blood transfusion need

1. Blood
Transfusion
Presented by :- Guided by:-
Aeliya Rukhsar Prof. Saiyad Shah Alam
PG Scholar HoD, Ilmul Jarahat
NIUM NIUM
Bengaluru-560091 Bengaluru-560091

2. Content
• Definition
• Indication
• components of blood
• Blood grouping and cross matching
• Types
• Collection
• Blood substitutes
• Blood storage
• complication

3. Definition
Blood transfusion is the
transfusion of the whole blood
or its components such as
blood cells or plasma from one
person to another person.

4. Indication of blood transfusion
1. blood loss greater than 20% of blood
volume.
2. Hemoglobin level less than 8gm% in
normal patients.
3. Hemoglobin level less than 9 to 10
gm.% in patients with major disease like
ischemic heart disease.

5. Indication…….
4. transfusion is rarely indicated
when the Hb concentration is more
than 10 gm./ dl.
5. Transfusion is almost always
indicated when the Hb level is less
than 6gm /dl especially when the
anemia is acute

6. Indication……..
The 2006 ASA updated practice guidelines will
be updated again in 2015. the following
indication is recommend:
1. Blood loss greater than 20% of blood volume
when more than 100 ml.
2. Hb level less than 8gm/dl
3.Hb level less than 9- 10 gm./dl with major
disease emphysema and ischemic heart disease.
Hb level of less than 10gm/dl with autologous
blood
4. Hb level less than 11- 12 gm./ dl and
ventilator dependent

7. Indication…..
4.It is indicated during certain major operation ,
where good amount of blood loss example –
mastectomy abdominal perineal resection etc.
5.Preoperative blood transfusion is required
when the patients is anemic and surgery is
indicted urgently . When there is inadequate
time for effective iron therapy .
6.Postoperatively in a patient who has become
severely anemic from infection.

8. Indication…..
7. In a patients with bleeding disorders e.g.
hemophilia or thrombocytopenia etc.
8.After extensive burn where a good deal of blood
lost from burn skin.
9. In treating cases of erythroblastosis foetalis due
to Rh incompatibility , exchange transfusion also
performed through umbilical vein of new born baby.
10.In severe malnutrition and hypoproteinemia
blood transfusion is indicated before any type of
surgery

9. Whole blood-acute
blood loss , shock
Fresh frozen plasma
Liver disease
DIC
Factor 5,8 deficiency
Hemophilia A
Fibrinogen
deficiency
cryoprecipitate
PRBC-chronic severe
anemia, leukemia
Platelet concentrate-
thrombocytopenia
malignancy, major
surgery
granulocytes
neutropenia
Indication Related to Blood Components

10. Blood
Plasma – constitutes
55% of blood volume
Cells- 45% of cellular
fraction of body
Blood makes up about 7% of body
weight (about 5.6 liters in a 70kg
man.
In average 70 kg adult man a total
body water is about 60% of body wt
or about 42 litres.

11. Body fluid
Intracellular fluid
About 28 liters of fluid inside 100 trillions
of cells.
Extracellular fluid
about 14 liters.
Interstitial fluid
About 11 liters.
Plasma
About 3 liters.

12. Red blood cell
• Normal red blood cells are bi-concave discs having
a mean diameter of about 7.8 micrometer
thickness of 2.5 micrometer.
• The average volume of the red blood cell is 90-95
cubic micrometer.
• Red blood cells have the ability to concentrate
hemoglobin in the cell fluid up to about 34 gm. in
each 100 millimeters of cells.
• Each gram of pure hemoglobin is capable of
combining with 1.34ml of oxygen.
• Therefore in a normal man a maximum of about 20
milliliters of oxygen in each 100 milliliters of blood.

13. Blood groups
1.Erythrocyt
e related
2.
Leukocyte
related
Plat
elet
s
anti
gen
Since
Landsteiner's
discovery in
1900 a vast
number of
antigen
detected in
human blood
cells
At least 100
antigen have
been
recognized on
RBC surface
and almost 15
well defined
blood group
system
These
includes
HLA typing
1. HLA
typing
2. 2.plat
elets
specifi
c
match
ing
3. 4.ABO
Match
ing

14. Erythrocyte related blood groups
1. ABO 2.Rh
3.duffy 4.kell
5.lewis 6.MN
S

15.  At least 30 commonly occurring antigen and
hundreds of other rare antigen , each of which
can cause a antigen antibody reaction, which
have been found on the surface of cell
membrane of human blood cell.
 Two particular type of antigen are much more
likely than others to cause blood transfusion
reaction.
 They are the O-A-B system of antigen and the
Rh system.
ABO BLOOD GROUPING

16. ABO BLOOD TYPES
• 2 antigen type A and type B occurs
on the surface of RBC in large
population of human being.
• These antigen also called
Agglutinogens.
• Blood of donor and recipients are
normally classified into 4 major O-
A-B blood types.

17. 0-A-B blood types
Type AB – when both A and B agglutinogen is present
Type –B- where only type B agglutinogen is present.
Type-A – where only type A agglutinogen is present
Type-O where neither A or nor B agglutinogen are present

18. The genes A,B and O
alleles, any one of three
may occupy the ABO
locus on each pair of
chromosome.
if the chromosome
inherited from the father
carried the gene A and
the mother carried the
gene B the child will be
the genotype AB
Person who inherits o
genes from both parents
belongs to blood group
O. O gene is amorphous
it does not produce a
detectable antigen
O-A-B blood types

19. Gene determination
• 2 Genes one on each of 2 paired chromosomes determine O-A-
B Blood types . These genes can be of anyone of 3 types but
only one type on each of the 2 chromosomes TYPE O TYPE A
TYPE B.
• The type O gene is either functionless or almost functionless .so
it can cause no significant type o agglutinogenon the cells.
• Conversely type A and type B genes do cause strong
agglutinogens on cells.
• The six possible combination of genes are OO,0A,OB,AA,BB,and
AB.
• These combination of genes is called genotypes and each
person is one of six genotypes

20. • A person with
genotypes OO
produce no
agglutinogens.
therefore the blood
type is O.
• A person with
genotypes OA or AA
produce type A
agglutinogens
therefore the blood
type A.
• Genotype OB and BB
five type B blood.
• Genotype AB given
type AB blood.
Genotypes Blood
types
Agglutinog
ens
Agglutinins
OO O - Anti-A
Anti-B
OA or AA A A Anti-B
OB or BB B B Anti-A
AB AB A and B -

23. • When type A agglutinogen is not present in a persons red blood cells antibodies known as
anti-A agglutinins develops in plasma. Type A blood contain type A agglutiniogens and anti-
B agglutinins,
Agglutinins
• When type B agglutinogen is not present in the red blood cells, antibodies known as anti-B
agglutinins develops in plasma. Type b blood contain type B agglutinogen and anti-A
agglutinins.
• Type O blood, containing no agglutinogen does contain both anti-A and anti-B agglutinins.
• Type AB blood contain both A B agglutinogens but no agglutinins.

25. 1.The H antigen is produced by
fucosyl transferase which is
present on chromosome 9 .
2. fucosyl transferase made
fucose sugar.
3.Fucose sugar binds to the
oligosaccharides to form H
antigen.
4.When n- acetylglactosamine
added in H antigen it formed A
antigen.
5.NAGA is produced by
enzyme transferase A present
in long arm of chromosome 9.
6.B antigen is produced by
transferase B which produced
galactose.
H antigen

26. A single agglutinin can attach to
two or more red blood cells at
the same time.

27. • The antibodies are gamma globulins
called immunoglobulins.
• They usually constitute about 20 % of
plasma proteins.
• It contains two heavy and two light
chains.
• End of each light and heavy chain called
variable portion.it attaches to particular
type of antigen.
• The remainder of each chain is called
constant portion.
• A combination of non covalent and
covalent bonds holds the light and
heavy chain together.
agglutinins/antibodies

28. • There are 5 classes of antibodies
igM, igG ,igE, igA , igD.
• Ig stand for immunoglobulins.
• igG constitute about 75% of the
antibodies of the normal person.
• igE constitute only small
percentage of antibodies but is
especially involved in allergy.
• The igM class antibodies is formed
during primary reponse.
Antibody………

29. Action of antibodies on invading agents.
Agglutination
• When blood are mismatched so that anti-A or anti-B plasma agglutinins are
mixed with red blood cell that contain A and B agglutinogen.
• Agglutinins have 2 binding sites (IgG types ) `or 10 binding sites in (igM type).
• A single agglutinins can attach to 2 or more red blood cells thereby causing the
cell to bound together by the agglutinins .
• This cause the cell to clump which is the process of agglutination .
• Theses clumps plug small blood vessel throughout the circulatory system.
• During hours or days either physical distortion of cell or attack by WBC destroys
membrane of agglutinated cell releasing hemoglobin into plasma which is
called hemolysis of cells.

30. Rh blood types
There are six common types of Rh antigen
each of which is called an Rh factor.
These types are designted C,D,E,c,d,e.
A person who has a C antigen does not have
the c antigen,but the person missing C
antigen always has the c antigen.
The type D antigen is widely prevalent in
population and considerably more antigenic
than the other Rh antigen anyone who has
this type of antigen is said to be Rh positive.
Whereas a person who doesnot have type D
is said to Rh negative.
There are six common types of Rh
antigen each of which is called an Rh
factor. These types are designted C,D,E,c,d,e.
A person who has a C antigen does
not have the c antigen, but the person
missing C antigen always has the c
antigen
The type D antigen is widely prevalent
in population and considerably more
antigenic than the other Rh antigen
anyone who has this type of antigen is
said to be Rh positive.
Whereas a person who does not have
type D is said to Rh negative.
Rh antigen

31. When a red blood cell
containing Rh factor injected
into a person whose blood does
not contain the Rh factor.
So anti Rh agglutinins develops
slowly ,reaching maximum
concentration of agglutinins
about 2-4 month later.
With multiple exposure to the
Rh factor an Rh negative person
eventually become strongly
sensitized to Rh factor
Rh antigen

32. Compatibility testing
Consisting of two parts
Major cross match involves
mixing donor cells with
recipients serum
It is designated to detect
antibodies in the recipients
serum.
Minor cross match involves
mixing recipients cells with
donor serum.
The minor test is usually
considered less important
because of large dilution of
donor antibodies.

33. A cross match is essentially A
trial transfusion within a test
tube in which donor RBC is
mixed with recipient serum to
detect a potential for serious
transfusion reaction.
. The cross match is completed
in 45- 60 minutes[.
It is performed in three
phases .
A. Immediate phase
B. Incubation phase
C. Anti globulin phase.
Major Cross matching

34. Immediate
phase
Incubation
phase
Anti
globulin
phase
Cross matching

35. Immediate
phase
The first and
immediate phase
is conducted at
room temperature
and check error in
abo typing .
. It detects abo
incompatibles and
those caused by
naturally occurring
antibodies in MN
P and Lewis
system. It take 1- 5
min to complete.
Cross matching

38. 1.The second or incubation phase involves incubation
of the first phase reaction at 37° Celsius in albumin or
low ionic strength salt solution.
2.The addition of albumin or low ionic solution aids in
the detection of incomplete antibodies or antibodies
able to attach to a specific antigen( sensitization) but
are unable to cause agglutination.
3.In a saline solution of RBC. This phase primarily
detects antibodies in the RH system.
4.An incubation period of 35- 40 minutes in albumin
and of 10 - 20 minutes in low ionic strength salt
solution
2. Incubation phase

39. Antiglobulin phase
Third phase or antiglobulin phase of the cross match the
indirect antiglobulin test. It involves the addition of
antiglobulin sera to incubated test tubes.
With this addition, antihuman antibodies present in sera
becomes attached to antibodies Globulin on the RBC
causing agglutination. This agglutination phase detects
most incomplete antibodies in blood grouping system
include RH Kell duffy and kidd blood grouping system.

40. COOMBS TEST
It is a test using antiglobulin
serum detect the antibody
coating the surface of red cells
Direct coombs test
To detects red cells
have absorbed
antibodies
Differentiate
between congenital
and acquired
haemolytic anemia
Indirect coombs
test
To detect incomplete antibodies during
pregnancy.
To detects D antigen

41. Types of blood transfusion
Autologous
blood
transfusion Allogeneic
blood
transfusion
Exchange
blood
transfusion

42. Autologous blood transfusion
Autologous blood transfusion as the name
suggest patients own blood is taken and
replaced back when necessary.
An healthy individual with no infection and
haematocrit of > 30% can predonate blood
few weeks prior to surgery which in turn can
be used at the time of surgery patient can
donate one unit of blood weekly .

43. Allogeneic blood
transfusion
Allogeneic transfusion
is when a donor and
recipient are not a
same person.

44. Exchange blood transfusion
An exchange transfusion is a medical procedure
in which your blood is removed and replaced
with plasma or donor blood.
This is donor via catheter
This procedure is used to save the life of an
adult or child with life threatening blood
abnormalities

45. Massive transfusion
It is defined as transfusion of total blood volume in less
than 24 hours
In adults it is 5-6 liters, in infants it is 85ml/kg body
weight.
or single transfusion of blood more than 2500ml
continuously
Massive transfusion is used in severe trauma associated
with liver vessel cardiac pulmonary pelvic injuries
Often it is required during surgical bleeding (primary
hemorrhage on table) of major surgeries

46. WHOLE BLOOD
Cellular
components Fresh frozen plasma
fractionation cryoprecipitate
Red blood cells
platelets
Coagulation factor
immunoglobulin
albumin

47. Packed red blood cells
It is obtained by centrifuging whole blood at 2000-2300g for 15-20 minutes
2. It can be stored for 35 days at 1 -6 degree Celsius.
3.one unit contains 300ml with haematocrit about 70℅ one unit raises Hb ℅
by 1.0gm.
Red blood cell concentrate or packed cells consist of whole blood from
which the plasma has been removed.

48. plasma
• If the whole blood is kept for sometime a
sediment will form at the bottom of the
container.
• The upper portion is the plasma and blood
sediment is packed red cells.
• If the whole blood is centrifuged at
the rate of 2000-2500g for 15-20
min the whole blood will be divided
into 2 groups plasma and packed
cells
Repeated fractionation of plasma by organic liquid
followed by heat treatment result in this plasma
fraction.it is useful in shock due to burn acute
pancreatitis and intestinal obstruction
albumin

49. Fresh frozen
plasma
It is the
good
source of
all
coagulation
factors .
It is prepared by
centrifugation of
donor whole blood
within 4 hours
.frozen at -30degree
Celsius
Shelf life of 12 month at -30
degree Celsius.
A unit is typically 200-250ml.
Dose of FFP is 15ml/KG
Indication.
1.Severe liver disease with
abnormal coagulation
function
2.Congenital clotting factor
deficiency .
3.Defeciency following
warfarin therapy DIC,
massive transfusion

50. Cryoprecipitate
Cold-coprecipitate
If the fresh frozen plasma is allowed to
bring at a temperature of 4 degree
Celsius . It will be divided into a white
glutinous precipitate and supernatant
plasma .
It is usually stored at -
40 degree celcius. It is
very rich source of
factoe viii
So it is best treatment
of hemophilia (factor
viii deficiency)
The glutinous
precipitate is
known as
cryoprecipitate .
It also contain a good
amount of fibrinogen
and may be used in
condition of
hypofibrinogenaemia

51. Platelet rich plasma is
prepared by slow
centrifugation of fresh
whole blood at the
rate of 150 to 200 g for
15 minutes to 20
minutes. Platelet rich
plasma contain 5.5 x
109/ liter in 50ml
plasma.
Platelet concentrate is
prepared from platelet
rich plasma by
centrifugation at the
rate of 1500g for 20
min. platelet
concentrate can
increase unto 10,000
platelet /cumm in ne
hour.
Platelet is transfused
at a dose 0.1 unit/kg.
Uses of both
are-
Thrombocytop
enia purpura
Shelf life of
both- 5 days at
room
temperature
22º Celsius.-
Platelet rich plasma and platelet concentrate

52. Platelet concentrate
platelets are the only blood products which are stored
at room temperature .
 Survival at room temperature is 4-5 days.
 1 unit platelet increases the count by 5,0000-10,000.
 Transfused platelet generally for 2-7 days following
transfusion.
 Platelets are derived from multiple donors ,the
chances of disease transmission are high.
 One unit of single donor platelet is equal to 5-8 units
of random donor platelets.
 Therefore increases the platelet count by 30,0000-
40,0000.

53. Granulocyte transfusion
These are useful to patient s
who are neutropenia to prevent
and treat infection.
It has very short shelf life of 24
hours at room temperature

54. Storage of blood
Blood is stored in the cold part of refrigerator at 4º
Celsius .
It can be stored for 21 days if acid citrate
dextrose is used.
It can be be stored for 35 days if preservative
CDPA-1 is used.
If can be stored for 42 days if anticoagulant
ADSOL or NUTRICE is used

55. • citrate phosphate dextrose adenine -1 (CPDA-1) is an
anticoagulant preservative in which blood stored at 1-6°
Celsius.[
• citrate is an anticoagulant phosphate serves as a buffer
and dextrose is red cell energy source..
• The addition of adenine to citrate phosphate
dextrose(CPD)allows RBC to resynthesize adenosine
triphosphate which extends the storage time from 21 to
35 days. As result RBC Or whole blood can be stored for 35
days when stored in CDPA-1
• the shelf life can be extended to 42 days when AS-1
(adsol) AS-3 (nutricel) is As-5 optisol is
• adsol contains adenine glucose mannitol and sodium
chloride.
• Nutricel contain glucose adenine citrate phosphate and
nacl.
• Optisol contain only dextrose adenine nacl and mannitol.

56. Selection of donor
1.age-17-60yrs
2.Weight /height-above 45kg
/5fit
5.BP-systolic-
100-200mmh
Diastolic-50-
100mmhg
6.pulse-50-
100/min
3.Frequency of
donation-once in 3
month
4.Haemoglobin
level-more equal to
12gm%
Tempreture-98-
98.6ºF

57. 8.vaccination-those having received killed vaccines-
cholera diphtheria, influenza, tetanus, whooping
cough should donate one week after vaccination.
.Those having received live vaccine- BCG , smallpox
yellow fever rabies etc. must not donate for at least
3 weeks after vaccination.
9. Medical ailments-asthma, allergies ,
bronchiectasis ,embolism ,emphysema , epilepsy
hepatitis B, hypo& hyper thyroidism cvs disorder are
permanently unfit for donation.
Selection of donor…

58. Complication of blood transfusion
• Early complication
• Transfusion reaction
• Pyrexial reaction
• Allergic reaction
• Circulatory overload
• Air embolism
• Hyperkalemia
• thrombophlebitis
Late complication
• Transmission of infection
• Viral (hepatitis A,B,C,HIV,)
• Bacterial(salmonella)
• Parasites(malaria)
• Iron overload

59. Hemolytic reaction
Acute
These are due to
ABO incompatibility .
There is intravascular hemolysis.
Blood as low as 10ml can produce haemolytic reaction.
Clinical manifestation-pain and
Burning in vein, fever with chills and
Rigors .dyspnea chest
Pain. Haemoglobinuria. As little as 50ml of
Incompatible blood may exceed the binding
Capacity of hepatoglobin which is
Bind to 100mg of Hb /100ml of
Plasma.when the level 150mg/dl haemoglobinuris occurs

60. Delayed hemolytic reaction
These are extravascular hemolytic reaction.
Theses are usually due to Rh system or other
system like kell, duffy these reaction are mild
and seen after 2-21 days these reaction are
diagnosed by coombs test.

61. .
Allergic reaction
These are mild manifesting as urticarial and are mainly due to plasma protein
Febrile reaction
Incidence of 1-3%
These are due to infusion of white cell micro aggregates
The incidence of this reaction are minimized by the use micro filter blood sets with pore size
of 20-40 micrometer instead of conventional blood set up with pore size of 170 micrometer
which permits the infusion of WBC micro aggregates by using blood products
.

62. Infectious complication
Several blood safety changes made from 1982
to 2008 have made the risk for diseases
transmission by allogeneic blood so small that
even demand of autologous blood
Infectious
disease testing
for BT 1998
1.hepatitis-b, c 2.HIV 1 and 2
Serologic test
for syphilis
CMV

63. Bacterial
infection
Contamination most
commonly occurs
with
Pseudomonas
Staphylococcus
Yersinia enterocolitica
Rare transmission of
syphilis , brucellosis
Salmonella
Rickettsia disease
Metabolic
complication
Hyperkalemia
hypocalcaemia
Coagulation
abnormalities
Dilutional
thrombocytopenia

64. THANKYOU