERATELY SEVERE REACTIONS 5 Give IV corticosteroids and bronchodilators if there are anaphylactoid features like bronchospasm,stridor 6 Collect urine for next 24 hours for evidence of haemolysis and send to laboratory.
    163 : TREATMENT CATEGORY 2: MODERATELY SEVERE REACTIONS 7 If clinical improvement, restart transfusion slowly with new blood unit and observe carefully. 8 If no clinical improvement within 15 minutes or if signs and symptoms worsen, treat as Category 3.
    164 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS Signs Rigors Fever Restlessness Hypotension (fall of =20% in systolic BP)
    165 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS Tachycardia (rise of =20% in heart rate) Haemoglobinuria (red urine) Unexplained bleeding (DIC)
    166 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS Immediate management 1 Stop the transfusion. Replace the infusion set and keep IV line open with normal saline. 2 Infuse normal saline (initially 20–30 ml/kg) to maintain systolic BP. If hypotensive, give over 5 minutes and elevate patient’s legs.
    167 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS 3 Maintain airway and give high flow oxygen by mask. 4 Give adrenaline (as 1:1000 solution) 0.01 mg/kg body weight by slow intramuscular injection. 5 Give IV corticosteroids and bronchodilators if there are anaphylactoid features (e.g. broncospasm, stridor).
    168 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS 6 Give diuretic: e.g. frusemide 1 mg/kg IV or equivalent. 7 Notify the doctor responsible for patient and blood bank immediately
    169 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS 8 Send blood unit with infusion set, fresh urine sample and new blood samples (1 clotted and 1 anticoagulated) from vein opposite infusion site with appropriate request form to blood bank for investigations. 9 Check a fresh urine specimen visually for signs of haemoglobinuria.
    170 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS 10 Start a 24-hour urine collection and fluid balance chart and record all intake and output. Maintain fluid balance.
    171 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS Assess for bleeding from puncture sites or wounds. If there is clinical or laboratory evidence of DIC , give platelets (adult: 5–6 units) and either cryoprecipitate (adult: 12 units) or fresh frozen plasma (adult: 3 units).
    172 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS 12 Reassess. If hypotensive Give further saline 20–30 ml/kg over 5 minutes Give inotrope, if available. 13 If urine output falling or laboratory evidence of acute renal failure (rising K+, urea, creatinine): Then Maintain fluid balance accurately Give further frusemide Consider dopamine infusion, if available
    173 : TREATMENT -CATEGORY 3: LIFE-THREATENING REACTIONS Seek expert help: the patient may need renal dialysis. 14 If bacteraemia is suspected (rigors, fever, collapse, no evidence of a haemolytic reaction), start broad-spectrum antibiotics IV.
    174 : GENERAL MEASURES TO PREVENT AND TREAT REACTIONS The blood is run through a filter hooked to the IV. The filter cleans small pieces of platelets and WBCs out of the blood.
    175 : GENERAL MEASURES TO PREVENT AND TREAT REACTIONS All patients receiving blood products should be placed on continuous cardiac monitoring and pulse oximetry.
    176 : In case of Hemolytic transfusion reaction Stop transfusion as soon as a reaction is suspected. Replace the donor blood with normal saline. Examine the blood to determine if the patient was the intended recipient and then send the unit back to the blood bank. Furosemide may be administered to increase renal blood flow. Low-dose dopamine may be considered to improve renal blood flow. 0Make efforts to maintain urine output at 30-100 mL/h.
    177 : In case of Nonhemolytic transfusion reaction Aggressive treatment of simple febrile reactions is not necessary. However, because the nonspecific symptoms are similar to those of a hemolytic transfusion reaction, differentiating this entity from a hemolytic reaction is necessary.
    178 : In case of Nonhemolytic transfusion reaction The transfusion should be terminated. Evaluate the patient for evidence of hemolysis. The patient's fever can be treated with acetaminophen.
    179 : In case of Anaphylactic reaction Stop the transfusion immediately. Support the airway and circulation as necessary. Administer epinephrine, diphenhydramine, and corticosteroids. Maintain intravascular volume.
    180 : In case of Minor allergic reaction Administer antihistamines. Although the necessity of stopping the transfusion is unclear, in more severe cases and in uncertain cases, the transfusion should be stopped.
    181 : In case of Transfusion-related acute lung injury Monitor oxygen saturation. Provide supplemental oxygen to maintain oxygen saturation greater than 92%. Hypoxemia severe enough to require endotracheal intubation and positive-pressure ventilation occurs in 70-75% of patients. No evidence supports the routine use of corticosteroids. The blood bank should be notified.
    182 : GVH disease No effective therapies currently exist. Emphasis needs to be placed on prevention.
    183 : In case of Massive transfusion To decrease the risk of hypothermia in patients receiving massive transfusion, administer the blood through a blood warmer. Do not place blood in a microwave oven to warm, as this causes hemolysis.
    184 : In case of FFP Do not administer platelets and fresh frozen plasma routinely. Only administer with evidence of abnormal bleeding associated with thrombocytopenia or an elevated PT or aPTT.
    185 : In case of FFP Treat symptomatic hypocalcemia with calcium chloride or calcium gluconate.
    186 : (Prognosis) The outcome depends on the severity of the reaction. The disorder may disappear without problems. Or, it may be severe and life threatening.
    187 : Other Complications Other Complications Acute kidney failure Anemia Discomfort Lung dysfunction Shock
    188 : Prevention Donated blood is put into ABO and Rh groups to reduce the risk of transfusion reaction. Before a transfusion, patient and donor blood is tested (crossmatched) to see if it is compatible. A small amount of donor blood is mixed with a small amount of patient blood. The mixture is checked under a microscope for signs of antibody reaction.
    189 : DRUGS COMMONLY USED IN BLLOD TRANSFUSION REACTIONS & THEIR DOSAGE Allergic (IgE mediated) Common skin reactions Anaphylaxis in severe cases(broncospasm plus low BP) Hydrocortisone IV 100 mg Chlorpheniramine IV 10 mg Adrenaline IV 1 ml of 1in 10,000
    190 : DRUGS COMMONLY USED IN BLLOD TRANSFUSION REACTIONS & THEIR DOSAGE Fébrile réactions (anti leucocyte antibodies) Paracetamol 500mg to 1gm oral can give I/M also Hydrocortisone plus chlorphenaramine in severe cases
    191 : DRUGS COMMONLY USED IN BLLOD TRANSFUSION REACTIONS & THEIR DOSAGE Delayed extravascular hemolysis( recipient antibody mediated e.g., to - Duffy. Kelly) unexpected fall of BP at 7-10 days, Jaundice,+ve Coombs test. Direct Coombs test-detects IgG antibodies on red cell Indirect Coombs test-detects IgG and IgM antibodies in serum used during pregnancy.
    192 : DRUGS COMMONLY USED IN BLLOD TRANSFUSION REACTIONS & THEIR DOSAGE For wheezing Aminophyline 125-250 mg IV slowly over 5 minutes support (O2, ventilation) Severe cases may require assisted ventilation with high FIO2.
    193 : DRUGS COMMONLY USED IN BLLOD TRANSFUSION REACTIONS & THEIR DOSAGE Epinephrine For severe, acute reactions including laryngeal edema or bronchospasm. 0.1-0.5 mg (0.1-0.5 mL of a 1:1000 solution) SQ; may repeat q 10-15 min. total SQ dose rarely > 5mg/24hr.
    194 : DRUGS COMMONLY USED IN BLLOD TRANSFUSION REACTIONS & THEIR DOSAGE To Prevent ARF IVF: loading dose of NS or D5/0.45NS. Maintain UOP > 1 ml/kg/h (e.g., IVF 100 mL/hour) until the urine is free of hgb. Lasix 40-80 mg IV. May repeat x 1. Lack of response in 2-3 hours indicates the presence of acute renal failure. Peds: Lasix 1-2 mg/kg/dose. May repeat x1 at 2-4 mg/kg. Mannitol
    195 : DRUGS COMMONLY USED IN BLLOD TRANSFUSION REACTIONS & THEIR DOSAGE For infections Blood culture for any infection broad spectrum antibiotics
    196 : Teaching should be such that what is offered is perceived as a valuable gift and not as a hard duty.

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