haematology

Haematology  Non-Immune Reactions i.

inco incorr rrec ectl tly y sto store red d or or ou out-of t-of-d -dat atee bl blood ood

ii.

inad inadv verte erten ntly tly froze rozen n bloo blood d

iii.

overheated bl blood

iv.

infected blood

v.

mechanical destruction

- infusion under pressure

 Acute Haemolytic Transfusion Reactions 1.

incidence

~ 1:4000-14,000

2.

mortality

~ 1:100,000

3.

aetiology

~ 23% anti-Fya (mainly IgM) ~ 18% anti-A ~ 12% anti-D intravascular haemolysis * complement fixing with direct intravascular

4.

symptoms & signs

- fe fever & chills, na nausea, fl flushing - chest pain, dyspnoea, apprehension - bleeding diathesis§ § - hypotension § may be the only signs under GA § - haemoglobinuria haemoglobinuria

5.

complications

- an anaemia, th thrombocytopaenia, DI DIC - haemoglobinuria haemoglobinuria (? acid (? acid haematin precipitate - ARDS, MOSF

6.

7.

(2.5-10%)

 ARF) →  ARF)

investigations i.

FBE & film

- Hb, platelets, helmet cells, ghosts - free Hb, ↓ haptoglobin, urine [Hb]

ii.

APTT, INR, FDP/XDP's

iii.

fibrinogen

iv. iv.

return return used used uni unitt for re-crossm re-crossmatch atch,, Ab scree screen n & direc directt antig antiglob lobul ulin in test test

v.

sample for culture

vi.

MBA20

- not ↓'d with storage,

∴ ↓ = DIC most likely

- K+, renal function

management i.

cease TX immediately

ii.

ABC

- ↑ FIO2 ± IPPV as required - maintain BP, volume volume loading ± inotropes

iii. ii.

main aintain tain urin rine ou outpu tput

≥ 1.0 ml/kg/hr - IV fluids fluids ± mann mannitol itol 12.5-50 12.5-50 g ± frusemide

iv.

alkalinise urine HCO3acetazolamide

→

pH > 8.0 ~ 0.5-1.0 mg/kg

37