Engidaw Ambelu

1. Blood Transfusion
For Anesthesia II
Dr. Bereket Hailu

2. Objectives
• Should know the General concept of blood transfusion.
• Types of transfusions and their use
• Indication in decision making for transfusion
• Complications associated with transfusion

3. • Blood transfusion:- is a replacement of whole blood or
components a blood for a specific indications.
• Components of a blood: RBC, Platelets, fibrinogens,
Coagulation factors…etc.
• Every donated blood is screened for many infectious
organisms(HIV, Syphilis, Hep B & C, toxoplasma,
malaria…etc) and typing should be done.
• To maintain the quality of a blood it must be stored in
optimized temperature & bagged with anti-coagulant
containing bags to preserve the components.
• Transfusion should be started 30min after removal of the blood
from the storage fridge and the transfusion should be
completed in 4hrs.

4. Types of Transfusion
• Fresh whole Blood
• Platelet concentrates
• FFP(Fresh frozen plasma)
• Cryoprecipitate
• Leukocyte reduced/washed RBC
• Human polymerized Hemoglobin(poly heme)

5. Fresh whole Blood:- its unseparated blood
We call it fresh if it is transfused within 24hrs of duration
Contains all component of a blood but their availability
depends on the age of the blood & the way it is stored.
One unit commonly contains 350ml or 450ml of blood
and one unit of blood approximately raises the Hct 3-4%.
In pediatrics the volume of blood to be transfused should
be calculated (use 15-20ml/kg to give one unit of blood)

6. • Massive transfusion: when we transfuse 50% or more, of the
patients blood volume in 12 to 24hrs.
Packed RBC:- Concentrated suspension of RBC which is
prepared by removing most of the supernatant plasma after
centrifugation.
One unit contains 200-300ml
unit value are similar in adults as whole blood but in pediatrics
calculated with 10ml/kg
Used in patients who need Restrictive transfusion.

7. Anemia :- Hgb <13 g/dl Male
<12 g/dl Female
In pediatrics:- age dependent
• Every anemic patient is not transfused with whole blood.
It is decided with the condition of the patient and if there
is any additional risk factors.
• A patient with severe anemia (Hgb <7g/dl) should be
transfused.

8. General Indications
1. Improvement in oxygen carrying capacity
2. Treatment of anemia
Hct <30% indicates a need for preoperative red blood
cell transfusion.
3. Volume replacement: the most common indication for blood
transfusionin surgical patients.
In acute blood loss Hct measurements might be misleading so
we use the ff classification.
Class I: <750ml, 15% blood loss
Class II: 750-1500ml, 15-30%
Class III: 1500-2000ml,30-40%
Class IV: >40%

9. • Blood loss above 25% requires replacement of the blood
with whole blood or pRBC.
4. Damage control resuscitation
aimed at halting and/or preventing rather than treating
the lethal triad of Coagulopathy, Acidosis, and
Hypothermia.
Current resuscitation algorithms are based on the
sequence of crystalloid followed by red blood cells and
then plasma and platelet transfusions.

10. Platelet concentrate
• Separated platelets from whole blood.
• Shelf life of platelets is 120hrs(5days)from time of donation
• One unit of platelet concentrate is 50ml and the therapeutic
levels of platelets reached after therapy are in the range of
50000 to 100000/µl.
• Platelet concentrates are stored at room temperature up to
72hrs at 20-240c which accounts for greater risk of bacterial
growth(cold induces clustering of Von willbrand factor
receptors on platelet surfaces)
• Should be administered as rapidly as possible as the patient’s
cardiovascular permits(within 30min period)

11. • Fever after transfusion within 6hrs should be considered as
sepsis because of platelet transfusion and empirical antibiotics
treatment should be started.
Indications
Thrombocytopenia caused by massive blood loss or inadequate
platelet production and qualitative platelet disorders.
Acute thrombocytopenia in presence of micro vascular
bleeding.
Prophylactic transfusion or prevention of spontaneous bleeding
(in patients with platelet <10-20,000cells/mm3)

12. FFP(Fresh frozen plasma)
• Separated from the whole blood donated within 6hrs and
it’s the source of Vit K dependent coagulation factors.
• Also contains Albumin, Immunoglobulin, stable clotting
factors.
• Usual 1packed unit volume is 200-300ml and stored in
frozen state at -250c or colder for up to 1yr.
• Before administration ABO compatibility must be
checked
• Dosing can be 10-15ml/kg.

13. Indications
treatment of hemorrhage from presumed coagulation
factors deficiency.
Patients treated with warfarin who exhibit spontaneous
bleeding or require emergency surgery to achieve
immediate hemostasis.
Depletion of coagulation factors in patients receiving
large volume transfusion
During surgery if PT or aPTT or both are at least 1.5 x
longer than normal(Lab result must correlate with clinical
pictures)
Patients with Coagulopathy.

14. Cryoprecipitate
• When FFP is thawed at 4oc, a precipitate remains which can be
separated by centrifugation.
• Contains mainly Fibrinogen, factor VIII, Von willbrand factor.
Monitoring of transfusion
starts before transfusion and as soon as started.
Every 15min for the first 1hr and continue at least every 1hr upto
completion of transfusion.
General appearance, To, PR, BP, RR, Fluid balance(UOP, IV fluid,
PO)
We should strictly follow for any transfusion reaction(by asking
for any new complaint or with objective evaluation)

15. Complications of transfusion
• Transfusion related events are estimated to occur in
approximately 10% of all transfusions, but <0.5% are serious.
• Transfusion related deaths, although rare, do occur and are
caused primarily by transfusion-related acute lung injury(16-
20%), ABO hemolytic transfusion reactions(12-15%), and
bacterial contamination of platelets(11-18%).
Febrile non-hemolytic reactions
increase in temperature (>10c)associated with transfusion and are
fairly common(caused by preformed cytokines in donated blood)
the incidence can be reduced by using leukocyte-reduced blood
products or using pre-transfusion Acetaminophen use, reduces the
severity.

16. • Bacterial contamination of infused blood(rare) gram-negative
organism are one of the most common causes of Febrile
NHTR. Commonly in platelet transfusion.
Allergic reaction
 relatively frequent, occurring in approximately 1% of all
transfusion.
Allergic reaction commonly manifest with rash, urticaria, pruritus,
erythema, fever…
Ranges from Mild to severe. In rare instances, Anaphylactic shock
develops.
Rx: slow transfusion rate, anti-histamine, D/C transfusion
Can be prevented by using prophylactic anti-histamines.

17. Hemolytic reactions
• Can be classified, Acute and Delayed reactions.
• Acute hemolytic reactions occur immediately after start of
transfusion, with the administration of ABO-incompatible
blood.
• Characterized by intravascular destruction of RBC and
consequent hemoglobinemia and hemoglobinuria.
• Manifests with pain at site of transfusion, facial flushing, fever,
back and chest pain, restlessness, Hypotension…
• In unconscious or Anesthetized pt, diffuse bleeding and
hypotension are hallmarks.
• Prevented by appropriately checking the labeling of blood bag.
• Rx: D/C the transfusion and maintain the fluid balance with IV
fluids.

18. • Delayed hemolytic reaction occur 2-10days after
transfusion and characterized with extravascular hemolysis,
mild anemia, and indirect hyperbilirubinemia.
• It is reaction for non-ABO antigens.
• Rx: supportive
TRALI(transfusion related acute lung injury)
Non-cardiogenic pulmonary edema related to transfusion.
Commonly occurs within 1 to 2 hrs after onset of transfusion, but
virtually always before 6hr.
TACO(transfusion-associated circulatory overload)
pulmonary edema caused in pediatric, older patients and
CHF pts by transfusion of large volume of blood.

19. Metabolic abnormalities associated with blood transfusion
Metabolic alkalosis
Hyperkalemia: RBC hemolysis
Hypocalcaemia: caused by citrate found in blood storage bag.

20. Thank you.