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Characterize the symptoms:

Low red blood cell count or low hemoglobin level

❑ Difficulty concentrating
Difficulty sleeping
Dizziness
Easy fatigability
Headache
Pale skin
Rapid heart beat
Shortness of breath

Low white blood cell count

❑ Abnormal bleeding
Fever
Irritability
Neurasthenia
❑ Recurrent infections - canker sores, gingivitis, periodontitis

Low platelet count

❑ Blood in urine or stool
❑ Easy or excessive bruising
Heavy menstrual flow
❑ Prolonged bleeding during surgery
or after dental work
❑ Prolonged bleeding from cuts
 
 
 
 
 
 
 
 
 
 
Obtain a detailed history:

❑ Review medical records
❑ Past medical history

❑ Previous blood transfusion
❑ Cardiovascular disease
Hypertension
Arryhthmias
Trauma
❑ Previous Surgery
Infections e.g., HIV
Malignancy
Chronic kidney disease
Chronic lung disease
Medications - anticoagulants, thrombolytics
-
 
 
 
 
 
 
 
 
 
 
Examine the patient:

❑ Vital signs:

Blood pressure: ↓
Pulse rate: ↑ or ↓
Respiratory rate: ↑ or ↓
Oxygen saturation: ↓ (<90%)
Temperature: ↑ or ↓ in sepsis
❑ Skin:
Pallor
Jaundice
Petechiae, ecchymosis
Active bleeding
❑ Central nervous system:
Altered sensorium
❑ Personality changes
❑ Lungs:
❑ Abdomen:
Abdominal distension
Abdominal tenderness
 
 
 
 
 
 
 
 
 
 
 
Order laboratory tests (Routine):

CBC
Serum electrolytes
BUN, creatinine
❑ Type and screen (when transfusion is unlikely)
❑ Type and crossmatch (if transfusion is certain)

ABO blood group system#ABO AntigensABO antigens and antibodies
Rhesus (D) antigen
❑ Antibodies to red cell antigens (antibody screen)

Note - Send fresh samples whenever a second transfusion is required


Other additional laboratory tests to determine etiology:
TSH
Urinalysis
Arterial blood gas
ANA, rheumatoid factor
❑ Diagnostic tests for hemochromatosis, pheochromocytoma
Radionuclide ventriculography or MRI
Coronary angiography
Endomyocardial biopsy

Pulmonary artery catheterization - in respiratory distress or shock
 
 
 
 
 
 
 
 
 
 
 
Pre-transfusion preparation:










 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low hemoglobin level
 
Coagulopathy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low platelets
 
Coagulation factor deficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Indications
 
Indications
 
Indications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider fresh frozen plasma
 
Consider cryoprepitate
 
Consider prothrombin complex concentrate
 

PRBCs