Blood Transfusion

By nusaiba Ibrahim
 Outline
• -Definition
 Introduction

• •Blood transfusion is one of the most

common procedures in the hospital.
• •It is a potentially life saving
procedure especially during Trauma
or surgery.
 Definition

 The administration of blood or its products

intravenously into a patient for various
indications.
 classifications
• Homologous (Allogenic) blood transfusion:
when it is done with blood from one
compatible donor of the same specie.

• Autologous blood transfusion: is the collection

and subsequent re-infusion of the patient’s
own blood.
 Blood donation
• Donor selections involves:
 History:
 Age: 18-65yrs
 Not in high risk group
 No blood donation in past 6months
 No pregnancy within 12months, not lactating
 No dental procedure in last 72hours
 No major surgery in past 6months
 No blood transfusion or organ transplant in past 12months
 No tattoo or skin piercing in last 12months
 Not vaccinated in last 4weeks.
 No history of HIV infection, HBV, syphilis
 Medical history: no HTN,DM, Cardiac , renal or liver disease, cancer, bleeding
disorder, SCD.
 Cont’d
 examination: Clinically stable, weight>
51kg,normal BP, Pulse, chest and abdominal
findings.

 Investigations: Hb 12.5g/dl or more (Female),

13.5g/dl or more (Male),seronegative for HIV I
&II,HBsAg,HCV, VDRL antibodies. No MPs.
Negative for anti-CMV antibodies in some cases.
Blood group.
 Indications for transfusion
• Severe haemorrhage following trauma or tumour
• Preoperative anaemia correction
• During major operation in which blood loss is
inevitable
• Postoperative anaemia
• To arrest haemorrhage or as a prophylactic measure
prior to operation in patients with haemorrhagic
states
• Anaemia from chronic surgical conditions e.g colonic
tumors,haemorhoids
Blood component and their indications
• Whole blood: contains all blood components-
CELLS: RBCs,WBCs,Platelets
PLASMA: clotting factors, proteins, electrolytes,
gasses, glucose, minerals.
FRESH when it is collected and used within 3hours.
Indications: sudden loss >20% of blood volume.
Exchange blood transfusion(EBT) e.g in
hyperbiluribinemia
Lack of appropriate blood component.
 Cont’d
• RBC products: Packed RBC obtained after
centrifugation of whole blood at 3000r/m and
removing the supernatant.
- 1unit increases HB by 1g/dl in 70kg man or 3%
PCV.
- Indications: chronic anaemia,elderly, children,
fluid overload and cardiac failure.
 Cont’d
• Washed RBC: washed in saline to remove
plasma proteins. Used in uncontrollable febrile
or anaphylactic reactions to plasma proteins.
Shelf life is 24 hours.

• Irradiated RBCs: Gamma irradiated. Indicated

for GvH (graft vs host) disease in
immunocompromised patients, Intrauterine
foetal blood transfusion.
 Cont’d
• Platelet concentrates: obtained either via
manually: WB at 1000r/m for 3min , then
supernatant at 300r/m for 5min OR
Automatically using precessors.
-stored at 20- 24 celsius with continuous
agitation, 5units Whole Blood gives a pint,
shelf life is 5 days.
Indicated: Thrombocytopaenia, consumptive
coagulapathy, Aplastic anaemia.
 Cont’d
• Fresh Frozen Plasma: contains all components of
coagulation and fibrinolytic system. Stored at -30 to -70
celsius upto a year and thaw at 37celsius before use at
10-15mls/kg.

• Cryoprecipitate: Is the precipitate when FFP is allowed to

thaw at 4 celsius and the supernatant plasma removed.
Rich in F8,F13,vWF,Fibrinogen stored at -30celsius. Shelf
life is 12months.
Indicated for: Haemophilia, von Willebrand disease.
 Cont’d
• Granulocyte concentrates: These are prepared
from single donors by using cell separator and
should be used within 24hours(6hours).
• Indicated for: severe neutropenia, focal
bacterial infection unresponsive to antibiotics.
 Cont’d
• Others:
 Albumin concentrates
 coagulation factor concentrates
 Immunoglobins
 Anti thrombin III concentrate
 Protein concentrates
 Pretransfusion blood handling.
• Standard blood bag contains 450 +/- 45mls
blood, with 60mls of anticoagulant
preservative.
• Stored at 2-6oC
• Anticoagulants include:
• Heparin: 24hrs
• Acid-citrate-dextrose(ACD): 21days
• Citrate-phosphate-dextrose(CPD): 28days
• Citrate-phosphate-dextrose-adenine(CPDA): 35days
 Effects of storage
• RBC-
• 1% cell population are lost per day of storage.
• Viability decreases as ATP and 2,3 DPG levels
fall.

• Leucocytes and platelets: Not viable after

24hrs of storage.
 Electrolytes-
• K+: Plasma levels increases at rate of 1mmol/day
• Na+: concentration increases because of the Na
citrate in the CPD anticoagulant.
• Ca2+: no ionizing calcium, it displaces Na in the
anticoagulant forming unionized calcium citrate.
• pH: falls from 7.2 to about 6.8 at 20days due to
increase lactic acid concentration from continuing
anaerobic RBC glycolysis.
 ..
• Clotting factors-
• Activity of clotting factors fall after 24hrs most
activity after 7days.
 Blood grouping
• There are > 30major blood group system.
• ABO and Rh is the most important!
• ABO system base on presence of antigen A or
B
• Rh is base on presence of antigen D(Rh factor)
• Other, kell, duffy, MNS, lewis, kidda etc
 ABO grouping
Blood group Antigen Antibody(plasma Donors
agglutinin)

A Ag A Ab B A &O

B Ag B Ab A B&O

AB Ag A & B None ALL

O None Ab A & B O
 Compatibility testing
• Cross matching is done to detect the rare Ags
present on the recipient RBCs such as kell,
duffy.

• Plasma protein Ag capable of causing reaction

can be detected.
 Blood ordering
• Maximal surgical blood ordering schedule
• This is the system of blood ordering for
elective surgeries.
• Blood bank know the standard required for
each surgical procedure
• For patients at high risk of bleeding,extra pints
are saved above requested.
 Principles of blood adminstration
• Should only be done when necessary
• Only what is needed should be given
• Indication should be clearly stated.
• Counseling and consent
• Strict asepsis
• Doubly checked: name, age, hospital number
• Check blood bag for damage, expiry date,
discolouration of the blood.
 Cont’d
• Pre transfusions vital signs.
• IV line must be secure and patent before
opening the bag
• Warming with blood warmer when necessary.
• Administration must commence within 30mins
of leaving the blood bank.
• Monitoring is crucial in 1st 30mins.
 Administration and rate
• Determine volume to be transfused
• Use blood giving set or infusion pump
• Symptoms of adverse effects usually occur
during transfusion of the first 100mls.

• Thus start at 20-30drops/min (2-3mls/min),

then increase to 60-80drops/min after 1hour
• In children and elderly 40 drops/min.
 Massive blood transfusion
• The replacement by transfusion of blood
equivalent to or greater than a patient’s total
blood volume within a 24hr period
OR
Replacement of more than half of the patient’s
blood volume in 1hour.
 Indications
• Haemorrhage shock from trauma eg fractures,
splenic rupture, rupture aortic
aneurysm,massive GI haemorrhage, liver
transplant.
• Obstetric complications
 Complications
• Technical and clerical errors
• Circulatory overload
• Hypothermia
• Hyperkalaemia
• Hypocalceamia
• Acidosis
• ARDS
• DIC
 Precautions
• Platelet concentrates and fresh frozen plasma
1unit / 5units of banked blood.

• 10mls of 10% calcium gluconate/ L of blood.

• Fresh blood 1unit/ 3units of banked blood.

 Complications
• Immediate reactions
1. Febrile non-haemolytic reaction
2. Allergic and anaphylactic reaction
3. Haemolytic reaction
4. Bacterial contamination
5. Circulatory overload
6. Cardiac arrest
7. Air embolism
8. Non-cardiogenic pulmonary oedema
• Delayed reactions:
1. Thrombophlebitis
2. Delayed haemolytic reaction.
3. Post transfusion thrombocytopaenia purpura.

4. Transmission of diseases: viral hepatitis- A,B,C,D.

Malaria,syphilis,CMV,
Trypanosomiasis,toxoplasmosis, brucellosis,
infectious mononucleosis,AIDS.
• Iron overload
• Immunosuppression
• Post-transfusion GvH disease.
Treatment of Transfusion Reactions
• Stop transfusion
• Take blood for regrouping and crossmatching
• If fever,give antipyretics
• Give steroids e.g hydrocortisone
• Antiemetics/antihistamine e.g promethazine
• Oxygen depending on severity and need
 Blood substitude
• Include: Plasma substitutes
Red cell substitutes
Platelet ‘’
• Plasma substitutes include:
Crystalloids: NS,RL
Colloids:
Dextran 70, 40, 110
Gelatins- haemacel, gelofuscine
Stable plasma protein solution
Albumin
Hydroexyethyl starch preparations: hetestarch,
pentastarch.
• Red cell substitutes: Diaspirin cross linked Hb,
Perfluorocarbons,encapsulated Hb, stroma
free Hb, recombinant DNA derived Hb.

• Platelet substitute: pegylated Recombinant

Human Megakaryocyte Growth and
Development factor.
 Conclusion
• A surgeon must have a sound understandings
of blood use in surgery.
• Thank you.
• Questions???