Lecture about Blood transfusion from A to Z (Blood function, volume, Donor selection, donation, screening tests, blood separation & complication)

1. Blood Transfusion
DR. MOHAMED SHAHEEN
MBBCH, MSC, MD, IPCD, HHMD
LECTURER OF CLINICAL PATHOLOGY- AL-AZHAR UNIVERSITY
CHIEF OF INFECTION CONTROL TEAM - EL-HUSSIEN HOSPITAL

2. Main Topics
 Introduction
 Sources of blood donation
 Blood components separation
 Indications for blood transfusion
 Steps in blood transfusion
a. Donor
b. Tests for transfusion transmissible infections
c. Blood Groups
d. Compatibility
 Complications of blood transfusion

3. ‫الثواب‬ ‫حسن‬ ‫و‬ ‫النية‬ ‫استحضر‬

4. Introduction
 Blood volume: 4-6 liters circulating in the body.
 Blood components
- Plasma:
- Cells:

5. Blood components

7. Functions of Blood
Plasma:
1. Transport of nutrients, waste products , Processed molecules & Regulatory molecules
2. Regulation of pH and osmosis
3. Maintenance of body temperature
4. Coagulation factor: Clot formation
RBCs:
1. Each RBC contain ~270 million molecules of Hb, a protein that binds oxygen.
2. RBCs transport O2 to tissues, and remove CO2 from the tissues.
WBCs : Protection against foreign substances (Bacteria, Virus ,Protozoa, …)
Platelet : Clot formation

8. Indications of
blood transfusion
TRANSFUSE BLOOD
WHEN NECESSARY

9.  TRANSFUSE BLOOD WHEN NECESSARY
Increase Demand
 Every 3 seconds someone needs blood.
 About 1/10 people entering a hospital needs blood.
Shortage of available
 There is no substitute for human Blood .

10. Best use of blood
 Use right products to the right patient at the right time
 Use alternative treatment to transfusion if possible (eg. IV fluids)
 Prevention and early diagnosis & treatment of Anemia are
NECESSARY
 Good anesthetic and surgical management to minimize blood
loss are NECESSARY .
 Transfusion carries the risk of adverse reactions and transfusion
transmissible infections.
Weight the risk against benefit

11. Steps of Blood Transfusion
Selection Donation Serology Storage Transfusion Monitoring

12. Selection
1. Registration: Age (18-55y), sex, occupation & ID.
2. Medical History:
- No medical problem: CHD, RF, LCF, Blood; Thalassemia, Leukemia, …
- Date of last donation :
 Whole blood: ≥ 2 months
 Apheresis: ≥ 2 weeks
1. Physical Examination:
- General condition: good.
- Weight: > 50 kg
- Pulse: Regular and 50-100 beat/min.
- Blood pressure: Maximum 140/90 mmHg & Minimum: 90/60mmHg.
- Temperature: about 370C.

13. 4. Investigations:
 Blood grouping: ABO and Rh. [to ensure that donor is receiving compatible
blood]
 Compatibility tests: blood must be done between donor and recipient
(Cross matching).
 Normal Hb: (No anemia) > 13g/dl in males and 12 g/dl in females
 Normal Serology:
• Negative for HCV Ab, HBsAg, HIV Ab, Syphilis &
• Common infectious agent….(as specific protocol).

14. Rejection
 General causes:
1. Diseases: Malignancy, CVS, CNS or Bleeding.
2. Positive serology: HCV, HBV, Syphilis, Malaria, SARS-CoV-2.
3. Travelling to malaria endemic areas in the past 12 months.
4. Tattooing in the past 12 months, or needle brick.
 Drugs or vaccines: Cytotoxic drugs, Live attenuated vaccines before 4 weeks

15. Donation

16. DONOR REACTIONS
 Vasovagal reaction
 Sudden fainting due to hypotension
 Neurophysiological response :Emotional stress .Sight of blood
 Prevention: Psychological support through positive donor-staff relationship & reassurance
 Hyperventilation
 Increased inspiration and expiration either rate or depth
 Prevention and treatment: Ask the donor to cough to interrupt the pattern of breathing
 Hematomas
 Usually results from the rupture of a blood vessel .Resolves spontaneously or by apply ice pack

17. POST DONATION INSTRUCTIONS
 Rest in the donation chair for 10 minutes before getting up
 Eat and drink something before leaving
 Drink more fluids than usual during the next 4 hours
 If there is bleeding from needle insertion site, raise your arm
and apply pressure.
 If you feel dizzy or faint, lie down or sit down, placing your
head lower than your knees.
THANK YOU FOR YOUR DONATION.
WE HOPE TO SEE YOU AGAIN SOON!

18. TRANSFUSION REACTION WORK-UP FORM
Date /time : _________________________
Patient's name:_____________________
Ward : _____________________________
File number: ______________________
Number of Pregnancies/deliveries
:________________
Number of previous
transfusions:_______________
Diagnosis :_______________________________________________________________________________
________________________________________________________________________________________
Transfusion time discontinued :
Transfusion date/time started
Temp discontinued:
Temp started:
Reaction noted : put  if indicated and please specify time reaction started and duration:
Pruritus
Hematuria
Anxiety
Chest Pain
Pain in legs
Oliguria
Restlessness
Chills
Pain in back
Anuria
Headache
Fever
Rigor
Jaundice
Urticaria
Sweating
Bronchospasm
Shock
Pallor
Nausea
Dyspnea
Cyanosis
Erythema
Vomiting
Pulmonary edema
Precordial distress
This form should be filled by the physician :

19. SOURCES OF BLOOD DONATION
 ALLOGENIC BLOOD DONATION: from donor to recipient (other).
 AUTOLOGOUS BLOOD DONATION : (Same)
- derived from self; same individual.
 APHERESIS DONATION:

20. Autologous Blood Donation
Advantages Disadvantages
1. Prevents transfusion-transmitted
disease.
2. Prevents some adverse transfusion
reaction.
1. Is more costly than allogenic blood.
2. Results in wastage of blood not
transfused .
3. Subject patients to perioperative
anemia & increased likelihood of
transfusion.

21. Types of transfusion bags

22. Quality control
 General visual QC
1. Intact bag; No tear
2. No hemolysis, No discoloration, No clots
3. Labling
4. Expire date
5. ABO group
 Specific

23.  Anticoagulant:
o CPD: Citrate – Phosphate – Dextrose → 21 days
o CPDA: Citrate – Phosphate – Dextrose – Adenine → 35 days
o SAGM: Saline – Adenine – Glucose – Mannitol → 42 days
 Bag: Polyvenile chloride: neutralizes toxicity (Closed System)
- Double bags: used to prepare RBCs + Plasma
- Triple bags: for RBCs + PLTs + FFP
- Quadraple bags: RBCs + PLTs + Cryoprecipitate + Cryopoor Plasma.
- Pedi bags: 75ml
Anticoagulants

24. Serology
Bag must be free or negative from the following:
 HBsAg
 HCV Ab
 HIV Ab
 Syphilis
 CMV

25. Separation
1. SEDIMENTATION
2. CENTRIFUGATION
3. APHERESIS

26. Separation Method
Sedimentation
Manual
(Centrifugation):
Automated
(Apheresis)

27.  Definition of apheresis
- The process of removal of whole blood from a donor or patient, then
separating out specific portions & returning other portions to the
donor/patient.
 Indication:
1. Harvesting specific components for transfusion (Plasma, Platelet,
RBCs).
2. Removal of specific pathologic substances.
Apheresis

28. Types of apheresis
Apheresis Removal of Uses
Plasma Plasma Remove circulating factors in plasma. Auto-Abs, circulating
immune complexes, soluble inflammatory factors, & paraproteins.
It is considered 1st line therapy in Good pasture’s Syndrome & TTP.
Plasma exchange Replacement of patient’s plasma with (Albumin or donor plasma).
WBCs WBCs leukemia or hyperleukocytosis
Peripheral blood stem cells (PBSCs) Harvest for ttt purposes.
RBCs RBCs SCA treatment; Remove Sickled cells & replaced with normal RBCs.
Thrombocyte PLT Treat thrombocytosis.

29. Apheresis
 Anticoagulant: ACD
 Time: according to type of Plasmapheresis.
 Adverse reactions:
- Allergic reaction. - Air embolism
- Vaso-vagal attack - Citrate toxicity & hypocalcemia.
- Vascular access complication: Hematoma - Mechanical hemolysis
- Depletion of protein and Igs.

30. Blood
Components

31.  Importance of separation/Fractionation
o To provide maximum benefit from each blood donation and
to extend shelf-life, blood banks fractionate blood into
several products
 Separation of 1 donated unit can give this components
- RBCs , Platelets
- Plasma, Albumin ,
- Clotting factor , Cryoprecipitate , Fibrinogen concentrate
- Immunoglobulins (antibodies).

32. Blood components
Component Volume/ml Content Clinical response
Whole blood 450ml All blood components ↑ Hb 0.5-1 gm/dl & HCT 3%
Packed RBCs 180-200 RBCs with plasma &
variable WBCs
↑ Hb 1 gm/dl & HCT 3%
Platelets 1 pack: 50
6 packs: 300
5.5 X1010/Pack ↑ PLT 5,000-10,000/ul
FFP 200-250 Plasma protein
Coagulation factors
PC,PS & AT-III
↑ Coagulation factors 2%
Cryoprecipitate 10-15 Fibrinogen
Factor VIII, vWF
Mostly used for Low fibrinogen or
Hemophilia

36. Cell containing components
 Whole blood( fresh or not)
 Red cells:
1. Packed RBCs
2. Washed RBCs
3. Frozen RBCs
4. Leukocyte – reduced RBCs
5. Irradiated blood (kill WBCs & prevent viral transmitted Diseases)
 Platelet concentrates.
 WBCs: Granulocytes , mononuclear cells or Peripheral blood progenitor cells.
 Plasma and its products

37.  Content: WBCs, RBCs, PLT (not functioning), Plasma, coag. Fs (no labile fs F5-F8).
 Preparation: using closed system.
 Storage: 2-6 C0
 Shelf life: 35 days.
 Dose response: raise Hb 0.5-1g & Hct: 3%.
 Disadvantages:
• No active PLTs and No FV or FVIII, If stored.
• Massive blood transfusion cause acute lung injury.
 Indication: Acute bleeding to ↑ O2 carrying capacity and correct hypovolemia.
• Acute massive blood loss & open heart surgery.
• Exchange blood transfusion.
• Non available packed RBCs.
Whole blood

38.  Content: RBCs, small amount of WBCs, Plasma.
 Preparation: remove plasma after Centrifugation (5000xg-5min-50C) / Sedimentation.
 Volume: 250-300ml. HCT:≤ 80%
 Storage: 2-60C for
 Shelf life: CPDA=35 days & SAGM= 42 days.
 Usual dose: 10 cc/kg infused over 2-4 hours
 Dose response: 1 unit raise Hb 1 g.
 Indications:
• Chronic anemia to ↑ O2 carrying depending to Hb and clinical condition
• Acute blood loss: > 1L (<1L if cardiac)
• Pre-operative: < 7g/dl (<10 g/dl if cardiac)
• Importance: avoid hypervolemia and save other components
Packed RBCs

39. Guidelines for
whole blood or RBCs therapy
If there are signs or symptoms of impaired oxygen transport
Lower thresholds may be acceptable in patients without
symptoms and/or where specific therapy is available e.g. IDA.
< 7 g/dL
During marrow suppressive therapy.
Aim: control anemia-related symptoms.
8 - 9 g/dL
Not appropriate unless there are specific indications as
Preoperative for surgery associated with major blood loss.
 Acute blood loss >30-40% of total blood volume.
10 g/dL

40. Platelets
 Storage
 Up to 5 days at 20-24°C on shaker
 Indications
 Thrombocytopenia, Platelet < 10,000 as prophylaxis
 Bleeding and Platelet < 50,000
 Surgery or invasive procedures and Platelet < 50,000
 Considerations
 Contain Leukocytes and cytokines
 Platelet count increase by 5000-10,000 for every unit.
 Donor and Recipient must be ABO identical.

41. 1. Fresh-frozen plasma
2. Cryopresipitate
3. Coagulation factor concentrates
4. Immunglobulin preperations
5. Albumin

42.  Content: Plasma contains all coagulation Fs, carbohydrates, protein & lipids.
 Volume: 200- 250 ml.
 Preparation:
 Shock method:
1. Centrifugation: 5000xg X 5 min X 4-50C shortly after collection (within 6 hrs)
2. Remove plasma and immediately freeze -18/-300C
3. Thaw inside the refrigerator
4. Centrifugation, transferred into the attached satellite bag, and rapidly frozen at –
25°C or lower within 6 hours of collection because after this time, labile
coagulation factors (F V and F VIII) are lost.
 Plasma-pharesis: with minimal interval 4 weeks
Fresh Frozen Plasma

43.  Storage: immediately after separation:
o -180C X 12 months.
o -300C X 6 months.
 Thawing: 30-370C to avoid crypt
 Indications:
o Single factor deficiency but factor conc. is preferred
o Multiple factor deficiency with INR > 1.5 or APTT > 45 seconds
o Warfarin toxicity but PCC is preferred (OAC overdose)
o Massive transfusion but rVII is preferred
o Plasma exchange in TTP and HUS but cryo-poor plasma is preferred
o Bleeding patient with coagulopathy as DIC or liver disease has invasive procedure.
 Compatibility:
- Plasma contains ABO Abs, So ABO compatible is a must, Not contain RBCs (No Rh compatibility)

44.  Content: Plasma contains fibrinogen, coagulation Fs (F I, VIII, vWF, XIII).
 Volume: 10- 20 ml.
 Preparation: FFp is thawed at 2-60C for 8-10 hours till it becomes slushy → Hard spin at 2-60C →
Separation of the precipitate → Freezing within 1 hour
 Thawing: At 370C and then stored at 2-60C for 4-6 hours
 Pooling: Up to 10-15 bags
 One unit of Cryoprecipitate contains:
 ≥150 mg fibrinogen
 100 units of FVIII,
 100 units of vWF,
 50 units of FXIII
 Compatibility: Not required [ABO compatible preferred (but not limiting)]

45.  Description
 Precipitate formed/collected when FFP is thawed at 4°
 Storage
 After collection, refrozen and stored up to 1 year at -18°
 Dose: 1 unit/5-10 kg of recipient body weight
 Indications:
1. ↓ FVIII → Hemophilia A.
2. ↓vWF → VWD
3. FXIII deficiency
4. Fibrinogen deficiency

46.  Preparation: by cold ethanol fractionation of pooled plasma.
 Types: Specific and Non specific
 Non-specific or “Normal” Immunoglobulins:
- Prepared: from pooled plasma of non-selected donors (Abs against common infectious agents).
- Indications for non-specific Igs are:
• Passive prophylaxis against HAV
• Congenital or acquired hypo-gamma-globulinemia
• ITP to temporarily raise platelet count.
 Specific Immunoglobulins
- Prepared: from high IgG titre Abs donors(Immunized patients or convalescing from infectious diseases).
- Specific Igs include:
• Specific Igs for passive prophylaxis against HBV, VZV, CMV, or tetanus.
• Anti-RhD Ig, which is used for prevention of immunization against RhD antigen in Rh D-negative mothers during
pregnancy. It is obtained from Rh-ve persons immunized to Rh D Ag.

47.  Indication: Passive immunization against infections.
1. Hypo-γ-globulinemia
2. Infection
- Prophylaxis as in HBV – VZV
- Treatment as in HAV – Measles
1. Autoimmune diseases
2. Rh Ig: Rh (-) Mother with Rh (+) baby
3. ITP: blocking of RES

48. White Blood Cells

49.  Preparation: either from a single donor unit by differential centrifugation or by
leucapheresis.
- Leucapheresis is preferred because of better granulocyte yield.
 Method:
1. G-CSF is given to donor.
2. Irradiation for killing of lymphocytes
 Storage:
- Prepared at the time for immediate transfusion (No storage is preferred)
- 20-240C X 8 hours without agitation

50. Granulocyte Transfusions
 Indications:
• Aplastic anemia (BMF).
• Severe neutropenia (< 500/cmm)+ infection that has failed antibiotic therapy
• Neutrophils < 3000/cmm in neonates, not responding to appropriate antibiotic therapy.
 Disadvantages/complications: rarely used because:
1. Most infections can be effectively controlled by appropriate antibiotic therapy
2. Single donor unit of GC has insufficient granulocytes & is also heavily contaminated WBCs.
3. Risks of NHTR, lung infiltrates & viral infection as CMV. Severe allergic reactions

51.  Indications
1. Immunodeficiency
2. Harvesting stem cells
 Disadvantages/complications: rarely used because:
1. Risks of NHTR & viral infection as CMV.
2. Severe allergic reactions

52. Modified Blood
Components

53. Modified Blood Components
Component Procedure Aim/Indications
Washed RBCs - Washed with saline &
- Removes Plasma (>99%) &
WBC’s (85%), RBCs (20%)
- Must be used within 24 hrs
- Prevent recipient allo-immunisation to WBC’s
- IgA deficiency
- Previous Allergic reactions
Leucocyte reduced - < 5x106 WBC’s/unit
- Using WBCs filters
-Prevent reactions caused by WBC Abs as in Febrile-
NHTRs
-Prevent alloimmunization
-Prevent CMV transmission
Irradiated RBCs Method: Cesium 137 or Cobalt 60
(25 GY)
Prevent GVHD as in Congenital immune deficiency
1.Related donor or HLA compatible single donor
2.Immunodeficiency
3.Organ transplantation & HSCT.
4.Hematological malignancy & Aplastic A
Frozen RBC’s Autologous transfusion or rare blood groups

54. Pathogen inactivation
 FFP:
 Pooled FFP: Solvent detergent which causes disruption of the lipid envelop
 Single unit: Methylene blue followed by exposure to 10 ng wavelength
visible light
 Nano-filtration - Fractionation
 Heat - Pasteurization
 PLTs: Psoralene followed by UVR
 RBCs: difficult due to the high light absorbance and high viscosity but can
be inactivated by DNA targeting

55. Leukoreduction
 Removal of:
1. WBCs (99.9%) + PLTs (Almost all) + RBCs (15-20%)
 Method: Filtration through small pores (170) & through adhesion to the surface of the filter:
1. In-line reduction: during donation
2. Pre-storage: ↓ biological response modifiers: IL1 – IL6 – TNF – C5a – C3a
3. Post-transfusion
 Disadvantages: PLTs can’t be prepared
 Storage: 40C X 24 hours
 Indications:
1. Prevention of HLA-related adverse reactions as FNHTR
2. Transplantation
3. Chemotherapy
4. Neonates
5. Multiparous females

56. Irradiated blood component
 Method: Cesium 137 or Cobalt 60 (25 GY)
 Storage:
 RBCs: 28 days
 PLTs: No affection of the shelf-life
 Advantages: prevent transfusion related GVHD as in Congenital immune deficient states
 Disadvantages: High K
 Indications:
1. Related donor or HLA compatible single donor
2. Immunodeficiency
3. Organ transplantation & HSCT.
4. Hematological malignancy - Aplastic anemia
5. Intra-uterine transfusion - Prematures or LBW <1250g

57. Blood groups

58. What are the different blood groups?
• The differences in human blood are due to the presence or absence of certain
protein molecules called antigens (Ags) & antibodies (Abs).
• Ags are located on the surface of the RBCs & Abs are in plasma.
• Individuals have different types and combinations of these molecules.
• Blood group difference depends on inheritance from parents.
• There are more than 20 genetically determined blood group systems known
today

59. • Mixing incompatible blood groups leads to blood clumping or
agglutination, which is dangerous for individuals.
 The AB0 and Rhesus (Rh) systems are the most important ones used
for blood transfusions.

60. Worldwide Prevalence of blood groups
Blood group Prevalence Blood group Prevalence
O+ 37.4% B+ 8.5%
O- 6.6% B- 1.5%
A+ 35.7% AB+ 3.4%
A- 6.3% AB- 0.6%

61. Blood Types

62. Rh Blood Group System
One of the 23 known blood
group systems.
Consist of 45 different antigens.
Clinical significant antigens: D、C、
c、E、
D antigen is the most important.
Ｄ antigen
RhD positive
No Ｄantigen
RhD negative

63. The Rhesus (Rh) System
 The Rh antigen. May be present or not.
 If it is present, the blood is RhD positive, (85%)
 If not it's RhD negative. of the population is (15%) of the population
 A person with Rh+ve does not have Rh Abs naturally in the blood plasma
 A person with Rh-ve can develop Rh Abs (IgG) if he or she receives Rh+ve
blood & can cross placenta (N.B: most anti-A or anti-B Abs are of the IgM
class ,large molecules,)

64. Laboratory Determination
of the ABO group & Rh

65. Several methods for testing the ABO group & Rh of an individual exist. The
most common method is:
Serology: This is a direct detection of the ABO antigens. It is the main
method used in blood transfusion centres and hospital blood banks.
This form of testing involves two components:
a) Antibodies that are specific at detecting a particular ABO antigen or Rh
on RBCs.
b) Cells that are of a known ABO group or Rh that are agglutinated by the
naturally occurring antibodies in the person's serum.

66. Blood Group System
Type O
Anti-D Anti-D
Rh Positive Rh Negative

67. Matching Blood
When a transfusion is given, it is preferable for patients to
receive
- same blood group (ABO & RhD)
- If the same blood group isn’t available (emergency ), a
patient may be receive another compatible group.

68.  For blood transfusions, patients are always matched with
donor blood based on their major blood groups
For 95% of patient transfusions, this level of matching blood is
sufficient
O+ O- A+ A- B+ B- AB+ AB-
 If the wrong blood type is used the person’s own immune
system immediately attacks the donor’s blood and causes
clots and RBC destruction that can lead to kidney failure .

69.  People with blood group O are
called "universal donors“
 people with blood group AB
are called "universal receivers."
O
B
AB
A
As regard packed RBCS

70. O
B
AB
A
As regard plasma
And platelets

71. RBCs compatibility table

72. Plasma compatibility table
Donor
Recipient
AB
B
A
O
√
AB
√
√
A
√
√
B
√
√
√
√
O

73. • Frequently transfused patients can form antibodies (immune responses) to some
red cell antigens
• These patients require more precisely matched blood to prevent transfusion
reactions and the production of more antibodies
• Conditions that require frequently blood?
• Sickle Cell Anemia
• Thalassemia (or Cooley’s Anemia)
• Leukemia
• Pregnancy
• Chemotherapy Treatment
more precisely matched

74. ”
“ Complications
of blood Transfusion

75. Transfusion Complications
Acute
1. Hemolytic Reactions (AHTR)
2. Febrile Reactions (FNHTR)
3. Allergic Reactions
4. TRALI (Transfusion Related
Acute Lung Injury)
5. Bacteremia
Chronic
1. Alloimmunization
2. Infection
3. GVHD
4. Fe Overload
Massive
1. Coagulopathy with Massive
transfusions

76. Acute TRs
Hemolytic Rs (AHTR)
Febrile Rs (FNHTR)
Allergic Reactions
Acute Lung Injury
Bacteremia
Chronic TRs
Alloimmunization
GVHD
Fe overload
Infection
Massive
transfusion
Coagulopathy
Complication of Blood Transfusion

77. Acute Hemolytic Transfusion Reactions
(AHTR)
Cause:
 Transfusion of incompatible RBC’s into a recipient with pre-formed Abs
(usually ABO or Rh)
 Labeling error is most common problem
Mechanism:
 Abs activate complement system, causing intravascular hemolysis
Time: Symptoms occur within minutes of starting the transfusion
Volume: This hemolytic reaction can occur with as little as 1-2 cc of RBC’s
Complication: Can be fatal

78. Symptoms of AHTR
 High fever/chills
 Hypotension
 Back/abdominal pain
 Oliguria
 Dyspnea
 Dark urine
 Pallor

79. Monitoring in AHTR
 Monitor patient clinical status and vital signs
 Monitor renal status (BUN, creatinine)
 Monitor coagulation status (DIC panel– PT/PTT, fibrinogen, D-dimer/FDP, Plt,
Antithrombin-III)
 Monitor for signs of hemolysis (Hemoglobinemia, Hemoglobinuria. Positive
DAT, Hyperbilirubinemia
 LDH, haptoglobin)

80. What to do? If an AHTR occurs
 STOP TRANSFUSION
 Maintain IV access and run IVF
 Monitor and maintain BP/pulse
 Give diuretic
 Send remaining blood back to Blood Bank to
repeat crossmatch

81. Febrile Non-hemolytic Transfusion Reactions
(FNHTR)
 Definition: Rise in patient temperature >1°C (associated with
transfusion without other fever precipitating factors)
 Incidence:
• 1% of RBCs transfusions &
• 20% of Platelets transfusions
 Mechanism:
• FNHTR caused by alloantibodies directed against HLA
antigens

82. What to do?
If an FNHTR occurs
 STOP TRANSFUSION
 Use of Antipyretics
 Use of Corticosteroids for severe reactions
 Use of Narcotics for shaking chills
 Future considerations
 May prevent reaction with leukocyte filter
 Use fresh platelets , Washed RBC’s or platelets

83. Allergic Non-hemolytic Transfusion
Reactions (ANHTRs)
 Etiology
 Plasma proteins or blood preservative/anticoagulant, IgA
deficient patients with anti-IgA antibodies
 Cl/P: Presents with urticaria and wheezing
 Treatment
 Severe reactions—Must STOP transfusion and may require
steroids or epinephrine
 Prevention: Premedication (Anti-histamincs)

84. Transfusion Related Acute Lung Injury
TRALI
 Definition: Clinical syndrome similar to ARDS
 Time: Occurs 1-6 hours after receiving plasma-containing blood products
 Cause: WBC Abs present in donor blood that result in pulmonary
leukostasis
 Treatment: is supportive
 Complication: High mortality

85. Massive Transfusions
 Definition: replacement of ≥1 blood volume(4-5L) Or ≥ 10 blood units within 24hrs.
 Complication of massive blood transfusion.
1. Coagulopathy:
- Transfusion of massive amounts of blood (10 units) in short time
- Cause: effect of (Hypothermia, Acidosis, dilution of coag. factors, PLT consumption/Old)
1. Citrate toxicity (Binding of Calcium by citrate)
2. Hypothermia (Rapid transfusion of cold blood)
3. Acidosis
4. Hyperkalemia (Breakdown of stored RBC’s)
5. Immunosuppression

86. Bacterial Contamination
 Incidence:
1. More common and more severe with platelet transfusion (platelets are
stored at room temperature18-25°C)
2. Risk increases as blood products aged (use fresh products for
immunocompromised)
 Organisms
1. Platelets—Gram (+) organisms, ie Staph/Strep
2. RBC’s—Yersinia, enterobacter

87. Chronic Transfusion Reactions
 Alloimmunization
 Transfusion Associated Graft Verses Host Disease (GVHD)
 Iron Overload
 Transfusion Transmitted Infection

88. Alloimmunization
 Incidence: Can occur with RBCs or platelets
 RBCs
• Incompatibility of minor antigens (Kell, Duffy, Kidd)
 Platelets
• Usually due to HLA antigens
• May reduce allo-immunization by leukoreduction
(since WBC’s present the HLA antigens)

89. Transfusion Associated GVHD
 Incidence: Mainly seen in infants, BMT patients
 Cause: Engraftment of donor lymphocytes of an immunocompetent donor
into an immunocompromised host
 Symptoms: Diarrhea, skin rash, pancytopenia
 Complication: Usually fata
 Treatment: no treatment
 Prevention: Irradiation of donor cells (Kill WBCs).

90. Common transfusion transmitted
pathogens
Viruses & bacteria
• HBV, HCV, HIV
• SARS
• Human T-Lymphotropic
Virus (HTLV I/II)
• CMV: Immunocompromized
• West Nile virus
• Simian foamy virus (SFV)
• Syphilis: killed at refrigerator
• Skin flora
Parasites
• Malaria (Plasmodia spp)
• Babesiosis
• Chagas disease
• Leishmaniasis
• Lyme disease.
Others
Variant Creutzfeldt–Jakob
disease (vCJD)

91. Example for MCQs
 Major complication of transfusion reaction is :
1. Febrile non hemolytic transfusion reaction
2. Hemolysis
3. Transfusion of infection
4. Electrolytes imbalance
 Complication of massive blood transfusion:
1. Iron deficiency
2. Heart failure
3. Coagulopathy
4. Hemolytic anemia
 Which is stored at 20-24 °C?
1. Packed RBCs
2. Platelets
3. Fresh frozen plasma
4. Cryoprecipitate

92. Important Links on you tube
 Lecture on YouTube
• https://www.youtube.com/watch?v=HkQBsEn5Z4s
 Channel on YouTube
• https://www.youtube.com/@Shaheen-MAS1985/videos

93.  Advanced Laboratory Methods in Hematology: R. Martin
 Essentials of Hematology: Shirish M.Kawthalkar, 3rd ed. 2020.
 Hoffbrand‘s Essential Hematology: A.vector Hoffbrand, 8th ed.2020.
 BLOOD TRANSFUSION from science to skill; Salwa Youssef 1st ed. 2019
REFERENCES