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blood, blood product, blood transfusion

  1. 1. Blood, Blood Products and Blood Transfusion By; SITI AFIFAH MARDHIYYAH Supervisor; DR SALEHUDIN
  2. 2. Contents • Definition • Functions of the blood • Blood products • Indication for transfusion • Maximum surgery blood order schedule (MSBOS) • blood transfusion: hemovigilance • Blood transfusion reaction and its management • Other complications of blood transfusion • Take home massage
  3. 3. Definition: • Blood - connective tissue (fluid) consisting of plasma and cellular component. • 8% of total BW
  4. 4. Functions of the blood • supplies o2 and substances absorbed from the GIT to the tissues. • returns co2 to the lungs, and other products of body metabolism to the kidneys. • Transport hormones produced by respective glands of endocrine systems Transportation • White cells- preotection of the body againts pathogen • Platelets- limiting blood lossProtection • Body temperature • blood pressure • pH balanceRegulation
  5. 5. Blood product & Blood Transfusion • Blood product- A blood product is any component of the blood which is collected from a donor for use in a blood transfusion • Blood transfsusion-is the process of transferring blood or blood components from one person into the circulatory system of another
  7. 7. Blood products Whole blood • Blood taken from a suitable donor using a pyrogen free anticoagulant container. The major use is used for blood component separation. Packed red cells • A component derived by removing part of the plasma from whole blood Platelet • A component derived from fresh whole blood by centrifugation which contain majority of the platelets content in theraputically effective form.
  8. 8. Fresh frozen plasma • A component prepared either from fresh whole blood or from plasma collected by apheresis, frozen at an appropiate temperature to preserve the activity of labile coagulation factors. Cryoprecipitate • A component containing the cryoglobulin fraction of plasma obtained by further processing of fresh frozen plasma prepared from hard spun cell free plasma and concentrated to a final volumes required. Cryosupernatqant • A component prepared from plasma by removal of cryoprecipitate
  9. 9. Indication for transfusion of blood product 1. Packed red cells
  10. 10. 2. Platelet Hematological malignancies To maintain platelet > 20x 109 Massive transfusion Acute bleeding, multiple trauma DIVC Acute DIC, aim to maintain platelet >50x109 CABG/ Ruptured AAA Reserved for post op bleeding Immune thrombocytopaenia Platelet function disorders If all other measures fail to control the bleeding
  11. 11. 3. Fresh Frozen Plasma
  12. 12. 4. Cryoprecipitate
  13. 13. Maximum surgery blood order schedule (MSBOS) • Reference used to guide clinicians in ordering blood before surgery. • The Maximum Surgical Blood Order Schedule (MSBOS) is a table of elective surgical procedures which lists the number of units of blood routinely requested, and cross-matched for them pre-operatively.
  14. 14. MSBOS • For cases where blood; –Not likely to be transfused – GSH is perfomed. –Likely to be transfused – GXM is performed. *However when antibody screen is positive, compatible blood must be made available in all cases before surgery
  15. 15. Group Crossmatch • The patient's serum is screened and tested directly for compatibility with the red cells of the units of blood to be transfused. • Crossmatched blood will retained for 48hours in blood bank. Group, Screen, Hold • Consist of process ABO, Rh D grouping and antibody screen • Serum/plasma is retained for 48 hours in the blood bank.
  16. 16. MSBOS ; General surgery Abdominal – perineal resection 4 cholecystectomy GSH Gastectomy 2 Hemicolectomy, small bowel resection GSH Hiatus hernia repair Abdominal Transthoracic 2 GSH Inguinal hernia repair GSH Laparotomy GSH Perforated viscus 2 Mastectomy GSH Oesophagectomy 4 Pancreatectomy 4 Portocaval shunt 4 Spelenectomy 2 Thyroidectomy, Parathyroidecomy GSH Varicose vein GSH Vagotomy GSH Whipples procedure 4
  17. 17. C:T Ratio • Crossmatch : transfusion ratio • An indicator to assess the appropriateness of cross matching of blood to the units of blood transfused • Standard value ≤2.5
  18. 18. C: T ratio • C: T ratio surgical department for the year 2013 JAN FEB MAC APR MAY JUN JUL AUG SEP OKT NOV DIS GXM 467 497 626 341 569 550 495 538 509 315 270 547 TRANSFUSIO N 231 235 379 158 289 280 260 280 253 301 231 268 RATIO 2.0 2.1 1.7 2.2 2.0 2.0 1.9 1.9 2.0 1.0 1.2 2.0
  19. 19. Consent of blood transfusion • Written consent • Patient should be explained regarding the benefits and risks of blood transfusion • Explain: – Indication – Complications • Infection • Reaction • The patient’s consent should be obtained for the planned transfusion and recorded in the patient’s medical chart.
  20. 20. Hemovigilance • Haemovigilance is a system of surveillance and alarm, from blood collection to the follow-up of the recipients. 1. Blood taking 2. Giving blood
  21. 21. 3 3 2 1 2 1 BLOOD BANK
  22. 22. Monitor adverse effects VITAL SIGN SYMPTOMS • BP • PR/HR • RR • Temperature • Fever • Chills and rigors • Pain at infusion site/abdomen/chest • Respiratory distress • Urticaria/rashes • Nausea/vomiting
  23. 23. COMPLICATION OF BLOOD TRANSFUSION • Acute – during transfusion/within 24 hours • Delayed – after 24 hours IMMUNE MEDIATED NON-IMMUNE MEDIATED ACUTE DELAYED ACUTE DELAYED • Hemolytic reaction • Febrile non- hemolytic • Urticaria • Anaphylactic • Hemolytic Reaction • Post Transfusion Purpura • Graft Vs Host Disease • Septic • Circulatory Overload • Metabolic • Hyperkalemia • Hypocalcaemia • Metabolic alkalosis • Infection • Iron Overload
  24. 24. Management of transfusion reaction ADVERSE EFFECT STOP TRANSFUSION Pruritus Urticaria, Rashes Chest pain, pain at infusion site, respiratory distress, loin/back pain Hypotension, hematuria, DIC Anxiety, SOB, Palpitation, Headache Flushing, Rigor, Fever, Tachycardia, Restless • Antihistamine • If symptoms subside : resume transfusion at slower rate • Maintain A, B, C • Adrenaline Furosemide/ corticosteroid/ bronchodilator/ antibiotic • Antihistamine and/or Antipyretic • Withold transfusion LIFE THREATENINGMODERATEMILD
  25. 25. Investigations • Blood reaction kit (immediate & post 24hr) • 4ml in plain tube for antibody identification • 2ml in EDTA tube for FBP • >10ml urine sample- may have haemoglobin and albumin • The remaining blood bag, containing the partially transfused blood, and all the blood bags cross-matched for the same patient at the same time of the request should be examined for the presence of free haemoglobin or discolouration before being sent to the laboratory.
  26. 26. • The “Report of Reaction to Blood or Plasma Transfusion” form must be completed. • Fill up the “Transfusion Adverse Event” form in duplicate and send to the blood bank. Send also a copy of this form to the National Blood Centre.
  27. 27. • Other adverse transfusion reactions include: – Fluid overload – Metabolic disturbances e.G. Hyperkalaemia and hypocalcaemia. – Hypothermia – Embolism – Iron overload – Alloimmunisation to red cell, white cell or platelet antigen. – Immunosuppression and immunomodulation – Transmission of viral infection
  28. 28. Transmitted Infection Incident HIV 1 : 1,900,000 Hep A 1 : 1,000,000 Hep B 1 : 1,800,000 Hep C 1 : 1,600,000 Bacteria Infection 1 : 3,000
  29. 29. Take home massages 1. Blood product mainly consist of cellular component and fresh plasma. 2. The decision to transfuse depends on many factors such as haemoglobin level, anemic symptoms and risk of bleeding. 3. MSBOS used to guide clinicians in ordering blood before surgery. 4. The patient’s consent should be obtained for the planned transfusion and recorded in the patient’s medical chart.
  30. 30. Take home massage 4. 1 person take blood and label- confirm patient’s name and identification before label. 5. Confirm patient’s name and identification with patient’s note, compatibility label and request form before transfusion. 6. If an adverse transfusion reaction is suspected, the transfusion should be stopped immediately and must be reported.
  31. 31. References 1. Transfusion Practice Guidelines for Clinical and Laboratory Personnel 3rd edition March 2008. National Blood Centre, Ministry of Health Malaysia 2. Guidelines for the rational use of blood and blood products. National Blood Centre, Ministry of Health Malaysia 3. Blood Transfusion guideline (2006), National Users’ Board Sanquin Blood Supply

Notas do Editor

  • The circulatory system: the transport system that supplies o2 and substances absorbed from the GIT to the tissues, returns co2 to the lungs, and other products of body metabolism to the kidneys, functions in the regulation of the body temperature, and distribute hormones and other agents that regulate cell functions. Blood id the carries of these subsntances.
  • An important factor
    that can be considered in the establishment of an MSBOS is the
    identification of those procedures that can be accommodated
    performed. Where blood by the group, antibody screen and hold
    (GSH) procedure. For cases where blood is likely to be transfused, a
    group screen and hold is likely to be transfused, a full cross-match is
    done. However when antibody screen is positive, compatible blood
    must be made available in all cases before surgery.
  • Developing MSBOS
    Data on blood request for all procedures for 6 months is analysed.
    For each procedure, indicate the number of units cross-matched and the number of units transfused.
    Calculate the percentage of blood usage:
    Total No. of Units transfused x 100 = %
    Total No. of Units cross-matched
    In procedures where blood usage is less than 30%, GSH are performed. Other procedures are allotted a tariff based on the average number of blood transfused.
  • How the schedule is generated is basically based on 6months data of all blood requests.
  • The decision to transfuse is complex and depends on many factors e.g. the cause of anaemia, its severity, chronicity, the patient’s ability
    to compensate for the anaemia, the likelihood for further blood loss and the need to provide some reserve before the onset of tissue hypoxia.