hello people in this video let's look at the complications of blood transfusion so you take blood and what and all can go wrong so basically they have classified it as immune infectious and complications of massive blood transfusion if you take massive blood transfusion there'll be some other major issues that you will have to know otherwise immune immune means what uh you are not able to adjust to the blood that they are giving so either there can be hemolytic reactions or non hemolytic reactions like the blood group itself can mismatch right you can have a major incompatibility right or you can have a minor incompatibility will come to that or that could be non-hemolytic reactions guys like you can have an a febrile reaction that your temperature can rise right fever etc or you could have an allergic reaction or there could be an acute lung injury so this is called astrali transfusion related acute lung injury so lungs can get injured focus people where are we we are looking at the complications of blood transfusion so you have in that we're looking at the immune ones and then you can have congestive cardiac failure so the lung the card so many things are affected coming to infectious causes you can have you can get aids hepatitis malaria syphilis right you can get then complications of major massive blood transfusion what exactly is massive blood transfusion you should know and what can that result in it can result in disseminated intravascular coagulation right if i'm not wrong if there is massive blood transfusion there can be volume overload iron can increase calcium level can significantly decrease they are saying okay because of the citrate which is added as a preservative in this blood that they are giving you so in general these are the complications of blood transfusion let us go into the details of each one what do you say people okay so let us look at the immune reactions so under this they are saying hemolytic that is there is lysis of rbc's let's say major incompatibility incompatibility that is uh in major incompatibility reaction is because of mismatch right so here they are saying they are giving the mismatched blood due to technical error sampling labeling problem dispatching problem so that can that can lead to intravascular hemolysis so if this happens that they give you the absolute wrong blood what can happen you can have blood and urine and that is called as hematuria you can have pain in the loins okay you can have bilateral pain in the loins you can have fever with chills and dryers oliguria you can have because your renal tubules are going to be blocked right blocking of the renal tubules can happen you can have oliguria that has less urine output and this blockage can finally you can it can lead to acute renal tubular necrosis okay so how will you treat this condition as a doctor listen guys you will have to stop the blood send it to the blood bank and ask them to recheck it you'll have to repeat the coagulation profile you'll have to give iv fluids you'll have to monitor urine output you'll have to check the urine for uh hemoglobin then you will have to give diuresis with furosemide you want to remove you want to remove some fluid okay by giving diuretics so that the kidney gets flushed so that is why they are talking about diuretics that is furosemide and manitol okay guys did you get it so what will you do you will stop the blood you will uh give iv fluids to this person you will give diuretics so that the kidney will get flushed right you'll give furosemide and what manitol etc so you will flush the kidneys then what else did they tell you will uh that's it you will just check the monitor the urine output etc you will check the urine for hemoglobin okay now let us why hemoglobin because it is hemolysis is happening hemoglobin is coming out now let us talk about minor incompatibility reaction where are we people just focus where exactly are we minor incompatibility reaction so where are we so in complications of blood transfusion under immune are the hemolytic one we have the major and minor we have finished the major now we are going to the minor so they are talking about extravascular hemolysis here this is a minor condition uh compared to the major one here what will happen it occurs due to the antibodies okay to some minor antigens some antibodies will come and attack that's it okay so this these people will have some malaise jaundice and fever okay again why jaundice because it is hemolytic right and treatment is supportive whatever supportive treatment only you will give okay so basically some antibodies to some minor antigens will lead to extravascular hemolysis right this is a mild reaction only you will give supportive treatment what exactly these people will have malaise jaundice and fever you will give supportive treatment yes we are done with the immune one right in that we are done with the hemolytic one actually now let us look at the non-hemolytic reaction guys where there there's actually no break of the rbc right non hemolytic let's look at those you have febrile reaction because of um we're looking here guys focus here we're looking at the non hemolytic reactions so basically febrile reaction guys so basically occurs due to the sensitization of wbcs and platelets so the platelets and wbcs have become sensitized okay and there's increase in the temperature okay but there is no hemolysis you should understand this so what will you do here you will give leukocyte depleted blood so you should better to give leukocyte depleted blood so they want to not they don't want to give wbcs etc right okay then allergic reaction guys focus where are we febrile over febrile was because of wbc's and platelets don't give that that they are saying just give whatever is required to that patient don't give wbc's and all that will help coming to allergic reaction guys there can be allergy to plasma products okay this will manifest as chills rigers and rashes so you should give antihistamines to these people what antihistamines will you give you can give you can give chlorphenetamine okay so where are we here so allergic reaction is because of what plasma products there you will give antihistamines like chlorpheniramine malleate okay now coming to injury to the lung so transfusion related acute lung injury guys wake up and tell me what is t r a ld trolley trolley t r a l e l i l i what am i saying t r a l i trolley transfusion related acute lung injury endless lung that much if you understand we are talking about blood transfusion transfusion related acute lung injury so what happens to the lungs because you are doing blood transfusion what can happen to the lungs of this guy poor guy's lungs what is going to happen let us look at this trolley trolley so here has his lungs and let's see what happens it is a rare complication occurring within six hours of transfusion due to the presence of anti-leukocyte antibodies in the transfused plasma so this plasma whichever is coming you can see here this plants blood is coming here in this what is there anti-leukocyte antibody some antibodies are coming here let me draw some antibodies here some antibodies are coming in this blood which are against these guys rbc's anti are leukocyte antibodies in the transfused plasma which are causing patients white cells to aggregate in the pulmonary circulation so in the pulmonary circulation that is from the heart to the lungs and lungs to the heart is it pulmonary circulation the white cells let us say white blood cells isn't it wbcs white cells aggregate so this will lead to the degranulation of the leukocytes causing increased capillary permeability and non-cardiogenic pulmonary edema so there will be pulmonary edema but this will not be because of the heart okay so this is non-cardiogenic pulmonary edema focus guys so non-cardiogenic pulmonary edema why because there is the granulation of the leukocytes which causes the increased capillary permeability obviously permeability becomes more there is going to be edema okay the symptoms may vary from mild dyspnea to full-blown acute respiratory distress syndrome so either this guy will have some mild dyspnea he can have right he's not able to breathe properly that's what is dyspnea right mildest nia he can have or he can have a full-blown acute respiratory distress syndrome okay so you will have to give supportive therapy again so see that it will resolve so what did you see the blood that you transfuse can have some antibodies okay in the plasma which will attack the wbcs of the patient where in the pulmonary circulation this will cause increased capillary permeability leading to non-cardiogenic pulmonary edema how will you handle this t-r-a-l-i you will have to give um some supportive therapy basically he can either have a mild dyspnea to a full-blown acute respiratory distress syndrome very good now let us go to the last one in the immune and the non-hemolytic okay so uh come on tell me non-hemorrhagic water and all you saw non-hemorrhagic you saw febrile allergic um trolley and now we are going to the fourth one that is congestive cardiac failure very good people wake up okay let's go to the congestive cardiac failure guy so guys this one no congestive cardiac failure they're telling if people have anemia right and suddenly you go and give this person whole blood okay what are you giving given whole blood whole blood means you're giving rbc wbc everything whole blood okay that to what you did you gave rapidly now what will happen this person can go into congestive cardiac failure so that's why they're saying you should do slow transfusion you should give furosemide so there's no volume overload isn't it packed cell infusion is the choice in these patients so you don't have to give whole blood packed cell infusion means what it's going to be more concentrated right you will get the packed cells i have a feeling when they are saying fat cells they actually are referring to packed red blood cells only so when this person has anemia so why do you want to give whole blood and give volume overload just give pact red blood cells that's what they look uh they're telling okay you're only going to give rbcs okay so um don't give whole blood okay you give what you give packed cells and also if you're giving whole blood or whatever they're saying give it slowly and you should give furosemide so that you can maintain the manage the volume overload okay let's be done with the uh major chunk now let us go to the small ones where are we we are looking at uh uh complications of blood transfusion we are done with the immune ones now let us go to the infectious ones okay this is very easy for you you will definitely write because of blood transmission a person can get hepatitis is this aids malaria syphilis so poor guy what and all he'll get he'll get malay he can get malaria syphilis aids hepatitis etc they can be transmitted anyways you will screen the blood right but still there are chances that the person can get okay so you should screen the blood for these diseases which diseases did they say a lot of diseases you can screen for but aids hepatitis malaria and syphilis okay prevention is better than cure that's what they are adding you also write that in the exam now let us come to the last point here guys complications of massive blood transfusion why will you give a person massive blood transfusion think so basically if they are having massive bleeding or they or you know for whatever surgeries etc you have to give a lot of blood right so what do you call as massive blood transfusion what is the pro what is that what is the definition of massive blood transfusion guys so there are like four things that they're telling anyways uh look at this so basically in five minutes you're giving over 500 ml or within one hour or something you are giving greater than four rbc units or there is something else called as in six hours you are giving greater than half the patient's blood volume and there is one more that is within 24 hours you are giving greater than one blood volume or greater than 10 units of packed cells in 24 hours so four things okay five minutes something you're giving one hour something six hour something and 24 hours something so four of these together this is the definition of massive blood transfusion okay so if you are doing any one of this it can be blood massive blood transfusion okay so they are saying if there is a blood loss greater than 150 ml per minute with hemodynamic instability and there is need for transfusion they are also calling it as massive blood transfusion okay massive blood loss can occur when whenever there is trauma or postpartum hemorrhage or during major surgeries okay so what can happen what are the problems that is what we have come here for this video right this video is about the complications of massive blood transfusion is it too much take a break very good so the problems itself are mentioned in this uh table you can see here so there can be citrate toxicity there can be hypocalcemia this person can the calcium levels can become very low because of what because of citrate which is a preservative in the blood thrombocytopenia so thrombocytes means what our platelets becomes less is it clotting factors can become less and there can be acute lung injury standard lung stuff is written here right so in patients with massive bleeding what you should do is you want massive blood transfusion so you should intimate the blood bank immediately okay to activate massive transmission protocol that is called as mtp so i was thinking mtp so many uh terms are there in medicine like medical termination of pregnancy now they are saying it is massive transfusion protocol okay so mtp here means what massive transfusion protocol guys focus a blood sample you should send for cross matching right and you will request for what initially you will ask for four units of all negative red blood cells only red blood cells okay you will ask for o negative red blood cells how many four units okay and after this if mtp is requested the blood bank releases the blood products in different boxes look at this guys release of blood products on activation of mtp so what are they talking about here packed rbc's one two three four so what is this box all boxes box one box two box three box four ffb fresh frozen plasma accented plate net cryo precipitate so they are giving a lot of boxes with a lot of things in it so where are we people massive blood transfusion so we told you that there are four boxes and blood bank will release the blood products in different boxes okay the blood products what we will do you'll obtain box by box as necessary okay so four boxes one by one box you will collect from the blood bank the blood products if the bleeding stops then you will intimidate the blood bank and you will terminate this mtp so if the bleeding stops for this guy no need of any further boxes so you will terminate this mtp if bleeding continues box three and four are alternately requested for so you will need three and four blocks if it is the patient is continuing to bleed or you need more blood okay and then what will you do when you're giving massive blood to the sky you will have to monitor acid base status hemoglobin you have to main manage you'll have to check platelets you'll have to check because here they have written thrombocytopenia could be a problem isn't it then thrombin time you have to check because clotting factors can become deficient remember right then you'll also have to check the activated partial thromboplastin time you will have to check the fibrinogen all that for blood clotting you'll also have to check the serum calcium why people because of the citrate which is there in the blood as a preservative the patient can go into hypercalcemia so you have to monitor all this work and all you really check for you'll check for hemoglobin will check for platelets you will check for clotting factors prothrombin time activated partial thromboplastin time fibrinogen then check for calcium right all this you will check for acid-base status okay guys one thing you have to remember because of massive blood transfusion there can be dic that is disseminated intravascular coagulation dic so what happens when you take so much blood all the coagulation factors factors of coagulation get used up okay i'm thinking because you are adding anticoagulants or something uh to this blood that they are giving so i'm all the factors of coagulation are used up so that will result in what in bleeding it will result in this bleeding right bleeding disorder it will result in this so what actually happens is there will be severe a fibrinogenia okay fibrin fibery no genemia so a fibrinogenemia so what will you have to give these people you have to replace with fibrinogen as simple as that cryoprecipitate and other clotting factors will have to give these people okay so what will you do you will have to give these people fibrinogen that's it otherwise they will go into bleeding that's it okay so how will you treat this um disseminated intravascular coagulation you have to give them fibrinogen with other clotting factors because these people have a fibrinogenemia that's it so we are done with the complications of blood transfusion we looked at immune that is hemolytic non hemolytic where you have febrile allergic congestive cardiac failure then you have infectious where you mentioned only four diseases they told you to remember hiv malaria syphilis hepatitis b then complications from massive blood transfusion you should know what massive blood transfusion is and what in all it can really really lead to hypocalcemia coagulation factors can go uh less that can be disseminated intravascular coagulation that can be active in lung injury then one more thing they told you was one more word i was there what is thrombocytopenia yeah so that's it guys we have completed the complications of blood transfusion in this video bye bye