Cari amici e lettori del blog,
non ho fatto in tempo a tradurre in italiano il seguente poster, preparato per la formazione dei nostri infermieri qui a Chaaria. Spero che, nonostante la lingua inglese, possa risultare utile per chi si sta preparando a venire.
Le trasfusioni sono una pratica molto frequente, ed è bene che gli infermieri ed i medici volontari siano informati sulle nostre pratiche trasfusionali, in modo da poter collaborare appieno con il nostro staff. Eccovi il breve testo.
GENERAL GUIDELINES FOR APPROPRIATE TRANFUSION PRACTICE IN CHAARIA
Introduction
Blood should be tranfused only when required to save life.
The decision to transfuse should be based on an estimate of patient’s risk for developing complications of inadequate tissue-oxygen delivery.
Therefore the decision must be based both on haematologic and clinical status of the patient.
Blood should not be transfused in response to HB determination alone, or to an increase of heart and/or respiratory rate.
They can be normal compensatory mechanisms for anaemia.
Studies have proved that BLOOD TRANSUSION improves survival only when it is given immediately at the time when it is needed.
Dose of blood
Effective transfusion requires a minimum of 2 pints of whole blood for an adult.
Or 20ml/Kg for a child.
Efficacy of blood transfusion is checked with HB at the end of the procedure
Transfusion is not a cure
Blood Transfusion is not a cure for anaemia. It is used to relieve clinical signs of cardiac and respiratory distress, but the underlying cause of anaemia still needs to be investigated and treated:
Malaria, splenomegaly, hook worms, Leishmaniasis, kidney failure, malnutrition, concealed bleeding, abortion, etc
Whole blood
A RBCs transfusion is intended to increase the delivery of oxygen to the tissues.
A unit of whole blood has a volume of approximately 400-500 ml, with a haematocrit of 45-55%.
Each unit of blood contains approximately 60 g of HB and 250mg of iron.
It contains a small quantity of citrate anticoagulant and additional preservative solutions
Storage
A blood unit in citrate anticoagulant can be stored up to 35 days in our blood bank at a temp of 4° to 8°C
Dose
One unit of blood normally increases the HB of an adult of about 1 g/dl.
Transfusion is normally given slowly (apart from very selected emergencies) because citrate can give adverse effects on heart rhythm.
SOME SPECIFIC POINTS ON TRANSFUSION IN CHAARIA
we consider the possibility of blood transfusion only when the HB is 5 g/dl or below, unless there are clear signs of imminent danger (severe dyspnoea, fast breathing, much pallor of mucosas making us think that the patient could be even more anaemic, extreme tachycardia, collapse).
Let us remember that chronic anaemia (for instance 2° to Tropical Splenomegaly) is generally more tolerated than acute anaemia (for example High Density malaria or serious vaginal bleeding). This means that a patient with HB=5 g/dl can be very stable, or in life threatening situation.
It is the clinical presentation guiding us to decide on blood transfusion.
The risk of mortality is very high when HB is 3.5-4 g/dl, in spite of stable conditions.
In ischaemic heart disease the risk of mortality increases with a level of HB of around 6-7.5 g/dl.
Perioperative transfusion is absolutely indicated when there is a level of <6 g/dl prior to operation. For levels between 6-7 g/dl the need depends on blood loss during operation and general conditions of the patient
The Ministry of health here in Kenya gives us the following indications:
DO NOT TRANSFUSE ABOVE 5 g/dl UNLESS SYMPTOMATIC.
TRANSFUSE ALWAYS WITH HB = or < 5 g/dl
Transfusion in pregnancy
In pregnancy maternal plasma volume increses by 40% and RBCs by 25%.
The mean blood loss during vaginal delivery is 500 ml, while during Caesarian/Section is 1000 ml.
Indication for blood transfusion are similar to those for non pregnant women
Blood transfusion should be considered for pregnant women with HB = or < 6 g/dl who are symptomatic with dyspnoea, shock, or orthostatic hypotension.
Blood should be available in labour room in case of Post Partum Haemorrhage in women with HB < 7 g/dl previous to delivery.
Transfusion is not indicated in anaemic women who are stable after delivery, if HB above 5 g/dl.
In case of Post Partum Haemorrhage very important is to identify and treat the source of bleeding
Paediatric and neonatal Blood Transfusion
In a child transfusion is mandatory at a level of 4 g/dl or below.
Transfusion is indicated even for Hb 5 or 6 when there are signs of cardiac or respiratory distress.
Dose of blood for a child is 20 ml/Kg
Transfusion must be given slowly over around 4 hours period.
Children must be monitored closely to avoid fluid overload.
A single dose of lasix can help to avoid the risk of overload.
Fr Beppe Gaido
non ho fatto in tempo a tradurre in italiano il seguente poster, preparato per la formazione dei nostri infermieri qui a Chaaria. Spero che, nonostante la lingua inglese, possa risultare utile per chi si sta preparando a venire.
Le trasfusioni sono una pratica molto frequente, ed è bene che gli infermieri ed i medici volontari siano informati sulle nostre pratiche trasfusionali, in modo da poter collaborare appieno con il nostro staff. Eccovi il breve testo.
GENERAL GUIDELINES FOR APPROPRIATE TRANFUSION PRACTICE IN CHAARIA
Introduction
Blood should be tranfused only when required to save life.
The decision to transfuse should be based on an estimate of patient’s risk for developing complications of inadequate tissue-oxygen delivery.
Therefore the decision must be based both on haematologic and clinical status of the patient.
Blood should not be transfused in response to HB determination alone, or to an increase of heart and/or respiratory rate.
They can be normal compensatory mechanisms for anaemia.
Studies have proved that BLOOD TRANSUSION improves survival only when it is given immediately at the time when it is needed.
Dose of blood
Effective transfusion requires a minimum of 2 pints of whole blood for an adult.
Or 20ml/Kg for a child.
Efficacy of blood transfusion is checked with HB at the end of the procedure
Transfusion is not a cure
Blood Transfusion is not a cure for anaemia. It is used to relieve clinical signs of cardiac and respiratory distress, but the underlying cause of anaemia still needs to be investigated and treated:
Malaria, splenomegaly, hook worms, Leishmaniasis, kidney failure, malnutrition, concealed bleeding, abortion, etc
Whole blood
A RBCs transfusion is intended to increase the delivery of oxygen to the tissues.
A unit of whole blood has a volume of approximately 400-500 ml, with a haematocrit of 45-55%.
Each unit of blood contains approximately 60 g of HB and 250mg of iron.
It contains a small quantity of citrate anticoagulant and additional preservative solutions
Storage
A blood unit in citrate anticoagulant can be stored up to 35 days in our blood bank at a temp of 4° to 8°C
Dose
One unit of blood normally increases the HB of an adult of about 1 g/dl.
Transfusion is normally given slowly (apart from very selected emergencies) because citrate can give adverse effects on heart rhythm.
SOME SPECIFIC POINTS ON TRANSFUSION IN CHAARIA
we consider the possibility of blood transfusion only when the HB is 5 g/dl or below, unless there are clear signs of imminent danger (severe dyspnoea, fast breathing, much pallor of mucosas making us think that the patient could be even more anaemic, extreme tachycardia, collapse).
Let us remember that chronic anaemia (for instance 2° to Tropical Splenomegaly) is generally more tolerated than acute anaemia (for example High Density malaria or serious vaginal bleeding). This means that a patient with HB=5 g/dl can be very stable, or in life threatening situation.
It is the clinical presentation guiding us to decide on blood transfusion.
The risk of mortality is very high when HB is 3.5-4 g/dl, in spite of stable conditions.
In ischaemic heart disease the risk of mortality increases with a level of HB of around 6-7.5 g/dl.
Perioperative transfusion is absolutely indicated when there is a level of <6 g/dl prior to operation. For levels between 6-7 g/dl the need depends on blood loss during operation and general conditions of the patient
The Ministry of health here in Kenya gives us the following indications:
DO NOT TRANSFUSE ABOVE 5 g/dl UNLESS SYMPTOMATIC.
TRANSFUSE ALWAYS WITH HB = or < 5 g/dl
Transfusion in pregnancy
In pregnancy maternal plasma volume increses by 40% and RBCs by 25%.
The mean blood loss during vaginal delivery is 500 ml, while during Caesarian/Section is 1000 ml.
Indication for blood transfusion are similar to those for non pregnant women
Blood transfusion should be considered for pregnant women with HB = or < 6 g/dl who are symptomatic with dyspnoea, shock, or orthostatic hypotension.
Blood should be available in labour room in case of Post Partum Haemorrhage in women with HB < 7 g/dl previous to delivery.
Transfusion is not indicated in anaemic women who are stable after delivery, if HB above 5 g/dl.
In case of Post Partum Haemorrhage very important is to identify and treat the source of bleeding
Paediatric and neonatal Blood Transfusion
In a child transfusion is mandatory at a level of 4 g/dl or below.
Transfusion is indicated even for Hb 5 or 6 when there are signs of cardiac or respiratory distress.
Dose of blood for a child is 20 ml/Kg
Transfusion must be given slowly over around 4 hours period.
Children must be monitored closely to avoid fluid overload.
A single dose of lasix can help to avoid the risk of overload.
Fr Beppe Gaido
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