1. Introduction Blood groups and grouping methods Cross matching Blood collection Blood components Whole blood Red blood concentrate Platelet FFP And others Apheresis

2. History of Transfusion Blood transfused in humans since mid-1600s 1818 First successful human blood transfusion 1900 Landsteiner described ABO groups 1918 First use of blood storage. 1939 Levine described the Rh factor 3. INTRODUCTION Blood transfusion is one of the oldest forms of therapy. Critical care frequently requires the urgent use of large numbers of blood component, often as a lifesaving supportive measure. Blood component transfusion plays a very important role in modern transfusion. Through modern medical methods, many kinds of blood components are separated from whole blood. 4. The routine separation of donor blood into components and plasma fraction has made it possible for blood banks to provide the specialized blood products required for the support of patients in multiple treatment modalities. The infusion of blood component is called component transfusion or blood component therapy. 5. Each blood donation can help as many as 4 people 43732 blood donations in one day is the world record held by INDIA (Haryana) in 2010 6. Types Autologous Allogenic 7. Autologous Transfusion of patients own blood. Can be undertaken by 1. Autologous pre deposit donation 2. Intra operative normovolaemic hemodilution. 3. Intra operative cell salvage 4. Post operative cell salvage 8. Indications Where patients have formed multiple alloantibodies, particularly those to high frequency antigen, so that selection of compatible allogenic unit is not practical. Any surgeries which might need post surgical transfusion. Advantages Safe, No risk of disease transmission Rare blood group. 9. Contraindications Infections or risk of bacteraemia Aortic stenosis Angina Significant cardiac or pulmonary disease Coronary heart disease Cyanotic heart disease Uncontrolled HTN 10. Blood groups Major ABO Rh Minor Duffy blood group I blood group Kell blood group Kidd Lewis Lutheran MNS Bombay blood group 11. ABO- A, B, AB, O Rh- D, c, C, e, E 12. Blood groups 13. Blood grouping methods: Landsteiners law : 1. The first law holds true for all types of blood grouping. 2. The second law is a fact for ABO blood groups. 3. The Rh and other blood groups do not follow the second part of Landsteiner's law. 14. Cont.. Three manual methods can be used when performing blood grouping Glass slide or white porcelain tile Glass test tube Microwell plate or microplate Newer techniques Column technique (sephadex gel) Solid phase tests 15. FRONT TYPE whats on the cells? Agglutination indicates presence of antigen 16. BACK TYPE whats in the serum? Agglutination indicates presence of antibody 17. INTERPRETATION OF RESULTS 18. Bombay blood group First discovered in Bombay by Dr.Y.M.Bhende Individuals with the rare Bombay phenotype (hh) do not express H antigen (also called substance H), the antigen which is present in blood group O. Persons will lack H, A & B antigens on RBC & whose plasma contains antiH, antiA & antiB Present in about 4 per million of human population generally. In Mumbai it is 1 in 10,000 More common in India. 19. Cross matching The two main functions of the cross-match test can be cited as, I- It is a final check of ABO compatibility between donor and patient. 2-Detects clinically significant unexpected antibodies. 20. Major cross-match test, consisting of mixing the patients serum with donor RBCs. Minor cross-match test, consisting of mixing the donors plasma with patients RBCs The minor cross-match test has been completely eliminated in most blood banks, because donor samples are screened beforehand for the more common Antibodies. 21. Immediate Spin Technique (IST) Detects only IgM antibody, reactive at 22oC. Clinically significant IgG antibody reactive at 37oC not detected Patient serum 2 drops Donor RBC 1 drop, 5% Immediate centrifuge ABO incompatibility 22o C 22. Conventional AHG-crossmatch Patient serum 2 drops Incubation 37oC, 1 hr Donor RBC 1 drop, 5% 3 washes Centrifuge 2 drops AHG Mix properly Agglutination = incompatible No agglutination = compatible Detects clinically significant (IgG) antibody 23. Serological cross match Phase Detects IS phase ABO incompatibilities AHG phase Rh, Duffy, Kidd, others Points to remember: Preserve recipients serum & donor red cell segment for a week. However, fresh sample of the patient is needed after 48 hrs of transfusion 24. No compatibility testing required for platelets and plasma components Only ABO matching is required for fresh frozen plasma No need for compatibility, ABO and Rh matching for platelet concentrates and cryoprecipitate 25. Clinical urgency Immediate Within an hour(45 min)Minutes (15) Group O Rh neg Packed RBCs ABO & Rh D type Group specific blood ABO & Rh D type Complete crossmatch Cross matching: Special Circumstances 26. Blood collection Types of donor 1. Replacement 2. Voluntary donor Volume collected- 350 to 450 Ml ( according to weight) 27. 28 Blood collection process Registration Donor provides identification and demographic information Donor reads information about blood donation (Educational material) Donor consents to blood donation Health history and limited physical examination Health history questions asked by blood center staff Blood pressure, pulse and hemoglobin levels are checked Donation Arm is cleansed Blood is drawn (6-10 minutes) Needle is removed Recovery Rest ~ 15mins Snacks 1 2 3 4 Average donation process takes just under one hour 28. Mandatory screening test 1. HBsAg 2. Anti HCV 3. Anti HIV 1 and 2 4. VDRL 5. Malaria parasite 29. Blood collection bag 30. Blood processing Differential Centrifugation First Centrifugation Whole Blood Main Bag Satellite Bag 1 Satellite Bag 2 RBCs Platelet-rich Plasma First Closed System 31. Differential Centrifugation Second Centrifugation Platelet-rich Plasma RBCs Platelet Concentrate RBCs Plasma Second 32. Fresh Whole Blood Packed Red Cells Light spin, o C(within 8 hrs) Platelet Rich Plasma Platelet Concentrate Fresh Plasma Store at o C Freeze(FFP) Heavy spin, o C 33. TYPES Blood- Fresh Whole Blood Reconstituted whole blood Blood Products Cellular Components- Red Cell Concentrates Platelet Concentrates Granulocyte Concentrate Plasma Components- Fresh Frozen plasma Cryoprecipitate Stored plasma Plasma Derivatives- Albumin Immunoglobulin Coagulation Factors 34. WHOLE BLOOD Contains RBCs and plasma clotting factors. Only few units are stored as whole blood. Can be reconstituted from a unit of RBCs and FFP. Once WB has been stored for 24 hours at 4C, platelet function is lost. Furthermore, by day 21 of storage, factors V and VIII lose 5% to 30% of their activity 35. However, in most cases blood components are preferred because each component has specific optimal storage conditions and component therapy maximizes the use of blood donations. Stored at 2C to 6C. 36. Indications. Only use whole blood for patients who have a symptomatic deficit in oxygen-carrying capacity combined with hypovolemia of sufficient degree to be associated with shock, particularly in clinical situations where the transfusion of viable platelets and therapeutic levels of labile coagulation factors are also required. (Massive trauma) 37. Packed Red Blood Cells (PRBCs) The whole blood is spun to sediment out the RBCs, and most of the plasma is removed by pushing it into a pre-attached satellite bag. After plasma is separated from red cells from 350 ml whole blood, the RBC component has a volume of about 200 ml and Hct of about 80 %. 38. Generally 100 to 110 mL of a nutrient additive solution is added back to the packed RBCs, creating an additive RBC product that has a final hematocrit of 55% to 60%. These solutions prolong the shelf life of the RBC product from 21 days (packed RBCs in CPD) to 42 days (additive RBCs). PRBCs are the most commonly used blood product in transfusions. Red blood cells (RBCs) are transfused to increase the oxygen-carrying capacity of the blood and, to maintain satisfactory tissue oxygenation. 39. Available forms of RCCs The following forms of RCCs are available for the treatment of anaemia. RBC concentrates. RBC concentrates deprived of the buffy coat. RBC concentrates with additive solutions. 40. RBC concentrates deprived of the buffy coat and re suspended in additive solutions. Washed RBC. Leukocyte depleted RBC. Frozen RBC. Aphaeretic RBC. Irradiated RBC. 41. ANTICOAGULANT-PRESERVATIVE SOLUTIONS (Additive solutions) Function : (1) Maintain blood products in an anticoagulated state, (2) Support the metabolic activity of red cells and maintain function of cellular constituents while in storage, and (3) Minimize the effects of cellular degradation during storage. 42. Red Cell Concentrates Indications Treatment of symptomatic anemia Prophylaxis in life-threatening anemia Restoration of oxygen-carrying capacity in case of hemorrhage RBC are also indicated for exchange transfusion 1. Sickle cell disease 2. Severe parasitic infection (malaria, babesiosis) 3. Severe methemoglobinemia 4. Severe hyper bilirubinemia of newborn 43. Red Cell Concentrates Thalassemia Periodic regular blood transfusions Every 3 to 4 weeks. Pre transfusion Hb level -9-10g/dl Post transfusion Hb should not rise >14g/dl 44. Red Cell Concentrates Thalassemia Annual blood consumption=total blood transfused over 12 months/ patients weight in middle of the year. If blood consumption is >200ml/kg/ year splenectomy should be considered 45. Sickle cell disease Indications for simple top up transfusion Severe anemia / hemolysis Splenic or hepatic sequestration Stroke (chronic transfusion) Indications in surgery Organ transplantation Eye, major abdominal surgery Raising HB >10g/dl will cause increase in viscosity. 46. Red Cell Concentrates Dose for blood transfusion-10ml/kg cardiac failure-5ml/kg Increase Hb by~ 2 g/dl Rate of Blood Transfusion -3ml/kg/hr, slow for 1st 15 min. NEVER mixed with Calcium containing solutions May cause clumping or clots Dextrose May cause hemolysis or clumping 47. Leucoreduced Red Blood Cells Most of the plasma & 70-80% WBC (buffy coat) is removed. WBC :