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transfusion
Speaker : R2 Chang, H.C.
Supervisor : VS Jeng, C.S.
Blood Component
Whole blood
Packed red blood cells
Platelet concentrates
Fresh frozen plasma
Cryoprecipitate
Others
Table 47-1 -- American College of Surgeons' classes of acute hemorrhage
Class I Class II Class III Class IV
Factors
Blood loss (mL) 750 750–1500 1500–2000 2000 or more
Blood loss (% blood volume) 15 15–30 30–40 40 or more
Pulse (beats/min) 100 100 120 140 or higher
Blood pressure Normal Normal Decreased Decreased
Pulse pressure (mm Hg) Normal or Decreased Decreased Decreased
increased
5% Dextrose in water 1+ 4+
Plasmanate 1+ 3+
5% Dextrose in 0.2% 0 3+
saline
5% Dextrose in 0.4% 0 0
saline
5% Dextrose in 0.9% 0 0
saline
0.9% Saline 0 0
Normosol-R, pH 7.4 0 0
Lactated Ringer's 0 (clotted) 0 (clotted)
Platelet Concentrates
Effectiveness
19 gauge needle or larger
Storage at room temperate ( 20 - 24 ℃ )
7000 to 10000 platelets/mm3 after transfusion of
one platelet concentrate to the 70-kg adult
Decreased recovery
Splenomegaly
Previous sensitization
Fever
Sepsis
Active bleeding
Bacterial contamination
Platelet Concentrates
Should not be given
Prophylactically with massive blood transfusion
Prophylactically after cardiopulmonary bypass
Immune thrombocytopenia purpura
(unless there is life-threatening bleeding)
Platelet Concentrates
ASA Task Force 2 recommendation
1. Prophylactic platelet transfusion is rarely indicated when
thrombocytopenia is due to increased platelet destruction (e.g.,
ITP).
2. In surgical patients with thrombocytopenia due to decreased
platelet production or with microvascular bleeding
Platelet count is below 50 × 109/L : indicated
Platelet counts is 50 to 100 × 109/L : Based on the patient's risk of
bleeding.
Platelet count is greater than 100 × 109/L: Rarely indicated
Major risk
Transmission of infectious diseases
Dilutional coagulopathy
Prothrombin time more than 17 seconds
Administration of more crystalloids is anticipated
FFP
FFP is contraindicated for augmentation
of plasma volume or albumin
concentration
The practice of administering PRBCs
and FFP to the same patient should be
discouraged
Cryoprecipitate
Factor VIII
Fibrinogen (150 – 300 mg/unit)
Von Willebrand factor ,Fibronectin
Indication
Factor VIII deficiency
Hemophilia A
Fibrinogen deficiencies
Others
Prothrombin complex
Single-Donor plasma
Laboratory tests
PT , APTT
Platelet count
Fibrinogen
Thrombin time
D-dimer
TEG
Complication
Changes in oxygen transport
Coagulopathy
Hemolytic transfusion reaction
Transfusion-related acute lung injury
Citrate intoxication
Hyperkalemia
Hypothermia
Acid-Base abnormalities
Infectivity of blood
Microaggregates
Others
Changes in Oxygen Transport
Leftward shift of the oxygen
dissociation curve in vitro
P50 and 2,3-DPG levels decrease
DIC-like syndrome
Dilutional thrombocytopenia
FFP therapy
Generalized bleeding that cannot be controlled with
surgical sutures or cautery
Partial thromboplastin time at least 1.5 times normal
Platelet count greater than 70,000/mm3
DIC-like syndrome
Accompanying microvascular thrombosis is uncommon.
Rarely causes significant organ damage and infarction.
Accompanying large-vessel thrombosis is relatively
common but is probably not primarily caused by DIC
Although bleeding is common, severe bleeding usually
originates from sites of local disorder (e.g., lacerated liver).
High mortality rates primarily because of the severity of
patients' underlying disorders.
Platelet therapy
Clinical coagulopathy is also present.
Platelet counts is less than 50000 to 75000/mm3
Transfusion reaction
Acute hymolytic reaction
Errors involving ABO incompatibility
Intravascular v.s. Extravascular hemolysis
Under anesthesia
Bleeding diathesis
Hypotension
Hemoglobinuria
Acute renal failure
Stop the transfusion
Maintain the urine output at a minimum of 75 to 100mL/hour
Generously administer IV fluids ( Lactated Ringer's solution )
Allergic
Urticaria associated with itching., facial swelling
Not necessary to discontinue the transfusion
Antihistamines
Anaphylactic reaction
Dyspnea, hypotension, laryngeal edema, chest pain, and
shock
Transfusion-Related Acute
Lung Injury
Under-diagnosed and under-reported
Noncardiogenic pulmonary edema
Caustic factors : All blood components, especially FFP
Symptoms and signs
1 to 2 hours after transfusion and in force within 6 hours
Fever, dyspnea, fluid in the ETT, severe hypoxia
During anesthesia
A persistent decrease in blood oxygen saturation
Blood warmer
Dilution
Acid-Base Abnormalities
Metabolic acidosis
Storage media
plastic container of blood
Metabolic alkalosis
Citrate
Transfusion-related
immunomodulation
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