本帖最后由 shenxiu2 于 2011-7-10 08:39 编辑
Massive transfusion adverse reactions
Severe trauma, major surgery or cardiovascular surgery, organ transplantation due to massive blood loss requiring massive transfusion. Refers to the so-called massive transfusion is a transfusion of greater than 2500ml, or the amount of blood transfusion within 24 hours to meet or exceed 5000ml. Stored in the 1 ~ 6 ℃ contain citric acid in the blood, over time can cause the concentration of potassium in the blood increased, pH decreased, red blood cell ATP ,2,3-DPG content decreased, the destruction of platelets and coagulation factors such as change, so a large number of blood transfusions in addition to the complications mentioned in the next section, the metabolic status of patients and can lead to significant change, and even lead to serious consequences.
(A) low temperature
Quickly enter a large number of frozen blood can cause severe hypothermia, thoracic or abdominal surgery for patients with particularly severe. Low body temperature increases the oxygen affinity of hemoglobin, damage platelet function, when the deep body temperature below 34 ℃, when the blood loses its coagulation. Such as central venous catheter through blood transfusion, when the catheter tip near the sinus node can lead to fatal cardiac arrhythmias.
(B) electrolyte, acid-base balance disorders
As the library increased blood potassium levels, a large number of rapid blood transfusions can cause hyperkalemia in theory. But very few actually hyperkalemia on clinical, blood transfusion unless the rate of more than l00 ~ 150ml/min. Usually due to hemorrhagic shock patients need rapid blood transfusion, the body aldosterone, antidiuretic hormone, and corticosteroids such as increased, so , the absence of renal dysfunction, often leading to hypokalemia. As the sodium bicarbonate into sodium citrate anticoagulant, massive blood transfusion can cause alkalosis. Alkalosis and oxygen affinity of hemoglobin increases its oxygen uptake of the organization as the degree of alkalosis different. Mild alkalosis, due to the while promoting the activity of glycolytic enzymes to increase the intracellular concentration of 2,3-DPG, the oxygen affinity of hemoglobin offset the increase in adverse effects. Severe alkalosis due to the affinity of hemoglobin for oxygen increased significantly, can lead to tissue hypoxia. When you enter a large number of banked blood, because of the acidity and plasma potassium concentration, can cause a transient metabolic acidosis, compensatory function well if the body can quickly self-correcting, or acidosis sustainable development. Rapid blood transfusion when a large number of different conditions may produce different electrolytes, acid-base balance disorder, the judge relies on correct and timely detection of blood gas analysis and electrolytes.
(C) citric acid poisoning
When patients in the low temperature, liver dysfunction and shock, the body of citrate metabolism slowed down a lot of input in the sodium citrate anticoagulant containing blood or plasma citric acid poisoning can occur when its major toxic calcium ion binding is due to be over. Hypocalcemia can cause low blood pressure, pulse pressure is reduced, left ventricular pressure, end-stage diastolic blood pressure, pulmonary arterial pressure and central venous pressure increased. Clinical manifestations of convulsions or seizures, an increase in the surgical field bleeding, arrhythmia, blood pressure, and even cardiac arrest.
(D) 2,3-DPG changes
Stored within 3 weeks of 2,3-DPG content of red blood cells decreased significantly, when a large number of input close to the end of such storage can result in blood Hb decreased oxygen release, if the patient in the hematocrit (hematocrit, Hct) decrease Fashion with heart dysfunction ,2,3-DPG to reduce potentially harmful to patients.
(E) changes in coagulation
In the 1 ~ 6 ℃ kept more than 24 hours of blood, the platelets lost nearly all activity. Therefore, the large scale importation of banked blood can cause dilution of thrombocytopenia, such as acidosis accompanied by low temperatures and even increase the patient's coagulopathy.
Clinical experience of patients required massive blood transfusion should have fully prepared, on the one hand rapid blood transfusion using pressure to ensure that the requirements of the other blood transfusion before the appropriate use of blood warmers heating (no more than 40 ℃, in order to avoid hemolysis) to prevent the occurrence of hypothermia, warm the patient while doing the work. In massive transfusion should be actively monitoring the patient's blood gas, electrolyte changes, each output should be 500 ~ 1000ml blood intravenous 10% calcium gluconate 20ml to prevent citrate toxicity. Ruoyi appear acid-base and electrolyte balance disorders, should be promptly corrected. Coagulopathy should be found to replenish fresh whole blood, fresh plasma or fresh frozen plasma, clotting factor conditions can be based on the lack of case to add the appropriate ingredients.
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