ppt by dr souparno mandal

1. BLOOD TRANSFUSION

2. BLOOD TRANSFUSION
INTRODUCTION AND INDICATION

3. BLOOD COMPONENT
• Red cell concentrates
• Plasma
• Platelet concentrate
• Cryoprecipitate

4. PLASMA DERIVATIVE
• Albumin
• Coagulation factor concentrate
• immunoglobulin

5. objective
• To increase the oxygen capacity of blood by giving red cells.
• To restore the blood volume to maintain effective tissue
perfusion.
• To replace platelets, coagulation factors and other plasma
proteins

6. Transfusion trigger
One unit of whole blood/PRBC can increase Hb by 1g/dL in an adult or
Hct by 3% (Hb of unit must be >75%).
• Perioperative transfusion: – 8g/dL for patient undergoing
cardiovascular surgery, orthopaedics and acute GI bleeding.
• Chronic anaemia : – 7g/dL in adults.
• Acute blood loss: – 30% of volume of blood.

7. INDICATIONS
• Blood may be needed in the following circumstances:
• Blood loss: – Bleeding – Trauma
• Inadequate production – Diseases such as thalassemia ,
leukaemia
• : Excessive destruction of cells: – Disease,
• Mechanical

8. Whole blood
Indications: · Red cell replacement in
acute blood loss with hypovolaemia.
·,Exchange transfusion.
Contraindications: Risk of volume
overload in patients with: · Chronic
anaemia. · Incipient cardiac failure

9. Platelet concentrates (PC)
Indications: Treatment of bleeding due to: · Thrombocytopenia. ·
Platelet function defects. ·
Prevention of bleeding due to thrombocytopenia as in bone
marrow failure.
Contraindications: · Idiopathic autoimmune thrombocytopenic
purpura (ITP).
· Thrombotic thrombocytopenic purpura (TTP).
· Thrombocytopenia associated with septicaemia, or in cases of
hypersplenism

10. Fresh Frozen Plasma (FFP)
Definite indications: · Replacement of a single coagulation factor deficiency,
where a specific or combined factor concentrate is unavailable or
contraindicated. · Immediate reversal of warfarin effect where prothrombin
complex concentrate is unavailable. · Thrombotic thrombocytopenic
purpura. · Inherited coagulation inhibitor deficiencies where specific
concentrate is unavailable. · C1 esterase inhibitor deficiency where specific
concentrate is unavailable.
. Conditional indications: · Massive blood transfusion. · Acute DIC if there
are coagulation abnormalities and patient is bleeding. · Liver disease, with
abnormal coagulation and bleeding – prophylactic use to reduce
prothrombin time (PT) to 1.6‐1.8 x normal for liver biopsy

11. Cryoprecipitated anti‐haemophilic factor

12. BLOOD COLLECTION &
STORAGE

13. Blood collection
• Why blood collection ?
Non availability of artificial blood
• Only Source of blood :
Through Blood donation
DONATE BLOOD , SAVE LIVES

14. Donor selection criteria
Parameter Criteria
Age 18 to 65 year , if first time < 60 year
Body weight 45 kg – 350ml , >= 55kg – 450 ml
Haemoglobin 12.5 to 17.5 gm/dl
Last donation 3 months for male, 4 months for female
Surgery DEFERRMENT
Major surgery 12 months after recovery
Minor surgery 6 months after recovery ,

15. Medical history :
DISEASE DEFERRMENT
Hepatitis A & E 12 MONTHS
Measles , Mumps , Chicken pox 2 week
Malaria 3 months
Typhoid 12 months
Dengue 6 moths ,
Hepatitis B & C , HIV ,
Tuberculosis , Leishmaniasis ,
leprosy , malignancy , sever
allergic disorder ,
Permanent deferral

16. Vaccination history :
Vaccine DEFERRMENT
Non live vaccine and toxoid 2 weeks
Live attenuated vaccines 4 weeks
Anti rabies vaccine 1 year
Drug history :
Medication DEFERRMENT
Insulin, Anti arrhythmic , Anti
convulsions , Anti coagulant , Anti
thyroid , Any cytotoxic drugs
Permanent deferral

17. Blood collection method
• Apply a sphygmomanometer cuff 1.5 inch above the area of collection i.e.
antecubital vein .
• Under proper aseptic condition 16G butterfly I.V. set is introduced which is
attached with blood collection bag
• Ask the donor to open and close the fist slowly every 10 to 12 seconds
during the collection
Remove the sphygmomanometer cuff when the
blood flow is established or after 2 min
which ever comes first

18. • Blood bags - sterile, pyrogen free and disposable PVC bag ,
with a closed system of collection (ISO / ISI )
• Multiple interconnected plastic bags should be
used for blood component preparation (closed system)
• Mix the blood and anticoagulant in the
blood bag with an automated mixing
equipment

19. Donation for paediatric population
• Paediatric blood bags are used to split the blood unit into 4 equal
paediatric size bags .

20. Anti coagulant solutions :
• Citrate-Phosphate-Dextrose (CPD) Solution. 14 ml solution is
required for 100 ml of blood.
• Citrate-Phosphate-Dextrose-Adenine (CPDA-1) solution. 14 ml
solution is required for 100 ml of blood.
• Saline adenine glucose mannitol with citrate and phosphate (SAG-
M) 100 ml is added to packed cells after separation of plasma for
storage

21. Function of anti coagulant solution
• Citrate – chelates with calcium and prevents clot formation
• Phosphate – acts as buffer to maintain optimum pH
• Dextrose – provides nutrition
• Adenine – maintains ATP for red cell viability
• Sodium chloride – maintains isotonicity
• Mannitol – reduces RBC lysis

22. Temperature of collected blood :
• Immediately after collection, the blood should be placed at 4*C to
6*C except if it is used for component separation it will be
stored at 22*C +/- 2*C until the platelets are separated
Separation of blood components should be done within 6 hours of
blood collection

23. Essential tests
• Blood groups & Rh(D) TYPE
• Blood group O – Blue
• Blood group A - Yellow
• Blood group B - Pink
• Blood group AB – White
• Infectious disease
• Hepatitis A - anti HAV antibody
• Hepatitis B- HBsAg
• Hepatitis C- anti HCV antibody
• HIV1&2 – Antibodies using ELISA
method
• Syphilis – VDRL / TPHA
• Malaria – thick smear

24. QUARANTINE STORAGE :
•The whole blood or components should not
be issued for transfusion,
till the mandatory tests are completed
and reported as non-reactive

25. Blood storage :
• Blood bank refrigerator/walk-in-cooler
should have inside
temperature of 4*C ± 2*C .
• Deep freezer
should have
inside temperature of
-20*C or -80*C

26. • Platelet incubator with agitator should have inside temperature of 22*C+/-2*C
• All systems should have continuous temp monitoring and alarm system .
• Can we store blood bag in ward refrigerator ?

27. Whole blood
• 450 ml
• 63 ml of anticoagulant solution
• Store at 4 - 6*c
• Administered through standard blood filter (150 – 280 micron ) with ABO &
Rh D compatibility
• Infuse within 4 hours of issue
• One unit – increase in Hct 3% or Hb 1gm/dl
• Shelf life:
• CPD- 21days
• CPDA – 35 days
• SAGM- 42 days

28. Whole blood
• Disadvantages :
• After storage for more than 24 hours , platelets and WBC lose their
function
• Factor V & VIII decrease with storage
• Fluid overload

29. Packed RBC
• 250 – 300 ml (less than whole blood)
• Store at 4 – 6*c Shelf life : same as whole blood
• Increases Hct 3% or Hb 1gm/dl = one unit whole blood
• Minimum chance of TRALI (Transfusion related acute lung injury )
• Irradiated RBC : gamma radiation to kill T lymphocytes to decrease
incidence of graft vs host disease.
• Leukocyte depleted RBC : minimize chance of FNHTR ( Febrile non
haemolytic transfusion reaction)

30. Platelet rich plasma
• 40 – 50 ml
• Store at 20 – 24*c for maximum 3 days with constant agitation
• One unit – increases platelet count 10k / micro L
• Infuse as soon as possible after issue and must not be
refrigerated before infusion

31. Fresh frozen plasma
• 250 – 300 ml
• Shelf life :
• One year if stored at -20*c
• Five year if stored at -70 to -80*c
• Maximum level of clotting factors and Protein C & Protein S
• Administered as soon as possible after thawing ( with in 6 hours )
• One unit – increases factor VIII by 2% and factor IX by 1%

32. Cryoprecipitate
• 10 – 20 ml
• Store at – 20*c
• Shelf life – one year
• Contains coagulation factor VIII , XIII , fibrinogen , VWF ( von Willebrand
factor )
• ABO and Rh compatibility not required
• Transfuse with in 6 hours of thawing

33. Changes in stored blood
• Shape of RBC changes to spherocytes
• Decrease in ATP , 2,3-DPG(Di phosphoglycererate) , sodium,
coagulation factors
• Increase in free haemoglobin in plasma , potassium
• Decrease in pH

34. Shelf life of different components
Whole
blood
Packed
RBC
Platelet
rich
plasma
Fresh
frozen
plasma
Cryoprecip
itate
• CPD-
21days
• CPDA –
35 days
• SAGM-
42 days
• CPD-
21days
• CPDA –
35 days
• SAGM-
42 days
• 3 days • One year
if stored at
-20*c
• Five year
if stored at
-70 to -
80*c
• one year

35. Complications of Blood
Transfusion

36. Blood Transfusion Reactions
IMMEDIATE
A) Haemolytic
B) Non Haemolytic-
1. Allergic
2. Febrile Non haemolytic(FNHTR)
3. Bact. Contamination and septic shock
4. TRALI
5. TACO
6. Cardiac arrest
DELAYED
A) Delayed Haemolytic Transfsion
Reaction
B) Post Transfusion Purpura
C) Transfusion Associated Graft vs Host
Disease
D) Transfusion transmitted infections

37. A) Acute Haemolytic Transfusion Reaction
• Intravascular haemolysis( ABO
incompatibility
• Incompatibility arises from-
a) Error in blood request form
b) blood from wrong patient into pre
labeled sample tube
c) Incorrect labelling of blood sample

38. a) Allergic reactions
• Due to allergens, usually plasma
proteins in donor plasma
• Type I HSR
• Mediated by histamine and
leucotrienes
• Urticaria , myalgia,arthralgia.
bronchospasm

39. b) Febrile Non Haemolytic Transfusion Reaction
(FNHTR)-
* Type 2 HSR
* most common transfusion
reaction
* Anti HLA antibodies in
receient’s plasma reacts with
donors’s WBC- release of
pyrogen leads to fever

40. c) Bacterial contamination and Septic shock
• Blood may be contaminated by- a)
Donor” skin (staphylococci)
• b) Bacteraemia present in the blood
of donor during collection
• c) Improper handling during blood
processing
• d) Defect or damage to blood bag
• e) Thawing FFP or Cryoprecipitate in
water bath (often contaminated)

41. d) Anaphylactic Reaction
• characterized by-
a)Cardiovascular
collapse
b)Respiratory distress
c) Without Fever
• Risk increased by rapid infusion, typically
when FFP is used
• IgA deficiency in recipient’s plasma is a
rare cause of very severe anaphylaxis

42. e)Transfusion Related Acute Lung Injury (TRALI)-
*Most common cause of death
following blood transfusion
*Definition- a) ARDS within 6hours
b) Hypoxia (O2
saturation <90%)
c) B/L chest infiltrate
*Mechanism- Anti HLA antibodies of
donor’s plasma reacts with
recepients WBCs

43. f) Transfusion Associated Circulatory Overload(TACO)
Occur when:-a) Too much blood
b) Too rapidly
c) Impaired renal function
• Fluid overload occurs in- chronic
severe anaemia, pre-existing
CVD

44. h) Cardiac arrest
• Rare complication
• Mainly seen with Massive Blood
Transfusion
• Cold blood may cause vagal
stimulation and subsequent cardiac
arrest
• Hyperkaelimic Cardiac arrest

45. DELAYED REACTIONS
A) Delayed Haemolytic
Transfusion Reaction:-
• IgG mediated lysis of transfused
RBCS
• Extravascular, Non fatal
• Fever,Jaundice,falling Hct
• Positive Direct Coomb’s test

46. (B) Post Transfusion Purpura
• Occurs due to antibodies directed
against platelet specific antigen
in the recipient
• Most commonly seen in
multigravida female patients

47. (C) Transfusion Associated Graft vs Host Disease
a) Immuno-deficient patient of BM Transplants
b)Immuno-competant- blood relatives
particularly 1st degree
• Signs/Symptoms (1-12 after BT): Fever,
• skin rash & desquamation,
• diarrhoea,
• hepatitis,
• pancytopenia

48. (D)Transfusion transmitted infections
a) HIV, Hep-B, Hep-C, Syphilis,
b)Malaria
b) CM
c) Other TTI : EB virus,
Parvovirus B19
Toxoplasmosis

49. Massive Blood transfusion
• Replacement of a blood volume
equivalent within 24hours
• >10 units within 24 hours
• Transfusion >4 units in 1 hour
• Replacement of a 50% blood
volume in 3-4 hours

50. Complications associated with MBT
• Hypothermia
• Metabolic alkalosis
• Metabolic acidosis
• Hyperkalemia
• Hypokalemia
• Hypocalcaemia
• Hypomagnesaemia
• Dilutional Coagulopathy

51. THANK YOU