Section II. TRANSFUSIONS
3-15. INTRODUCTION
Transfusions of blood or blood products are normally initiated at the direction of
the physician during surgery. These transfusions differ from the infusion of other fluids
in many ways. The products used are generally prepared in a laboratory. Many
products need to be matched to the patient by using laboratory analysis. The rate of
transfusion is often slower, and a greater variety of complications is possible. The
venipuncture site may be different. Even the equipment differs from other
administration sets. Most blood products have special refrigeration requirements to
prevent spoilage. The most common reasons for transfusions are replacement of red
blood cells for oxygen-carrying capacity or restoration of blood volume. Transfusion
should not be initiated too hastily. Most patients in good general health can sustain a
loss of about 1,000 milliliters and need replacement by colloid or crystalloid solutions
infusion alone. Transfusion should be used as a last resort. It may lower the production
of erythrocytes by the patient's own body. The normal red cell has a life span of about
80 to 120 days. Each unit of blood contains red blood cells of all ages between 1 and
120 days. As a unit of blood is stored, the red blood cells continue to age. A unit of
blood is stored for no more than 35 days. These aged blood cells are removed from the
patient's circulation by his own body within 24 hours after transfusion of the unit of
blood. About 70 to 79 percent of the red blood cells survive 24 hours after transfusion
and begin to age normally. Many surgeons believe that surgical blood loss can usually
be replaced with packed red blood cells and saline.
3-16. PRODUCTS FOR TRANSFUSION
Sodium chloride solution (normal saline) is the only solution suitable for use in
the transfusion of blood products containing red blood cells, platelets, or leukocytes.
Any other solution causes adverse effects on the body and/or blood product. There are
three general categories of products used for transfusion-products containing red blood
cells, plasma products, and plasma expanders.
a. Red Blood Cell Products. Red blood cell products generally require type
and cross-match laboratory procedures. Examples of these are:
(1) Whole blood (human). Whole blood is anticoagulated blood from which
none of the components have been removed. Acute significant hemorrhage is the only
indication for whole blood in medical patients. Traditionally, whole blood has been used
to replace blood loss at surgery. This use is gradually changing to the use of packed
red blood cells and a balanced saline solution.
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