Blood transfusion

Blood transfusion is the intravenous administration of whole blood or blood products to a patient.

INDICATIONS in surgical practice

• Blood loss from trauma, or pathological lesions eg from GIT ( more than 1500 ml or 3% blood volume).
• Preoperatively, in case of anemia (10/30 rule).
• During major operative procedures.
• Postoperatively, after significant blood loss.

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• To arrest hemorrhage or as a prophylactic measure prior to surgery in a patient with hemorrhagic state such as thrombocytopenia, DIC, etc (INR > 1.6 Plt count

Adverse Effects

• Immunologic Reactions
• Infections (HIV, HBV, HBV, Malaria, CMV, Syphillis)
• Metabolic derangement (hypocalcemia, metabolic alkalosis)
• Coagulation failure
• Volume overload
• Thrombophlebitis
• Iron overload

Febrile nonhemolytic transfusion reaction

• Fever, chills & rigors, mild dyspnea
• Cytokines released from donor leucocytes
• Incidence 2-7%
• If
• If>40+unstable: treat as acute hemolysis

Acute hemolytic reaction

• Fever, burning at transfusion site, back/flank plain, reddish brown urine
• ABO Incompatability
• ARF, Shock, DIC
• Labs: Direct Coombs. LDH, Haptoglobin,

Management

• Normal Saline (to maintai BP and promote diuresis)
• Furosemide (20-40 mg IV over 1-2 min repeated 2hrs if urine output >30 ml/hour)
• Cradiac monitoring risk of hyperkalemia
• Supportive care

TRali

• SOB, fever, hypotension non-cardiogenic pulmonary edema, sense of impending doom
• During or within 6 hours of transfusion
• Bilateral patchy infiltrates on CXR
• Supportive care, steroids. mechanical ventilation

urticarial reactions

• Rash, pruritus, hives, hypotension, headache
• Transfusion resumed after antihistamines

anaphylactic reactions

• Dyspnea, irritability, chest tightness, hypotension, cramps, nausea
• Selective IgA deficiency
• Epinephrine 0.3 ml of 1:1000 IM
• Corticosteroids
• Supportive care
• Use IgA def products for further transfusions.

Citrate toxicity

• Citrate (anticoagulant) binds calcium and magnesium
• Mild: perioral or peripheral paresthesia, nausea, muscle cramps
• Severe: tetany, laryngeal spasm, bradycardia, arrhythmia
• Calcium replacement

prevention

• Strictly follow proper protocol.
• Clerical errors number 1 cause of transfusion reactions.
• Close monitoring for early detection and prompt action.
• Use of blood products instead of whole blood.
• Leucoreduced blood, Gamma irradiated blood.
• Autotransfusion.