输血英语.ppt

上海交通大学瑞金临床医学院 外科教研室Blood TransfusionHistoryType of TransfusionIndicationTransfusion ReactionsAutologous transfusion Component TransfusionBlood TransfusionHistory and SignificanceLower (1665)First blood transfusionPhilip(1825)First human blood transfusionLandsteiner(1900)Discovery of ABO typeHow to store blood longer?World war IIs there any suitable Blood SubstitutesWorld war IISuccessful blood transfusion is relatively recentCrossmatchingAnticoagulationPlastic storage containerBlood TransfusionType of Transfusion：nWhole Blood；nBlood Component；RBC PLT FFP Leukocyte concentrate nPlasma Substitutes；Use of whole blood is considered to be a waste of resourcesBlood TransfusionSymptomatic anemia(providing oxygen-carrying capacity)Transfusion trigger (HCT30%;HB10g/dl)1 Unit increases 3%HCT or 1g/dlShelf life=42 d(1-6)Red Blood CellsThrombocytopenia (50,000)Platelet dysfunctionEach unit increase 5,000 PLTs after 1 HPlateletsProfoundly granulocytopenia(500)Serious infection not responsive to antibiotic therapyGranulocytesCoagulation factor deficiencies1 ml increases 1%clotting factorsBeing used as soon as possibleAlbumin,hetastarch,crystalliods are equally effective volume expander but safer than FFPAfter use of 5 U of RBCs,matching 2 U of FFPFresh Frozen Plasma (FFP)-Volume ExpanderDextranMost widely usedLow/Middle M.W.(40,000-70,000)Massive transfusion could impair coagulationOccasional ALLERGIC reactionHydroxyethyl Starch Formulation(HES)More stableContaining essential electrolytesNo allergic reactionPlasma SubstitutesIndication：nAcute massive blood loss;nAnaemia and hypoalbuminemia;nOverwhelming Infection;nDysfunction of Coagulation;Blood TransfusionTechnique of Transfusion:nApproach Route:Peripheral Vein,Center VeinnFiltration before Transfusion：nVelocity of Transfusion：5-10ml/minBlood TransfusionnDouble Check:Name,Type and CrossmatchnStorage Time:Citrate Phoshate DetroseAcidic Citrate Detrose 21D,35DnPre-heat：nNo any other Medication：nObservation during/after Transfusion：AttentionAttention：Blood TransfusionIncidence：2%Chills,Fever 39-40.CHeadache,SweatinessNausea,Vomiting,Flushing15min-1hrFebrile Reactions：Transfusion ReactionsnImmuno-reaction：nEndo-toxins：nContamination or Hemolysis：nAnalyze possible reasons：nStop Transfusion：nGeneral Support：Treatment：Febrile Reactions：Transfusion ReactionsUrticariaAbdominal cramps DyspneaVomitingDiarrheaAnaphylactic reactions：Transfusion ReactionsnImmuno-reaction：IgEnHereditary Immunoglobulin：IgAReason：nAdminister antihistaminesnAdminister epinephrine,diphenhydramine,and corticosteroids：nSupport airway and circulation as necessary：Treatment：Anaphylactic reactions：Burning at the intravenous(IV)line siteFever,Chills,DyspneaShockCardiovascular CollapseHemoglobinuria,HemoglobinemiaRenal FailureDICHemolytic transfusion reactions Transfusion ReactionsnABO incompatibility nRh Incompatibility nNon-immune HemolysisnImmune Hemolysis Reasons：Hemolytic Transfusion Reactions nStop Transfusion as soon as reaction is suspectednCheck the name,type and crossmatchnUrine Exam nRenal Protection(Aggressive Fluid Resuscitation,Furosemide)nDIC MonitorTreatment：Hemolytic Transfusion Reactions nDouble Check name,type and crossmatchnOperate carefully and routinely nTemperature MonitorPrevention：Hemolytic Transfusion ReactionsMassive transfusion complications:Volume OverloadCongestive Heart Failure TachycardiaTachypneaCyanopathyTransfusion ReactionsnVolume OverloadnHeart Functional FailurenLung Functional FailureReasons：nStop TransfusionnHeart Functional SupportnDiuresis (Furosemide)Treatment：Massive Transfusion Complications:Contamination:FeverShockDIC Bacterial ContaminationReasons：Transfusion ReactionsnStop TransfusionnBacterial Exam and Culture nAntibioticsTreatment：nDouble Check nOperate carefullyPrevention：Contamination:nHepatitis B,Hepatitis CnHIVnCytomegalovirus(CMV)nSyphilisnMalariaAcquired diseases：Transfusion ReactionsnNo risk of infectious disease transmission nNo transfusion reactions nNo compatibility testing nReduced demand on blood bank stores nAn immediate source of autologous blood Autotransfusion：nRed Blood CellsPacked RBCnWhite Blood CellsnPooled PlateletsBlood Cell：Component Transfusion：Saving blood sourceLess likely carrier of transmitted diseasesShortage of quality bloodGreater shelf life than whole bloodHelping to make blood safer by filtrationInfusing regardless of ABO type in some blood products giving only essential/desired blood componentComponent Transfusion：