Blood transfusion

Whole Blood

Indicated in patients who have lost > 20% blood volume, exhibit signs of hypovolaemic shock, or in whom this appears inevitable.

Always take blood for grouping in severely traumatised patients and proceed to cross-match as indicated by the clinical signs. Always use cross-matched blood. Massive transfusions create problems with hyperkalaemia, thrombocytopenia, and low levels of clotting factors. Therefore, in patients with severe haemorrhage, simultaneous fresh frozen plasma (4—6 units) and platelets (6 units) will be needed.

 

 

Autologous blood

Blood donated by a patient prior to elective surgery for the use only on themselves. This avoids the risk of cross-infection, but requires a specially interested haematology department. Autotransfusion is sometimes used in vascular surgery.

 

 

Packed cells

Used for the correction of anaemia if too severe for correction with iron, or if needed prior to surgery. This reduces fluid load to the patient. Cover with 40mg frusemide PO or IV if the patient is elderly or suffering heart failure.

 

 

Tips

¨ 1 unit of blood raises the Hb by 1g/dl

¨ Except in shock, transfuse slowly—1 unit over 2—4 hours

¨ Heart failure can be induced by over-rapid transfusion

 

 

 

Blood may be required for patients in an acute situation, electively during major surgery or to correct a chronic anaemia.