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The Clinical Use Of Blood in Medicine, Obstetrics, Paediatrics, , Surgery & Anaesthesia, Trauma & Burns

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Website: World Health Organization

Title: The Clinical Use Of Blood in Medicine, Obstetrics, Paediatrics, , Surgery & Anaesthesia, Trauma & Burns

Contents

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? 31115.1 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