BLOOD TRANSFUSION

BY

IVIE MARVELLOUS UGHULU

 OUTLINE
• Introduction
• Types of blood transfusion
• Indications
• Components of blood
• Donation of blood
• Collection of blood
• Blood grouping and cross matching
• Administration and rate of blood transfusion
• Complications of blood transfusion
• Management of complications
• Conclusion
 INTRODUCTION
• Blood transfusion is a routine medical procedure that
involves the transfer of blood or its components from one
person (donor) into another person’s (recipient)
bloodstream.
• It is an invaluable therapeutic measure and should not be
given without a good reason because of its potential hazards.
• Safe transfusion practice rests on 3 main pillars:
1. Getting blood from a voluntary altruistic donor
2. Good quality screening and testing of donated blood
3. Safe storage and transfusion only when absolutely
necessary
 TYPES OF BLOOD TRANSFUSION
• Allogeneic transfusion
• Autogenic transfusion
• Exchange blood transfusion
 INDICATIONS
• Acute blood loss, to replace circulating volume and
maintain oxygen delivery
• Perioperative anemia, to ensure adequate oxygen
delivery during the perioperative phase
• Symptomatic chronic anemia, without hemorrhage
or impending surgery
• To enhance primary hemostasis with platelet
transfusion
• To enhance secondary hemostasis with
cryoprecipitate and other plasma fractions
 COMPONENTS OF BLOOD
1. Whole blood
2. Packed red cells
3. Fresh frozen plasma
4. Cryoprecipitate
5. Platelets
6. Prothrombin complex concentrates
 WHOLE BLOOD
• It is coagulation factor rich and if fresh, more
metabolically active than stored blood
• It is used in the treatment of massive
bleeding, in exchange transfusion, and in
autologous blood transfusion
 PACKED RED CELL
• They are spun-down and concentrated packs of
RBCs. Each unit is approximately 330mL and has a
hematocrit of 50-70%.
• One unit raises the Hb by approximately 1g/dl in a
70kg adult
• They are stored in a saline, adenine, glucose,
manitol (SAGM) solution to increase the shelf life to
5weeks at 2-6
• They are used for transfusion in all anemic patients.
 FRESH FROZEN PLASMA
• It is rich in coagulation factors and is removed
from fresh blood and stored at -40 to - with a
2yrs shelf life
• It is the first-line therapy in the treatment of
coagulopathic hemorrhage
 CRYOPRECIPITATE
• It is the precipitate when FFP ia allowed to
thaw at 4⁰C and the supernatant plasma
removed
• It is rich in factors VIII, fibrinogen and von
Willebrand’s factor
• It is stored at -40⁰C with a 2yrs shelf life.
• It is used in haemophilia, hypofibrinogenaemia
and von Willebrand’s disease
 PLATELET
• They are supplied as a pooled platelet
concentrate
• One unit of platelet concentrate raises the
platelet count by approximately 5-10 × 10^9/L in
an adult
• They are stored on a special agitator at 20-24⁰C
and have a shelf life of only 5 days
• They are given to patients with
thrombocytopaenia or with platelet dysfunction
PROTHROMBIN COMPLEX CONCENTRATE

• They are highly purified concentrates

prepared from pooled plama. They contain
factors II, IX and X. Factor VII may be included
or produced separately
• It is indicated for the emergency reversal of
anticoagulant (warfarin) therapy in
uncontrolled haemorrhage
 DONATION OF BLOOD
• Donors who should be between 18-65yrs and over 51kg in weight
should be:
1. Fit i.e
 No major operation in the last 6months
 No blood donation in the past 4 months
 No clinical malaria in the past 1 month in endemic areas
 No blood transfusion, tissue or organ transplantation within the past 12
months
 Free from severe hypertension, splenomegaly, hepatomegaly, bleeding
disorder or allergic conditions like asthma
 No recent unexplained weight loss of 4.5kg or more
 Not had tattoos, ear or skin piercing, acupuncture or accidental needle
prick injury within the past 12 months
2. Free from history or clinical evidence and not
carriers of the following diseases:
Viral hepatitis
HIV infection
Syphilis
Trypanosomiasis
Brucellosis
3. Unvaccinated within the last 3 weeks and
must not belong to any of the risk groups for HIV
infection e.g. homosexuals, IV drug users,
commercial sex workers and their clients.
 COLLECTION OF BLOOD
• Collection of blood should be done under
strict asepsis into a sterile plastic bag
containing 60mL of CPD (Citrate-Phosphate-
Dextrose) as anticoagulant and preservative
• CPD keeps the red cells viable for 21days in
vitro
• The use of CPDA-1, adenine enriched CPD,
extends the shelf life to 35days
• The labeled plastic bag is stored as early as possible
in a special blood bank refrigerator dedicated for
that purpose at 2-6⁰C. Afterwards, the following
tests are done on donor blood collected into a
separate container:
ABO and Rh grouping
Serological tests for syphilis, HBsAg, HCV, HIV I and
II, e.t.c.
• Donated blood found to be positive for any of the
screened markers are discarded
BLOOD GROUPS AND CROSS MATCHING
• Human red cells have on their cell surface
many different antigens. Two groups of
antigens are of major importance in surgical
practice - the ABO and the Rh systems
 ABO SYSTEM
• The important blood groups for transfudion
purposes are: A, B, AB & O
• Blood group O is the universal donor type as it
contains no antigens to provoke a reaction
• Blood group AB individuals are universal
recipients and can receive any ABO blood type
because they have no circulating antibodies
 Rh SYSTEM
• The D(Rh+) antigen is present in 85% of
caucassians and 95% of black Africans.
• Those without D antigen may develop
antibodies to it if transfused with D+ blood
 CROSSMATCHING
• ABO & Rh compatible blood should be
crossmatched with the recipient’s serum
before use to avoid serious adverse antigen
antibody reactions of incompatibility
 ADMINISTRATION AND RATE OF BLOOD
TRANSFUSION
• Blood to be transfused should always be
identified and checked against the recipient’s
name, group, hospital no, and ward.
• The drip is set up under strict asepsis using a
17 gauge or large needle.
• Untoward symptoms usually occur during the
infusion of the initial 100ml. The rate should
therefore initially be 20-30 drops i.e
2-3ml/min.
• It is increased after 30mins to 60-80 drops/min.
• If there is blood loss, the rate of infusion should
be rapid, squeezing if necessary the plastic bag
containing the blood
• In the elderly and children, the rate should be
very slow- about 40drops or less/min
• The patient’s general condition, pulse and bp
should be monitored closely
 COMPLICATIONS
• IMMEDIATE REACTIONS
• DELAYED REACTIONS
• COMPLICATIONS FROM MASSIVE
TRANSFUSION
 IMMEDIATE REACTIONS
• Febrile non-hemolytic reaction
• Allergic and anaphylactic reaction
• Hemolytic reaction
• Bacterial contamination
• Circulatory overload
• Cardiac arrest
• Air embolism
• TRALI
 DELAYED REACTIONS
• Thrombophlebitis
• Delayed hemolytic reaction
• Post transfusion thrombocytopenic purpura
• Transmission of diseases e.g viral hepatitis A,
B, C & D, AIDS, malaria, syphilis etc.
• Iron overload
• Post transfusion graft vs host disease
• Immunosuppression
 COMPLICATIONS FROM MASSIVE
TRANSFUSION
• Coagulopathy
• Hypocalcemia
• Hypokalemia
• Hyperkalemia
• Hypothermia
 MANAGEMENT OF COMPLICATIONS
1. For febrile non-hemolytic transfusion reaction:
• Transfusion is stopped temporarily and it is
expected that the condition settles after a few
hours. If not, it is investigated to exclude a
hemolytic reaction, septicemia or malaria
• Aspirin or pcm, brings down temperature
• Future transmission in such individuals and in fact
all persons should be with leucocyte-depleted
blood products by use of appropriate filters
 2. For allergic reactions:
• The transfusion should be interrupted and
antihistamines and steroids should be given
• If symptoms are severe adrenaline should be
given iv
• In future, such patient should have pre
medications with antihistamines before
transfusion or be given plasma free
components e.g washed packed rbc
 3. For bacterial contamination:
• The blood transfusion is stopped and an
aliquot of donor’s blood is taken for culture
and gram staining
• Recipient’s blood is also cultured
• Broad spectrum antibiotics are administered iv
• Iv fluids, steroids and vasopressors like
dopamine are given to combat shock
 4. For circulatory overload:
• Transfusion is stopped and the patient is
propped up
• Iv frusemide removes excess fluid
• In an emergency, phlebotomy is done to
relieve the overload
• Digitalization is done to improve myocardial
function
5. For cardiac arrest:
• Cold blood transfused rapidly may cool the
heart and precipitate cardiac arrhythmias

6. For air embolism:

• Oxygen is administered, the patient is turned
on left side and foot of the bed raised. The air
in the heart is then aspirated
7. For thrombophlebitis:
• Analgesics are administered for the pain and
the affected limb is rested
• A sample is taken from the tip of the needle or
cannula for culture and sensitivity
• Appropriate antibiotics are given if there is
fever
8. For hemolytic reactions:
• The transfusion should be stopped and the
remainder plus recipient’s blood should be
taken for grouping and crossmatching
• Lab. Confirmation of hemoglobinemia,
hemoglobinuria,methemoglobinemia,hyperbil
irubinemia and red cells agglutination should
be done
• Diuresis should be carried out to flush the
renal tubules of Hb and prevent its blockage
• Alkalinization of urine using iv bicarbonate
should be done to make Hb soluble and
prevent its deposition in tubules as insoluble
acid hematin
 CONCLUSION
• Blood transfusion remains an invaluable
therapeutic measure, but utmost precautions
must be taken to avoid the possible life
threatening complications.
Thank you