Definition (Transfusion): Introduction of blood or any Blood products directly into the blood.
Definition (Infusion): Therapeutic introduction of any fluid, other than blood directly into the circulation is known as infusion.
Indication of blood transfusion:
(1)For the replacement of acute sever blood loss,
- Crush injury, major fracture.
- Rupture spleen, Liver, great vessels.
- Bleeding peptic ulcer.
- Rupture ectopic pregnancy.
(2)For the correction of peri-operative anemia,
- Gastrectomy, thyroid surgery.
- Heart, Lung surgery.
- Liver surgery etc.
(3)Sever burn, gross infection, and septicemia.
(4)Sever anaemia – (Hook warm) packed cells.
(5)Certain blood disorders:
- a plastic anemia.
(6) During chemotherapy.
(7) Certain liver disease.
Contraindication of blood transfusion:
(1) Advanced bilateral renal disease.
(2)Sever heart disease.
(4) Established heart failure.
(5) Coronary artery thrombosis.
(6) Pulmonary odema, embolism.
Complication of blood transfusion:
(1) Febrile reactions.
- Pyrogen and minor bacterial contamination.
- Immunological reaction to WBC, Platelet.
#Plasma antigen from donor occasionally cause itch, headache. (3)Hemolytic reactions 🙁 50 ml blood can cause)
- Acute intravascular haemolysis.
- Pain at infusion site.
- Loin pain.
- Hypotension, chest pain, renal failure.
- Circulatory embolism.
- Air embolism.
- Pulmonary embolism.
(6)Transmission of diseases,
- Hepatitis B.
- Malaria etc.
- After massive transfusion of stored blood.
(8)Haemosiderosis=after repeated transfusion.
Complication of massive blood transfusion:
(2) Multiple micro emboli.
(3) Acid base disturbance, metabolic acidosis.
Management of blood transfusion:
- Immediately stop the transfusion.
(1) Inj.Hydrocortisone 100 mg.
(2) Inj.Chlorpheniramine 10 mg.
(3) Keep the I/V line open with 0.9% NaCL.
(5) Vasopressor drugs.
(6) O2 inhalation.
(8) Mannitol(Increase BP & Urine output)
(9) Bicarbonate with Ringer”s lactate
(10) Dialysis, if required-peritoneal and haemodialysis
(11) Check identity against name on unit
(12) Send the unit of blood, sample of fresh blood & urine
(For haemoglobinuria) to the lab.
Certain precautions must be followed before and during the transfusion of blood to a patient.
PRECAUTIONS TO BE TAKEN BEFORE THE TRANSFUSION OF BLOOD
- Donor must be healthy, without any diseases like:
- Sexually transmitted diseases such as syphilis
- Diseases caused by virus like hepatitis, AIDS, etc.
- Only compatible blood must be transfused
- Both matching and cross-matching must be done
- Rh compatibility must be confirmed.
PRECAUTIONS TO BE TAKEN WHILE TRANSFUSING BLOOD
- Apparatus for transfusion must be sterile
- Temperature of blood to be transfused must be same as the body temperature
- Transfusion of blood must be slow. The sudden rapid infusion of blood into the body increases the load on the heart, resulting in many complications.
HAZARDS OF BLOOD TRANSFUSION
Hazards of blood transfusion are of four types:
- Reactions due to mismatched (incompatible) blood transfusion – transfusion reactions
- Reactions due to massive blood transfusion
- Reactions due to faulty techniques during blood transfusion
- Transmission of infections.
REACTIONS DUE TO MISMATCHED BLOOD TRANSFUSION – TRANSFUSION REACTIONS
Transfusion reactions due to ABO incompatibility and Rh incompatibility are explained.
REACTIONS DUE TO MASSIVE BLOOD TRANSFUSION
Massive transfusion is the transfusion of blood equivalent or more than the patient’s own blood volume. It leads to
- Circulatory shock, particularly in patients suffering from chronic anemia, cardiac diseases or
- Hyperkalemia due to increased potassium concentration in stored blood
iii. Hypocalcemia leading to tetany due to massive transfusion of citrated blood
- Hemosiderosis (increased deposition of ion in the form of hemosiderin, in organs such as
endocrine glands, heart and liver) due to iron overload after repeated transfusions.
REACTIONS DUE TO FAULTY TECHNIQUES DURING BLOOD TRANSFUSION
Faulty techniques adapted during blood transfusion leads to:
- Thrombophlebitis (inflammation of vein, associated with formation of thrombus).
- Air embolism (obstruction of blood vessel due to entrance of air into the bloodstream).
TRANSMISSION OF INFECTIONS
Blood transfusion without precaution leads to transmission of blood-borne infections such as:
- Hepatitis B and A
iii. Glandular fever or infectious mononucleosis (acute infectious disease caused by Epstein-
Barr virus and characterized by fever, swollen lymph nodes, sore throat and abnormal
- Herpes (viral disease with eruption of small blister-like vesicles on skin or membranes)
- Bacterial infections.
Fluids infused into the body instead of whole blood are known as blood substitutes.
Commonly used blood substitutes are:
- Human plasma
- 0.9% sodium chloride solution (saline) and 5% glucose
- Colloids like gum acacia, isinglass, albumin and animal gelatin.
Exchange transfusion is the procedure which involves removal of patient’s blood completely and replacement with fresh blood or plasma of the donor. It is otherwise known as replacement transfusion. It is an important life-saving procedure carried out in conditions such as severe jaundice, sickle cell anemia, erythroblastosis fetalis, etc.
Procedure involves both removal and replacement of affected blood in stages. Exchange transfusion is carried out in short cycles of few minutes duration, as follows:
- Affected person’s blood is slowly drawn out in small quantities of 5 to 20 mL, depending upon the age and size of the person and the severity of the condition.
- Equal quantity of fresh, prewarmed blood or plasma is infused through intravenous catheter. This is carried out for few minutes.
- Catheter is left in place and the transfusion is repeated within few hours.
- This procedure is continued till the whole or predetermined volume of blood is exchanged.
CONDITIONS WHICH NEED EXCHANGE TRANSFUSION
- Hemolytic disease of the newborn (erythroblastosis fetalis).
- Severe sickle cell anemia.
- Severe polycythemia (replacement with saline, plasma or albumin).
- Toxicity of certain drugs.
- Severe jaundice in newborn babies, which does not respond to ultraviolet light therapy. Normally, neonatal jaundice is treated by exposure to ultraviolet rays. It breaks down the bilirubin which is excreted by liver.
AUTOLOGOUS BLOOD TRANSFUSION
Autologous blood transfusion is the collection and reinfusion of patient’s own blood. It is also called self blood donation. The conventional transfusion of blood that is collected from persons other than the patient is called allogeneic or heterologous blood transfusion.
Autologous blood transfusion is used for planned surgical procedures. Patient’s blood is withdrawn in advance and stored. Later, it is infused if necessary during surgery.
This type of blood transfusion prevents the transmissionof viruses such as HIV or hepatitis B. It also eliminates transfusion reactions.