12B - Blood Therapy

Group Testing & Cross Match

• Group

  • Test RBC for antigens (A, B, and Rh) on membranes

• Screen

  • Screen serum for irregular blood antibodies

• Cross matching

  • Check donor’s RBCs and recipient’s serum compatibility

  • Full cross match can take up to 1.5 hours

  • Quick match (less sensitive) can be done in 15 – 20 min

ABO Blood Group

Blod transfusion Compatibility

ABO Blood Group

Rh Blood Group

• Negative - no antigen

• Positive - with antigen

Blood products

WBC → RBC, Platelets, plasma

Bloof transfusion Equipment

• 16 – 18 gauge IV (adults)

• Y-type blood tubing set with filter (170-260 micron)

• flush with Normal Saline

  • NEVER flush with RL cause it can cause clots

• Blood and Fluid warmer

  • prevent hypothermia

Indication in OR for transfusion

• replace blood loss

• Maintain adequate oxygen-carrying capacity

• Correct coagulation deficits

Replace Blood Loss

• Patient can tolerate up to a 30% loss of blood volume if it is replaced with crystalloids or colloids

  • The difference is what compounds are used to bring the fluid up to the appropriate blood osmotic values

  • Crystalloids use salt and/or solutions

  • Colloids use large amount (albumin)

• Transfusion of whole blood is rarely used

• Packed Red Blood Cells (PRBC) with normal saline is often used as a replacement for whole blood

Maintain Adequate Oxygen -Carrying Capacity

• monitor oxygenation

• monitor hemoglobin value

What to give to Correct Coagulation Deficits

• Fresh Frozen Plasma (FFP)

• Platelets

Fresh Frozen Plasma (FFP)

• Contain all coagulation factors except platelets

• Emergent reversal of anti-coagulation therapy such as Coumadin/Warfarin

Platelets

• Can be given separately to treat hypocoagulation problems

• Thrombocytopenia, impaired platelet function

Risk/ Complications

• Transmission of infectious diseases (ex. Hepatitis, HIV, West Nile Virus)

• Transfusion-Related Acute Lung Injury (TRALI)

  • Characterized by noncardiogenic pulmonary edema

• Transfusion-Associated Circulatory Overload (TACO)

• Hypothermia (core temperature < 35 oC)

• Metabolic abnormalities

Transfusion Reactions

Febrile reactions

Allergic reactions

Hemolytic reactions

Febrile Reactions

• Fever rarely increases above 38oC

• Possible mechanism is a reaction to:

  • Lysed red blood cells

  • Donor white blood cells or cytokines

Treatment

• slow down infusion rate

• Antipyretics

Allergic reactions

• hives (Uticaria)

• anaphylaxis

Treatment for Hives

antihistamines via IV

Anaphylaxis signs

Hives, dyspnea, hypotension, wheezing, laryngeal and

pulmonary edema, shock

Require immediate treatment for anaphylaxis

Stop transfusion!!!

Epinephrine

Bronchodilators

Antihistamines

Steroids

Circulatory support

Hemolytic reaction

Most serious and life-threatening complication

Result of ABO- and/or Rh-incompatibility

signs of hemolytics reaction

Fever and chills

Chest or back pain

Hypotension and tachycardia

Nausea and vomiting

Skin flushing

Dyspnea

Renal failure

Diffuse bleeding due to Disseminated Intravascular

Coagulation (DIC)

Tx for hemolytic reactions

Stop transfusion!!!

Manage hypotension with fluids, inotropes

Maintain urine output with crystalloids, diuretics

Increase FiO2

Reaction can be delayed if patient has been

sensitized to RBC antigens from previous

transfusion

Autologous Blood Transfusion

Patient can predonate blood prior to a scheduled

procedure for possible transfusion during

perioperative period

Intraoperative blood salvage

• AKA: Cell saver

• Autologous transfusion can occur during the surgical procedure if blood loss is collected and processed for re-infusion.