Homologous Blood Trasfusion Practice Shorts

HOMOLOGOUS BLOOD TRASFUSION
PRACTICE
Dr . Prasad Ingley.
Junior Resident I I
NKP Salve Institute of Medical Sciences & L.M.H. Nagpur, India.
MUST BEFORE TRANSFUSION
 Disposable sterile transfusion sets.

 170 to 200 micron filters.
 By physician or qualified nurse
 Blood grouping.
 Cross – matching & compatability testing.
 Inspection of blood / blood product bag.

TIME LIMIT FOR THE INFUSION
 Whole blood or packed cells – start within 30 minutes &

complete within 4 hours.
 Platelet concentrate – As soon as received and complete

within 15 – 20 minutes.
Do not put in refrigerator.
 Fresh frozen plasma – As soon as possible after thawing

& complete within 15 – 20 minutes.
MONITORING THE
TRANSFUSED PATIENTS
 Before starting the transfusion.
 As soon as the transfusion is started.
 For 15 minutes after starting transfusion.
 At least every hr during transfusion.
 On completion of transfusion.
 4 hours after completing transfusion.

MONITORING THE
TRANSFUSED PATIENTS
For-
 Patient’s general appearance.

 Temperature, BP, Respiratory rate.
 Signs of any adverse reactions –
 Fever with back pain (Acute Hemolytic T.R.)
 Anaphylaxis, hives or pruritis (urticarial reaction )
 Congestive heart failure (Volume overload )
 Fever alone (Febrile non hemolytic T.R.)

PRECAUTIONS DURING INFUSION
 Only isotonic saline ( 0.9 %) or 5 % albumin can be

used to dilute blood component.
 Blood Warming is not required :

Infusion of 2-4 units of refrigerated blood over several hours
causes no harm.
WHO NEEDS WARM BLOOD?
 Adults receiving multiple transfusion

at rate >50 ml/ kg/hr.
 Children receiving transfusions
at rate >15 ml/ kg/hr.
 Infants receiving exchange transfusions.
 Patients receiving rapid transfusion through central venous
catheter.
 Patients with cold agglutinins.
TRANSFUSION REACTIONS
 Category I – Mild reactions.
Symptom Possible cause Management

& signs
Itching, Hypersensitivity -Slow the t/f

rashes -Antihistaminics
Category II – Moderate reactions.
Symptom & Possible Management
signs Causes
Anxiety, Hypersensitivity, Stop t/f, keep IV
itching, FNHTR- line open, inform,
flushing, Ab- WBCs/ send blood unit to
rigor, fever, platelets/proteins bank with fresh
palpitation (IgA), blood and urine
headache, contamination samples,
dyspnoea, antihistaminic,
tachycardia steroids,
bronchodilator
Category III – Life threatening .
Symptom & Possible causes Management

signs
Chest pain, Acute hemolysis, With measures in
pain at t/f bact. catg. II-
site, resp. Contamination, fluid Maintain air way,
distress, low overload, oxygen, adrenalin,
back pain, anaphylaxis, diuretics, steroids,
fever, TRALI. fluid balance,
tachycardia DIC- platelets
hypotension
Hypotension-
, red urine,
dopamine
DIC
Infection- antibiotics
MASSIVE BLOOD TRANSFUSION
 This is defined as the transfusion of the equivalent of the the

circulating blood volume within a 24hour period (in practice 10-20
units in an adult)
 Common identifications for massive blood transfusion are
major trauma,
gastrointestinal bleeding,
obstetrics complications.
MASSIVE TRANSFUSION
GUIDELINES
Criteria for Activation of the MTG:
 1. Adult patients requiring > 4 units of PRBCs in first hour of
resuscitation or pediatric patient requiring > 20 ml/kg of PRBCs in
first hour of resuscitation.
 2. Adult patients with the high likelihood of requiring transfusion of

> 10 units of PRBCs within the first 12 hours of resuscitation or
pediatric patient with the high likelihood of requiring transfusion of
> 0.1 units/kg of PRBCs within the first 12 hours of resuscitation.
Major problems associated with massive blood
transfusion include,
•Citrate toxicity & hypocalcemia.
•Acidosis.
•Underlying coagulopathy.
•Dilutional thrombocytopenia.
•Lack of coagulation factor 5 & 8 & fibrinogen.
•Hyperkalaemia.
•Hypothermia.
•Microaggregates
MANAGEMENT OF A PATIENT WHO IS BLEEDING
ALGORITHM FOR DIAGNOSING & TREATING A MASSIVE BLOOD LOSS
From blood sample CBC,PC,PT,PTT,

FIBRINOGRN
Blood to lab 4
units PRBC in ED
Indications for type O
NO blood :BP<70 mmHg
Indication for Crystalloid + re-evaluate
immediate transfusion
Indications for transfusion protocol
YES BP<90 mmHg .
Give 2 units PRBCS
NO Crystalloid + bl .by lab values Blood loss=circulating volume.
YES
Review lab results YES Give 4 units of FFP & 6 Monitoring protocol
Coagulopathy present? packs of platelets HCT,PT,PTT,PC,
NO
HCT < 30 % ?
YES Give whole blood or
Transfusion thresholds HCT,PT,PTT,
PRBCS to HCT 30
NO INR>2.0 Usually.
PC<75,000,Fibrinogen<100mg/dl
PT > transfusion
threshold?
NO
Give 6 packs of platelets to
PC < transfusion threshold? YES PC 25-50,000
NO
Anticipated ongoing Transfuse to maintain thresholds:
blood loss HCT<30% FFPwith PC ratio of 1:1
NO Platelates with PC in ratio 1:1
De-activate massive
transfusion protocol
METHODS FOR REDUCED BLOOD USE IN
SURGERY
 PREOPERATIVE
* Surgery elective – Correct the Haemoglobin level.
Stop drugs that interfere Haemostasis
 INTRAOPERATIVE
 Posture
 Use of Vasoconstrictors
 Use of tourniquets
 Use of anti-fibrinolytic drugs eg Aprotinin
 Using Fibrin Sealant
 POST OPERATIVELY
 Blood can be salvaged from drains into collection devices that permit reinfusion
 Decision to transfuse post operatively should depend

* Age of the patient
* Ability to tolerate lower levels of anaemia
* Rate & amount of continuing blood loss
PEDIATRIC TRANSFUSION
 RED CELLS - 10 – 15 ml/kg.
 PLATELETS - 5 - 10 ml/kg.
 FFP - 10 – 15 ml/kg.
 CRYOPRECIPITATES – 1- 2 unit/kg.
NO ONE SHOULD DIE WITHOUT BLOOD.
NO ONE SHOULD DIE WITHOUT BLOOD

DONATION.
Thank yoU!

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HOMOLOGOUS BLOOD TRASFUSION

 Disposable sterile transfusion sets.

 By physician or qualified nurse

 Cross – matching & compatability testing.

 Inspection of blood / blood product bag.

 Whole blood or packed cells – start within 30 minutes &

 Platelet concentrate – As soon as received and complete

 Fresh frozen plasma – As soon as possible after thawing

 As soon as the transfusion is started.

 For 15 minutes after starting transfusion.

 At least every hr during transfusion.

 4 hours after completing transfusion.

 Patient’s general appearance.

 Signs of any adverse reactions –

 Fever with back pain (Acute Hemolytic T.R.)

 Anaphylaxis, hives or pruritis (urticarial reaction )

 Congestive heart failure (Volume overload )

 Fever alone (Febrile non hemolytic T.R.)

 Only isotonic saline ( 0.9 %) or 5 % albumin can be

 Blood Warming is not required :

 Adults receiving multiple transfusion

Symptom Possible cause Management

Itching, Hypersensitivity -Slow the t/f

Symptom & Possible causes Management

 This is defined as the transfusion of the equivalent of the the

 Common identifications for massive blood transfusion are

 2. Adult patients with the high likelihood of requiring transfusion of

From blood sample CBC,PC,PT,PTT,

 Decision to transfuse post operatively should depend

NO ONE SHOULD DIE WITHOUT BLOOD

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