blood tranfusion ppt
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blood transfusionTRANSCRIPT
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Ms. Wong Pei SeLecturerPharmacy Practice Dep.Lecturer, School of Pharmacy and Health [email protected] ; ext 2786
Blood Transfusion
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Blood Transfusion Blood given through an intravenous (IV) line.
Procedure usually takes 1 to 4 hours, depending on the amount of blood transfused.
Blood is made up of red blood cells, white blood cells, platelets & plasma.
Blood can be be transfused either as whole blood or, more often, as individual components.
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Indication for blood / blood product transfusion
Trauma e.g. accidentSurgery Chronic diseases e.g. cancer , renal diseaseDrug induced e.g. haemolytic anaemiaHereditary blood disorders e.g. thalasaemia Bleeding disorder e.g. haemophilia, thrombocytopenia
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Blood Products Whole Blood
Blood Components
Blood Derivatives
•Packed Red Cells•Granulocyte concentrate•Platelet Concentrate•Fresh frozen plasma•Cryoprecipitate
•F VIII Concentrate•F IX Concentrate•Albumin•Immunoglobulins•Prothrombin complex concentrate
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Whole BloodsOne unit contains 450‐500ml (include 70ml anticoagulant )to maintain the viability of red blood cells.
RisksVolume overload Compromised cardiovascular function
Indications Acute massive blood lossExchange transfusion
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Packed Red Blood CellsChoice of blood product to increase haemoglobin (Hb). Prepared by removing most of the plasma from whole blood. Indication : Anaemia Consists of double amount of red cells for a given volume of WB
Transfusion of packed red cells lowers risk of volume overload.
One unit of PRBC is expected to raise circulating Hb by approximately 1 g/dL Rise is detected within 24 hours after transfusion
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Adverse Effects of TransfusionImmediate effects
ImmunologicalFebrile non‐haemolytictransfusion reactionsHaemolytic transfusion reactionsAllergic reactionsTransfusion associated lung injury
Non immunologicalCirculatory overloadBacterial contamination of donor blood unit
Delayed ImmunologicalHaemolytic transfusion reactionsPost transfusion purpuraGraft vs. host diseaseNon immunologicalTransmission of infectious organismsIron overload
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Circulatory Overload
High rate of transfusion caused failure to redistribute fluid efficiently Likely to occur in patients with chronic severe anaemia and compromised cardiovascular function. Leads to cardiac failure and pulmonary oedemaManaged by oxygen, intravenous diuretics
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Febrile Non‐HaemolyticTransfusion Reactions
Signs : Fever, chills, flushing, headache, anxiety, itching & tachycardiaMay begins 30‐60 mins after transfusionCaused by
Release of cytokines from leucocytes during storage of bloodReaction of allo‐antibodies in the recipient, with transfused white cells leading to release of pyrogens.
ManagementStop transfusionAdminister antipyretics and antihistamineInvestigation of condition e.g. blood compatibility
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Haemolytic Transfusion Reaction (1)
Most commonly caused by ABO incompatibility and mediation of IgM and IgG ; anti‐antibodies.Signs : Pain, fever, breathlessness, hypotension, bleeding manifestationsAcute: occur within minutes of transfusionDelayed: occur on second or repeat exposure to blood transfusion
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Haemolytic Transfusion Reaction (2)
Severe cases may lead to renal failure, shock & disseminated intravascular coagulation. Management
Stop transfusion immediatelyMaintenance of intravenous access with normal salineManagement of hypotension, renal failure and disseminated intravascular coagulation.
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Bacterial Contamination Contamination may lead septicaemia shockCommon with platelet concentrates than whole blood or packed red cells Platelet concentrates are stocked at higher temperature that favours proliferation of bacteria. Signs :‐ resemble acute haemolytic transfusion reactionManaged by high dose antibiotic, and supportive measures e.g. oxygen, normal saline
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Transmission of Infectious Organisms
More prevalent in certain geographic area or populationOrganisms include Hepatitis B & C, HIV 1 and HIV 2, and malaria parasite .
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Measures to prevent transmission by transfusion of hepatitis & HIV infections
Transfuse only when essentialExclude high risk donors e.g. intravenous drug abusers, prostitutes, homosexualsScreening of all blood donations Use of autologous transfusion wherever possibleViral inactivation of blood components and derivativesPatient requiring regular transfusion therapy (e.g. haemophilics and thalasaemics) should be given HBV vaccine.
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Transfusion associated with Graft vs. Host disease
Develops in immunodeficient individuals. Mortality rate :80‐90%, prevalent:0.1‐1%Caused by reaction of donor lymphocytes that react against host tissues.Occurs 10‐12 days post‐transfusion, patient develops fever, skin rash, diarrhoea, hepatitis, and bone marrow suppresion.
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Post‐Transfusion Purpura
Managed by plasma exchange & intravenous immunoglobulins.
Rarely develop in some women with multiple pregnancy(multiparous) or mean who undergone previous transfusions5-10 days after transfusionDue to sensitisation of recipient alloantibodies to platelet antigen due to previous exposure.Lead to destruction of patient's own platelet.
Purpura = purple-colored spots (0.3-1 cm ) and patches that occur on the skin
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Iron Overload
Each unit of blood contains 200mg of iron
Daily loss about 1mgCommon in patients receiving long term blood transfusionDeposition of excess iron in heart, liver, and endocrine glands lead to organ failure.Iron chelating therapy : desferrioxamine can be used to minimise iron overload.
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
Desferrioxamineremove excess iron that accumulates with chronic blood transfusions.
Poor absorption from the gastrointestinal tract , therefore must be given parenterally, as a continuous subcutaneous infusion, or as a continuous intravenous infusion Removal of excess iron ‐between 30‐70 mg iron/day Neutralization of "free" iron ‐blocks the ion's ability to catalyze redox reactions
BPharm S2 Haematology, Blood Transfusion by Wong Pei Se
The End . Thank you !!Referenceshttp://www.nhlbi.nih.gov/health/dci/Diseases/bt/bt_whatis.html [
National Heart, Lun & Blood Institute ; last accessed Jan 2010]
http://www.who.int/topics/blood_transfusion/en/ [World Health Organisation, last accessed Jan 2010]