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DR MURUGESANDR PRAMOD SARWA
Blood transfusion
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OVERVIEW HISTORICAL BACKGROUND BLOOD COMPONENTS types available properties indication PEDIATRIC CONSIDERATION physiological TRASFUSION GUIDELINES COMPLICATIONS AND MANAGEMENT
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SEGREGATION OF BLOOD PRODUCT Whole blood ….. Pc Platelet rich plasma …. Platelet Platelete poor plasma ….ffp…cryo …f
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What is different……..
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Oxygen delivery
DaO2 =Cardiac output X CaO2 [oxygen content]
Oxygen content[Hb saturation X 1.34 X Hb conc] + 0.003 X PO2Amount of oxygen carried by 100 ml of blood
Fetal hemoglobin
Cardiac reserve Increased metabolism
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Fetal hemoglobin
HbF – 70-80% of full term and 97% of premature infants’ total hemoglobin at birth
Fetal hemoglobin
Shorter life span of 90 days (HbA- 120 days)
HbF interacts poorly with 2,3,DPG P50 with HbF is 19 mmHg P50 with HbA is 27 mmHg
Leftward shift of ODC
ODC
Hemoglobin for equivalent oxygen delivery
P 50 Hb
Adult 27 10
Infants [>3 month]
30 8.2
Infants [<3 month]
24 14.7
Motoyama et al. 1990
6 months- 6 years12
7-13 years 136 months- 6 years 127- 13 years 13
Preoperative hemoglobin
Term infant with Hb < 9 g/dl Preterm infant <7 g/dl
Haemoglobin levels that are adequate for the older patients may be suboptimal in the younger infant
Fetal hemoglobin
Cardiac reserve Increased metabolism
Adult vs children - cardiac reserve
• Children have a higher cardiac output to blood volume ratio than adults
Estimated circulating blood volumeAge Blood volume
(ml/kg)Premature infant 90-100Term infant – 3 months 80-90Children older than 3 months 70Very obese children 65
Sandra et al. Pediatric anesthesia 2005