BLOOD TRANSFUSION

Begashaw M (MD)

Definition

• is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream

Indications

In acute hemorrhage is based on:• volume lost >2000• rate of bleeding• hemodynamic status

Indications

In Chronic blood loss:-Healthy, younger individuals HCT<21%-Cardio respiratory compromised patients

HCT < 25-33% If severe ,even <40%

Perioperative red blood cell transfusion criteria

Component therapy

• specific factor deficiencies -factor VIII concentrates -classic

hemophilia

ABO blood group system

-Blood group O is the universal donor-Blood group AB is the universal recipient

Cross matching

o Blood grouping-ABO and Rhesus antigenso Antibody screening• Detects atypical red cell antibodies in

recipients serumo Crossmatching• Tests donor red cells against patients

serum

Blood products

• Whole blood• Packed red cells• Granulocyte concentrates• Platelet concentrates• fresh frozen plasma• Plasma protein fraction• Human albumin 25%• Cryoprecipitate• Clotting factors - Factor VIII / IX

Blood Components

Component therapy

• Factor VIII for classic hemophilia • Platelet transfusion for patients with

bone marrow suppression

preparation

FRESH UNIT WHOLE BLOOD+CPDAPRBCs 80% HCT

STORED AT 1-6 degree celcius

PLASMA AND 70% OF PLTS

PLT PELLET

and CLOTTIN

G FACTOR

S EXCEPT FACTOR

III

PLASMA STORED AT -18 to-30 DEGREE

CELCIUS

THAW

AT 4 degree celcius

CRYOPRECIPITATE

PROTEINS

Whole blood

• is collected in citrate phosphate dextrose- adenine solution (CPDA-)

• 450 ml of whole blood and approximately 60ml of anticoagulant preservative

• within 24 hours-freshwhole blood• shelf life of 35 days • one unit of whole blood raises the

recipient’s hematocrit by 3%

Whole blood

Packed RBC

• are remains after plasma has been separated from whole blood

• One unit raises the recipient’s hematocrit by 3%

• warmed to a temperature not exceeding 37 c before transfusion

• Shelf life is 35 days

Packed RBC

Platelet concentrate

• Platelets are separated from one unit of blood

• may be stored for 3-7 days • One unit of platelet concentrate contains

about 5.5×1010 platelets and increases the platelet count by 5000/ml

• For a patient with platelet count below 25,000/mm3, 6-8 units are usually given

• Platelet concentrate must be administered through a special platelet filter

Fresh frozen plasma_is anti-coagulated plasma separated from a

person’s blood and frozen within 6 hours_stored up to 1 year_contains all clotting factors _provides proteins for volume expansion

Cryoprecipitate

_is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 degree centigrade

_white precipitate_shelf life of about 1 year_contains factor VIII, fibrinogen and factor XIII _treatment: -classic hemophilia -DIC

21

FRESH FROZEN PLASMA

Cryoprecipitate

Protein

Albumin - for oncotic support and plasma

expansion - disadvantage-rapid excretion & expensePlasma protein fraction-Similar to albumin but contains additional

protein molecules

Complications of Blood Transfusion

Complications

• Hemolytic transfusion reactions• Non-hemolytic transfusion reaction

Hemolytic transfusion reactions

• Intravascular hemolytic transfusion reactions

• life threatening reactions• due to incompatibility of the ABO

system• are very rare occurring in 1 out of

15,000 -20,000 transfusions

Pathophysiology

• all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuria and renal failure

• activate the complement system with subsequent release of vasoacative amines causing hypotension

• Complement activation -intravascular thrombosis, DIC & hemorrhage

Clinical features

• Patient feels unwell and agitated• back pain and pain at infusion site• shortness of breath, rigors• hypotension, oliguria and bleeding from

venepuncture sites• Urinalysis will show haemoglobinuria

Management

• Discontinue transfusion immediately and remove giving set

• Check unit of blood against patients identity

• Give intravenous crystalloid• Transfer to ICU• Take blood for CBC, haemoglobin,

clotting, repeat grouping• Monitor urine output

Non-hemolytic transfusion reaction

• Febrile reaction: - in 0.5% -1% - is usually treated with antipyretic

drugs• Allergic reaction: - in 2-3% - manifests by urticaria and rashes- Antihistamins, steroids or epinephrine

• Transmission of disease-include:- Hepatitis- HIV- Malaria- Epstein- bar virus, cytomegalovirus- Brucellosis

Other complications

• Citrate toxicity• Acidosis• Hyperkalemia