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Clinical Use of Blood in Medicine, Obstetrics, Paediatrics, Surgery & Anaesthesia, Trauma & Burns PDF

344 Pages·2001·1.57 MB·English
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The Clinical Use of Blood in Medicine Obstetrics Paediatrics Surgery & Anaesthesia Trauma & Burns World Health Organization Blood Transfusion Safety GENEVA Contents Preface Acknowledgements Introduction 1 PART 1: PRINCIPLES, PRODUCTS AND PROCEDURES 1 The appropriate use of blood and blood products 7 1.1 Appropriate and inappropriate transfusion 9 1.2 Blood safety 10 1.3 Prerequisites for the appropriate clinical use of blood 16 1.4 Principles of clinical transfusion practice 18 2 Blood, oxygen and the circulation 20 2.1 Body fluids and compartments 22 2.2 Blood 24 2.3 Oxygen supply to the body 28 3 Anaemia 38 3.1 Definitions 40 3.2 Measuring haemoglobin concentration and haematocrit 42 3.3 Clinically important anaemia 43 3.4 Interpreting haemoglobin values 44 3.5 Causes of anaemia 46 3.6 Adaptation to anaemia 47 3.7 Anaemia due to acute blood loss 48 3.8 Anaemia due to chronic blood loss 52 3.9 Chronic anaemia due to other causes 53 3.10 Principles of the treatment of anaemia 54 3.11 Principles of the prevention of anaemia 55 4 Replacement fluids 57 4.1 Definitions 59 4.2 Intravenous replacement therapy 60 4.3 Intravenous replacement fluids 60 4.4 Other routes of administration of fluids 64 4.5 Replacement fluids: characteristics 65 5 Blood products 72 5.1 Definitions 74 5.2 Whole blood 74 5.3 Blood components 75 5.4 Component separation by apheresis 81 5.5 Plasma derivative production (plasma fractionation) 81 5.6 Blood products: characteristics 82 6 Clinical transfusion procedures 94 6.1 Getting the right blood to the right patient at the right time 96 6.2 Ordering blood products 100 6.3 Red cell compatibility testing (crossmatching) 108 6.4 Collecting blood products prior to transfusion 112 6.5 Storing blood products prior to transfusion 112 6.6 Administering blood products 115 6.7 Monitoring the transfused patient 122 6.8 Specialized procedures 124 7 Adverse effects of transfusion 126 7.1 Transfusion reactions 128 7.2 Initial management and investigation 129 7.3 Acute transfusion reactions 134 7.4 Delayed complications of transfusion: transfusion-transmitted infections 140 7.5 Other delayed complications of transfusion 146 7.6 Massive or large volume blood transfusions 149 PART 2: TRANSFUSION IN CLINICAL PRACTICE 8 Clinical decisions on transfusion 155 8.1 Assessing the need for transfusion 156 8.2 Confirming the need for transfusion 156 9 General medicine 159 9.1 Anaemia 161 9.2 Deficiency of haematinics 172 9.3 Haemolytic anaemias 175 9.4 Malaria 177 9.5 HIV/AIDS 181 9.6 Glucose-6-phosphate dehydrogenase (G6PD) deficiency 183 9.7 Bone marrow failure 184 9.8 Genetic disorders of haemoglobin 188 9.9 Bleeding disorders and transfusion 198 9.10 Congenital bleeding and clotting disorders 201 9.11 Acquired bleeding and clotting disorders 204 10 Obstetrics 209 10.1 Physiological & haematological changes during pregnancy 211 10.2 Chronic anaemia in pregnancy 213 10.3 Major obstetric haemorrhage 219 10.4 Haemolytic disease of the newborn (HDN) 225 11 Paediatrics & neonatology 228 11.1 Paediatric anaemia 230 11.2 The management of paediatric anaemia 234 11.3 Paediatric transfusion in special clinical situations 241 11.4 Bleeding and clotting disorders 243 11.5 Thrombocytopenia 244 11.6 Neonatal transfusion 245 12 Surgery & anaesthesia 255 12.1 Patient selection and preparation 257 12.2 Techniques to reduce operative blood loss 262 12.3 Fluid replacement and transfusion 264 12.4 Autologous blood transfusion 273 12.5 Care in the postoperative period 276 13 Trauma & acute surgery 279 13.1 Management of the acute surgical or traumatized patient 281 13.2 Initial assessment and resuscitation 281 13.3 Reassessment 288 13.4 Definitive management 291 13.5 Other causes of hypovolaemia 291 13.6 The management of paediatric patients 292 14 Burns 296 14.1 The management of burns patients 298 14.2 Assessing the severity of burn 299 14.3 Fluid resuscitation in burns patients 302 14.4 Continuing care of burns patients 306 14.5 Burns prevention 308 PART 3: PUTTING IT INTO PRACTICE 15 Making it happen: what can I do? 311 15.1 Where do I start? 313 15.2 Developing a plan of action 317 15.3 Hospital transfusion committee 319 15.4 Guidelines on the clinical use of blood 320 15.5 Education and training on the clinical use of blood 323 Glossary 325 Index 331 Preface Blood transfusion is an essential part of modern health care. Used correctly, it can save life and improve health. However, the transmission of infectious agents by blood and blood products has focused particular attention on the potential risks of transfusion. The World Health Organization (WHO) has developed the following integrated strategy to promote global blood safety and minimize the risks associated with transfusion. 1 The establishment of nationally coordinated blood transfusion services with quality systems in all areas. 2 The collection of blood only from voluntary non-remunerated donors from low-risk populations. 3 The screening of all donated blood for transfusion-transmissible infections, including the human immunodeficiency virus (HIV), hepatitis viruses, syphilis and other infectious agents, and good laboratory practice in all aspects of blood grouping, compatibility testing, component preparation and the storage and transportation of blood and blood products. 4 A reduction in unnecessary transfusions through the appropriate clinical use of blood and blood products, and the use of simple alternatives to transfusion, wherever possible. Many countries have established national blood transfusion services in accordance with WHO recommendations and guidelines. However, few countries have yet developed national policies and guidelines on the clinical use of blood or provide systematic education and training on the clinical use of blood and blood products. In 1998, WHO published Recommendations on Developing a National Policy and Guidelines on the Clinical Use of Blood. This document was designed to assist Member States in developing and implementing national policies and guidelines and ensuring active collaboration between the blood transfusion service and clinicians throughout the management of patients who may require transfusion. The Recommendations emphasize the importance of education and training in the clinical use of blood for all clinical and blood bank staff involved in PREFACE the transfusion process. The WHO team responsible for Blood Transfusion Safety (WHO/BTS) has therefore developed The Clinical Use of Blood to provide a set of comprehensive learning materials that can be used in undergraduate and postgraduate programmes, in-service training and continuing medical education programmes or for independent study by individual clinicians. The pocket handbook that accompanies the module is designed for quick reference by clinicians who need to make urgent decisions on transfusion. The Clinical Use of Blood is not designed to replace conventional textbooks or to provide a definitive text on the clinical use of blood. Rather, its purpose is to provide an accessible learning tool that will assist prescribers of blood to make appropriate clinical decisions on transfusion and contribute to wider efforts to minimize the unnecessary use of blood and blood products. The materials have been written by an international team of clinical and blood transfusion medicine specialists and have been reviewed by a wide range of specialists throughout the world. They have also been reviewed by the WHO Department of Reproductive Health and Research, the Department of Adolescent and Child Development, the Roll Back Malaria Initiative and the Human Genetics Programme. Nevertheless, clinical transfusion practice should always be based on national guidelines, where available. Users are therefore encouraged to adapt the information and guidance contained in the module and pocket handbook to conform with national guidelines and established procedures in their own countries. Dr Jean C. Emmanuel Director, Blood Safety & Clinical Technology World Health Organization Acknowledgements The World Health Organization acknowledges with thanks the many clinical and blood transfusion medicine specialists who have contributed to the development of these learning materials. Project Director Critical Readers Dr Jean C. Emmanuel, Director, Blood Safety and Dr Imelda Bates, Consultant Haematologist, St Clinical Technology, World Health Organization George’s Hospital Medical School, London, UK Dr Sunil Bichile, Professor and Head, Department Project Manager of Haematology, Topiwala National Medical College Ms Jan Fordham, Director, Open Learning and BYL Nair Charitable Hospital, Bombay, India Associates, London, UK Dr John Davy, Plastic and Reconstructive Surgeon, Harare, Zimbabwe Clinical Editors Dr Androulla Eleftheriou, Scientific Coordinator, Dr Jean C. Emmanuel, Director, Blood Safety and Thalassaemia International Federation Clinical Technology, World Health Organization Dr Elizabeth Letsky, Consultant Perinatal Dr Brian McClelland, Regional Director, Edinburgh Haematologist, Queen Charlotte’s and Chelsea & South-East Scotland Blood Transfusion Service, Hospital, London, UK Edinburgh, UK Dr S. Mitchell Lewis, Department of Haematology, Dr Richard Page, Consultant Anaesthetist, Royal Imperial College School of Medicine, Hammersmith Cornwall Hospitals, UK Hospital, London, UK Authors Dr Guy Levy, Zentrallaboratorium, Bern, Switzerland Dr Anthony Chisakuta, Consultant Anaesthetist, Dr Laurie Marks, Consultant Anaesthetist, Harare, Royal Belfast Hospital for Children, Belfast, UK Zimbabwe Dr Eve Lackritz, Assistant Chief for Science, Dr Stephen Munjanja, Obstetrician & International Activities Branch, Division of HIV/AIDS Gynaecologist, Harare, Zimbabwe Prevention, Centers for Disease Control and Prevention, Atlanta, USA Professor Greg Powell, Department of Paediatrics and Child Health, School of Medicine, University of Dr Brian McClelland, Regional Director, Edinburgh Zimbabwe, Harare, Zimbabwe & South-East Scotland Blood Transfusion Service, Edinburgh, UK Dra Maria de los Angeles Rodriguez, Head of Blood Bank, Hospital Naval, Viña del Mar, Chile Dr Richard Page, Consultant Anaesthetist, Royal Cornwall Hospitals, UK Mr Graham L. Sellars, Obstetrician & Gynaecologist, Harare, Zimbabwe Dr Henrik Zetterström, Medical Director, Östersunds Hospital, Östersund, Sweden ACKNOWLEDGEMENTS Participants in WHO Informal Regional Participants in WHO Inter-Regional Evaluation, Evaluation, Harare, Zimbabwe Limassol, Cyprus 11–12 April 1997 8–11 September 1997 Dr Henry W. Bukwirwa, Department of Dr Anwar Al-Khasawneh, Consultant General Anaesthesia, Makerere Medical School, Mulago Surgeon and Head, Department of General Surgery, Hospital, Kampala, Uganda Al Bashair Hospital, Amman, Jordan Dr Meena Nathan Cherian, Professor, Department Dr Sunil Bichile, Professor and Head, Department of Anaesthesia, Christian Medical College & of Haematology, Topiwala National Medical College Hospital, Vellore, India and BYL Nair Charitable Hospital, Bombay, India Dr M. E. Chitiyo, Medical Director, National Blood Dr Meena Nathan Cherian, Professor, Department Transfusion Service, Harare, Zimbabwe of Anaesthesia, Christian Medical College & Hospital, Vellore, India Dr Alison M. Coutts, Chairman, Department of Haematology, School of Medicine, University of Mrs Rosie Chimoyo, Nurse Anaesthetist, Malamulo Zimbabwe, Harare, Zimbabwe Hospital, Makwasa, Malawi Dr Vasumati M. Divekar, Professor of Dr Linda Ciu, Chief, Neonatal Clinic, University Anaesthesiology, Patil Medical College, Bombay, Hospital Tirana, Tirana, Albania India Dr Michael B. Dobson, Consultant Anaesthetist, Dr Michael B. Dobson, Consultant Anaesthetist, Nuffield Department of Anaesthetics, John Radcliffe Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK Hospital, Oxford, UK Dr Paul M. Fenton, Associate Professor, Professor A. Latif, Department of Medicine, School Department of Anaesthesia, College of Medicine, of Medicine, University of Zimbabwe, Harare, Blantyre, Malawi Zimbabwe Dr Valentina Hafner, Scientific Director, National Dr Katherine Mauchaza, Paediatrician, Harare, Institute of Haematology & Blood Transfusion, Zimbabwe Ministry of Health, Bucharest, Romania Dr K. Nathoo, Department of Paediatrics, School of Dr Gabriel M. Kalakoutis, Head of Department of Medicine, University of Zimbabwe, Harare, Obstetrics & Gynaecology, Makarios Hospital, Zimbabwe Nicosia, Cyprus Dr Dixon C. Tembo, Anaesthetist, Nkana Mine Dato’ Dr Mahmud bin Mohd. Nor, Head of Hospital, Kitwe, Zambia Department of Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia Dr Matt J. Oliver, Consultant Surgeon, Bulawayo, Zimbabwe Mr Christos Tapakoudes, Medical Laboratory Superintendent, Blood Bank, Nicosia General Hospital, Nicosia, Cyprus Introduction The Clinical Use of Blood forms part of a series of learning materials developed by WHO/BTS in support of its global strategy for blood safety, outlined in the Preface. In 1994, WHO published Safe Blood and Blood Products, a set of interactive learning materials designed for staff in blood transfusion services, public health laboratories and hospital blood banks who are responsible for the recruitment and selection of blood donors, and the collection, processing and issue of blood for transfusion. The materials contain four modules: Introductory Module: Guidelines and Principles for Safe Blood Transfusion Practice Module 1: Safe Blood Donation Module 2: Screening for HIV and Other Infectious Agents Module 3: Blood Group Serology The modules are being used in many countries throughout the world, both as resource materials in pre-service and in-service training programmes and in distance learning programmes. Establishing a Distance Learning Programme in Blood Safety: A guide for programme coordinators was published by WHO/BTS in 1998 to provide guidance for national blood programmes wishing to start a distance learning programme in blood safety using these materials. The Clinical Use of Blood The Clinical Use of Blood complements the earlier learning materials produced by WHO/BTS by focusing on the clinical aspects of blood transfusion. It aims to show how blood and blood products can be used appropriately at all levels of the health care system in any country, without compromising standards of quality and safety. It contains two components: (cid:1) A module of learning material designed for use in education and training programmes or for independent study by individual clinicians and blood transfusion specialists (cid:1) A pocket handbook for use in clinical practice. 1

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