医、技学院(华盛顿医疗手册培训-贫血与输血)分析.ppt

massive blood loss has resulted in cardiovascular compromise. Volume expansion with normal saline should be attempted initially. Blood typing can be performed in 10 minutes and cross-matching within 30 minutes in emergency situations. If unmatched blood must be used, it should be group O/Rh-negative type that has been previously screened for reactive antibodies. At the first sign of a transfusion reaction, the infusion should be stopped. Emergency RBC transfusions Risk of HIV-1, HIV-2, human T-lymphotropic virus type 1, and hepatitis C is estimated to be 1 in 2,000,000 to 3,000,000. Risk of hepatitis B virus transmission is approximately 1 in 50,000. Viral infections occur when donors are in the window period (undetectable to testing). CMV transmission from RBC and platelet transfusion is an important risk in immunocompromised patients. Transfusion-transmitted infections Bacterial transmission may occur from either a donor infection or a contaminant at the time of collection. Platelet transfusions are more likely than RBCs to have bacterial contamination because they are stored at room temperature. Most common organism identified in RBCs is Yersinia enterocolitica and in platelets is Staphylococcus aureus. Transfusion-transmitted infections Acute hemolytic reactions usually caused by preformed antibodies in the recipient and are characterized by intravascular hemolysis of the transfused RBCs soon after the administration of ABO-incompatible blood. Fever, chills, back pain, chest pain, nausea, vomiting, and symptoms related to hypotension may develop. Acute renal failure with hemoglobinuria may occur. In the unconscious patient, hypotension or hemoglobinuria may be the only manifestation. Noninfectious hazards of transfusion The transfusion should be stopped immediately. all IV tubing should be replaced. Clotted and EDTA-treated samples of the patients blood should be delivered to the blood bank along with the remainder of the suspected unit for repeat of the cro