1. SHOCK & BLOOD
TRANSFUSION
BY: R. NANDINII
GROUP K1

2. Overview:
• BLOOD
• SHOCK • HAEMORRHAGE TRANSFUSION
-Definition -Definition -Definition
-Pathophysiology -Classification -Indication
-Classification -Management -Blood products
-Severity -Complication
-Management
-Monitoring

3. SHOCK

4. Pathophysiology:
Cellular
When perfusion to
the tissue reduces
Glucose within cells are exhausted
↓ O2 delivery to tissue
Anaerobic respiration ceases
Cell Metabolism
Failure of Na/K pump in the cell
(aerobic
membrane & intracellular organelle
anaerobic)
Accumulation of Intracellular lysosome release
lactic acid in blood autodigestive enzymes
Cell lysis
Systemic metabolic
acidosis Intracellular content including K
released into the bloodstream

5. Pathophysiology:
Microvascular
Tissue ischemia Hypoxia & Activate
progresses acidosis complement & prime
neutrophils
Activation Of
Immune Generation of
& Coagulation oxygen free radicals
System & cytokine release
Tissue oedema
Injury of the capillary
ensues →
endothelial cells
exacerbating cell
hypoxia
Fluid leaks out

6. Pathophysiology:
Systemic
Systemic
 Cardiovascular: vasoconstriction
↓ Preload Compensatory Catecholamines
& baroreceptor ↑ release into the
Afterload response sympathetic circulation
activity
Tachycardia
 Respiratory:
Tachypnea
↑ Compensatory
Metabolic Respiratory
sympathetic
acidosis alkalosis
response
Excretion of
CO2 increased

7.  Renal:
↓ Glomerular ↓ urine
filtration output
↓ Kidney
Perfusion
Stimulate ↑ Na & water
Renin-angiotensin- reabsorption
aldosterone
 Endocrine:
vasoconstriction
Hypothalamus Vassopressin
Na & water
reabsorption
Adrenal Cortisol
Cortex Sensitizing cell to
catecholamine

8. Classification of shock:

9. Classification of shock:

10. Classification of shock:

11. Severity of Shock
Decompensated
Compensated
Mild Moderate Severe
Consciousness Normal Mild Anxiety Drowsy Comatose
Blood Pressure Normal Normal Mild ↓ Severe ↓
Pulse Rate Mild Increase ↑ ↑ ↑
Resp Rate Normal ↑ ↑ Laboured
Urine Output Normal Normal Reduced Anuric
Lactic Acidosis + ++ ++ +++
 Compensated : Compensatory responses reduce flow to non-essential organs to
preserve preload & flow to the lungs & brain.
 Decompensated : Further loss body’s compensatory mechanisms, Progressive
renal, respiratory & CVS decompensation; Occurs when there’s 30-40% loss of
Blood Volume.

12. Resuscitation
A. Conduct of resuscitation:

13. Resuscitation
B. Fluid therapy:

14. SHOCK STATUS:

15. Resuscitation
C. Vasopressor & Inotrope Support:

16. MONITORING

17. HAEMORRHAGE
Further haemorrhage Hypothermia
 ↓ Perfusion to the
tissue  unable to
generate heat
Coagulopathy Acidosis
Decrease function of coagulation
proteases  coagulopathy
Trauma Triad of Death

18. Definitions:

19. Degree & Classification

20. Management:
After control
aggressively
resuscitated,
warmed and
coagulopathy
corrected

21. Transfusion
Definition:
Process of transferring whole blood or blood components from
one person (donor) to another (recipient).
Indications:
Acute blood loss
 to replace circulating volume & O2 delivery
Perioperative anemia
 To ensure adequate O2 delivery during perioperative phase.
Symptomatic chronic anemia without haemorrhage or impending surgery
 Hb < 6 g/dl

22. Perioperative red blood cell transfusion criteria
Source: Bailey & Love’s Short Practice of Surgery 25th ed

23. Blood & Blood Products
Blood component Explanation
Whole blood • Very rarely used
[can be broken down to: RBC, • Carries greater risks of adverse reactions owing
platelets, fresh frozen plasma (FFP)] to the presence of leucocytes.
Packed Red Cell • Each unit is approximately 330 ml and has a
[do not provide viable platelets or haematocrit of 50–70%.
neutrophils] • For use in substantial hemorrhage & anemia,
symptomatic anemia
Platelet • For patients with bleeding due to either
[for the coagulation; also contain thrombocytopenia, platelet dysfunction
plasma (coagulation factors), some • Temporary thrombocytopenia occuring after
red cells and some white cells radio- and chemotherapy,
(leukocytes)] • Bleeding in patients with thrombocytopenia or
functional platelet abnormality,
• After massive transfusion (RBC) and
thrombocytopenia

24. Blood & Blood Products
Blood component Explanation
Fresh frozen Plasma (FFP) • Corrections of known congenital or acquired
[contains all coagulation factors in coagulation factor deficiencies.
normal amounts and is free of red cells, • Treatment of microvascular hemorrhage in the
leukocytes and platelets] presence of prolonged PT, aPTT
Cryoprecipitate • For Hemophilia A, von Willebrand disease, DIC,
[supernatant precipitate of FFP and is Hypofibrinogenemia (<100 mg/dl)
rich in
factor VIII and fibrinogen]
Factor VIII concentrates • Hemophilia A, & low titer factor VIII inhibitors
Factor IX Concentrates • Hemophilia B

25. Complication
Single transfusion Massive transfusion
 incompatibility haemolytic  • coagulopathy;
transfusion reaction;
 • febrile transfusion reaction;
 • hypocalcaemia;
 • allergic reaction;  • hyperkalaemia;
 • infection:  • hypokalaemia;
 – bacterial infection (usually as a
result of faulty storage);
 • hypothermia.
 – hepatitis;  Patients who receive repeated
 – HIV; transfusions over long periods of
time (e.g. patients with
 – malaria;
thalassaemia) develop iron
 • air embolism; overload. (Each transfused unit of
 • thrombophlebitis; red blood cells contains
 • transfusion-related acute lung approximately 250 mg of
injury (usually from FFP). elemental iron.)

26. Management of coagulopathy
 Correction of coagulopathy is not necessary if no active
bleeding/ haemorrhage
 However, coagulopathy following during massive
transfusion should be anticipated and managed
aggressively
 Standard guidelines:
 FFP : if PT or PTT > 1.5 X normal;
 Cryoprecipitate : if fibrinogen < 0.8 g/l
 Platelet : if platelet count < 50 x 109 ml

27. THANK YOU