BLOOD TRANSFUSIONS

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Slide 1 : COMPLICATIONS AND TREATMENT OF BLOOD TRANSFUSIONS By $@G@R KIMS, amalapuram.
Slide 2 : TYPES OF COMPLICATIONS: A.Transfusion reactions. B. Transmission of diseases. C.Reactions due to massive transfusion. D.Complications of over transfusion. E.Complications of general I.V. fluid administration. Transfusion reactions: Incompatibility Pyrexial reactions Allergic reactions Sensation to leucocytes and platelets
Slide 3 : Incompatibility: Causes: Incompatible blood group transfusion.Mainly ABO incompatibility,called as delayed hemolytic transfusion reaction. Transfusing blood alredy hemolysed by heating/over freezing/ shaking. Transfusing blood after expiry date.C/F:Initially rigor,fever. If patient not anaesthetised,c/o headache,nausea and vomiting, tingling sensation at extrimities, tightness in chest, dyspnoea. Loin pain charecteristic of renal tubular blockade, urine out put decreases , heamoglobinuria in 2-3 hrs, jaundice a definite sign in 24-36hrs ultimately renal failure due to heamatin.If a shock p/t condition aggravates.
Slide 4 : Treatment: Stop transfusion, give I.V. fluids. Alkalinise blood by 10ml isotonic sodium lactate &10 ml NaHCO3 to avoid precipitation of haematin. Furosemide 80-120mg I.V. to inc diuresis. Antihistaminic& Hydrocortisone, hemodialysis in extreme cases Pyrexial reactions: Causes: Improperly sterilised transfusion sets Pyrogens in donar apparatus Transfusing infected blood. Presence of sulphur compounds in rubber tubing. Rapid transfusion. C/F:pyrexia, chills, rigor, restlessness,headache,tachycardia, nausea& vomiting.
Slide 5 : Prevention:using plastic disposable sets. Treatment:stop transfusion temporarily, give antipyretics,antihistaminacs. If patient recovered start transfusion with new set &slow rate. It is called as Febrile non hemolytic transfusion reaction. Allergic reactions: Causes: Allergic to plasma products of donar’s blood. C/F:mild tacycardia,urticarial rash ,fever& dyspnoea. Acute cases include circulatory failure & anaphylaxis. Treatment: stop transfusion, Antihistaminics –chlorpheniramine, diphenhydramine. Hydrocortisone& calcium for acute anaphylaxis.
Slide 6 : Sensitisation to leucocytes&platelets Causes:developing Ab to donar’s WBC& platelets by p/t. Prevention: by giving packed cells. Treatment: antipyretics, antihistaminics& steroids. Transmission of diseases: more common mode. Serum hepatitis: called as non-A,non-B type in developed countries. Hepatitis-B more common in India. So every donar to be tested for Hep-B Ag. C/F of Hep-B manifests within 3 months of transfusion. AIDS: but less common compared to Hep-B. Bacterial infections: uncommon but due to faulty storage
Slide 7 : Improper refrigeration and is evidenced by septicaemia in recipient. Reactions by massive transfusion: Acid base imbalance: citrate in anticoagulant soln of sodium citrate becomes consumed and NaHCO3 forms causing alkalosis of blood. Hyperkalaemia: in stored blood k+ ions upto 30mEq/L due to shift of ions out from RBC at low temp storage. Transfused RBC take back same number of ions but end result is hypokalemia due to alkalosis. Citrate toxicity: excess citrate may use body calcium but rarely problematic then give calcium supplements. Hypothermia: in urgent cases refregirated blood directly given to p/t may drop bodily temp to 3-4 degrees.
Slide 8 : Failure of coagulation: 2 factors involved: Dilution of platelets & clotting factors by transfusion and stored blood has low platelets, clotting factors-V,VIII etc,fibrinogen hypothermia,DIC following a incompatable transfusion also seen. Treatment: maintain core body temp. correct acidosis, replete ions& transfusion with fresh frozen plasma, platelet concentrate or cryoppt. If DIC heparin is used. Complications of over transfusion : Noticed in cases of chronic anaemia in children and elderly then transfuse packed cells to avoid CCF. Treatment:packed cells transfused and diuretics used. Transfusion at rate of 4-6 hrs, not continuos and not > 300ml.
Slide 9 : Complications of general I.V. administration: Common complications are a)thrombophlebitis b) air embolism etc; Acute lung injury: due to anti-HLA Ab & antigranulocyte Ab development against granulocytes in lung may cause lung injury in the recipient. It is the 2nd most common cause for death in transfusion related reactions. Chest X-ray shows non cardiogenic pulmonary edema type view.
Slide 10 : THANK YOU

 


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