BLOOD

TRANSFUSIONS

Dr. Murali. U. M.S; M.B.A.

Prof. of Surgery

D.Y.Patil Medical College

Mauritius.

Objectives

• Blood Groups

• Indications

• Donor Criteria & Collection of Blood

• Complications

• Massive Transfusion

• Blood Substitutes 2

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Overview

• It is a procedure in which a patient receives a blood product through an intravenous line.

• It is the introduction of blood components into the venous circulation.

• Process of transferring blood-based products from one person into the circulatory system of another.

BLOOD GROUPS

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Types of blood groups

• There are more than 20 geneticallydetermined blood group systems known today

• The AB0 and Rhesus (Rh) systems are the most important ones used for blood transfusions.

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ABO blood grouping system

• There are four different kinds of blood types:

• A, B, AB or O (null).

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Blood Types

• Each person has one of the following

blood types: A, B, AB, or O.

• O can be given to anyone but can only

receive O, so called as Universal Donor.

• AB can receive any type but can only be

given to AB, so called as Universal

Recipients.

• Also, every person's blood is either

Rh-positive or Rh-negative.

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The ABO blood groups

• The table shows the four ABO phenotypes ("blood

groups") present in the human population and the genotypes

that give rise to them.

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Blood

Group

Antigens

on RBCsAntibodies in Serum Genotypes

A A Anti-B AA or AO

B B Anti-A BB or BO

AB A and B Neither AB

O Neither Anti-A and anti-B OO

The Rhesus (Rh) System

• Well, there's another antigen to be

considered always - the Rh antigen.

• Some of us have it, some of us don't have.

• If it is present, then blood is RhD positive,

if not it's RhD negative.

• So, for example, some people in group A

will have it, and will therefore be classed

as A+ (or A positive).

• While the ones that don't, are A- (or A

negative).

• And so it goes for groups B, AB and O.

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• According to above blood grouping systems, you can belong to either of following 8 blood groups:

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History Of Blood Transfusion

• 1492 – Pope Innocent VIII

• 1628 – William Harvey

• 1665 – Richard Lower

• 1667 – Jean – Baptiste Denis

• 1670 – France

• 1829 – James Blundell

• 1900 – Karl Landsteiner

• 1914 – Albert Hustin

• 1926 – British Red Cross

• 1939 – Rhesus system

India’s First Blood Bank

• School of Tropical Medicine, Kolkatta

• By SIR. UPENDRANATH BRAHMACHARI

• Chairman of Bengal Red Cross Society.

CROSS MATCHING

• DONOR’S R.B.C +

• RECIPIENTS SERUM +

• COOMB’S REAGENT

Blood Donor Criteria

• Age – 17 – 65 ( New upto 60 )

• Wt - > 45 kg

• Hb - > 13 M / > 12 F

• Fit without serious diseases – HIV / Hepatitis & Malaria

• A person can donate blood every 90 days (3 months).

Collection & Storage

• Bag – 75ml CPD

• Stored – Special Ref. - 4Deg C. +/-

2Deg C

• Shelf Life of CPD Blood - 3 wks

• R.B.C’s - 3 wks

• W.B.C – Rapidly Destroyed

• Platelets – Reduced in 24 hrs

• Clot. Factors – Labile – Levels fall

Blood Donation

• 475ml Blood + 63ml Anticoagulant

• Post – Transfusion Purpura

• Red cells + Optimal Additive solution

• SAGM

• Expiry date = 35 days

• One unit of blood raises the haemoglobin

concentration by approximately 1g/100 ml

Indications

• Acute blood loss – Due to Trauma.

• Chronic Anemia.

• Major Operative procedures

• As a Prophylactic measure to

Surgery

• Severe Burns

• Blood Dyscariasis

Transfusion Trigger

• The decision to transfuse any patient for a

given indication must balance the risks of not

transfusing.

• RBC transfusion not indicated when Hb>10g/dl

• Transfuse Criteria

- < 6g/dl - Benefit from Transfusion

- 6 - 8g/dl - Unlikely to benefit – absence of

bleeding

- > 8g/d l - Not indicated

IMMEDIATE

COMPLICATIONS

Immunological

- Febrile / non

haemolytic

- Allergic / Anaphylaxis

- Haemolytic TR

- TRALI

Non- Immunological

- Congestive Cardiac Failure

- Infection

- Air Embolism

- Thrombophlebitis

- TACO

Febrile Non Haemolytic Transfusion

Reaction

• Defined to be a rise in temperature

of 1 °C or more and >=38 °C,

within few hours of transfusion with

Chills & Rigors.

• Due to cytokines in the blood itself

and/or pyrogens in the transfusion

apparatus.

Allergic / Urticarial Transfusion

Reaction

• Most common usually due to allergies

to specific proteins in the donor’s

plasma.

• Mild – Trt – Steroids & Antihistamines.

• For severe (anaphylaxis), unit is

discarded. New washed RBC’s and

platelets are used.

Acute Haemolytic Reaction

• Transfusion of an incompatible blood

component. { ABO incompatibility }

• A disaster, almost always preventable.

• Most often due to ABO mismatch due

to a clerical error (i.e., the wrong blood

and/or the wrong recipient).

• Intravascular destruction – ARF & DIC

Acute Haemolytic Reaction

• Features - fever, hypotension, NV,

tachycardia, dyspnea, chest or

back pain, flushing & anxiety

• Post-op site: diffuse bleeding

• Trt - Fluids, diuresis and

transfusion support for bleeding

Transfusion Related Acute Lung Injury

[ TRALI ]

• Due to donor plasma containing an antibody,

usually against the patient's HLA or leukocyte

specific antigens.

• The donor antibodies cause these neutrophils

to release toxic products and thus produce

ARDS.

• Features - Dyspnea, hypotension and fever

typically begin 30 minutes to 6 hours after

transfusion

• chest x-ray shows diffuse non-specific

infiltrates , “white out”

Infections

• Bacterial infection – Due to faulty

storage.

• Serum hepatitis.

• HIV Infection

• Malaria transmission

• Viral – EBV / CMV

• Syphilis / Yersinia

Transfusion Associated Cardiac Overload

[ TACO ]

• 1% of Transfusions are Complicated by

TACO.

• Features – Dyspnoea, hypertension,

crepitations & low O2 Sat.

• Risk of volume overload / respiratory

distress especially in small / elderly pt.

• Largely avoidable by careful attention to

fluid balance.

Delayed Complications

• Delayed Haemolytic TR

• Post – Transfusion Purpura

• Transfusion related graft versus host

disease { TGVH }

• Immunosuppression

• Iron overload – Multi transfused

recipients

Delayed Haemolytic Transfusion Reaction

• Previously sensitized to an antigen

through transfusion or pregnancy.

• Can result in symptomatic or

asymptomatic hemolysis several days

(2-10 days) after a subsequent

transfusion.

• These present with flu-like symptoms,

recurrent anemia and jaundice.

Transfusion-associated graft-versus-host

disease (TA-GVHD)

• Donor T-cells attack host tissues.

• Symptoms occur within 1-4 weeks.

• Rare but always fatal.

• Features – Pancytopenia / Rash / Liver

dysfunction.

• Difficult to treat.

Skin manifestation of GVHD

Generalized swelling, erythroderma and bullous

formation

Massive Blood Transfusion

• Replacement Or Transfusion of blood

= pt’s blood volume within 24 hours [ In

normal adult – 10 units or 5-6 L ]

OR

• Single transfusion > 2500ml

continuously

MBT - Complications

• Coagulopathy

• Hyperkalemia / Hypocalcaemia

• Citrate toxicity

• Hypothermia

• Infections

• Incompatibility & Transfusion reactions

• ARDS / DIC

Blood Substitutes

DEXTRAN

• Most Widely Used

• Polysaccharides - ↑ Plasma volume

• Leuconostoc Mesenteroides Bacteria

• Low Mol.Wt (40,000 mol.wt )

• High Mol.Wt (70,000)

• Massive Transfusion – Impair Coag.

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Blood Substitutes

Human Albumin – 4.5%

• Plasma fractionation – Albumin Extract

• No risk - Hepatitis

• Can be used daily

• Expensive

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Blood Substitutes

Gelatin

• Haemaccel - Plasma Expander

• 30% Remains - Intravascular

Hydroxethystarch

• Contains – Starch / NaOH / Ethylene

Oxide

• Lasts – 6 hrs

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1. Which of the following is not a delayed

complication of blood transfusion ?

• A TRALI

• B TG-VH

• C Post – transfusion purpura

• D Iron overload

2. Which of the following is not a

complication of massive blood transfusions ?

• A Coagulopathy

• B Hypercalcemia

• C Hyperkalemia

• D Hypothermia.

3. The first successful documented human

transfusion was done by - ?

• A Karl Landsteiner

• B James Blundell

• C Richard Lower

• D Jean – Baptiste Denis

4. Shelf life of CPD Blood is -

• A 7 days

• B 14 days

• C 21 days

• D 28 days

5. One of the following is not a Blood substitute -

• A Hydroxystarch

• B Haemaccel

• C Human albumin

• D LMW – Dextran

Observing / Monitoring the Patient During a Blood / Blood

Component Transfusion is part of safe transfusion

Rigors

Haemoglobinuria

Tachycardia Hyper /

HypotensionPyrexia

Nausea /

vomiting

Breathlessness /

coughingRestlessness

Agitation

Confusion

Chest, abdominal,

muscle, bone or loin

pain

Flushing

Urticaria -Itchy rash

Headache

Collapse

Generally feeling

unwell

blood and blood transfusions 43

PRE-TRANSFUSION

RESPONSIBILITIES

• Assess laboratory values

• Verify the medical prescription.

• Assess the client’s vital signs, urine

output, skin color and history of

transfusion reactions.

• Obtain venous access. Use a

central catheter or at least a 20-

gauge needle, if possible.

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• Obtain blood products from a blood bank;

transfuse immediately.

• With another registered nurse, verify the

patient by name and number, check blood

compatibility and note expiration time.

• Administer the blood product using the

appropriate filtered tubing.

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• Remain with the patient during

the first 15-30 minutes of the

infusion.

• Infuse the blood product at the

prescribed rate.

• Monitor vital signs.

blood and blood transfusions 46

World Blood Donor Day-June 14th

THANKS