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Transfusion

  1. Required if blood loss> 20% or Haematocrit falls below 30
  2. Blood can be stored for 35 days if CPRA is used
    1. Citrate as anticoagulant
    2. Dextrose - energy for red cells
    3. Phosphate as buffer
    4. Adenine to RBC survival
  3. For 42 days if ADSOL (adenine, glucose, mannitol & NaCl) or Nutrite (Adenine, glucose, citrate, phosphate, & NaCl are used
  4. Blood is stored at 4oC
  1. Changes in stored blood
    1. pH = (6.98 at 35 days)
    2. Hb conc. (70% at 35 days)
    3. Potassium (K+)
    4. 2,3 DPG -
    5. Platelets - only 50% after 6-8 hrs. of storage & only 5% after 24 -48hrs.
  2. Coagulation factors -
    1. Factor V - Only 15% after 21 days
    2. Factor VIII - 50% after 21 days
    3. 1 unit of blood increases Hb by 1 gm%
    4. Hematocrit of stored blood 40% (Hb 12 gm%)
  3. Complication Of Blood Transfusion
    1. Transmission of viral diseases
      1. Hepatitis
      2. AIDS
      3. Cytomegalovirus
      4. HTLV type I
      5. Syphilis
      6. Malaria
      7. Yersinia enterocolitica
      8. Herpes
      9. Toxoplasmosis
      10. IMN
      11. leishmaniasis
      12. filariasis
      13. brucellosis
    2. Transfusion reactions
      1. Allergic - mild
        1. Rx - Diphenyl hydramine + steroid
        2. Slowing the rate of delivery
      2. Severe
        1. Immediately stop transfusion
        2. Epinephrine
      3. Febrile - mild with no hypotension
        1. Rx - no Rx required
        2. Severe - stop transfusion
      4. Haemolytic reactions (1 in 5000)
         
        S/S
        1. Fever with rigor & chills
        2. Chest pain / flank pain
        3. Nausea
        4. Flushing
        5. Dysnea
        6. Hypotension (*)
        7. Peritracheal Haemmorrlage (*)
        8. Hemoglobinuria (*)
           
          (*) S/S observed under anaesthesia
Rx
  1.  STOP transfusion
  2.  Maintain urine output (1-2 ml/min)
    • Fluid administration
    • Mannitol
  3. Alkalinize urine
    • Soda bicarbonate
  4. Assay urine Hb, platelet count, PTT, fibrinogen.
  5. Send remaining blood to blood bank for recross match
     
    Delayed Haemolytic reactions (2-21 days)
    • Decrease Hematocrit
    • Hemoglobinuria
  1. Acid base abnormal
     
    Variable results (citrate causes alkalosis pH of blood causes acidosis)
  2. Hyperkalemia especially if rate of infusion is high
  3. Hypocalcemia
  4. Coagulation abnormal
    1. bleeding tendency because of - dilutional thrombocytopenia
    2. Coagulation factors
    3. Haemolytic reaction
Rx
  1. Fresh blood transfusion is the best management
  2. Component therapies
  1. Infusion of microaggregates
  2. Immunosuppression
  3. Hypothermia





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