TOPIC:

DISCUSS THE USE OF BLOOD AND

BLOOD PRODUCTS IN SURGICAL
PRACTICE

PRESENTER: DR. JAGUSA T. J.

MODERATOR: DR. R. C. EZEH
CONSULTANT ORTHOPAEDIC SURGEON
 OUTLINE:
Introduction.
Definition of Blood
Definition of Blood Products
Historical Perspective
Types of Blood & Blood Products
Uses of blood and Blood Products
Complications of Blood and Blood Products
Modern Techniques in surgery to control bleeding.
Conclusion
References
 INTRODUCTION
Transfusion of blood or blood
products is an invaluable therapeutic
measure.
It should however not be given without
good reasons because of its potential
hazards.
Currently, whole blood is fractionated
into specific components which can be
tailored to the physiological needs of
the patients
 DEFINITION OF BLOOD
The fluid that circulates through
the heart,
arteries,
capillaries and
veins carrying nutrients and
oxygen to the body cells.
BLOOD PRODUCTS
These are blood fractions that
are being used therapeutically
to replace the use of whole
blood in surgical practice.
HISTORICAL PERSPECTIVE
The history of blood transfusion dates to over
300 years.
As a viable therapeutic procedure, it took its
place in clinical practice just before the second
world war.
There were difficulties physicians faced among
which include
Immunological incompatibility.
Blood coagulation
Storage of blood to be transfused..
RESEARCHERS AND EXPERIMENTS
1628
English physician: William Harvey,
discovered the circulation of blood.
Shortly afterwards, the earliest blood
transfusion was attempted.
1632 1723:
Sir Christopher Wrenn in 1656 in Oxford
infused opium, wine beer into dogs using
a squill and dogs bladder as syringes.
 1631 1690:
Richard Lower in february1665 the first
recorded successful blood transfusion
occurred in England.
He kept dogs alive by transfusion of blood
from other dogs.
1620 1704:
In Paris on June 15, 1667Jean Baptiste Denis
and Richard Lower in England separately
reported successful transfusion from lambs
to humans.
 Within ten years transfusing the
blood of animals to humans
became prohibited by law,
delaying transfusion advances for
about 150 years.
1795
In Philadelphia an American
physician, Philip Syngphisick claims
to perform the first human blood
transfusion, although he did not
publish this information.
 1790 1878-
James Blundell of Guys and St.
Thomas: a British Obstetrician
performed the first successful
transfusion of human blood to a patient
for the treatment of post partum
hemorrhage on September 20, 1818.
He then transfused six patients with
severe post partum haemorrages but
they all died because the blood was
given too late.
 His first success was in 1829.
1840:
At St. Georges school in London, Samuel
Armstrong aided by consultant Dr.
Blundell, performed the first successful
whole blood transfusion to treat
haemophilia.
1867:
English surgeon, Joseph Lister used
antiseptics to control infection during
transfusion.
 1873 1880:
U.S. physicians transfused milk from
cows, goats and humans.
1900:
Samuel Shattock in England observed
that human red cells could be
agglunated by serum of another
human.
Nobel prize winner:
Karl Lanosteinner discovered three
blood groups among his laboratory
staff in the university of Vienna.
 1902:
De Castello and Staril discovered the
fourth group.
1968 1943:
Karl Landsteinner participated in the
discovery of M and N blood groups
and the RH Antigen.
With the uncovering of the
agglutinins some of the untoward
reactions of transfusion became
clear.
 1890:
Arthus and Pages: In the university of Fribourg
demostrated the anticoagulant effect of sodium citrate
and sodium oxalate.
1882 1967:
M.Huston in 1914 of Belgium, introduced citrated
blood.
Two years later; Rous and Turner prolong the life span
of red cell by the addition of glucose. Thus enabling
storage of blood.

NOTE:In spite of this; blood was given

only occasionally.
 1943:
Loutit and Mollison: Determine the
proportion of acid. Citrate and Dextrose
which permitted blood to be stored for 21
days and preserved 70% of the red cells.
Citrated blood was used on a large
scale for the first time in the Spanish
civil war and by the outbreak of the
second world war, collection, storage
and usage of blood on a large scale had
become established.
 TYPES OF BLOOD
The plasma, Pale, Yellow, Liquid
Erythrocytes or red blood corpuscles
Leucocytes or white blood corpuscles
Thrombocytes of blood platelets
TYPES OF BLOOD PRODUCTS
BLOOD COMPONENTS:- platelet, red
and white cell concentrates,
cryoprecipitate and fresh frozen
plasma.
PLASMA DERIVATIVES:- Plasma
proteins prepared from large pools of
human plasma under manufacturing
conditions used in the pharmaceutical
industry e.g. immunoglobin, albumin,
clotting factor concentrates.
USES OF BLOOD AND BLOOD PRODUCTS.
HB< 8 9g/d/.
Marrow failure.
HB<6g/d/
SCD.
1 unit of blood (RCC) increase HB level by 1g/d/ in
adults.
Transfusion not usually for; Auto immune
Heamolytic anaemia.
SCD
Stroke
Acute chest syndrome and
Multiple Pregnancy
 INDICATIONS FOR TRANSFUSION OF
PLATELET CONCENTRATES
To prevent or treat bleeding in:-
A. Thrombocytopenia due to bone marrow
failure. Platelet <10 x 109/ht or < 20 x 109/ht if
there is infection.
B. Disorders of platelet function:-
- Inherited e.g. Thrombaesthenia.
- Acquired:- Antit platelet drugs e.g. Aspirin,
Clopidogel.
C. Disseminated intra vascular coagulation
(DIC).
 DEFINITION OF TERMS:-
Clinical and laboratory
TRANSFUSION SURGERY practice
of preparation and treatment with
blood products. Safety of the donor
and recipient is crucial in transfusion
surgical practice.
BLOOD PRODUCT:- Any therapeutic
substance prepared from human
blood. It includes blood components
and plasma derivatives.
 SOME BLOOD COMPONENTS:-
Fresh frozen plasma.
Red blood cell concentrative.
Platelet concentrative.
BLOOD DONATION
Blood donors meet criteria intended,
to exclude anyone who might be
harmed by donating blood.
1. Age: Donors are healthy adults.
Permitted age range may vary
between countries e.g. 18 65/70
years.
2. Hb level > 12.5g/dl: may vary
between countries, aim is to
exclude people who are anaemic
or may become so by donating
blood. Drop of blood sinks /
floats in cuso4 solution.
3. Pregnant and lactating
females excluded because of
increased iron requirements
as adolescents above.
4. Intervals between donations:
4 6 months about 2 3
times a year may vary
between countries. Iron
supplements if 4 monthly.
 TEST ON BLOOD DONORS TO
PROTECT RECIPIENTS
Predonation donor
information education to
enable self exclusion by
those who do not meet
criteria.
Mandatory test vary
according to country must
test for:-
HIV 1 & 2.
ABO and rhesus blood groups.
Hepatitis B & C viruses.
Hbs - sickle haemoglobin.
Syphilis.
 Depending on country recipient
needs. Other tests are for:
Malaria.
Cytomegaloviruses.
HTL VI
Other RBC antigens /
antibodies.
PRODUCTION OF BLOOD COMPONETS AND
PLASMA DERIVATIVES
RBC concentrates: by
centrifugation of whole blood
single units or platelepheresis
multiple units. Stored at 220c, room
temperature best shaking up to 5
days.
Fresh frozen plasma- FFP:
centrifugation of whole blood (single
units) or plasmapheresis 5 units.
Stored at 300c for up to 1 year.
 Cryoprecipitate: controlled
thawing of single FFP units.
PLASMA DERIVATIVES:
Fractionation of a pool containing
at least 20,000 in individual units
(5,000kg) of FFP .
Inactivation steps that kill but not
eliminate all viruses.
 DONOR AND RECIPIENT COMPARTIBILITY TESTS
(1)
AIM:- To prevent / reduce risk of
transfusion reactions.
1. Blood grouping determine ABO
&rhesus blood groups.
Mix Rh D+ RBCs and Anti D Abs
RBC agglutination (clumps).
RhD ve RBCs and Anti D Abs no
RBC agglutination.
DONOR AND RECIPIENT COMPARTIBILITY TEST (2)
CROSS MATCHING:-
a. Recipient serum is mixed with donor
RBCs and incubated at 370c for
45minutes.
This allows any RBC-antibody in
recipients serum to bind to its special
antigen if present on donors RBCs.
b. Next, antibody to human Ig (COOMBs
reagent) is added to the mixture above.
c. Aliquots of the mixture are
examined under the microscope
for agglutination of the donor
RBCs.
Above is called indirect
antiaglobulin (COOMBs) test.
It detects Abs in recipients serum
unable to agglutinate donor RBCs
directly on their own.
BLOOD TRANSFUSION REACTIONS:
To minimize risk of acute haemolytic
transfusion reactions, ABO groups of
donor and recipient must be compatible.
Ensure recipients receive units of blood
or components correctly labeled with
their names.
The commonest cause of incompatible
transfusion reaction is clerical error.
 To reduce risk of delayed
haemolytic transfusion reaction in
Rhd ve female with child bearing
potential and haemolytic disease of
the new born in their babies; give
ve
1. Rhd whole blood, RBC or platelet
concentrates to avoid stimulation of
anti D production.
If possible, give Rhd ve recipients
Rhd ve RBCs or platelets.
Features and Management of Acute
Transfusion Reactions:--
SYMPTOMS AND SIGNS:- Varied, non special
and may not point to a definitive type of
transfusion reaction.
Urticarial rash. . Fever .Low B P
Tachycardia. . Chills .High B P
Circulatory collapse. .Rigors .Dyspnoea
Flushing of skin. .Nausea .Feeling unwell
Pains in the bones, abdomen, back, muscles
chest.
 ACTIONS TO BE TAKEN IF ANY OF THE ABOVE
OCCURS:--
1. Stop the transfusion.
2. Call for assistance.
3. Assess patient clinically for above signs
and symptoms.
4. Measure temp, pulse rate, BP, RR, oxygen
saturation.
5. Check if identity of recipient corresponds
to details on unit , transfused and
document from blood bank.
DIFFERENTIAL DIAGNOSIS/TYPES OF
ACUTE TRANSFUSION REACTION:
Mild Allergic Reaction:- Patients antibodies
vs donor plasma proteins especially anti-
IgA.
Only urticarial rash occurs.
Otherwis well.
Treatment 10mg of chlorphenirmine =
(piriton) slowly I.V.
Re-start transfusion at a slower rate.
Observe and monitor patient closely.
2. SEVERE ALLERGIC REACTION:-
Anaphylaxis:-
Also caused by patients antibodies vs
donor plasma proteins.
SIGNS AND SYMPTOMS:
Bronchospasm.
Angioedema.
Hypotension.
Abdominal pain.
 TREATMENT:-
Stop and do not resume the
transfusion.
10mg chlorpheniramine I.V slowly.
O2 inhalation.
Salbutamol (Nebulizer).
If Bp is low, I.M adrenaline 0.5mg. 0.5ml
of 1:100solution.
Return untransfused units to blood
bank + patients clotted sample.
 IN FUTURE:-
Wash off plasma in transfusion units
with normal saline.
If anti-IgA in patients clotted
sample, give IgA definite units.
EMERGENCY TREAMENT OF ANAPHYLAXIS
Prompt I.M. injection adrenalin
0.5mg if age >12yrs. Then A, B, C, D,
E approach.
A Airway: Ensure patient airway,
positoin, nebulizer.
B Breathing: High flow 100%
oxygen.
C Circulation: Rapid I.V.
Fluidcirculating blood volume.
D Disability: Improve level of
consciousness
E Exposure of skin
 NOTE:
Alpha I: Adrenergic effect of
adrenaline reduces laryngeal
oedema and circulatory
collapse.
B2 Adrenergic: effect of
adrenalin reduces
bronchodilation and
histamine release.
TYPES OF ACUTE TRANSFUSION REACTIONS (2)
Febrile non haemolytic transfusion reach.
Patients antibodies vs donor WBS/platelet
special or HLA antigens.
Antibodies stimulated by previous
transfusion or pregnancy.
Most frequent type of acute transfusion
reaction in clinical practice.
Charestically, begins >30mins after onset
of transfusion.
 Usually , patient has only mild
fever, temperature rise <
0
1.5 c.
Sometimes, chills, rigors,
headache.
Vital signs stable.
Patient otherwise well.
No fall in BP, abdomen, back,
chest pain, dyspnoea or rash.
 TREATMENT:-
Paracetamol Igm stat.
Repeat as necessary.
Restart transfusion at slower
rate.
More frequent observation of
vital signs
NB: Antihistamines not helpful.
TYPES OF ACUTE TRANSFUSION REACTIONS (3)
Immediate haemolytic transfusion
reaction.
Most dangerous type of transfusion
reaction .
Usually caused by transfusion of ABO
incompatibility unit.
Clerical rather than lab error most
frequent cause.
Haemolytic Igm or complement binding
Ig G Anti A/B.
 Reaction stronger in group O
recipients with high titer
antibodies.
Antibody bind RBC Ag
complement mediated
haemolysis.
FEATURES:-
Typically occurs within 1 hour of
starting transfusion.
Heat in the vein into which blood is
transfused / other veins.
 Pains in the back or other sites.
Thrombing headache.
Tightness in the chest.
Flushing of face and skin.
Rigors. .Hypotension .Tachycardia.
Circulatory collapse.
Oliguria .Coke coloured (Hb)in
urine.
DIC bleeding.
 MANAGEMENT OF IMMEDIATE HAEMOLYTIC
TRANSFUSION REACTION
Stop transfusion.
Send blood unit and giving set to blood
bank.
Start I.V. 0.9% normal saline infusion.
Monitor vital signs (TPR & BP) strictly.
Monitor urine input/output chart.
Aim for output > 100mls per hour
 FBC + Diff + blood film with E/U +Cr.
Coagulation tests.
Bilirubin and haptoglobin.
Urinalysis.
If oliguria, give frusemide.
Refer pt to renal team.
If DIC occurs give platelet
concentrative, cryoprecipitate of FFP
as needed.
 If comatous, start general mgt of
unconscious patients.
Invite neurological team for expert
advice and mgt.
Inform blood bank of transfusion rxn.
Clotted blood sample for repeat
compatibility tests.
Urine for Hb nuria, haematuria
bleeding from DIC.
 TYPES OF ACUTE TRANSFUSION
REACTIONS (CONTINUED)
Transfusion related acute lung
injury trail.
Anti, WBC antibodies in donor
plasma vs patients WBC.
Donors usually multiparous
females sensitized by featal WBC
antigens from DAO.
 Should no longer donate blood.
Analogy HDN & alloimmune.
Neonatal thrombocytopenia.
Antibody bound WBCs
pulmonary infiltrates on CX R.
Features of left ventricular failure
low BP, normal CVP and acute
respiratory distress syndrome,
dyspnoea, fever, chills.
 TREATMENT
Stop transfusion.
Give 100% oxygen.
Treat as ARDS.
Monitor blood cases.
Endotracheal tube if
necessary.
 FLUID OVERLOAD:
Dyspnoea, Crepitation in lung bases.
CVP
Give oxygen by nasal inhalation
And diuretic I.V.:Frusemide 40
80mg.
Bacterial contamination of donor
unit septicaemia.
 DELAYED BLOOD TRANSFUTION
REATION:
Is Heamolytic reaction that occurs more
than 24 hours after blood transfusion.
Patient immunity vs Donor RBC antigents
before last transfusion e.g During
pregnancy or previous blood transfusion.
Antibody may not have been detectable
by compatibility(indirect antiglobulin )
test done prior to last blood transfusion.
Secondary immune response of last
transfusion boost antibody level.
 Usually (in 2 weeks of transfusion less
than expected rise in hb if severe hb
less than pre-transfusion.
Jaundice, fever, hb-nurin and renial
failure rarely occur).
MANAGEMENT:
Repeat compatibility test to identify
causative antibody.
Avoid blood with corresponding
antigen in future and if further
transfusion is needed.
 DELAYED BLOOD TRANSFUSION REACTIONS
CONTINUED
Post transfusion purpura; rare.
Recipient ve for human platelet antigen Ia develop
anti hpa Ia antibody for previous transfusion with hpa
+ ve petus (HPA Ia dad, recial HD - newborn).
Low platelet count and bleeding 5 7 days post
transfusion F >M.
How patient own HPA Ia ve platelets destroyed not
clear
A. HPA Ia antigens may be eluted from donor platelet
and later onto membranes of patients platelets which
antibody attacks.
 B. Ag Ab(immune) complexes may
deposit on patients platelet
surfaces which are lysed as innocent
bystanders.
TREATMENT:
I.V. Immunoglobulin 1g/kg/day x 2
days.
Second choice;plasma (exchange)
transfusion.
Efficacy < I.v. I.c.
 DELAYED BLOOD TRANSFUSION
REACTIONS CONTINUED
Transfusion associated graft versus host
disease A rare but usually fatal complication
of transfusing unirradiated blood to:
Immune compromised recipients e.g post
transplant or 1stand 2nd degree relatives who
share HLA antigens and so do not recognize
donor lymphocytes as non self.
The basis cause is failure to destroy immune
competent lymphocytes in donor blood.
 These proliferate and attack the
recipients tissues Multi- organ
failure and death.
PREVENTION:
Irradiate all blood components for
recipient with all immune
compromise.
Avoid transfusing blood from first
and second degree relatives.
 OTHER HAZARD OF BLOOD TRANSFUSION
Iron overload.
Air embolism.
Thrombophlebitis.
Transmission of infections: HIV 1&2.
Malaria. Trapanosominis cruzi.
Chagas disease.
Coagulation anomalies due to massive blood transfusion
(Transfusion of recipients blood volume within 24 hours).
NOTE:
Transfuse blood and blood products only when necessary.
In general ;when HB< 8 9g/d/.
In sickle cell disease; HB<6g/d/.
 Exchange blood transfusion = EBT,
erythrocytopheresis = Is a
procedure in which abdominal
RBCs are removed and replaced
with normal ones.
The indications include:- SCD,
Stroke, acute chest, syndrome,
multiple pregnancy.
II. Haemolytic disease of the new born to
high bilirubin and prevent brain damage
= kernicterus.
AUTOLOGOUS BLOOF TRANSFUSION
Is re-infusion of RCC or whole blood
previously collected from a person for
whom it is difficult to obtain compatible
blood.
Peri operative.
Eliminate infection from allogenic donor
to recipient.
 Platelet transfusion rare in autoimmune
thrombocytopenia if there is life
threatening e.g. intracranial bleeding.
Dosage:-Adult dose of platelet
concentrate is made from 4/5 units of
whole blood and raises the platelet
count in adults by at least 20 x 109/ht the
day after transfusion.
It contains > 240 x 409 platelets in a
volume of 250 400mls.
INDICATIONS FOR TRANSFUSION OF THE RED
FRESH FROZEN PLASMA
If possible, avoid plasma transfusion to
replace single proteins deficient in
blood.
Use specific protein concentrates.
DOSE 10 15mls / kg (child 10-
12mls/kg), Adult 12 15mls/kg.
INDICATION: DIC
Bleeding in liver failure if INR>2.
+- reverse wafarin effect.
 PLASMA EXCHANGE TRANSFUSION =
PLASMA PHERESIS
Removal of abnormal plasma from
patient and replacing it with
normal plasma.
INDICATIONS INCLUDE:-
Thrombotic thrombocytopenic
purpura = TTP.
Hyperviscosity syndromes e.g.
- Waldenstroms macrogl.
 Second choice treatment for
post transfusion purpura (IVIG
1st).
Hypercholesterolaemia.
Cryoglobulinaemias.
Myasthenia grains.
Acute guillain Barre syndrome.
TRANSFUSION NEONATES AND CHILDREN
I. Red cell concentrate: - Top-up
transfusion.
Volume required (mls) = Hb rise
wanted (gldl) x wt (kg) x 3.
10 20mls/kg (also for whole blood).
Rate of transfusion: 5mls/kg/hour.
If available = use small vol. units for
kids (pedipaks).
 EBT:Vol required: 80 100mls/kg to
correct anaemia, 160 200mls/kg for
neonatal jaundice.
II. Platelet concentrate (PC) and fresh
frozen plasma = FFP.
Volume required: 10 12mls/kg.
Rate: over hour.
III. Cryoprecipitate:-
Volume required = 5 10mls/kg.
Rate: over 20 30mins.
 Indications for irradiated or CMV
antibody negative RCC or platelets.
CMV antibody negative RCC or
platelet concentrate.
CMV antibody negative pregnant
women.
CMV antibody negative recipients
of allo HSC transplant.
Intrauterine transfusion.
Gamma irradiated RCC or
platelet concentrates
Hodgkins disease.
Intrauterine transfusions.
Allogenic HSC transplant
from time of conditioning.
 st
Units from 1 or 2nd
degree relatives
HLA selected platelet / HLA match
between patient and donor.
Patient on purine
analogues/fludarabine, cladribine, 2-
DCF.
Congenital immunodeficiency with
defective cell mediated immunity
e.g. SCID, thymic aplasia.
 INDICATIONS FOR ANTI RHESUS (D)
IMMUNOGLOBULIN:-
Prevention of Rh(d) haetolytic
disease of the new born.
About 4% of Nigerians are RhD-
ve and 96% Rh(D)+ve.
Rh(D)-ve mothers can be
stimulated by her Rh(D)+ve
foetus to produce Ig anti D
antibodies (DAD D+ve).
 Anti D crosses placenta to lyse foetal
RBCs HDN.
Exogenous anti D injection to mother
inhibits synthesis of her own
(endogenous) antibody and prevent (HDN).
Doses and schedule vary between
countries.
500 I.V. of anti D I.M at 28 and 34
weeks of pregnancy and delivery.
Extra 125 I.V/ml of foeto-maternal blood
7.4 mls at delivery.
 Indications for anti rhesus D
immunoglobulin.
Prevention of immunization after
inadvertent transfusion of D+ve females of
child bearing age.
Volume of blood transfused treatment:-
< 15mls 125I.V of anti-D/ml of blood.
> 15mls 500I.V of anti-D/4mls of blood.
> 2 units of blood.
Double volume EBT, removes 85 90% D +
red blood cells from patient.
 Estimate residual D+ RBC by flow
cystometry or kleuher.
Give 600 I.V of anti-D/10ml of residual
D+ blood.
Use I.V. (not I. M.) formulation of anti-D.
FOR LARGE DOSES:-
Rechecked residual D+ RBC every
48hours and give further anti-D till no D+
RBCs are detected.
NB: Exogenous anti D detectable
for 6 months in the body.
 INDICATIONS FOR ANTI-D
IMMUNOGLOBULIN (CONTINUED)
I. V. anti D may be given for ITP
in D+ patients.
Not effective in D negative
patients and after splenectomy.
Serious, even fatal haemolysis
uncommon.
Anti D > effect than STD IVIG in
HIV+ve people with ITP.
 INDICATIONS FOR INTRAVENOUS
IMMUNOGLOBULINS = IVIG:-
15 drops / MIW 1st 15minutes.
30 drops / MIW nest 15mins 54DPM.
To detect /reduce risk of allergic
transfusion reactions (1DPM =
3mils/hour).
Dosing:- 2 different schedules.
Each total of 2g/kg body wt.
1g/kg/day x 2days.
0.4g / kg / day / x 5days.
Thrombocytopenia.
Post transfusion purpura.
GuillianBarre syndrome.
Myasthenia gravis.
SLE with low platelet
count.
 Primary immunodeficiency < low
IgG; 0.2g/kg 3 4 weekly.
Secondary Hypo IgG (CLL /
Myeloma) with > 2 infections / year,
as above.
Neonatal alloimmune thrombo-
cytopenia:- 1g/g/kg/wk. affected
foetus with homozygous DAD from
WK 20 + 40 or platelet < 100 x 109/ht.
 IMMUNOGLOBULINS TO PREVENT INFECTIONS (ALL
I.M. INJECTIONS)
AIMS:-
To decrease risk of infection by conferring passive
immunity before development of endogenous
antibody / cell mediated (active) immunity.
1. Tetanus:- Human tetanus immunoglobulin (+teatnus
toxoid).
For unimmunized or incompletely immunized persons,
and immunized patients with tetanus prone
wounds.
Dose: 250 I.V. burns or > 24 hour since injury 500 I.V.
2. Hepatitis B:- Human hepatitis B 1g
(+hepatitis-B vaccines) for accidental :-
Needle stick.
Mucosal.
Non intact skin exposure.
Sexual contact.
Babies of high risk mums.
Dose:- 200 I.V. for age 0 4years.
- 300 I.V. for age 5 9years.
- 500 I.V. >10 years.
- 100 I.V.: Babies of high risk mothers.
3. Rabies:- Human rabies 1g 20
I.V. /kg (+ rabies vaccines).
Bite / mocous membrane
exposure to potentially rabid
animal e.g. Dogs Bats or
animal unavailable for
inspection.
 IMMUNOGLOBULINS TO PREVENT
INFECTIONS (ALL I.M. INJECTIONS)
Chicken pox:- Varicella zoster
immunoglobulin.
1. For pregnant women.
2. New born(s).
3. Immune compromised people exposed
to chicken pox or herpes zoster
shingles and have no antibody to
varicella zoster (V2) virus.
Dose: 250mg: 0 5years.
 500mg: 6 10yrs.
750mg: 11 14years.
1gm > 15 years.
2nd dose if further exposure occurs.
3 weeks after last dose.
Polio myelitis: Human normal
immunoglobulin (HWIG) for immune
compromised people inadvertently.
Given live polio vaccine.
Dose: 250mg < 1year.
500mg 1 2years.
750mg > 3 years.
 Same doses for measles if contact by
unimmunizedd babies, pregnant
women and immuned compromized
people immunosuppressed people.
HNIG:- rubella (only exposed pregnant
women = 750mg).
Hepatitis A vaccine preferred to HNIG
except outbreak with 1 week or delay
recognizing.
Doses:- - 250mg < 10years.
- 500mg > 10years.
DRUGS THAT PROMOTE HAEMOSTASIS:-
1. Tranexamic acid:- binds to
plasmin inhibits fribrinolysis.
Avoid if clots problems e.g.in
urinary tract bleeding.
Good for bleeding oral or nasal
mucosa and surgical sites.
Dose:- x 1gm x 3 x a day taken
orally.
 2. Desmopressin = DDAVP = desamino
D-arginyl vasopressin.
Releases FVIIIc and VWF from vascular
endothelium.
May improve platelet function in renal
liver failure.
For mild haemophilia A and VWD
(FVIIIc) 10 30I.V. / oil.
Dose:- 0.4 micro mg /kg over 20mins.
- Infusion may be repeated 6 hourly.
3. Protamine:- Antidote for UF
heparin.
Basic fish protein.
Neutralizes acidic heparin.
Dose:- 1mg / 100u of UFH.
Reduce dose by 50% for each
hour since heparin admin.