Blood transfusion. General surgery department of SGMU Lecturer ass. Khilgiyaev R.H.
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1 Blood transfusion General surgery department of SGMU
2 Sources of blood Donors Own blood of patient (autoreinfusion): autoreinfusion of blood from cavities (haemotorax, haemoperitoneum) in case of acute blood loss due to traumatic rupture of internal organs patient may donate his own blood before surgery should it be needed for transfusion (for elective surgery)
3 Whole blood and General surgery department of SGMU Blood components Whole blood Transfusion of whole blood can lead to sensitization of the patient, formation of antibodies to blood cells or plasma proteins, which can cause complications during subsequent blood transfusion or pregnancies So, today NO indications for transfusion of whole blood It is recommended that the product for transfusion contain the components of blood that the patients needs most of all
4 Whole blood and General surgery department of SGMU Blood components Whole blood Blood components Red blood cells Differ from whole blood in the minimal content of plasma and high concentration of red blood cells
5 Red blood cells Нt % Stored at 4-6 С for 35 day CDPA (citrate-dextrose-phosphateadenine) anticoagulant bind calcium ions, prevents blood from coagulating
6 Whole blood and General surgery department of SGMU Blood components Whole blood Blood components Red blood cells Packed red cells concentrates Modern and safe red cells component Is concentrate of red blood cells without plasma
7 Whole blood and General surgery department of SGMU Blood components Whole blood Blood components Red blood cells Packed red cells concentrates Platelet concentrates Granulocyte concentrates
8 Indications for blood transfusion acute anemia due to grave blood loss (25-30% of blood volume) with hemorrhagic shock or decrease of Hb level <70-80 g/l and Ht < 25%
9 Indications for blood transfusion acute anemia Chronic anemia (only for correction of anaemia signs )
10 Plasma Stored at temperature С - 3 years
11 Indications for Plasma transfusion grave blood loss (25-30% of blood volume) with hemorrhagic shock Diseases of liver with decrease of production plasma s factor of coagulation and its deficiency in circulations Plasmaferesis in grave toxity, sepsis
12 Blood preparations albumin High oncotic activity accounts for its ability to keep water within the body and hence increase the circulating blood volume Indicated for shock of whatever origin, burns, hypoproteinaemia in oncological patients
13 Blood preparations albumin Cryoprecipitate contains factor VIII factor XII fibrinogen Is indicated for patient with haemophilia A
14 Blood preparations albumin Cryoprecipitate Prothrombin complex contains factors II, VII, IX, X Is indicated for patient with haemophilia В
15 Blood preparations albumin Cryoprecipitate Prothrombin complex Fibrinogen Is indicated for congenital and acquired hypo- or afibrinogenaemia
16 Blood preparations albumin Cryoprecipitate Prothrombin complex Fibrinogen Thrombin Is used topically in parenchymal and capillary bleeding
17 Blood preparations albumin Cryoprecipitate Prothrombin complex Fibrinogen Thrombin Immune preparation ( - globulin) Contain high titres of antibodies
18 Main action of physician for blood transfusion Determine if the blood fit for transfusion Blood grouping Cross-match (Determine of the donor s and patient s blood compatibility) Testing for individual compatibility by ABO system Testing for individual compatibility by Rhfactor Biological compatibility
19 Main action of physician for blood transfusion Determine if the blood fit for transfusion: Hermetic of pack Rightly of label (donor s code, blood group, amount of blood and the date the blood was taken) Assesment of blood quality ( if the blood has clots, hemolysis, or blood is turbid- with flakes, films)
20 Main action of physician for blood transfusion Determine if the blood fit for transfusion Blood grouping
21 Blood Grouping With anti A and anti B celiclones Agglutination reaction Celiclone anti A Celiclone anti B Tested blood group I(0) II(A) III(B) IV(AB)
22 Rhesus factor (Rh) typing With anti D celiclone Rh +
23 Main action of physician for blood transfusion Determine if the blood fit for transfusion Blood grouping Cross-match (Determine of the donor s and patient s blood compatibility) Testing for individual compatibility by ABO system Testing for individual compatibility by Rhfactor
24 Testing for individual compatibility by ABO system 3-5 ml of blood is taken from the patient s vein, this is centrifuged Serum of patient and donor blood mixed at the ratio 5:1 10:1 on a plate Presence of agglutination indicates that blood groups of the patient and the donor are not compatible
25 Testing for individual General surgery department of SGMU compatibility by Rh-factor 2 drop serum of patient + 1 drop donor blood + 1 drop 33% polyglucin mixed in glass Glass is twisted in horizontal position during 3 min In 3 min 2-3 ml saline solution is added into glass Content mix by turning upside-down twice Evaluate result at light Presence of agglutination Blood is not compatible Absence of agglutination Blood is compatible
26 Main action of physician for blood transfusion Determine if the blood fit for transfusion Blood grouping Cross-match (Determine of the donor s and patient s blood compatibility) Testing for individual compatibility by ABO system Testing for individual compatibility by Rhfactor Biological compatibility
27 Biological compatibility The first ml of blood are allowed to flow fast; the infusion is stopped and patient s response and condition are observed (behaviour, skin colour, pulse and breath rates) Tachycardia, dyspnoea, facial hyperaemia and hypotension all suggest incompatibility of the donor s and patient s blood In the absence of signs incompatibility the test is repeated twice
28 Complications of blood transfusion Blood transfusion shock Due to incompatibility blood by ABO or Rhfactor system Resulting from rapid intravascular haemolysis of the transfused blood Periods: 1. Shock 2. Oliguria 3. Restoration of diuresis 4. Recovery Treatment: 1. Cardiovascular agent (strophantin), antihistamine (suprastin), corticosteroids (prednisolon),
29 Complications of blood transfusion Blood transfusion shock Due to incompatibility blood by ABO or Rh-factor system Resulting from rapid intravascular haemolysis of the transfused blood Periods: 1. Shock 2. Oliguria 3. Restoration of diuresis 4. Recovery Treatment: 1. Cardiovascular agent (strophantin), antihistamine (suprastin), corticosteroids (prednisolon), 2. To acccelerate the restoration of circulation: Saline solutions 3. To remove product of haemolysis: lasix 4. Oxygen therapy 5. Ineffective drug therapy is indication for haemodialysis
30 Complications of blood transfusion Blood transfusion shock Homological blood syndrome In massive blood transfusions when compatible blood of the same group and Rh, obtained from different donors is transfused, individual incompatibility of plasma proteins Bacterial-toxic shock Air embolism Acute cardiac dilatation of heart
31 Antishock solutions General surgery department of SGMU
32 Crystalloids (electrolyte solutions): saline, Ringer s, glucose solution) Improve rheologic properties of blood and restore microcirculation restore and maintain the osmotic pressure in the intestinal space Quickly leave circulation
33 Colloid solutions: 1) hydroxyethye starch: voluven, volecam, rephortan 2) dextrans: polyglucin, rheopolyglucin Increase the circulating blood volume and therefore restore blood pressure General surgery department of SGMU Stay in the blood stream over a long period and draw fluid from intercellular space
34 Advantages of colloid and crystalloids (electrolyte) solutions in shock emergent transfusion therapy there is no necessity to waste time (about min) to perform blood typing, for its ability to restore circulating blood volume donor blood is not superior to colloid product, therefore therapy is to be initiated with combinations of colloid and crystalloids solutions No risk of infection
35 Restoration of blood loss due to its degree Degree of blood loss mild and moderate Volume, ml Method of restore < 1500 Transfusion of crystalloids and colloid in ratio 3:1-300% from blood loss volume severe > 1500 Transfusion of crystalloids and colloid in ratio 3:1 + plasma + red blood cells
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