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    Hemorrhage & Blood Transfuion

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    This document provides learning objectives and content about hemorrhage (bleeding) and blood transfusion. It defines hemorrhage, classifies it by site, type of vessel injured, timing relative to trauma, and etiology. It describes clinical signs of different hemorrhage classes and outlines treatment. It then defines blood components for transfusion, indicates their uses, and lists testing and precautions for transfusion. Finally, it enumerates complications of transfusion including allergic, hemolytic and pyrogenic reactions, infections, and issues related to massive transfusion.

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    Hemorrhage & Blood Transfuion

    Uploaded by

    mhmdalbdyny764
    13 views30 pages
    This document provides learning objectives and content about hemorrhage (bleeding) and blood transfusion. It defines hemorrhage, classifies it by site, type of vessel injured, timing relative to trauma, and etiology. It describes clinical signs of different hemorrhage classes and outlines treatment. It then defines blood components for transfusion, indicates their uses, and lists testing and precautions for transfusion. Finally, it enumerates complications of transfusion including allergic, hemolytic and pyrogenic reactions, infections, and issues related to massive transfusion.

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    5. Hemorrhage & blood transfuion

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    This document provides learning objectives and content about hemorrhage (bleeding) and blood transfusion. It defines hemorrhage, classifies it by site, type of vessel injured, timing relative to trauma, and etiology. It describes clinical signs of different hemorrhage classes and outlines treatment. It then defines blood components for transfusion, indicates their uses, and lists testing and precautions for transfusion. Finally, it enumerates complications of transfusion including allergic, hemolytic and pyrogenic reactions, infections, and issues related to massive transfusion.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    13 views30 pages

    Hemorrhage & Blood Transfuion

    Uploaded by

    mhmdalbdyny764
    This document provides learning objectives and content about hemorrhage (bleeding) and blood transfusion. It defines hemorrhage, classifies it by site, type of vessel injured, timing relative to trauma, and etiology. It describes clinical signs of different hemorrhage classes and outlines treatment. It then defines blood components for transfusion, indicates their uses, and lists testing and precautions for transfusion. Finally, it enumerates complications of transfusion including allergic, hemolytic and pyrogenic reactions, infections, and issues related to massive transfusion.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 30

    Al-Azhar University

    Faculty of Medicine
    General Surgery
    Department
    Hemorrhage,
    Blood Transfusion
    ILOs
    By the end of this topic, you have to;
    Define hemorrhage
    Differentiate between arterial & venous bleeding
    Classify hemorrhage according to the onset of trauma
    Define reactionary & secondary hemorrhage
    Enumerate the causes of reactionary hemorrhage & secondary hemorrhage
    Describe changes of pulse, blood pressure, capillary refill, in different classes of hemorrhage
    Outline the treatment of hemorrhage
    Enumerate the blood components for transfusion
    Mention the tests must done before blood transfusion
    Enumerate complications of blood transfusion
    Describe allergic reaction after blood transfusion
    Recognize hemolytic reaction after blood transfusion, etiology, clinical presentation, management.
    Enumerate the complications of major hemolytic reaction after blood transfusion
    Enumerate the infections may transmits during blood transfusion
    Define massive blood transfusion
    Enumerate the complications of massive blood transfusion
    Mention the indications of whole blood, packed RBCs, Fresh frozen plasma transfusion
    Hemorrhage

    Definition; also known as a Bleeding, or simply blood


    loss, is blood escaping from the circulatory system from
    damaged blood vessels

     Typically, a healthy person can endure a loss of 10–


    15% of the total blood volume without serious medical
    difficulties (by comparison, blood donation typically
    takes 8–10% of the donor's blood volume).
    Hemorrhage
    Classification;
    According to site
     External; bleeding is visible as from skin or body orifices

    as epistaxis, hematemsis, bleeding per/rectum.


     Internal; as hemoperitonium, hemothorax
     Interstitial; bleeding occurs into tissues as hematomas

    According to type of injured vessels


     Arterial; blood is bright red, comes in pulsatile jets, occurs

    more from proximal than distal end


     Venous; dark red, comes in steady flow, more from the

    distal end
     Capillary; occurs as diffuse ooze of bright red blood
    Hemorrhage
    Classification;
    According to timing in relation to the onset of trauma
     Primary; occurs at the time of trauma

     Reactionary; occurs within 24 hours after trauma, causes; (rises

    blood pressure after correction of hypovolemia, slip of insecure


    ligature, dislodge a blood clots)
     Secondary; occurs 1-2 weeks after trauma due to infection

    eroding the vessel wall


    According to etiology
     Traumatic; accidental, surgical, interventional procedures

     Pathological; athersclerotic (rupture aortic aneurysm),

    inflammatory (bleeding peptic ulcer), neoplastic (hematuria in


    UT cancer)
     Bleeding diathesis; coagulation disorders
    Classes of Hemorrhage
    Grades of Hemorrhage
    According to WHO
    Hemorrhage

    Clinical picture;
    Depends on the class of hemorrhage
    Ranging from simple bleeding to picture of shock
    Hemorrhage

    Treatment;
    Depends on the class of hemorrhage,
    Aims;
    Stop bleeding, anti-shock measures & treatment of the
    cause
    Hemorrhage
    Anti-Shock Measures
     Stop hemorrhage;
     Packing
     Pressure is applied manually
     Elevation of the leg above the level of the heart stop venous
    bleeding & decrease arterial bleeding
     Supporting devices; pneumatic anti-shock garment which can
    tamponade lower limb, pelvis, abdominal bleeding. Balloon
    tamponade to compress bleeding esophagel V
     Maintain air way & oxygenation
     Analgesia; to relief pain & anxiety, to improve blood flow to brain
     Positioning of the patient; recumbent position with moderate
    elevation of lower limbs
     Temperature; keep the patient comfortably warm
    Hemorrhage
     Start intra-venous fluid resuscitation;
     2 large bore cannulas or do venous cut-down
     A blood sample is withdrawn for cross-matching
     Regimen; rapid infusion of lactated Ringer’s solution started
    immediately. Then blood transfusion may indicate depends on
    class of hemorrhage
     Alternative to blood transfusion; human plasma, Dextran,
    artificial blood substitutes
     Pharmacological support;
     Inotropic drugs; Dopamine in myocardial insufficiency
     Vasodilator drugs; given when blood volume & CVP has been
    restored to normal; to reduce afterload, increase cardiac output &
    decrease myocardial work
     Steroids
    Blood Transfusion
    Blood Transfusion
    Collection & storage of blood;
    The blood is collected and stored in citrate anticoagulant
    solution containing dextrose to preserve the viability of
    RBCs, the solution used are;
     Acid Citrate Dextrose (ACD)
     Citrate Phosphate Dextrose (CPD) or CPD plus adenine

    Frozen blood;
     Plasma is removed from the freshly collected blood, then

    glycerol is added to the red cell.


     Freezing at (-80 to – 190 C), kept for long periods
     The frozen blood don’t have coagulation factors, platelets,

    nor white cells


    Blood Transfusion
    Blood Components for Transfusion;
     Whole Blood; contains whole blood components.

     Packed Red Blood Cells; it improves the oxygenation ability without

    overloading the circulation, useful in elderly & cardiac patients


     Fresh plasma; it is the component of blood remaining after packed

    RBCs are separated, it rich in platelets & coagulation factors


     Fresh frozen plasma; plasma removed from fresh blood is rapidly

    frozen & stored at -40C, good source of all coagulation factors


     Platelets concentrates; as the half life of platelets is short (7-10

    days), they should freshly prepared


     Cryoprecipitate; it prepared from fresh frozen plasma, very rich in

    factor VIII & fibrinogen, it stored at -40C


     Human albumin 5 or 20%; stored for 4 years
    Indications of Blood Components Transfusion
    Blood Transfusion
    Blood Transfusion
    Blood Transfusion
    Blood Transfusion
    Testing & precautions;
     Donated blood should be tested for transfusion

    transmissible infections. These include HIV, hepatitis B,


    hepatitis C.
     Donated blood should also be tested for the ABO blood

    group system and Rh blood group system to ensure that


    the patient is receiving compatible blood
     In some countries platelet products are also tested for

    bacterial infections due to its higher inclination for


    contamination due to storage at room temperature
     Before a recipient receives a transfusion, compatibility

    testing between donor and recipient blood must be done


    (cross-matching).
    Blood Transfusion
    Complications of Blood Transfusion
    Pyrogenic reactions
     Etiology; due to minor bacterial contamination, or

    some pyrogens in the transfusion apparatus


     Clinically; chills, fever, headache, nausea, vomiting

    Allergic reactions
     Etiology; recipient’s response to allergens in the

    donor’s blood
     Clinically; mild itching & urticaria to a severe

    reaction with laryngeal edema & collapse


     Treatment; anti-histaminic & corticosteroids, if the

    reaction is severe stop transfusion


    Complications of Blood Transfusion
    Hemolytic reactions
     Etiology; due to presence of antibodies in recipient’s blood against one or more of the
    antigens in donor’s blood
     Clinically;
     The reaction occur after a transfusion of less than 50ml by chills, fever, constricting
    pain in the chest, dyspnea, pain in the flanks
     Examination; tachycardia, hypotension
     In anaesthetized patient, sudden tachycardia, hypotension, bleeding tendency
     A major hemolytic reaction will lead to, hemoglobinouria, jaundice, acute renal
    failure. Consumption coagulopathy will lead to bleeding tendency
     Treatment;
     Stop the transfusion immediately
     Repeat typing of the recipient’s and donor's blood
     Correct the shock by crystalloid solution infusion & corticosteroids
     Insert a Foley’s catheter & check urine output, an osmotic diuretics as mannitol may
    needed, keep an alkaline urine to protect against acute tubular necrosis, IV infusion of
    sodium bicarbonate may indicated
    Complications of Blood Transfusion
    Congestive heart failure;
     Etiology; occur usually in old patient especially if a large

    volume of blood is administrated rapidly


     It is recommended to transfuse packed RBCs rather than whole

    blood to correct anemia in elderly patients


    Transmission of infections;
     Viral hepatitis B, C, the most feared complication

     AIDS; HIV infection

     Syphilis; now rare, spirochetes cannot survive at blood bank

    temperature more than 4 days


     Malaria; transmitted only by red cells

     Septicemia; bacteria can survive in refrigerated blood, however

    if the blood is allowed to warm, bacteria can grow & Gram-


    negative endotoxins can cause septicemic shock
    Complications of Blood Transfusion
    Hyperkalemia;
     Etiology; with prolonged storage of blood, there is

    progressive loss of potassium from RBCs into the plasma,


    transfusion of several units of aged blood may produce
    arrhythmia or even arrest
    Citrate intoxication;
     Excess citrate will bind to the recipient’s calcium leading

    to hypocalcemia which augment the effect of hyperkalemia


    on heart.
     If more than 2 units of blood are administered, it is

    important to give 10ml of calcium gluconate


    Air embolism
    Complications of Blood Transfusion
    Complications of Massive blood transfusion;
     Definition; transfusion of 2500ml of blood at one time or

    5000ml or more over 24 hours


     It may result in;
     Hypothermia; warm the blood before transfusion
     Hyperkalemia
     Hypocalcemia
     Coagulation failure; due to dilution of clotting factors &

    platelets when large volumes of stored blood replace blood


    losses, stored blood is poor in platelets, factor VIII, factor
    V. In these situations it is recommended to give one unit of
    fresh frozen plasma and platelets for every unit of stored
    blood or transfuse fresh blood.
    How to minimize the need for
    Homologous blood transfusion

     Autologous blood transfusion; a patient who is going


    to have a major operation, can donate some units of
    his own blood over several days, the blood kept in
    refrigerator to be given back to him during surgery
     Preservation of blood loss during surgery; this needs a

    special apparatus (cell saver)


    Quiz
    Define hemorrhage
    Differentiate between arterial & venous bleeding
    Classify hemorrhage according to the onset of trauma
    Define reactionary & secondary hemorrhage
    Enumerate the causes of reactionary hemorrhage &
    secondary hemorrhage
    Differentiate between class II & III hemorrhage
    Describe changes of pulse, blood pressure, capillary refill, in
    different classes of hemorrhage
    Mention the amount of blood loss in different classes of
    hemorrhage
    Outline the treatment of hemorrhage
    Quiz
    Mention the solutions used for blood storage
    Enumerate the blood components for transfusion
    What is the packed RBCs & fresh frozen plasma?
    Mention the tests must done before blood transfusion
    What is the general donor & general recipient?
    Enumerate complications of blood transfusion
    Describe allergic reaction after blood transfusion
    Hemolytic reaction after blood transfusion, etiology, clinical presentation, management.
    Enumerate the complications of major hemolytic reaction after blood transfusion
    Anaesthetized patient with blood transfusion hemolytic reaction; mention the
    manifestations
    Enumerate the infections may transmits during blood transfusion
    Define massive blood transfusion
    Enumerate the complications of massive blood transfusion
    Mention the cause of coagulation failure during massive blood transfusion
    Mention the indications of whole blood, packed RBCs, Fresh frozen plasma transfusion
    Define autologous blood transfusion
    THANK YOU

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