2. OBJECTIVES
History of blood transfusion
Purposes for blood transfusion
Function and properties of blood
Time of blood transfusion
Blood component
Properties and indication of transfusion for every one
Complications and management of blood transfusion
3. HISTORYHISTORY The science of blood transfusion dates to the first decade
of the 19th century, with the discovery of distinct blood
types leading to the practice of mixing some blood from
the donor and the receiver before the transfusion.
First blood transfusion was
done by LOWER in 1665
from dog to dog
In 1901 Sir Austrian Karl
Landsteiner discovered
blood groups.
He was awarded nobel
prize for this discovery in
1930.
4. BLOOD TRANSFUSION
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.
5.
6. PURPOSES
To replace blood lost during surgery or a serious injury.
To restore oxygen-carrying capacity of the blood.
To provide plasma factors to prevent or treat bleeding.
Done if patient’s body is not capable of making blood
properly because of an illness or acute los of blood.
7. FUNCTION AND PROPERTIES OF BLOOD
A vehicular organ that perfuses all other organs
Blood and interstitial fluid deliver nutrients to cells and
remove wastes
Haemostatic governors are carried to and from
appropriate sites
Blood resembles an average 8% of body weight
8. FUNCTION OF BLOOD
• TRANSPORT:
suspended cells include RBCs that carry O2 , One
RBCs can carry 1 billion O2 molecule
Platelets that contributes to the haemostatic process ,
Chemicals dissolved in plasma (nutrients, waste,
hormones, etc)
metabolic heat for disposal
ONE cubic ml of blood contain 400.000 platelets
9. FUNCTION OF BLOOD
• REGULATION:
plasma contains pH buffers
plasma water absorbs heat
plasma solutes maintain osmolality
10. FUNCTION OF BLOOD
• PROTECTION:
plasma precursor proteins form blood clot when
stimulated
suspended WBCs attack bacteria and viruses ( body’s
defense )
plasma contains antibodies and opsonins for immunity
13. Blood transfusions can be grouped into two main types
depending on their source:
Homologous transfusions, or transfusions using the
stored blood of others.
Autologous transfusions, or transfusions using one's own
stored blood.
BLOOD TRANSFUSIONBLOOD TRANSFUSION
14. When Hb concentration falls below “acceptable” valuesWhen Hb concentration falls below “acceptable” values
and SaO2 is adequate, SVO2 or oxygen extraction ratioand SaO2 is adequate, SVO2 or oxygen extraction ratio
may be useful in predicting adequate tissue oxygenationmay be useful in predicting adequate tissue oxygenation
20% loss – no need20% loss – no need
20%-30% loss - plasma substitution20%-30% loss - plasma substitution
>30% - Blood transfusion>30% - Blood transfusion
WHENE BLOOD TRANSFUTIONWHENE BLOOD TRANSFUTION
))INDICATIONINDICATION((
16. FRESH WHOLE BLOODFRESH WHOLE BLOOD
Blood that has been drawn recently (within 24 hours) butBlood that has been drawn recently (within 24 hours) but
NOT separated into its components.NOT separated into its components.
Contains red blood cells, plasma, clotting cascade factors,Contains red blood cells, plasma, clotting cascade factors,
and plateletsand platelets
Anticoagulant (CPDA-1)-63mlAnticoagulant (CPDA-1)-63ml
Hct 35-45% . 1 Unit- 450mlHct 35-45% . 1 Unit- 450ml
17. Contents of fresh bloodfresh blood
o RBC’sRBC’s
o WBC’sWBC’s
o PlateletsPlatelets
o PlasmaPlasma
o Clotting factorsClotting factors
If refrigerated within 8 hours of collection, store up to 5 days,If refrigerated within 8 hours of collection, store up to 5 days,
the product only has RBCs and plasma as platelets becomethe product only has RBCs and plasma as platelets become
non-viable at 4oCnon-viable at 4oC
Indications
Acute loss of whole bloodAcute loss of whole blood
Massive transfusionMassive transfusion
Cardiovascular bypass surgeryCardiovascular bypass surgery
18. 1. PACKED RED BLOOD CELL ( PRBCs )PACKED RED BLOOD CELL ( PRBCs )
(PRBCs) 1 unit contain (250 ml and Hct.70%)
Healthy, normovolemic individual, tissue oxygenation is
maintained and anemia tolerated at Hct as low as 18-25% (Hb
6gm%).
RBC transfusion is rarely indicated when Hb > 10 g/dl and is
almost always indicated when Hb < 6 g/dl.
Fastest way to increase the oxygen-delivering capacity of the blood.Fastest way to increase the oxygen-delivering capacity of the blood.
A unit of whole blood or packed red cells will raise the hematocriteA unit of whole blood or packed red cells will raise the hematocrite
by 3% and the hemoglobin by 1 gm/dlby 3% and the hemoglobin by 1 gm/dl
19. RBCs made and destroyed by a rate of 2-3 million per second .
D5W lyses RBC’s.
ONE cubic ml of blood contain 5 million of RBCsONE cubic ml of blood contain 5 million of RBCs
We have approximately 25-30 trillion RBCs in our blood at any
given time
Each RBCs has 250 million hemoglobin molecule
Every hemoglobin molecule can hold 4O2 molecule so one
RBCs can carry 1 billion O2 molecule
One cubic milliliter of blood has only 5.000-10.000 white
WBCs
20. Contents
RBC’s
20% Plasma
Indications
Replace O2 carrying capacity
with less volume
Severe anemia, slow blood loss, CHF
21. 2. FFP ( initial therapeutic dose : 10-15 ml/kg )( initial therapeutic dose : 10-15 ml/kg )
4-5 units of FFP- in deterioration of normal hemostasis4-5 units of FFP- in deterioration of normal hemostasis
Stored at -30 CStored at -30 C (shelf life of 12 months) . Thawed rapidly at 37 C.shelf life of 12 months) . Thawed rapidly at 37 C.
ONE unit increase coagulation factors 2-3 %ONE unit increase coagulation factors 2-3 %
Infused intravenously through a standard blood set with on-lineInfused intravenously through a standard blood set with on-line
filterfilter
ABO group must be compatibleABO group must be compatible
Infusion of 1 unit should be complete within 4 hr of thawingInfusion of 1 unit should be complete within 4 hr of thawing
ContentsContents
Clotting factorsClotting factors
FibrinogenFibrinogen
ProthrombinProthrombin
Albumin & GlobulinsAlbumin & Globulins
22. indicationindication
Isolated factor deficienciesIsolated factor deficiencies
Reverse warfarin therapyReverse warfarin therapy
Correction of coagulopathy associated with liver diseaseCorrection of coagulopathy associated with liver disease
Used in patients who are received massive bloodUsed in patients who are received massive blood
transfusion with microvascular bleedingtransfusion with microvascular bleeding
Antithrombin III deficiencyAntithrombin III deficiency
TTP ( Thrombotic thrombocytopenic purpura )TTP ( Thrombotic thrombocytopenic purpura )
## Do not use for volumeDo not use for volume
23. 3. platelets
1 unit (50-70 ml, stored at +20 to +24c for 5 days)1 unit (50-70 ml, stored at +20 to +24c for 5 days)
indicationindication
thrombocytopenia or dysfunction platelets inthrombocytopenia or dysfunction platelets in
the presence bleedingthe presence bleeding
prophylactic : plt. counts below 10,000 to 20,000prophylactic : plt. counts below 10,000 to 20,000
prophylacticprophylactic preoperative : plt. counts belowpreoperative : plt. counts below 50,00050,000
Microvascular bleeding in surgical patientMicrovascular bleeding in surgical patient
with platelets < 50,000with platelets < 50,000
Neuro/ ocular surgery > 75,000Neuro/ ocular surgery > 75,000
24. 4. Cryoprecipitate4. Cryoprecipitate
Concentrate of factor VIII, von Willebrand’s factor and fibrinogenConcentrate of factor VIII, von Willebrand’s factor and fibrinogen
20 ml containing 150-300 mg of fibrinogen and 80-120 IU of factor VIII20 ml containing 150-300 mg of fibrinogen and 80-120 IU of factor VIII
Stored at -30 C (shelf life 12 month)Stored at -30 C (shelf life 12 month)
Also thawed at 37 CAlso thawed at 37 C
1U/ 10kg1U/ 10kg ↑↑ fibrinogen 50 mg/dL (usually a 6- pack)fibrinogen 50 mg/dL (usually a 6- pack)
Transfusion should be complete within 4 hourTransfusion should be complete within 4 hour
indicationsindications
Hemophilia AHemophilia A
Factor XIII deficiencyFactor XIII deficiency
Hypofibrinogenemia (congenital or acquired)Hypofibrinogenemia (congenital or acquired)
Microvascular bleeding (fibrinogen < 80-100mg/dL)Microvascular bleeding (fibrinogen < 80-100mg/dL)
25.
26. Complication of Blood Transfusion
A. Immediate reactions
– Febrile reactionFebrile reaction
– Allergic reactionsAllergic reactions
– Hemolytic transfusion reactionHemolytic transfusion reaction
– Circulatory over loadCirculatory over load
– Air embolismAir embolism
– Potassium toxicityPotassium toxicity
– Citrate toxicityCitrate toxicity
– Reaction due to infected bloodReaction due to infected blood
27. B-Delayed transfusion reactions
ThrombophlebitisThrombophlebitis
infectioninfection
-- AIDS (HIV) Hepatitis (HBV, HCV)AIDS (HIV) Hepatitis (HBV, HCV)
-- Syphilis (Treponema pallidum / Spirochetes)Syphilis (Treponema pallidum / Spirochetes)
-- Malaria , C.M.V & otherMalaria , C.M.V & other
Immunological sensitization or alloimmunizationImmunological sensitization or alloimmunization
Post transfusion purpuraPost transfusion purpura
hemolytic transfusion reactions (HTR)hemolytic transfusion reactions (HTR)
Complication of massive transfusionComplication of massive transfusion
28. Hemolytic transfusion reactions (HTR)
• Incompatibility between donors and recipient
99% of causes is human error and preventable by
•
Adequate knowledge of blood groupsAdequate knowledge of blood groups
Careful attention to all details of the techniquesCareful attention to all details of the techniques
- blood group incompatibility- blood group incompatibility
- outdated and infected blood- outdated and infected blood
- Haemolysed blood- Haemolysed blood
- Incorrect anticoagulant- Incorrect anticoagulant
29. Chills & rigorsChills & rigors
Chest painChest pain
Back painBack pain
Nausea, vomitingNausea, vomiting
Flushing, sweatingFlushing, sweating
Pain at infusion sitePain at infusion site
Abdominal discomfortAbdominal discomfort
Anxiety & RestlessnessAnxiety & Restlessness
Symptoms of hemolytic transfusion reactionsSymptoms of hemolytic transfusion reactions
31. Under anesthesia and sedationUnder anesthesia and sedation
Bleeding from wound / needle sitesBleeding from wound / needle sites
Persistent hypotensionPersistent hypotension
Tachycardia, hyperthermiaTachycardia, hyperthermia
Lab evidenceLab evidence
direct antiglobulin test ( DAT ) positivedirect antiglobulin test ( DAT ) positive
Indirect bilirubin increasedIndirect bilirubin increased
HemoglobinemiaHemoglobinemia
HemoglobinuriaHemoglobinuria
32. ManagementManagement
Stop transfusion immediatelyStop transfusion immediately
Maintain IV access with crystalloidMaintain IV access with crystalloid
Maintain BP, pulseMaintain BP, pulse
Ventilation & oxygenationVentilation & oxygenation
IV diuretics - mannitol IVIV diuretics - mannitol IV
frusemide IV bolusfrusemide IV bolus
Send blood samples to blood bank-5ml of plain blood &Send blood samples to blood bank-5ml of plain blood &
2ml of EDTA blood2ml of EDTA blood
CBC and blood pictureCBC and blood picture
Urine sample for hemoglobinuria
33. If intravascular hemolysis is confirmedIf intravascular hemolysis is confirmed
Monitor renal statusMonitor renal status
Monitor coagulation statusMonitor coagulation status
If Hb is markedly reduced ,compatible red cell transfusionIf Hb is markedly reduced ,compatible red cell transfusion
may be required to combat hypoxemia.may be required to combat hypoxemia.
Treat DIC if it occursTreat DIC if it occurs
34. Don’ts for Blood TransfusionDon’ts for Blood Transfusion
Don’t use blood without mandatory screening test.Don’t use blood without mandatory screening test.
Don’t delay initiation of blood transfusion.Don’t delay initiation of blood transfusion.
Don’t warm blood without proper monitoring.Don’t warm blood without proper monitoring.
Don’t transfuse 1 unit over more than 4 hours.Don’t transfuse 1 unit over more than 4 hours.
Don’t use 1 transfusion set for >4 hours or >2 units ofDon’t use 1 transfusion set for >4 hours or >2 units of
blood.blood.
Don’t leave patients unmonitored.Don’t leave patients unmonitored.
Don’t add any medication to blood bags.Don’t add any medication to blood bags.
Don’t forget to return unused blood to the blood bank forDon’t forget to return unused blood to the blood bank for
safe disposal.safe disposal.
Don’t store platelets in a refrigerator.Don’t store platelets in a refrigerator.
