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- 2. Safe blood transfusion By Dr. Mohammed Hosny Fouda Ass.prof, of clinical pathology
- 4. • Any therapeutic substance prepared from human blood: Whole blood • Blood components Red Cell Concentrate and suspension Platelet Concentrate • Plasma FFP Cryoprecipitate Cryosupernatent
- 5. • Plasma Derivatives • Human plasma proteins prepared from plasma under Pharmaceutical Manufacturing Conditions Albumin Coagulation factors concentrates Immunoglobulins
- 8. Principles of Clinical Transfusion Practices • Avoid blood transfusion • Transfusion is only one part of the patient’s management. • Prevention and early diagnosis and treatment of Anemia & underlying condition • Use of alternative to transfusion eg. IV fluids • Good anesthetic and surgical management to minimized blood loss.
- 9. • Prescribing should be based on national guidelines on the clinical use of blood taking individual patient needs into account. • Hb level should not be the sole deciding Factor Clinical evaluation is important • The clinician should record the reason for transfusion clearly. • A trained person should monitor the transfused patient and if any adverse effects occur respond immediately.
- 10. Triggers of Component Transfusion The lowest thresholds for transfusion of components are: • Hb level of 6-7g/dl. Clinical judgment • FFP threshold: PT & PTT 1.5 times the upper limit of the normal range. Platelet threshold of: • 10 000/µl- 20 000/µl for prophylactic transfusion • 20 000/µl for BMA and Biopsy • 50 000/µl for surgery, massive transfusion, Liver cirrhosis. • 100 000/µl for surgery to brain or eye.
- 11. Blood Transfusion -Guidance and Regulations WHO recommendations
- 12. • safe and adequate blood supply • also clinical transfusion process • Appropriate use of blood • Collection samples, patient ID • compatibility testing • Administration of blood • Adverse event reporting • Hospital transfusion committee
- 13. Safety in blood transfusion Measures to protect donor: 1. Should be voluntary 2. Age from 17 – 60 years 3. Weight above 50Kg 4. Hemoglobin >13 g/dL for men, >12 g/dL for women 5. Minimum donation interval of 12 weeks (16 weeks advised) with 3 donation per year maximum
- 14. 6- Exclusion of : • Pregnant and lactating women • Cardiovascular disease including hypertension • Respiratory disorders • Insulin dependent diabetes • Chronic renal diseases • Certain careers as drivers (bus ,plane , train) as delayed fainting is dangerous
- 15. Measures to protect recipient: 1. Donor selection 2. Microbiological tests of donations 3. Immunoheamatological testing of donations 4. Lecuodepletion of cellular products 5. Monitoring and testing of bacterial contamination
- 16. Microbiological tests of donation Must be done: HIV 1 and 2 Hepatitis B and C viruses Syphilis screening Should be done CMV May be done West Nile virus
- 18. Immunoheamatological testing of donations A. Blood grouping for donor and recipient B. Cross matching (pre transfusion testing)
- 27. Hazards and complications of blood transfusions Early: • Hemolytic reaction: immediate or delayed • Reactions caused by infected blood • Allergic reactions to white cells, platelets or proteins • Pyrogenic reactions (to plasma proteins or caused by HLA antibodies)
- 28. • Circulatory over load • Bacterial contamination • Air embolism • Thrombophilibitis • Post transfusion purpura
- 29. Late: • Transmission of infections • Iron overload • Transfusion-associated graft-versus-host disease
- 30. Hemolytic reaction: immediate or delayed Signs & Symptoms of a Transfusion Reaction Mild Reaction: • Fever • Urticaria • Rash • Pruritis
- 31. Severe Reaction: • Pyrexia, rigors • Hypotension • Loin/Back Pain • Increasing anxiety • Pain at infusion site • Respiratory Distress • Dark urine • Severe Tachycardia • Unexpected bleeding (DIC)