ACUTE HAEMOLYTIC TRANSFUSION RECTION — Transcript

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1. 0:00okay
2. 0:01we'll go to a bit detail on a few
3. 0:04transmission reaction the first one is
4. 0:06hemolytic transmission reaction
5. 0:10it is defined as occurrence of a lysis
6. 0:13or
7. 0:14accelerated clearance of donald cells in
8. 0:17a recipient
9. 0:18what i means this when we give the donor
10. 0:21results to a recipient usually it will
11. 0:24be inside the circulation of the
12. 0:27recipient for a certain amount of time
13. 0:30for example
14. 0:32two or three months because the life of
15. 0:34a red cells in a circulation usually 120
16. 0:38days
17. 0:38but for a donor that sells it will take
18. 0:41probably a little bit shorter so in
19. 0:44hemolytic transformation reaction there
20. 0:46will be a lysis or the breakdown of the
21. 0:49red cells or the accelerated clearance
22. 0:53they don't know that cells will be
23. 0:54cleared
24. 0:55from the recipient circulation much
25. 0:58faster than it should be and how does
26. 1:00this happen this is caused by
27. 1:03immunological incompatibility
28. 1:05between the blood donor and the
29. 1:07recipient okay and this is usually
30. 1:10common in translation of
31. 1:13incompatible red blood cells rather than
32. 1:16plasma
33. 1:17we can divide this into two first is
34. 1:19acute or we call immediate hemolytic
35. 1:22transition reaction or delayed hemolytic
36. 1:24transmission reaction
37. 1:26and the hemolysis
38. 1:28of these two are quite different
39. 1:31in acute hemolytic transmission reaction
40. 1:33usually
41. 1:34most of the time it occurs as
42. 1:36intravascular hemolysis
43. 1:39for the delayed one usually
44. 1:41extravascular hemolysis
45. 1:44i am sure my colleagues in red cells
46. 1:47have taught you about the difference
47. 1:50between intravascular or extravascular
48. 1:53so please look back into the previous
49. 1:56lecture notes or please read this
50. 1:58further
51. 2:01okay
52. 2:03this acute hemolytic transition reaction
53. 2:06occur very soon after
54. 2:09incompatible transmission of rbc or or
55. 2:12it also can occur after one to two hours
56. 2:15usually it can occur after the first 50
57. 2:18males of the red cells
58. 2:20transfuse into the patient
59. 2:22so in that moment it is very critical
60. 2:25for you especially the nurses
61. 2:28to
62. 2:28closely monitor the patient who is
63. 2:30undergo transmission most of the time
64. 2:33this is occurred due to clarical errors
65. 2:36for example
66. 2:38in the first example i have showed to
67. 2:40you just now the mother actually was
68. 2:43group o
69. 2:44but it was given that group b what
70. 2:46happened was
71. 2:48there are two patients with the same
72. 2:50name in that one so they mistakenly
73. 2:54identified the first patient as the
74. 2:56second patient so they took the blood
75. 2:59belong to the other person and
76. 3:02gave to that particular patient so that
77. 3:05is what we call clerical errors and it
78. 3:08is actually preventable
79. 3:10in acute hemolytic transmission reaction
80. 3:13most of the time the hemolysis are
81. 3:15intravascular hemolysis and the cyan
82. 3:18symptoms are like pivot and chills which
83. 3:20are very common
84. 3:22the back pain or the loin pain
85. 3:25hypotension patients suddenly develop
86. 3:27blood pressure which are very low
87. 3:29hemoglobin oil in which there is a
88. 3:33hemoglobin in the patient's urine so you
89. 3:36must monitor the color of the patient
90. 3:39the patient also can develop dic
91. 3:41disseminated intravascular coagulation
92. 3:44in which suddenly the patient have
93. 3:46increased bleeding
94. 3:48and this is particularly important to
95. 3:51monitor patients in ot because when
96. 3:54patients in ot patient is knocked out if
97. 3:57patient was put on general anesthesia so
98. 4:00the patient cannot complain what they
99. 4:02feel
100. 4:03so you must be very observant if there
101. 4:05are any changes in the urine color or
102. 4:08any bleeding from the line or from the
103. 4:11it tube that might be an
104. 4:14earlier sign of the social reaction
105. 4:16occurs
106. 4:17and the patient also sometimes if the
107. 4:19patient develops hypotension and shock
108. 4:23the patient won't produce any urine so
109. 4:25the patient will have anorea okay so
110. 4:29what are the underlying mechanism
111. 4:32okay these are the underlying mechanism
112. 4:34in which the donor have
113. 4:36different blood group of red cells and
114. 4:38the recipient have that antibody okay
115. 4:41for example take a patient with a blood
116. 4:44group o
117. 4:45okay
118. 4:46so the patient have or the recipient
119. 4:49will have nta ntp and nta comma b
120. 4:53right
121. 4:54so
122. 4:55if we give the patient blood group a for
123. 4:58example
124. 4:59what are the antigens present on the
125. 5:03donors red cell
126. 5:04the donald cell will have a antigens
127. 5:08right
128. 5:09okay so the recipient have nta
129. 5:12and also nta comma b
130. 5:14so these antibodies
131. 5:17will bind to the antigens on the donor
132. 5:20cells
133. 5:22because most of the time antibody in the
134. 5:25patients are igm because
135. 5:29antibodies are naturally occurring
136. 5:32antibodies which are usually itm
137. 5:35so when the igm bind to the antigen on
138. 5:38the red cells it will fix the complement
139. 5:41all right it will fix the complement
140. 5:43and
141. 5:44it will cause a chain of reaction in
142. 5:46which you will learn in immunology
143. 5:49and it will cause hemolysis
144. 5:53for acute hemolytic transition reaction
145. 5:56it will cause intravascular hemolysis
146. 6:00okay
147. 6:01but in some situation it also can cause
148. 6:04extravascular hemolysis when the
149. 6:06hemolysis occurs
150. 6:08the body will release all the cytokines
151. 6:12okay and these cytokines will cause this
152. 6:15time and symptoms such as
153. 6:17fever chills like cause pain all right
154. 6:20so that is how the
155. 6:23acute hemolytic constitution reaction
156. 6:25occurs
157. 6:29okay
158. 6:30so what to do for example you are the
159. 6:32one who actually reads the patient so
160. 6:34what you need to do is you need to stop
161. 6:36the transmission and spike it of the
162. 6:39unit
163. 6:40okay use a new giving set and give the
164. 6:43ib infusion with a normal line
165. 6:46and you must always call a medical staff
166. 6:49either the houseman or the mo or the
167. 6:51specialist
168. 6:53okay
169. 6:54and then usually the medical doctors
170. 6:56will do it they will check the
171. 6:58patient identity and the blood unit to
172. 7:00detect any discrepancy they need to make
173. 7:02sure that
174. 7:03that blood unit is actually belong to
175. 7:06that patient or whether we have
176. 7:08mistakenly give the wrong blood to that
177. 7:10patient
178. 7:11and then you need to save any urine that
179. 7:14the patient pass
180. 7:15you need to monitor the vital signs
181. 7:18every 15 minutes when i say monitor the
182. 7:21vital signs i mean
183. 7:23blood pressure
184. 7:25pulse temperature and also breathing
185. 7:28and then the further management depends
186. 7:31on the type of disability of the patient
187. 7:33some sometimes the patient are very
188. 7:35severe the patient collapse need calling
189. 7:37in the anaesthesis and need to send the
190. 7:39patient to icu sometimes the patient was
191. 7:42not very severe and we need to monitor
192. 7:44the patient and we just
193. 7:47give whatever necessary
194. 7:49and it at this point it is very
195. 7:51important to call the translation you
196. 7:53need for further advice on action if
197. 7:55necessary
198. 7:57okay
199. 7:58how do you want to investigate if this
200. 8:00thing happened
201. 8:02the blood sample must be taken from a
202. 8:04site other than the inflation site okay
203. 8:06we need to check for food blood count
204. 8:08for blood picture and heptoglobulin okay
205. 8:11for blood count because we want to check
206. 8:13whether there will be anemia
207. 8:15and also we want to see whether there
208. 8:17are evidence of hemolysis in the
209. 8:19peripheral blood picture
210. 8:20and also heptoglobulin heptoglobulin
211. 8:23will be very low in patient with
212. 8:26intravascular hemolysis also sometimes
213. 8:28heptoglobulin will be absent in patients
214. 8:30with intravascular hemolysis
215. 8:33lfd particularly we want to check for
216. 8:35bilirubin because the patient will have
217. 8:38jaundice and renewal function test in
218. 8:40which we want to know what are the
219. 8:42linear function obturation we really
220. 8:43want to do coagulation screen such as
221. 8:45pta ptt dt because we want to rule out
222. 8:49any divc
223. 8:50we need to take the urine sample and
224. 8:52send to the left because we want to see
225. 8:54whether the patient will have hemoglobin
226. 8:57in the urine or not
227. 8:58in some time we need to take the blood
228. 9:00culture if necessary
229. 9:02and the blood sample to send to
230. 9:05transmission you need
231. 9:06we need to recheck again for the blood
232. 9:08group and antibody screening
233. 9:10we need to do direct constants antibody
234. 9:13identification and repeat the cross
235. 9:15matching this is we want to compare with
236. 9:17the pre-transfusion sample to make sure
237. 9:19that
238. 9:20we don't miss anything
239. 9:24okay how do we want to prevent these
240. 9:27wrong blood incidents
241. 9:28of course the first one is the proper
242. 9:30training and attention to play bottoming
243. 9:32labeling issues and administration
244. 9:35so we need to train the doctors and the
245. 9:37nurses
246. 9:38and also the fleet bottom is split
247. 9:40bottoms are the one who will withdraw
248. 9:42the platform the patient
249. 9:44regarding how to identify the patient
250. 9:47how to label the blood bottles and also
251. 9:50print in the form
252. 9:52and issue an administration of the blood
253. 9:54and it is important for us to assess the
254. 9:57previous transformation history whether
255. 9:58this patient have any other antibody
256. 10:00that can cause transmission reaction
257. 10:03and it is very very important
258. 10:06to all the health professional to
259. 10:08strictly follow the transmission
260. 10:09policies and procedures and also we need
261. 10:12to have the effective quality system
262. 10:14okay
263. 10:15so as