4. THE FIRST BLOOD
TRANSFUSION ATTEMPT
• In1492 "the harrowing story was told that, at
the suggestion of a Jewish physician, the blood
of three boys was infused into the dying
pontiff ’s mouth (the concept of circulation
and methods for intravenous access did not
exist at that time). They were ten years old,
and had been promised a ducat each. All
three died."
Diario della città di Roma di Stefano Infessura scribasenato. 15th cent.
5. BLOOD AND CIRCULATION
• In 1628 William Harvey
published De Motu Cordis (On
the Motion of the Heart and
Blood) revealed the action
of the heart pumping blood
around the body in a circuit.
6. TRANSFUSION ATTEMPTS
• In
1667 Jean-Baptiste Denys, French
physician, performed transfusion with
sheep's and calf's blood.
• In
1818 James Blundell, successfully
performed transfusion for postpartum
hemorrhage, using patient's husband's blood.
• In1905 George Washington Crile, co-
founder of Cleveland Clinic, was the first
surgeon who used direct blood transfusion
in surgery.
7. BLOOD GROUPING
• In
1901, Karl Landsteiner discovered human blood groups.
Blood transfusion had become a lot safer since then.
8. DEVELOPMENT OF BLOOD
BANKING
• Anticoagulant was discovered in 1910, making the way to
blood banking.
• First stored blood was successfully transfused in 1916
by Oswald Hope Robertson, an English-born medical
scientist, during World War I.
• The first academic transfusion institution was found by
Alexander Bogdanov in Moscow.
• After Bogdanov's death Soviet established the world's first
blood bank in 1930s by Sergei Sergeevich Yudin at Nikolay
Sklifosovskiy Institute.
10. HOW IS DONATED BLOOD
PROCESSED?
• Blood and blood components come from potential donors.
• Wholeblood was used in first era of transfusion but blood
components are now wildly used for better efficient
management.
12. LEUKOCYTE REDUCTION
• WBC less than 5 x 106/unit*
• Reduced febrile reaction risk yte
oc !
Le uk d!
duce
• Reduced CMV transmission re
• ReducedHLA-
alloimmunization risk
13. IRRADIATION
• Inactivate donor’s T-cells
• Reduced GVHD risk
• Reduce shelf life to 28 days
• Increased K+ leak
16. WHOLE BLOOD
•Volume 350 or 450 ml
•Contain red cell, white cells,
platelets, and plasma
•Stored at 2-6°c
•No functional platelets and
labile factors
•May indicated in neonatal
blood exchange
17. PACKED RED
BLOOD CELL
•Volume ~300 ml
•Hct ~75%
•Contain red cells, white
cells, small of plasma
•Stored at 2-6°c
•10ml/kg raise Hct ~10%
18. PACKED RED
BLOOD CELL
•Volume ~300 ml
•Hct ~75%
•Contain red cells, white
cells, small of plasma
•Stored at 2-6°c yte
oc !
Le uk d!
•10ml/kg raise Hct ~10% ce
re du
19. PACKED RED
BLOOD CELL
•Volume ~300 ml
•Hct ~75%
•Contain red cells, white
cells, small of plasma
•Stored at 2-6°c yte
oc !
Le uk d!
•10ml/kg raise Hct ~10% ce
re du
20. PLATELET
CONCENTRATE
•Volume ~50 ml
• Contain platelet 5.5 x 1010
RBC 0.5 ml and white cells
•Stored at 20-26°c with
continuous rocking shelf
•1 unit/10 kg raise platelet
20,000-50,000 ml/mcL
21. POOLED
LEUKOCYTE-
POOR PLATELET
•Made of 4 unit of whole
blood
•Contain platelet 3 x 1011 and
RBC 5 ml
•Comparable to Plt. conc. 4-6
units (6 - 8 units for SDP)
22. POOLED
LEUKOCYTE-
POOR PLATELET
•Made of 4 unit of whole
blood
•Contain platelet 3 x 1011 and yte
oc !
RBC 5 ml Le uk d!
duce
•Comparable to Plt. conc. 4-6 re
units (6 - 8 units for SDP)
23. POOLED
LEUKOCYTE-
POOR PLATELET
•Made of 4 unit of whole
blood
•Contain platelet 3 x 1011 and yte
oc !
RBC 5 ml Le uk d!
duce
•Comparable to Plt. conc. 4-6 re
units (6 - 8 units for SDP)
27. THRESHOLD FOR RBC
TRANSFUSION
• Hb < 7 g/dL in general patient
• Hb < 10 g/dL in patient with ischemic heart disease
• Hb < 10 g/dL in pre-operative patient or bleeding patient*
• In symptomatic or frail patient*
28. PATIENT WHO SHOULD NOT
BE TRANSFUSED
• Nutritional anemia
• Autoimmune hemolytic anemia
• Patient with high peripheral blast count
29. PLATELET REQUIREMENT
• In bleeding patient: keep platelet > 50,000 - 80,000/mcL
• Bleeding in vital organ: keep platelet > 100,000/mcL
• In chronic thrombocytopenia: keep > 10,000/mcL
• In DIC keep platelet > 20,000/mcL
• In APL keep platelet > 30,000 - 50,000/mcL
31. FRESH FROZEN PLASMA
• Ingeneral each milliliter of plasma count as 100% factor
activity
100% + 0% = 50% Hemostat level = 40%
• Ifcoagulogram ≤1.5 times of normal, other causes of abnormal
bleeding should be sought
35. RH NEGATIVE
• Rh negative is determined by absence of D antigen
• Antibody occur 4 - 8 wks after expose to D antigen
• Rh negative person should receive only Rh negative blood
• Platelets
have no Rh antigen but contaminated RBC can
induce antibody
36. PLATELET TRANSFUSION IN
RH NEGATIVE
• Check if patient already have Rh
antibody
• Give anti-D IgG before or within 72
hr after platelet transfusion
• 100 units can neutralize RBC 5 ml
• 300 units can neutralize Plt. conc. 30
units or LPPC 3 units
37. MISMATCH TRANSFUSION
• Transfuse
packed red cell without foreign antigen to avoid
major mismatch reaction
• Transfuse
plasma without offending antibody to avoid minor
mismatch reaction
• Platelet is considered as plasma due to high plasma content
• Platelet recovery will be less than expected
38. TRANSFUSION
COMPATIBILITY
Blood group Compatible Compatible
A RBC
A, O Plt. & FFP
A, AB
B B, O B, AB
AB AB, A, B, O AB
O O O, A, B, AB
39. PLATELET REFRACTORINESS
• Corrected count increment (CCI) < 3,000/mcL
• Corrected count increment = (Pre - Post) x Body surface area
Transfused platelet
41. MASSIVE TRANSFUSION
• 1 Total blood volume within 24 hr.
• Keep platelet > 50,000/mcL
• Keep coagulogram less than 1.5 times
• Not recommend 1:1:1 transfusion protocol
43. TRANSFUSION PRACTICE
• Check if bags are in good condition
• No leakage
• No fibrin clot
• Recordvital sign at before, start, 15 min after, 1 hr after,
and 4 hr after transfusion
46. IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION
• ABO incompatibility is the most common cause
• Can be fatal even 30 ml of incompatible blood
• Intravascular hemolysis
• Renal failure
• Shock
57. IMMEDIATE HEMOLYTIC
TRANSFUSION REACTION
• IV fluid maintain urine output 100 ml/hr
• Furosemide or mannitol if needed
• Maintain blood pressure
• Check label
• Re-crossmatch on pre- and post-transfusion samples
• Prevention future event
58. DELAYED HEMOLYTIC
TRANSFUSION REACTION
• Occur 1 wk after transfusion
• Anamnestic immune response
• Extravascular hemolysis
• Usually subtle symptoms
• Antibody gradually decrease after expose to antigen
59. BACTERIAL CONTAMINATION
• Platelet
prone to have
bacterial overgrowth
enterocollitca can
• Yersinia
grow at 6°c etc.
• Antibioticshould be started
if suspected bacterial
contamination
60. ALLERGIC REACTION
• Allergic to plasma protein of donor
• Can give antihistamine to relieve symptoms
• In IgA deficiency patient should avoid plasma product
61. FEBRILE NONHEMOLYTIC
TRANSFUSION REACTION
• Fever
• Caused by alloantibody to HLA antigen on Plt. or WBC
• No specific treatment
• Must differentiate from other causes of fever
62. TRANSFUSION RELATED
ACUTE LUNG INJURY
• TRALI
• Causeby alloantibody from
donor to WBC of recipient
• Occur within 6 hours after
transfusion
• Symptoms is the same as
ARDS
63. TRANSFUSION RELATED
GRAFT-VERSUS-HOST DISEASE
• Cause by engraftment of donor T-cells
• Damage to epithelium and bone marrow
• Fatal condition
• Prevent with irradiation of blood component with T-cells
64. Recognize
T T
Engraft Reject Recipient
tissue
HLA antigen
T T-cells Transfusion related GVHD
65. PATIENT IN RISK OF GVHD
FROM TRANSFUSION
• Bone marrow transplant patient
• Intrauterine transfusion
• Hx of fludarabine use (follicular lymphoma, CLL, AML)
• HLA matched transfusion
• Transfusion from relatives
• Severe congenital immunodeficiency
66. PROTOCOL FOR
COMPLICATION EPISODE
Chill, fever, rash, flank pain, chest tightness,
vital sign change, alteration of consciousness,
dark urine
Stop transfusion!
Check vital sign, load IV fluid
maintain BP and urine output
Aware of renal complication
67. PROTOCOL FOR
COMPLICATION EPISODE
Check label and patient’s identification
Draw blood from patient Examine transfusing blood
Centrifuge for serum color Blood group
Coomb test Re-crossmatch with pre- and
Blood group post-transfusion samples
Hemoculture Hemoculture