Critical Care Obstetrics part 19 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Blood Component Replacement Transfusion practices Administration of blood and blood components Patient and donor unit identification Because inadvertent administration of ABO-incompatible cells is the most common cause of fatal hemolytic transfusion reactions 17 meticulous attention to patient and unit identification is mandatory before initiating transfusion. The spelling of the patient s name and hospital identification number on the patient s wrist band must be identical with that on the blood unit s compatibility tag 1 . Warming of blood and duration of transfusion Because blood administered at slower rates rapidly warms to the recipient s body temperature it is usually unnecessary to warm transfused blood even in the recipient who has cold alloantibodies. However cold stored red cells or plasma infused at a rate faster than 100 mL min for 30 or more minutes has been associated with cardiac arrest 18 . Therefore warming is necessary for recipients receiving large volumes of blood within short time periods and for those who have severe cold autoimmune hemolytic anemia. Contemporary blood warmers contain sensors to detect changes in rate of flow so that uniform temperature of administered blood may be maintained. Warming blood with a water bath or microwave is not permissible as overheating of red cells may result in hemolysis 5 . Because of the risk of bacterial infection blood which has been warmed to room temperature must be infused within 4 hours. A unit which has been warmed to 10 C or more may not be returned to the blood bank for reuse. Filters All infused blood products must be filtered. The standard in-line filter has a pore size of 170-260 microns and filters cellular debris cell aggregates and coagulated proteins. Because the aggregated proteins at room temperature foster bacterial growth as well as potentially slow the rate of transfusion it is probably best to change the filter every 4 hours 4 . Microaggregate filters pore size 20-40 microns will .
