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Transfusion Guide for Clinicians
Kanchan Bhardwaj
1:
Guidelines for Clinical Transfusion Procedures
CLINICAL DECISIONS ON TRANSFUSION
ASSESSING THE NEED FOR TRANSFUSION
CHECKLIST FOR CLINICIANS PRESCRIBING BLOOD
REQUISITION FOR BLOOD/ BLOOD COMPONENTS
INFORMING THE PATIENT
ORDERING BLOOD
Ordering Blood in an Emergency
Ordering Blood for Elective Surgery
Blood Ordering Schedule (Maximum Surgical Blood Ordering Schedule) (MSBOS)
BLOOD SAMPLES
DONOR
PROTOCOL FOR APHERESIS DONOR
CROSS-MATCH OF BLOOD
Routine Cross-Match
Emergency/Immediate Cross match/Spin Technique
ISSUE OF BLOOD UNITS
COLLECTING BLOOD/ PRODUCTS PRIOR TO TRANSFUSION
COMPONENTS
DOSE/OUTCOME OF BLOOD/BLOOD COMPONENTS
STORING BLOOD PRODUCTS PRIOR TO TRANSFUSION
Platelet Concentrates (PC)/ Random Donor Platelets (RDP) Apheresis Platelets (Single Donor Platelets)/Platelet Rich Plasma (PRP)
Fresh Frozen Plasma (FFP) and Cryoprecipitate (Cryo/CP)
ADMINISTERING BLOOD PRODUCTS
TIME LIMITS FOR INFUSION
DISPOSABLE EQUIPMENT FOR TRANSFUSION
BLOOD WARMING
Procedure
PRESSURE DEVICES FOR RAPID INFUSION
RECORDING THE TRANSFUSION
MONITORING THE TRANSFUSED PATIENTS
ACUTE TRANSFUSION REACTIONS
PROTOCOL FOR ADVERSE REACTION OF BLOOD TRANSFUSION
2:
Blood Components and its Uses
PACKED RED BLOOD CELLS (PRBCs)
Indications
Dose
LEUKOREDUCED RED CELLS
Indications for Leukoreduced Blood Components
Methods of Leukoreduction
Indications
PLATELETS
Indications
Contraindications
Dose
Corrected Count Increment (CCI)
Percentage Platelet Recovery (PPR)
Platelet Refractoriness
Management
FRESH FROZEN PLASMA (FFP)
Indications
Contraindications
Dose
Solvent-Detergent Fresh Frozen Plasma (SD-FFP)
Contraindications
Single Donor Plasma and Cryoprecipitate Poor Plasma (CPP)
Indications
CRYOPRECIPITATE (CP/Cryo)
GRANULOCYTES
Indications
Dose
IRRADIATED RED CELLS
Indications
CRYOPRESERVED RED CELLS
3:
Apheresis
APPLICATIONS
Apheresis Components
Therapeutic Apheresis
Peripheral Blood Stem Cells (PBSC)
SEPARATION TECHNIQUES
Manual Apheresis
Automated Separation by Centrifugation
Separation by Membrane Filtration
Separation by Adsorption
General Requirements for Apheresis
DONOR ASPECTS
Criteria for Selecting Apheresis Donor
Donors Investigations Prior to the Procedure
Criteria for Plateletpheresis Donor
Criteria for Plasmapheresis Donors
Donor Reactions
APHERESIS COMPONENTS
Advantages of Single-Donor Components
CYTAPHERESIS
Plateletpheresis
Dose
Increment
Leukapheresis
Erythrocytapheresis
Neocytapheresis
Plasmapheresis
Benefits of Apheresis Plasma
Applications of Non-Therapeutic Plasmapheresis
THERAPEUTIC APHERESIS
Therapeutic Cytapheresis
Therapeutic Plateletpheresis
Therapeutic Leukapheresis
Therapeutic Erythrocytapheresis
THERAPEUTIC PLASMAPHERESIS (PLASMA EXCHANGE)
PERIPHERAL BLOOD STEM CELLS (PBSCs)
Benefits of PBSC's Over Bone Marrow Transplantation
Fluids Used in Apheresis
Contraindications to Apheresis
Risks of Repeated Apheresis
Limitations of Apheresis
4:
Transfusion Practices in Clinical Medicine
MASSIVE TRANSFUSION
Clinical Settings with Massive Transfusion
Sequelae of Massive Transfusion
Indications for Components
DISSEMINATED INTRAVASCULAR COAGULATION
Causes of DIC
Symptoms
Laboratory Findings
Management
MULTI-TRANSFUSED PATIENTS
Indications
SICKLE CELL ANEMIA
Indications for Transfusion Therapy in Sickle Cell Disease
Laboratory Investigations
Transfusion in Sickle Cell Crisis
For Prevention of Crisis
For Treatment of Crisis and Severe Anemia
Sequestration Crisis
Aplastic Crisis
Management of Pregnancy and Anesthesia in SCD
Transfusion of Fresher RBCs
Exchange Transfusion
THALASSEMIA
Management
Blood Products Used in Thalassemics
Iron Overload
Iron Chelation in Thalassemia
Vitamin C
Neocytes Transfusion
Splenectomy
Indications
Prevent Isoimmunization
Bone Marrow Transplantation
HEMOPHILIA
Lab Findings
Blood Products Used:
Treatment
Acute hemorrhage
Replacement Therapy
VON WILLEBRAND'S DISEASE
Lab Investigations
Management
Dose
DISORDERS OF VITAMIN K-DEPENDENT COAGULATION FACTORS
Clinical Features
Laboratory Findings
Management
MALARIA
AUTOIMMUNE HEMOLYTIC ANEMIA
Blood Transfusion in AIHA
Detection of Allo-Antibodies in AIHA
Compatibility Testing and Selection of Blood in AIHA
ANEMIA
Chronic Anemia
Causes
Clinical Features
Acute Anemia
Causes
Laboratory Investigations
Management
Treatment of Chronic Anemia
SEVERE (DECOMPENSATED) ANEMIA
Transfusion in Severe (Decompensated) Anemia
GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY
BONE MARROW FAILURE
Transfusion in Bone Marrow Failure
Platelet Transfusion to Control Bleeding
Platelet Transfusion to Prevent Bleeding
GASTROINTESTINAL BLEEDING
5:
Transfusion Practice in Obstetrics
BLOOD LOSS DURING DELIVERY
Transfusion
TRANSFUSION GUIDELINES FOR CHRONIC ANEMIA IN PREGNANCY
Duration of Pregnancy < than 36 Weeks
Duration of Pregnancy 36 Weeks or More
Elective Cesarean Section
MAJOR OBSTETRIC HEMORRHAGE
Management of Major Obstetric Hemorrhage
Resuscitate
Monitor/Investigate
Stop the Bleeding
DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
Management
HEMOLYTIC DISEASE OF THE NEWBORN (HDN)
6:
Neonatal and Pediatric Transfusion Practice
NEONATAL TRANSFUSION
HEMOLYTIC DISEASE OF NEWBORN (HDN)
Classification of HDN
Pathophysiology of HDN
RhD HEMOLYTIC DISEASE OF NEWBORN (RHD HDN)
Antenatal check up:
Amniocentesis
Prevention of HDN
Antenatal Management
Postnatal Management
EXCHANGE TRANSFUSION
Indications of Exchange transfusion
Blood Group Choice for Exchange
Volume for Exchange Transfusion
Compatibility Testing for Exchange Transfusion
Procedure
Types of Exchange
Calculations for Neonatal Exchange Transfusion
Partial Exchange Transfusion
Two-volume red Cell Exchange Transfusion
Transfusion Procedure
Precautions
ABO HEMOLYTIC DISEASE OF THE NEWBORN (ABO-HDN)
Management
INDIRECT HYPERBILIRUBINEMIA
Management
PAEDIATRIC ANEMIA
Indication for Transfusion
Transfusion Procedure
BLEEDING AND CLOTTING DISORDERS IN PEDIATRICS
ACQUIRED BLEEDING AND CLOTTING DISORDERS
Vitamin K Deficiency in the Neonate
THROMBOCYTOPENIA
Platelet Transfusion for Bleeding due to Thrombocytopenia
Transfusion of Platelet Concentrates (PC)
Prophylactic Platelet Transfusion
RED CELL TRANSFUSION
NEONATAL ALLOIMMUNE THROMBOCYTOPENIA
FRESH FROZEN PLASMA IN PEDIATRICS
7:
Transfusion Practice in Surgery and Hemorrhage
RED BLOOD CELL TRANSFUSION IN ANAEMIA
Acute Anemia / Blood Loss
Guidelines of Red Cell Transfusion (Excluding Neonates)
Acute Blood Loss
Hb Level
Chronic Anemia
ANEMIA AND SURGERY
RECOMBINANT ACTIVATED FACTOR VII (rFVIIa)
Guidelines for Practical use of rFVIIa
SURGERY AND COAGULATION DISORDERS
Acquired Coagulation Disorders
Congenital Coagulation Disorders
Preoperative Thrombocytopenia
ANTICOAGULANTS: WARFARIN, HEPARIN
Patients on Warfarin (Fully Anticoagulated)
Elective Surgery
Emergency Surgery
Patients on Heparin (Fully Anticoagulated)
Elective Surgery
Emergency Surgery
Patients on Low Dose Heparin
MANAGEMENT OF A BLEEDING PATIENT WHO HAS RECEIVED FIBRINOLYTICS OR PLATELET INHIBITORS
Systemic Fibrinolytics
Aspirin or Clopidogrel
Aspirin and Clopidogrel
High-Avidity Agents such as Abciximab
Low-Molecular-Weight Agents (e.g. Eptifibatide, Tirofiban)
TRANSFUSION IN ELECTIVE SURGERY
Replacement Fluid
Maintenance Fluid
Adult
Children
Body Cavity Losses
8:
Approach to a Patient of Trauma and Burns
PHASE I: ASSESS & RESUSCITATE
PHASE II: REASSESS
PHASE III: DEFINITIVE TREATMENT
PHASE I: ASSESSMENT AND RESUSCITATION
Monitoring
Hypovolemia
Intravenous Access
Fluid Resuscitation
PHASE II: REASSESSMENT
MANAGEMENT STRATEGY
PHASE III: DEFINITIVE MANAGEMENT
PEDIATRIC PATIENTS
Hypovolemia
APPROACH TO A PATIENT OF BURNS
Fluid Resuscitation
Formula for Calculating Fluid Requirement for Burns Patient
Adults
Children
9:
Transfusion in CardioPulmonary Bypass Surgery
THROMBOELASTOGRAPHY
10:
Transfusion in Transplantation
TRANSFUSION IN BONE MARROW TRANSPLANTATION
Transfusion Protocol for BMT Recipients
TRANSFUSION IN SOLID ORGAN TRANSPLANTATION
Transfusion Protocols
Other Solid Organ Transplantation
11:
Transfusion Transmitted Infections
WINDOW PERIOD
HBV
Screening Tests for HBV
HCV
Screening Tests for HCV
HIV
Serological Profile of HIV Infection
Detection of HIV infection
Screening Tests
Antibody Testing
Confirmatory Test
Interpretation
Detection of HIV-Ag
SYPHILIS
MALARIA
Bacterial Contamination
VIRAL INACTIVATION
PATHOGEN INACTIVATION
ROLE OF THE CLINICIANS
PREVALENCE OF TTIs
HOW SAFE IS TRANSFUSION?
NUCLEIC ACID TESTING (NAT)
12:
Transfusion Reactions Protocol
CLASSIFICATION OF TRs
ACUTE / IMMEDIATE REACTIONS
DELAYED TRANSFUSION REACTIONS
Signs and Symptoms of TRs
MANAGEMENT AND INVESTIGATIONS
Actions to be taken by the Nursing Personnel
Actions to be taken by the Doctor
LAB STUDIES
TRANSFUSION TRANSMITTED INFECTIONS—DELAYED COMPLICATIONS OF TRANSFUSION
ERRORS IN TRANSFUSION PROCESS
PREVENTION OF TRs
SHOT UK Report 1996-2009
Patient Identification
Clinical Handover
13:
Autologous Transfusion
TYPES OF AUTOLOGOUS TRANSFUSION
1. Preoperative/Predeposit Autologous Transfusion
Criteria for Autologous Donation
Transfusion of Autologous Blood
2. Acute Isovolemic Normovolemic Hemodilution (ANH)
3. Intraoperative Blood Salvage
Indications/uses
Contraindications
4. Postoperative Salvage
Indications
Advantages of Autologous Transfusion
Disadvantages of Autologous Transfusion
Contraindications for Autologous Transfusion
Adverse Reaction
14:
Fresh Blood
15:
Blood Group Choice
16:
Umbilical Cord Blood
17:
Hospital Transfusion Committee
18:
Plasma Derivatives and Plasma Substitutes
PLASMA PROTEIN SOLUTIONS
Albumin Preparations
Characteristics of Albumin Preparation
Indications for 5% albumin and PPF
FACTOR VIII CONCENTRATE
FACTOR IX CONTAINING PLASMA DERIVATIVES
IMMUNOGLOBULIN PREPARATIONS
PLASMA SUBSTITUTES
Colloidal Solutions
Crystalloid Solutions
19:
Alternatives to Transfusion
PHARMACOLOGICAL AGENTS
DDAVP or Desmopressin
Epsilon Aminocaproic Acid (EACA)
Danazol
Aprotinin (Trasypol)
Intravenous Immunoglobulins
Vitamin K
RECOMBINANT HEMATOPOIETIC GROWTH FACTORS
Recombinant Human Erythropoietin (EPO)
Other Blood Cell Growth Factors
Thrombopoietin
Recombinant Human Antihemophilic Factor (rh-Factor VIII)
Recombinant Activated Factor VII (rFVIIa)
RED CELL SUBSTITUTES
Constitution of an Ideal Blood Substitute
Hemoglobin Based Oxygen Carriers (HBOCs)
Benefits
Challenges
Perfluorochemical Compounds
Disadvantages
PLATELET-DERIVED PRODUCTS
Frozen Platelets
Cold Liquid-Stored Platelets
Three approaches
Photochemically Treated Platelets
20:
Recent Advances in Transfusion
PROTEOMICS
Applications in Transfusion Medicine
GENE THERAPY
PATHOGEN INACTIVATION SYSTEM
ADOPTIVE IMMUNOTHERAPY
Thromboelastography
Recombinant Activated Factor VII (rFVIIa)
RECENT ADVANCES IN APHERESIS
Immunoadsorption
Photopheresis
21:
Frequently Asked Questions about Transfusion
Abbreviations
Glossary
Appendices
DEPARTMENT OF TRANSFUSION MEDICINE (BLOOD BANK), RAJINDRA HOSPITAL GOVT. MEDICAL COLLEGE, PATIALA
BLOOD REQUISITION FORM
PRE-TRANSFUSION HEMATOLOGICAL VALUES
INDICATION FOR TRANSFUSION
TYPE OF REQUEST
BLOOD/BLOOD COMPONENTS REQUIRED
PATIENT/RELATIVES CONSENT
DOCTOR'S CONSENT
DOCTOR CONSENT FOR RAPID SCREENING TEST FOR TRANSFUSION TRANSMITTED INFECTIONS
INFORMING PATIENTS
Why might a blood transfusion be needed?
What can be done to reduce the need for blood?
Are transfusions safe?
CONSENT FORM FOR THE TRANSFUSION OF BLOOD/BLOOD COMPONENTS
Authorization by Patient
Patient's Attendant/Next of Kin
DONOR FORM
Transfusion Reaction Form
Blood Transfusion Reaction Protocol for Clinicians
GOOD TRANSFUSION PRACTICES
NORMAL HEMATOLOGICAL VALUES IN ADULTS
NORMAL HEMATOLOGICAL VALUES IN CHILDREN
CRITERIA FOR ANEMIA
Directed donation—‘I want to donate blood for my own relative’
PATIENTS WHO DO NOT ACCEPT TRANSFUSIONS
Information for Clinical Staff
Elective Surgery
At time of referral (surgical outpatient department)
Suggested Reading
INDEX
TOC
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