Blood Transfusion

1. BLOOD TRANSFUSION
PRESENTED BY: DR SANISH MANANDHAR
1ST-YEAR RESIDENT (GENERAL SURGERY)
FACILITATOR: DR ELLINA DANGOL

2. Haemorrhage
•Bleeding from a damaged blood vessel.
•Should be recognized and managed aggressively.
• Reduce severity and duration of shock
• Avoid multiple organ failure
• Avoid death

3. Haemorrhage
•Treated by arresting the bleeding
•Not by fluid resuscitation or blood transfusion in
case of ongoing haemorrhage.
•Physiological exhaustion (coagulopathy, acidosis
and hypothermia) and death.

5. Classification
1. Revealed
• External haemorrhage- exsanguination from an
open wound or from massive hematemesis from
a duodenal ulcer.
2. Concealed
• Contained within the body cavity
• Traumatic or non traumatic

6. Classification
1. Primary
• Immediately due to injury (or surgery)
2. Reactionary
• Delayed haemorrhage within 24 hours
• Dislodgement of clot by resuscitation and
normalization of BP and vasodilation
• Slippage of ligature
3. Secondary
• Occurs 7-14 days after injury
• Sloughing of wall of a vessel (infection, pressure
necrosis or malignancy)

7. Classification
1. Surgical
• Direct injury
• Amenable to surgical control
2. Non-surgical
• Coagulopathies
• Packing (no surgical means)
• Correction of coagulation abnormality

8. Classification
1. Arterial
◦ Rapid and profuse
◦ Spurting with the heart beat
◦ Most difficult to control
2. Venous
◦ Steady flow
◦ Easier to control
◦ Low-pressure system
3. Capillary
◦ Slow and oozing
◦ Easily controlled
◦ Stops spontaneously

9. ATLS classes of hemorrhagic shock

10. Management
•Identify haemorrhage
•Immediate resuscitative manoeuvres
•Identify the site of the haemorrhage
•Haemorrhage control – Damage control surgery
•Damage control resuscitation

11. Damage control resuscitation
•Anticipate and treat acute traumatic coagulopathy
•Permissive hypotension until haemorrhage control
•Limit crystalloid and colloid infusion to avoid
dilutional coagulopathy
•Damage control surgery to control haemorrhage
and preserve physiology

12. BLOOD TRANSFUSION
•Blood transfusion is the IV administration of
whole blood or its component such as
plasma, packed red blood cells or platelets
from one person (donor) into another person
(recipient) to correct or treat a patient’s
(recipient’s) clinical condition.
•First successful transfusion in 1818 (James
Blundell)

13. PURPOSE
•To increase circulating blood volume.
•To increase the no. of red blood cells & to
maintain haemoglobin level.
•To provide plasma clotting factors, to help in
controlling bleeding.
•To combat infection due to decreased or
defective white cells or antibodies.

14. WHOLE BLOOD AND BLOOD
COMPONENTS

15. WHOLE BLOOD AND BLOOD
COMPONENTS
◦Whole blood
◦Red blood cell concentrate (packed red
blood cells)
◦Platelet concentrate
◦Fresh frozen plasma
◦Cryoprecipitate

16. WHOLE BLOOD
•1 unit - 450 ml of whole blood
•Anticoagulant - CPDA-1 (Citrate Phosphate Dextrose
Adenine)
•Preservation– up to 35 days
•Storage – 2-6ºC. Transfusion started within 30 minutes of
removal from the refrigerator
•Whole blood can be used as it is, or is separated into “blood
components”
•Fresh whole blood is more metabolically active.

17. WHOLE BLOOD
Indication of transfusion
◦Acute blood loss
◦Shock
◦Exchange transfusion in
neonate

18. PACKED RED BLOOD CELLS
•1 unit – 350ml (hematocrit of 50-70%)
•Storage – SAGM solution (Saline-adenine-glucose-
mannitol) > increase shelf life to 5 weeks at 2-6ºC
•Indication of transfusion
◦ Chronic severe Anemia
◦ Leukemia
◦ Thalassemia

19. PLATELET CONCENTRATE
•1 unit = 200-300 ml
•Contains about 250 X 109/L of
platelets
•Storage – 20-24ºC
•Shelf life – 5 days
•Indication of transfusion
◦ Thrombocytopenia
◦ Bleeding due to platelet dysfunction
◦ Malignancy
◦ Major surgery

20. FRESH-FROZEN PLASM
•Rich in coagulation factors
•1 unit = 200-300ml
•Storage - –20 to –40ºC
•Shelf life – 2 years
•Indication of transfusion
◦ Liver disorders
◦ DIC
◦ Coagulation factor deficiency (V, VII)

21. CRYOPRECIPITATE
•Supernatant precipitate of FFP
•1 unit = 10-20 ml
•Rich in fibrinogen, factor VIII, factor XIII and Von
Willebrand factor
•Storage - –30ºC / Shelf life – 2 years
•Indication of transfusion
◦ Hemophilia A
◦ von Willebrand’s disease
◦ Fibrinogen deficiency

22. PRE-TRANSFUSION TESTING
ABO and Rh (D) blood grouping :
◦ Patient’s and donor’s blood sample
Cross matching of blood sample:
◦ To prevent transfusion reactions
◦ Recipient’s serum mixed with donor’s cells to confirm
ABO compatibility and to test for rhesus and any other
blood group antigen-antibody reaction
◦ Full cross-matching – 45 mins
◦ Type-specific blood matching (ABO/rhesus) – 10-15 mins

23. BLOOD GROUPING

24. PRE-TRANSFUSION TESTING
Screening for Transfusion transmitted diseases
(Donor Sample)
HIV 1 and 2 AIDS
HBsAg Hepatitis B
HCV Hepatitis C
Treponema pallidum Syphilis
Plasmodium species Malaria

25. Perioperative red blood cell
transfusion criteria
•Hb level < 6 gm/dL – Probably will benefit from
transfusion
•Hb level 6-8 gm/dL – Transfusion unlikely to be
benefit in absence of bleeding or impending
surgery
•Hb level >8 gm/dL – No indication for transfusion in
absence of other risk factors

26. Massive Blood Transfusion
•Replacement of one entire blood volume within 24 hours
•Transfusion of > 10 units of packed PRBCs in 24 hours
•Transfusion of > 4 units of PRBCs in 1 hour
•Replacement of 50% of total blood volume within 3 hours

27. Complications
•Coagulopathy
•Hypocalcemia
•Hyperkalemia
•Hypokalemia
•Hypothermia

28. Massive Transfusion Guideline
Patients who are unstable or receive 1-2 RBCs and do not rapidly respond should be
considered candidates for massive transfusion guideline

29. Complications of Blood
Transfusion
•Incompatibility hemolytic transfusion reaction
•Febrile transfusion reaction
•Allergic reaction
•Infection
•Transfusion-related circulatory overload (TACO)
•Transfusion-related acute lung injury (TRALI)

30. Hemolytic reaction - Acute
•Immediate hemolytic reactions characterized by
intravascular destruction of RBCs.
•Fever, Hypotension, DIC, Hemoglobinuria, Hemoglobinemia,
Renal insufficiency
•Mechanism
• Transfusion of ABO-incompatible blood
• Preformed IgM Ab to ABO Ag
•Prevention – Transfuse appropriately matched blood
•Intervention
• Transfusion stopped
• Adequate hydration – urine output monitoring

31. Hemolytic reaction - Delayed
•2-10 days after transfusion
•Characterized by extravascular hemolysis
•Anemia, Indirect hyperbilirubinemia, Decreased
level of haptoglobin level
•Mechanism – IgG mediated
•Prevention – identify patient’s Ag to prevent a
recurrence
•Do not usually require specific intervention.

32. Non-hemolytic Transfusion
Reaction
•Febrile reaction
• Preformed cytokines in donated blood
• Recipient antibodies directed against HLA antigens on donor
WBCs or platelets
• Prevention – Use leukocyte-reduced blood
•Bacterial contamination
• High fever, chills, DIC, emesis, diarrhoea
• Caused by infusion of contaminated blood
•Allergic reaction
• Rashes, hives, itching
• Caused by soluble transfusion constituents
• Prevention – Antihistaminic prophylaxis

33. TACO
•Causes – Rapid infusion of blood, plasma expanders and
crystalloids, particularly in older patients with underlying
heart disease
•Large amount of fluid administered – monitoring of central
venous pressure
•Overload manifested – rise in CVP, dyspnea, cough, rales
generally heard at lung bases
•Treatment
• Diuresis
• Slowing rate of blood administration
• Minimizing fluids while during blood transfusion

34. TRALI
•Non-cardiogenic pulmonary edema related to transfusion
•Administration of any plasma-containing blood products
•Symptoms – dyspnea and associated hypoxemia accompanied
by fever, rigors and bilateral pulmonary infiltrate on chest X-ray.
•Occurs 1-2 hours of the onset of transfusion and virtually always
before 6 hours.
•Mechanism – Anti-HLA or anti-HNA Ab in transfused blood
attacks circulatory and pulmonary leukocytes
•Prevention – Limiting female (multiparous) donors
•Treatment – discontinuation of transfusion + pulmonary support

35. CAUSES OF TRANSFUSION REACTIONS
Clerical errors:
◦ Inadequate labelling
◦ Wrong blood issued
Technical errors:
◦ Error in blood grouping & cross-matching
◦ Incorrect interpretation of test results
Others:
◦ Blood contamination during phlebotomy
◦ Blood infusion through a small bore needle
◦ Blood cooler to -30⁰C or warmed to > 42⁰ C
◦ Concomitant administration of blood & drugs through a
common set

36. THANK YOU…