BLOOD TRANSFUSION HISTORY INDICATIONS CRITERIA BLOOD COMPONENTS TRANSFUSION REACTIONS

1. BLOOD
TRANSFUSION
DR.ANUSREE.K
KANNUR MEDICAL
COLLEGE

2. HISTORY

3. 1492
POPE
INNOCENT VIII

4. 1665
RICHARD LOWER

5. 1667 JEAN-BAPTISTE DENIS

6. 1678

7. 1818 JAMES BLUNDELL

8. 1901 KARL LANDSTEINER
1907
REUBEN OTTENBURG
FIRST TRANSFUSION AFTER TYPING
AND CROSSMATCHING

9. 1914
ALBERT HUSTIN

10. 1926
1939

11. 1940 EDWIN COHN
COLD ETHANOL FRACTIONATION: BREAKING DOWN PLASMA
INTO COMPONENTS AND PRODUCTS
ALBUMIN
GAMMA GLOBULIN
FIBRINOGEN

12. INDICATIONS

13. DONOR CRITERIA
F:11.5g/dl
M:12.5g/dL
45 kg
S: 100-140
D: 60-90
37.5
60-100 bpm
REGULAR

14. DONOR CRITERIA
SHOULD NOT BE FASTING BEFORE
DONATION
ANTICOAGULANT : BLOOD – 1:7
450mL (405-495)/
12% OF TOTAL BLOOD VOLUME/
10.5mL/kg BW

15. PRE TRANSFUSION TESTING
HEPATITIS B
HEPATITIS C
HIV-1
HIV-2
SYPHILIS
MALARIA
ABO
RHESUS D
RED CELL ANTIBODIES

16. BLOOD TRANSFUSION
WHOLE BLOOD
BLOOD COMPONENTS
PLASMA DERIVATIVES
RED CELL CONCENTRATE(PRBC)
PLASMA
PLATELET CONCENTRATE
CRYOPRECIPITATE
ALBUMIN
COAGULATION FACTOR CONCENTRATE
IMMUNOGLOBULINS

17. WHOLE BLOOD
SLOW CENTRIFUGATION
PLATELET RICH PLASMA
PRBC
HIGH SPEED CENTRIFUGATION
RANDOM DONAR PLATELET
FFP
THAWING
PRECIPITATION OF PLASMA PROTEINS
CENTRIFUGATION
CRYOPRECIPITATE

18. WHOLE BLOOD
COAGULATION FACTOR RICH
IF FRESH- MORE
METABOLICALLY ACTIVE THAN
STORED BLOOD

19. WHOLE BLOOD
PLASMA CELLS
VOLUME EXPANSION OXYGEN CARRYING CAPACITY
ACUTE HAEMORRHAGE
>/=25%
4 DEGREE CELSIUS
DECREASE IN 2,3-BISPHOSPHOGLYCERATE
INCREASE AFFINITY FOR OXYGEN
DECREASE CAPACITY TO DELIVER OXYGEN

20. UNIVERSAL PRE -STORAGE LEUKOCYTE REDUCTION
CYTOKINES ARE GENERATED IN STORED PRODUCT
PRE STORAGE FILTERATION IS SUPERIOR TO BED SIDE
FILTRATION
<5X1000000 DONOR WBC
REDUCES
POST TRANSFUSION FEVER
CMV INFECTIONS
ALLOIMMUNIZATION

21. PRBC
INCREASE OXYGEN CARRYING CAPACITY

22. SPUN DOWN AND CONCENTRATED
1UNIT=330ml
HAEMATOCRIT= 50-70%
Hb=2g/dL
STORAGE:SALINE –ADENINE-GLUCOSE- MANNITOL
STORAGE: 2-8 DEGREE CELSIUS
SHELF LIFE: 42 DAYS
OLDER:CPD(CITRATE-PHOSPHATE-DEXTROSE-SOLLUTION)
SHELF LIFE:35 DAYS

23. PLATELET
REDUCES INCIDENCE OF BLEEDING
THRESHOLD FOR PROPHYLACTIC TRANSFUSION – 10,000/MICRO L
WITHOUT FEVER/INFECTION – 5000/MICRO L
INVASIVE PROCEDURES – 50,000/MICRO L
2 UNIT RD/ SQUARE METER OF BODY SURFACE AREA - 10,000/MICRO L

24. THROMBOCYTOPENIA
SEPSIS
ABNORMAL COAGULATION
LUMBAR PUNCTURE
GASTROSCOPY AND BIOPSY
INSERTION OF INDWELLING LINES
LIVER BIOPSY
LAPAROTOMY
OPERATION IN CRITICAL SITES

25. REFRACTORINESS TO PLATELET TRANSFUSION - ALLONIMMUNIZATION
CORRECTED COUNT INCREMENT
CCI
POST TRANSFUSION COUNT PRE TRANSFUSION COUNT
NO. OF PLATELETS TRANSFUSED X 10^-11
BSA
X=

26. FRESH FROZEN PLASMA
 RICH IN COAGULATION FACTORS
 150-300ml plasma from one donation of whole blood
 PLASMA PROTEINS-
FIBRINOGEN,ANTITHROMBIN,ALBUMIN,PROTEINS C AND S
 REMOVED FROM FRESH BLOOD AND STORED AT -40 TO -50
DEGREE CELCIUS
 2 YEAR SHELF LIFE
 FIRST LINE THERAPY FOR TREATMENT OF COAGULOPATHIC
HAEMORRHAGE

27.  CORECTION OF COAGULOPATHIES
 REVERSAL OF WARFARIN
 SUPPLYING DEFICIENT PLASMA PROTEINS
 TREATMENT OF THROMBOTIC THROMBOCYTOPENIC
PURPURA
ACELLULAR-DOES NOT TRANSMIT INTRACELLULAR INFECTIONS

28. CRYOPRECIPITATE
10-20ml PACK
FIBRINOGEN: 150-300 mg
FACTOR VIII : 80-120 U
VWF : 80-120 U

29. SUPERNATENT PRECIPITATE OF FFP
PRODUCED BY CONTROLLED THAWING
RICH IN FACTOR VIII,FIBRINOGEN,VWF
POLED UNITS(10 DONATIONS)-RAISE FIBRINOGEN BY 1g/L
STORAGE: -30 DEGREE CELSIUS
2 YEAR SHELF LIFE
INDICATION
ANY FACTOR DEFICIENCY
VWD
HAEMOPHILIA

30. BLOOD COLD CHAIN
DONATED WHOLE BLOOD OR PLASMA
TRANSPORT BOX AT +20 TO +24 FOR MAX.6hrs
PREPARATION OF COMPONENT RED CELL PLASMA PLATELET
QUARANTINE STORAGE BLOOD REFRIDGERATOR
+2 TO +6
BLOOD REFRIDGERATOR
+2 TO +6
PLASMA FREEZER
-30 OR LOWER
PLASMA FREEZER
-30 OR LOWER
PLATELET AGITATOR
+20 TO +24
PLATELET AGITATOR
+20 TO +24
TRANSPORT BOX
+2 TO + 10
TRANSPORT BOX
LESS THAN -20
TRANSPORT BOX
+20 TO +24
STOCK STORAGE
HOSPITAL BLOOD BANK
BLOOD RECIPIENT(PATIENT)

31. ADULTS PAEDIATRIC PATIENTS
WHOLE BLOOD
PRBC
PLATELETS/PLASMA
150-200mL/hour 2-5mL/hour
150-300mL/hour
100-150mL/hour
1-2mL/minute
2-5mL/hour
RATES OF TRANSFUSION

32. BLOOD PRODUCTS
WHOLE BLOOD/PRBC
PLATELET CONCENTRATE
FFP
CRYOPRECIPITATE
START INFUSION
WITHIN 30 MIN OF REMOVING
FROM REFRIDGERATOR
IMMEDIATELY
AS SOON AS POSSIBLE
AS SOON AS POSSIBLE
COMPLETE TRANSFUSION
</=4hrs
WITHIN 30 MINUTES
WITHIN 30 MINUTES
WITHIN 30 MINUTES
DURATION TIMES FOR TRANSFUSION

33. TRANSFUSION
REACTIONS
IMMUNE - MEDIATED
NON- IMMUNE MEDIATED

34. IMMUNE - MEDIATED

35. HAEMOLYSIS
ACUTE HAEMOLYTIC TRANSFUSION REACTIONS
HAEMOGLOBINAEMIA
HAEMOGLOBINURIA
RAISED HAPTOGLOBIN,LDH,INDIRECT BILIRUBIN
CHEST AND FLANK PAIN

36. YYY
DIRECT COOMBS TEST / DIRECT ANTIGLOBULIN TEST
ANTIBODIES ON THE SURFACE OF RBC

37. YYY
YYYINDIRECT COOMBS TEST/INDIRECT ANTIGLOBULIN TEST
ANTIBODIES IN SERUM

38. DELAYED HAEMOLYTIC TRANSFUSION REACTIONS
Ag + BLOOD
Y Y
CLEARED BY RETICULO
ENDOTHELIAL SYSTEM
ALLO Ab

39. FEBRILE NON HAEMOLYTIC
TRANSFUSION REACTION
Ab to
 LEUKOCYTE
 HLA ANTIGEN
 MULTIPLE TRANSFUSIONS
 MULTIPAROUS WOMEN
 NON LEUKODEPLETED
BLOOD
 LEUCODEPLETED BLOOD
 LEUKOREDUCTION BEFORE STORAGE

40. ALLERGIC REACTIONS
URTICARIAL REACTIONS-PLASMA PROTEINS
SYMPTOMATIC MANAGEMENT
ANTIHISTAMINE
DIPHENHYDRAMINE,50 mg orally or IM

41. ANAPHYLACTIC REACTIONS
DIFFICULTY IN BREATHING
COUGHING
NAUSEA
VSSOMITING
HYPOTENSION
BRONCHOSPASM
LOSS OF CONSCIOUSNESS
RESPIRATORY ARREST
SHOCK
STOPPING THE TRANSFUSION
MAINTAINING VASCULAR ACCESS
ADMINISTERING EPINEPHRINE

42. GRAFT VERSUS HOST REACTION
T
CELL HLA
D R
+
MARROW
APLASIA
PANCYTOPENIA

43. FETUS-INTRA UTERINE TRANSFER
IMMUNOCOMPETENT INDIVIDUAL
IMMUNO COMPROMISED STATE
BLOOD RELATIVES
H/O MARROW TRANSPLANTATION
IRRADIATION OF CELLULAR COMPONENTS
(MIN 2500cGY) BEFORE TRANSFUSION

44. TRANSFUSION RELATED ACUTE LUNG INJURY
HYPOXIA
 CHEST X-RAY- BILATERAL INTERSTITIAL INFILTRATES: During or within 6 hours
of transfusion
HLA CLASS II Ab Vs RECIPIENT LEUKOCYTES
AGGREGATION OF LEUKOCYTES IN PUL VASCULATURE
MEDIATORS
INCREASE CAPILLARY PERMEABILITY

45. NON- IMMUNE MEDIATED

46. FLUID OVERLOAD
TRANSFUSION- ASSOCIATED CIRCULATORY OVERLOAD
DYSPNOEA
BILATERAL INFILTRATES ON CHEST X-RAY
SYSTOLIC HYPERTENSION
HYPOTHERMIA
REFRIDGERATED OR FROZEN BLOOD
COMPONENTS
EXPOSING SA NODE TO COLD-
DYSARRHYTHMIAS
USE OF IN- LINE WARMER

47. ELECTROLYTE TOXICITY
RBC LEAKAGE DURING STORAGE-INCREASE POTASSIUM
HYPERKALAEMIA
USE FRESH OR WASHED RBCs
CITRATE-ANTICOAGULANT-CHELATE CALCIUM-INHIBIT
COAGULATION PATHWAY
HYPOCALCAEMIA
CIRCUMORAL NUMBNESS
TINGLING SENSATION OF FINGERS AND TOES
CITRATE IS QUICKLY METABOLZED TO BICARBONATE

48. IRON OVERLOAD
EACH UNIT OF RBC-200-250mg IRON
100 UNITSOF RBC-SYMPTOMS
ENDOCRINE
CARDIAC
HEPATIC
CHELATING AGENTS- DESFEROXAMINE

49. HYPOTENSIVE REACTIONS
HYPOTENSION IN PATIENTS ON ACE INHIBITORS
INFECTIONS
HEPATITIS C
HEPATITIS B
HIV
MALARIA
SYPHILIS
CYTOMEGALOVIRUS

50. THANK
YOU…