Transfusion Guide for Clinicians Kanchan Bhardwaj
INDEX
×
Chapter Notes

Save Clear


1Transfusion Guide for Clinicians2
3Transfusion Guide for Clinicians
Kanchan Bhardwaj MD FIAC FIMSA MISBTI MIAPM MISHTM MIMA Associate Professor Department of Transfusion Medicine Government Medical College, Patiala Punjab, India Forewords JG Jolly SS Gill Jai Kishan
4
Jaypee Brothers Medical Publishers (P) Ltd
Headquarter
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Offices
JP Medical Ltd
83 Victoria Street London
SW1H 0HW (UK)
Phone: +44-2031708910
Fax: +02-03-0086180
Jaypee-Highlights Medical Publishers Inc.
City of Knowledge, Bld. 237, Clayton
Panama City, Panama
Phone: 507-317-0160
Fax: +50-73-010499
© 2012, Jaypee Brothers Medical Publishers
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Transfusion Guide for Clinicians
First Edition: 2012
9789350255551
Printed at
5Dedicated to
My loving parents
Mrs Surjit Saini and Er BK Saini and my teachers
6
7Foreword
It is a matter of great satisfaction that all the clinical departments take the advantage of this manual for using it as a guide in promoting the Blood Transfusion Program. This can be achieved through a variety of techniques in the furtherance of incorporating Blood Transfusion Services and thus achieving the objective that helps in satisfying the needs for which all activities of this service is achieved.
Thus, the objective of blood transfusion activities serves the purpose of achieving the objective for which the purpose of all aspects of Blood Transfusion Program is achieved.
It is a matter of great satisfaction that the author has taken great care in providing all aspects of blood and its components in serving the purpose of achieving the objective for which this manual has been prepared.
JG Jolly
MD FAMS
Emeritus Professor
Department of Transfusion Medicine
PGIMER, Chandigarh, India
8
9
BABA FARID UNIVERSITY OF HEALTH SCIENCES
 M.S. (Orthopaedics)
  Vice Chancellor
Sadiq Road,
Faridkot-151 203 (Punjab)
Phone : 01639-256232, 256236
Fax : 01639-256234
No. 01-BFUHS(PA-Reply-13)10/17587
Foreword
There was a time when Transfusion Medicine had been considered as a paraclinical subject but in today's advanced scenario, it has now become a full-fledged clinical subject in the field of medical sciences. Medical services are incomplete and cannot run without its support for which complete set-up of Transfusion Medicine in a hospital is absolutely necessary. Professionals working in this area must know the new methods and techniques; have complete knowledge on the subject and application thereof on the patients. They must know how to test, investigate, store and distribute blood. Owing to advent of diseases like HIV and hepatitis, utmost need to adopt the highest standards of safety for the employees and blood transfusion recipients and that too in the most cost-effective manner is required. In addition, maintaining of detailed records is also very important part in order to track all blood products and evaluate transfusion outcomes.
Transfusion Guide for Clinicians written by Dr Kanchan Bhardwaj, who is an Associate Professor (Blood Transfusion) in Government Medical College, Patiala, Punjab, India, is a good record for the students and practitioners. In this book, the author has made an endeavor to provide complete data on the subject. I do hope, the book will be very useful to the students and practitioners to adopt advanced methods and techniques on safe blood transfusion and equip them to work on latest resources and technologies so that they could serve the suffering humanity in a better way.
I feel pleasure in contributing the foreword of the book and congratulate Dr Kanchan Bhardwaj, for her contribution in the field of health sciences.
SS Gill
MS (Orthopaedics)
Vice Chancellor
Baba Farid University of Health Sciences
Sadiq Road, Faridkot, Punjab, India
10
11
DIRECTORATE OF RESEARCH AND MEDICAL EDUCATION, PUNJAB, SCO NO. 87, SECTOR 40-C, CHANDIGARH
Phone No. 0172-2690854, Mobile No. 098887-74425, Email: jaikishantb@gmail.com
DR. JAI KISHAN
M.D., F.C.C.P. (USA)
M.A. (Human Rights)
P.G.C.C. (Hospital Management)
P.G.C.C. (Health & Family Management)
Director, Research and Medical Education, Punjab
Director, STDC Patiala, Punjab
Governor, American College of Chest Physicians (USA)
Chairman, Zonal Task Force RNTCP (North India)
President, Punjab Nurses Registration Council
Registrar, Punjab State Pharmacy Council (Ex)
Patron, Indian Red Cross Society, Punjab
Foreword
Blood transfusion is a household name. Blood transfusion is oft en required in clinical practice. Transfusion medicine has witnessed exponential technical advances. Blood transfusion is panacea for life-threatening conditions but should be used with caution and only when it is indicated. Not only the whole blood but also its components be used as per the requirement to make the optimal use of the available blood, which is in scarcity. Blood transfusion should be carried out by taking all the precautions so that instead of being useful may not harm the recipient. Every precaution should be taken in requisition of blood and its component, while releasing blood by the Blood Bank, during transportation and during transfusion. Keen observation should be made to identify the early and late blood transfusion reaction. Although many institutions have initiated postgraduate courses in Immunohematology and Transfusion Medicine but the majority of the practicing doctors are not aware of the guidelines of blood transfusion, indications for whole blood or its components and good transfusion practices. This book on Transfusion Guide for Clinicians by Dr Kanchan Bhardwaj, Government Medical College, Patiala is an endeavor to empower the clinicians with adequate knowledge for good transfusion practices. I feel that every clinician should go through this book so that blood transfusion is a win-win situation for the donors/recipient and the clinician.
I congratulate Dr Kanchan Bhardwaj on bringing out the book Transfusion Guide for Clinicians.
Jai Kishan
MD FCCP (USA) MA (Human Rights) PGCC (Hospital Management)
PGCC (Health & Family Management)
Director, Research and Medical Education, Punjab
Director, STDC Patiala, Punjab
Governor, American College of Chest Physicians (USA)
Chairman, Zonal Task Force RNTCP (North India)
President, Punjab Nurses Registration Council
Registrar, Punjab State Pharmacy Council (Ex)
Patron, Indian Red Cross Society, Punjab, India
12
13Reviews
Blood Transfusion Service (BTS) is an important component of modern health care delivery system. For effective Blood Transfusion services, there should be a close, cordial and active collaboration between the blood providers and blood users which unfortunately at present is lacking. To achieve this goal, there was an urgent need of a book and Dr Kanchan Bhardwaj has taken the lead and has really toiled hard or provide this publication entitled Transfusion Guide for Clinicians.
The primary aim of this book is to assist the clinicians to make informed clinical decision on Blood Transfusion Therapy and rational use of blood and also to manage adverse blood transfusion reactions effectively.
I have gone through the book and came to the conclusion that Dr Kanchan has done a marvelous job in writing and covering all the chapters relevant to the title in a comprehensive yet lucid manner. All the chapters are well structured and are of outstanding educational value.
I congratulate Dr Kanchan for this much needed endeavor.
May god bless all of us in providing safe and effective blood and its products to the needy patients.
TR Raina md
Professor and Head
Department of Immunohematology and Blood Transfusion Medicine
Government Medical College/SMGS Hospital, Jammu
Principal Investigator
Human Research and Counselling Centre
Government Medical College/University, Jammu
Consultant Blood Banks/Laboratories
Health Department, Jammu Region
Regional Co-ordinator
J&K State AIDS Control and Prevention Society
Chairman ISBTI
J&K Chapter14
Transfusion Guide for Clinicians by Dr Kanchan Bhardwaj is a book of outstanding merit. It fulfills a very long standing need of students, postgraduates, medical officers working in blood banks, clinicians, practitioners, all blood users who will take its benefit in transfusion related problems.
Kumkum Sharma md
Professor and Head
Department of Transfusion Medicine
Acharya Sri Chander College of Medical Sciences and Hospital, Jammu
Ex-Professor and Head, Government Medical College, Jammu, India
It is a pleasure writing review of this book Transfusion Guide for Clinicians written by my colleague. This book is meant to be used in the wards, operation theatres, day care centres, intensive care units, trauma care centres, etc. by the doctors working there. It is a basic tool for them. The book should be prescribed for the undergraduates as well, who are future specialists. All clinical specialists who are the real blood users should always carry this with them. The broad idea about the transfusion reactions and their management is meant for all nursing staff in addition to the doctors. This can avoid reactions and can also help in early detection which can be life-saving.
Cord blood banking is also becoming a routine these days. Every obstetrician should know about it and guide the expecting mothers for the simplicity of the procedure. The risk of transfusion transmitted infections has been taken up briefly to convey about the risks of transfusions, so that transfusion risks should be overweighed by its benefits before prescribing it.
Shashi Prabha md
Professor and Head
Department of Transfusion Medicine
Government Medical College
Patiala, Punjab, India
It was my pleasure to review Transfusion Guide for Clinicians. This document was well written in a comprehensive manner for clinical departments of hospitals. This document will be helpful in bedside practices, where the text is written with short definitions with bullet points and multiple tables. It will help clinical residents, staff nurse and faculty for using in bedside situations. It has covered almost all topics related to laboratory and bedside transfusion medicine. I wish a success in publication, circulation and proper utilization amongst medical fraternity.
N Choudhury
Editor, Asian Journal of Transfusion Science
Senior Consultant
Department of Transfusion Medicine
Tata Medical Center
14 MAR (EW), Jyoti Basu Nagar (Newtown)
Rajarhat, Kolkata, India
15Preface
Blood transfusion is an essential part of modern health care. When used correctly; it can save life and improve health. However, the transmission of infectious agents by blood and blood products has focused particular attention on the potential risks of transfusion.
The Transfusion Guide for Clinicians will act as a quick reference for clinicians involved in the transfusion process that needs to make urgent decisions on transfusion. This will help promote rational use of blood. It will update the clinicians about the present scenario of transfusion service in an understandable manner. It covers all the clinical aspects of Blood Transfusion Services including Guidelines for clinical transfusion procedures, Blood components and its uses, Apheresis, Transfusion practices in clinical medicine, Transfusion in obstetrics, Pediatrics, Surgery, Trauma, Burns, Cardiopulmonary bypass surgery and Transplantation, Umbilical cord blood, Transfusion transmitted infections, Transfusion reactions— its protocol, Autologous transfusion, Recent advances in transfusion and Blood group choice. Plasma derivatives and substitutes, alternatives of transfusion and Frequently Asked Questions about transfusion are written by Dr BL Bhardwaj, Professor of Medicine in Government Medical College, Patiala and Dr Aastha Miranpuri, University of Wisconsin, USA. They have covered each and every question coming to the mind of clinicians.
The book has been written for use of the practicing clinical specialists, resident doctors of clinical specialties, ICU specialists, etc. and others involved in the transfusion process. The undergraduate students should also acquaint themselves with transfusion practices so as to make the transfusion safest in future.
The manuscript has been written, keeping in mind the national guidelines on clinical use of blood. It will also help the clinicians to know about the legal issues regarding the transfusion process. Suggestion from the readers will be appreciated and can be sent by e-mail tgfc_kb@yahoo.com.
Kanchan Bhardwaj
16
17Acknowledgments
The first and the foremost heartfelt thanks to Dr JG Jolly, Professor Emeritus, Department of Transfusion Medicine, PGIMER, Chandigarh, whose kind guidance for writing this manuscript for promoting the rational use of blood has gone a long way. I convey my special thanks to Dr SS Gill, renowned Orthopedic Surgeon and a gifted writer, Vice Chancellor, Baba Farid University of Health Sciences, Faridkot, who has prompted and encouraged me to write this book which will be useful for all clinicians during their day-to-day practice. I am also grateful to Dr Jai Kishan, Director, Research and Medical Education, Chandigarh, for his consistent guidance and encouragement for writing this book; without his kind help, it could not have been possible for me to complete this book. I thank the encouragement given by Mr Yudvir Singh, President, Indian Society of Blood Transfusion and Immunohematology for writing this manuscript for promoting rational use of blood.
I acknowledge the inspiration given to me by my revered teachers, late Dr Raminder Kaur Popli, Professor and Head, Department of Pathology, late Dr PS Sethi, Associate Professor, Department of Pathology, who since long had been inspiring me to write a book but are not with us to see this book.
I express my gratitude and thanks to Dr KD Singh, Principal, Government Medical College, Patiala, Punjab, India, for his kind and expert guidance. I am also thankful to all the clinicians of my institute, Government Medical College, Patiala, Punjab, India, who have expressed the need for some written guidelines about blood transfusion, which can be helpful in their day-to-day clinical practice and can guide the junior residents about how best to utilize the blood bank services without much inconvenience and side-effects to the patients. I convey my special thanks to Dr Surinder Singh, former Principal, Government Medical College, Patiala, Punjab, India; Dr MM Gupta, former Head, Department of Medicine; Dr HS Sandhu, Head, Department of Medicine; Dr VK Sharda, Head, Department of Surgery; Dr HK Rao, former Head, Department of Medicine; Dr RS Gupta, former Head, Department of Medicine; Dr Manjit Kaur Mohi, Head, Department of Obst and Gyne; Dr Prabhat Shobha, former Head, Department of Pediatrics; Dr Paramjit Kaur and Dr Khushpreet Kaur, Professors, Department of Obst and Gyne; Dr TS Punia, Head, Department of Anesthesia; Dr AS Sidhu, Head, Department of Ortho; Dr JPS Walia, Dr Mohinder Singh, Dr Chitranjan Vij, Dr Preetkamal Sibia, Dr Ardaman Singh, Dr Maninder Kaur, and Dr Manpreet Kaur.
I highly appreciate the kind help and guidance given by my colleagues from other institutes like Dr TR Raina, Head, Department of Transfusion Medicine, Government Medical College, Jammu; Dr Ravneet Kaur, Associate Professor, Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh; Dr Neelam Marwaha, Head, Department of Transfusion Medicine; and Dr RR Sharma, Associate Professor, Department of Transfusion Medicine,18 Postgraduate Institute of Medical Education and Research, Chandigarh; Dr Sabita Basu, Head, Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh; Dr Kumkum Sharma, former Head, Department of Transfusion Medicine, Government Medical College, Jammu; Dr Kabita Chatterjee, Head, Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi; Dr PK Seghal, Head, Department of Transfusion Medicine, Pt. BD Sharma, University of Health Sciences, Rohtak; Dr RN Makaroo, Sr Consultant, Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi; Dr Anil Vij, Head, Department of Medicine, Punjab Institute of Medical Sciences, Jalandhar, Punjab; Dr Dharampal, Civil Surgeon (Retd); Dr ML Bansal, Editor-in-chief of Current Medical Journal of North Zone; Dr Amarjit Kaur, Head, Department of Transfusion Medicine, Dayanand Medical College, Ludhiana, Punjab; Dr BK Aggrawal, Head, Department of Medicine, Maharishi Markendeshwar Institute of Medical Sciences and Research, Mullana, Haryana; Dr RP Kudiar, Head of the Department, ASCOM, Jammu; Dr BB Gupta, Head, Department of Medicine, Government Medical College, Jammu; Dr PS Gehlot, Head, Department of Medicine; Dr Samarjit, Head, Department of Pathology, Guru Gobind Singh Medical College, Faridkot, Punjab; Dr Lovedeep Saini, Dr Sumeet Pal Saini, Dr Sukhwinder Singh, Joint Director, BS & QA, Punjab State AIDS Control Society, Chandigarh, Dr Sartaj Kaur Dhillon and Dr Satwant Singh Dhillon, Wisconsin, USA, Dr Jasbir Kaur, Principal, Gian Sagar Medical College and Hospital, Ram Nagar, Patiala; Dr Meena Garg and Dr Naresh Garg.
I am thankful to all my friends and colleagues, who have helped me in writing this book in one way or the other. My special thanks to Dr Shashi Prabha, Head, Department of Transfusion Medicine; Dr MS Bal, Head, Department of Pathology; Dr Vijay Kumar, Dr Anil Suri, Dr Mohanveer Kaur, Dr Harshinder Kaur, Dr Gurpal Singh, Dr Rajesh Goyal, Dr Rajani Bassi, Dr Aradhana Sharma, Dr Manmeet Kaur, Dr Sandeep Tandon, Dr Poonam Singhal, Mr Mahesh Kumar, Mr Sukhvinder Singh and Mr Pawan Kumar, who have contributed in one way or the other for this manuscript.
I express my special thanks to Dr Manmohan Singh, DM Cardiology and President, Punjab Medical Council; Dr Sudhir Verma, DM Cardiology for their ever available guidance and help.
I am thankful to Dr Amrendra Miranpuri, MD, Dr Gurwatan Singh Miranpuri, University of Wisconsin, Madison, USA; Ms Ravisha Bhardwaj, Mr Harnoor Singh Bhardwaj, Ms Ankita Saini, Mrs Nisha Bhardwaj, Dr Kavita Bhardwaj and Ms Shivani Bhardwaj for their unstinting support, constant encouragement, prompt help and cooperation.
I extend my sincere thanks to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for bringing out this manuscript.