Friday, March 13, 2015
Sunday, December 28, 2014
PT and aPTT modified according to the reagent (PT more sensitive)
PT and aPTT not really prolonged
Ecarin clotting time, Haemoclott or anti-IIa
PT, aPTT and TT modified according to the reagent (aPTT more sensitive)
Ref. MM Samama et al Clin Chem Lab Med 2011;49,761
Wednesday, August 27, 2014
Wednesday, June 11, 2014
Saturday, June 7, 2014
- Use is encouraged when expected surgical blood loss > 800 ml.
- It is indicated when Hemoglobin value is between 10 and 13 without iron deficiency anemia.
- Dose approved is 600 U/kg/week subcutaneously.
- It is given in 3 injections.
- It should be started 3 weeks prior to surgery without exceeding hemoglobin target level of 15.
- Monitor blood pressure before each injection.
Ref. MAPAR 2014
Monday, June 2, 2014
Sunday, June 1, 2014
Acute Hemolytic Transfusion Reaction
Antibody reaction + Complement fixation to rbc A, B, Kell, Kidd, Duffy and Ss antigens
Hemolysis, acute renal failure, hypotension, bronchospasm, DIC
Supportive measures: inotropes and vasopressors to prevent shock, maintain intravascular volume and urine output with IVF and diuretics
Delayed Hemolytic Reactions
Prior sensitization to donor antigens (kidd, kell, Rh) – low levels of antibodies over time such that they are not detected on routine screening. Transfusion exposure causes an anamnestic response.
Usually rbc destruction occurs extravascularly and symptoms are less severe than AHTR. Low grade fever, ↑ indirect bilirubin, jaundice, anemia
Supportive, hydration and transfusion of compatible rbc as necessary
Minor Allergic Reactions
Allergic reaction to donor plasma proteins
Rash, pruritus, swelling
Prior sensitization in a patient with IgA deficiency and subsequent exposure to IgA containing product
Dyspnea, bronchospasm, angioedema, hypotension
Antibody reactions to donor leukocytes.
Typically >1◦C rise in temperature within 4 hours of transfusion plus chills, myalgia, nausea, non-productive cough, respiratory distress
Acetaminophen. Usually defervesce in 48 hours.
Transfusion-Related Acute Lung Injury (TRALI)
Anti- HLA antibodies in the donor interacts with recipients leukocytes causing aggregation in the pulmonary circulation
Fever, chills, non-cardiogenic pulmonary edema, bilateral pulmonary infiltrates and severe pulmonary insufficiency
Supportive. Usually resolves in 24-48 hours with supportive care
Graft-Versus-Host Disease (GVHD)
Donor lymphocytes may not be rejected in immunosuppressed patients. They can proliferate and establish an immune response against the recipient. Typically with transfusion of cellular products, less with FFP and cryoprecipitate.
Irradiation of blood products is the only proven preventive measure.