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Transfusion - Coggle Diagram
Transfusion
Complications
Haemolytic
Immediate
Coombs test +ve
Haemoglbinuria
Delayed
Anaemia
Fever
Allergic
Febrile
Anaphalaxis
Metabolic
Hyperkalaemia
Hypocalcaemia
Metabolic acidosis
Iron overload
Desferrioxamine
Infection
Bacterial
Viral
HIV
Hep B
Hep C
CMV
New varietn CJD
TACO
Acute LVF within 6 hours
TRALI
ARDS within 6 hours
Immune mediated
Mortaility 10%
Blood products
PRBC
Haematocrti
0.6-0.7
Leucodepleted
FFP
Clottign factors
ALbumin
Stored -30degrees
lasts one year
-30
Used within 24 hours
Octaplas
Treated FFP
More standardised clotting factor concentration
Pooled from 1500 doners
Used in neonates as standard
Platelets
55x10^9 in 50mls of plasma
Pooled from 4-6 FFP donations
Stored +20-24 degrees
Agitation to prevent clumping
Cryoprecipitate
150-300mg fibrinogen
70 IU factor VIII
vWF
10units combined to form one pack circa 200mls
Trials
ABLE 2015
no difference in fresh versus older transfusion products
TRICC 1999
Restrictive <70g/l target significantly lower mortaility in >55 and APCHE II score <20
TRACS 2010
no difference in cardiac patients with restrictive
TRISS 2014
No difference in ischaemic events in sepsis in those wiht Hb <90
TITRe2
Increase in death in restrictive group after cardiac surgery
Patient blood management
Concept
Peri-operative anaemia
1/3rd pre-assessment patients
ICU+hospital LOS
increased mortaility
Detection
Levels
<120 women
<130 Men
Treatment
IV/oral iron
EPO
Find source
Minimise perioperative blood loss
Antiplatelets/anticoagulants
Surgical haemostasis
Physiological optimisation
intraoperative cell salvage
Management of post-operative anaemia
Can have iron/EPO post-operatively
Aviod secondary bleeding
Use evidence based transfusion thresholds
Doner blood
Testing
HIV
HCV
Hep B
Syphilis
crossmatching
0- universal doner
AB+ universal recipient
0+most common in the UK
AB- rarest in the UK
85% are Rh +
Storage
CPDA preservative 35 days
Citrate
binds calcium
Phosphate
ATP
Dextrose
energy
Adenine
Increases ATP levels
Storage lesion
Hyperkalaemia
Acidosis
Reduced 2,3 DPG
Fall in platelets count
Factors V + VIII activity falls
Definition of Massive Transfusion
Whole circulating volume in 24 hours
50% circulating volume in < 3 hours
Ten units of blood