输血分析.ppt

Learning objectives After reading this chapter students should be able to: Identify indications for blood transfusion Know blood transfusion reactions and their preventions Mention types of blood component therapy Guidline of blood transfusion (2000): Hb100 g/L No ! Hb70 g/L RBC(CRBC) Hb 70~100 g/L depends on status For patients with chronic blood loss or chronic anemia replacement of blood (RBC) should be based on the HCT level (20%). Transfusion Reactions Same like ARDS Dyspnea , hypoxemia, edema Low Bp , fever Treatment: oxygen therapy Prevention：avoid collect blood from multiple pregnancy Transfusion Reactions 8.Transfusion associated graft versus host disease,TA-GVHD 输血相关性移植物抗宿主病 9. Immunosuppression 免疫抑制 Autotransfusion Type: 1.Salvaged autotransfusion 2.Predeposited autotransfusion 3.Hemodiluted autotransfusion Symptomatic anemia (providing oxygen-carrying capacity) Transfusion trigger (HCT30% ; HB7g/dl) 1 Unit increases 3% HCT or 1g/dl Shelf life =42 d (1-6 ℃) Thrombocytopenia ( 50,000) Platelet dysfunction Each unit increase 5,000 PLTs after 1 H Plasma Fresh frozen plasma(FFP) frozen within 6 hours ofthe time of collection，stored up to 1 year contains all clotting factors provides proteins for volume expansion Coagulation factor deficiencies 1 ml increases 1% clotting factors Being used as soon as possible Plasma Cryoprecipitate 冷沉淀 thawed at 4℃，removed from a unit of FFP contains factor VIII, fibrinogen ，factor XIII used for the treatment of: ?? classic hemophilia, ?? DIC ?? Other clotting abnormalities with specific therapy commonly not available. Plasma Albumin 白蛋白 It’s a plasma component used for oncotic support and plasma expansion. Disadvantages：rapid excretion as well as expense. Dextran 右旋糖酐 Most widely used Low/Middle M.W. (40,000-70,000) Massive transfusion could impair coagulation Occasional ALLERGIC reaction Plasma Substitutes Hydroxyethyl Starch (HES)