BLOOD PRODUCTS

1. BLOOD AND BLOOD
PRODUCTS
Candidate : Dr Shreya Singh Kushwaha
SR Guide : Dr Natasha Gupta
Consultant Guide : Dr Jyoti Meena
Co-Guide : Dr. Hem C Pandey, Consultant(Transfusion Medicine)

2. OVERVIEW
 Historical Background
 Introduction – indications of transfusion
 Whole blood
 Blood Components
 Ordering blood components
 Pretransfusion Check and Administration
 Massive Transfusion Protocol (MTP)
 Autologous Blood Transfusion
 Transfusion Reactions
 Safe Transfusion

3. HISTORICAL BACKGROUND
1795 – Philip Physick (Philadelphia) performed first
human blood transfusion
1818 – James Blundell, a British Obstetrician,
performed first successful blood transfusion of
human blood for treatment of PPH
1900 – Karl Landsteiner discovered first three
human blood groups – A,B,C (later changed to O).
His colleagues added AB as fourth type. (Nobel
prize – 1930)
1912 – Roger Lee and White described Lee-white
clotting system. Lee described about universal
donor and recipient
1916 – First blood depot was developed during
World War I in Britain
American Association of Blood Banks (AABB)

4. BLOOD
 Blood is a fluid connective tissue
composed of
 Plasma : Proteins
Coagulation factors
Metabolic substances
 Cells : Red blood cells
White blood cells
Platelets

5. INTRODUCTION
 India has a population demand of blood of 26.5 million out
of which Obstetrics & Gynaecology owes 13.8%
Medicine
39.9%
Surgery
25%
Pediatrics
21.3%
O&G
13.8%
NACO : National Estimation of Blood Requirements in India 2016-2017

6. Population need for transfusion acc. to specific
conditions in Obstetrics and Gynaecology
CONDITION PERCENTAGE
Obstetric haemorrhage 23.6%
Anaemia 15.2%
Hysterectomy for gynaecological cause
(AUB, Prolapse, Adenomyosis, etc)
16.6%
Hepatic disorders 13.6%
Abnormal Uterine Bleeding 10.2%
Myomectomy 5.6%
Ectopic pregnancy 4.8%
Abortion 1.5%
NACO : National Estimation of Blood Requirements in India 2016-2017

7. MAJOR INDICATIONS OF BLOOD TRANSFUSION IN
OBSTETRICS & GYNAECOLOGY
 Obstetric haemorrhage
 Anaemia of pregnancy and
haemoglobinopathies
 Surgeries where significant blood loss is
expected

8. OBSTETRIC HEMORRHAGE
 Obstetric haemorrhage is responsible for more than a quarter of
the estimated 3.03 Lakhs maternal deaths that occurred
globally in 2015
 Major cause of maternal mortality and leading cause of direct
maternal deaths
 Obstetric conditions associated with the need for blood
transfusion may lead to morbidity and mortality if not managed
correctly
RCOG Green-Top Guidelines No. 47 May 2017

9. BLOOD TRANSFUSION IS AN ESSENTIAL
COMPONENT OF QUALITY MEDICAL CARE
The increasingly important issues in blood transfusion are
 Adverse events associated with transfusion (potential
infection and potential transmission of prions)
 Rising costs of collecting and processing
 Possible future problems of availability
RCOG Green-Top Guidelines No. 47 May 2017

10. AIM OF TRANSFUSION
MAIN GOAL
 Enhance O2 carrying capacity of blood
 Maintain haemostasis
There should be appropriate use of blood products that
should neither compromise the affected woman nor
expose her to unnecessary risk
RCOG Green-Top Guidelines No. 47 May 2017

11. WHOLE BLOOD
 Replace loss of both RBC mass and plasma volume
 Volume : 350 ml, 450 ml
 Stored at 2-6 degree Celsius
 Indications : In patients with Massive Transfusion
 No functional platelets, no labile coagulation
factors (V and VIII)
 Complete transfusion within 4 hours of
commencement
 Increases haematocrit level 3-5% or Hb 1-1.5 g/dl
Administration
Must be ABO and RhD compatible with recipient
Never add medication to a unit of blood
WHO – The Clinical Use of Blood 2005

12. NEED OF COMPONENT PREPARATION
 Blood from one donor can be used for various patients, giving
optimal use of every unit of donated blood
 Transfusion of specific blood component that patient requires
 Avoids use of unnecessary component
 Optimal survival of each component

13. COMPONENT PREPARATION
Principle –
Differential centrifugation
Plasma +
Platelets
Buffy
RBC
Whole
blood

15. BLOOD COMPONENTS
Cellular Components Plasma Components Plasma Derivatives
Red cell concentrate Fresh frozen plasma Albumin 5% and 25%
Leucocyte reduced red
cell
Single donor plasma Plasma protein fractions
Platelet Concentrate Cryoprecipitate Coagulation factor
concentrates
Platelet apheresis Cryo-poor plasma Immunoglobulins
Granulocyte apheresis Fibrinogen

16. PACKED RED BLOOD CELLS (PRBC)
Component Content Characteristics
PRBC Red blood cells  250-350 ml
 1 unit increases Hb by 1-1.5
g/dl
 Transfusion rate : first 15 min
– 2ml/min f/b 60-80 ml/hr
Packed red blood cells (RBCs) - prepared from whole blood by
removal of plasma
WHO – The Clinical Use of Blood 2005
NACO - Standards for blood bank and blood transfusion services 2007

17.  No firm criteria for initiating red cell transfusion.
 Decision to provide blood transfusion should be made on clinical and
hematological grounds
 Ideally ABO identical/compatible PRBC must be given.
PRBC (CONT.)
RCOG Green-Top Guidelines No. 47 May 2017
PATIENT ABO TYPE COMPATIBLE RBC BLOOD
COMPONENT
O O
A A & O
B B & O
AB A, B, AB & O

18. BRITISH COMMITTEE GUIDELINES FOR
PRBC TRANSFUSION
Do not transfuse if Hb>10 g/dl
Transfusion indicated if Hb<7 g/dl (assess the symptoms)
Transfusion essential if Hb<5 g/dl
Symptomatic patients should be transfused
British Committee for Standards in Hematology 2012

19. INDICATIONS FOR TRANSFUSION IN
PREGNANCY
 ANTEPARTUM PERIOD
 Pregnancy <34 wk
a) Hb <5 g/dL
b) Hb 5-7 g/dL with impending heart failure
 Pregnancy >34 wk
a) Hb <7g/dL
b) Anaemia with decompensation
 Hemoglobinopathy or Bone Marrow failure syndromes
 Acute haemorrhage – always if Hb<6 g/dL or hemodynamic
instability due to ongoing haemorrhage
FOGSI Recommendations for management of IDA in pregnancy 2016

20. INDICATIONS FOR TRANSFUSION IN
PREGNANCY
 INTRAPARTUM PERIOD
 Hb <7 g/dL
 Depends on medical history and symptoms
 POSTPARTUM PERIOD
 Anaemia with signs of shock
 Acute haemorrhage with hemodynamic instability
 Hb <7 g/dL if symptomatic
FOGSI Recommendations for management of IDA in pregnancy 2016

21. PRBCs(SAGM)
Description:-
 180-250ml red cells with 60-100 ml normal saline, adenine,
glucose, mannitol (SAGM)
 Hemoglobin 15g/100ml
 Hematocrit 50-70%
 10-20ml or less plasma
Advantages:-
Lower packed cell volume, reduce viscosity and easy to
infuse
Better preservation, longer shelf life than whole blood or
packed cells

22. VARIANTS OF PRBC
Component Content Indication Contraindication
Leucocyte reduced PRBC
Technique of leukocyte
reduction:
-Centrifugation
-Removal of buffy coat
-Leucofilter method
(micro aggregate)
99.9% WBC
filtered out
 Multi-transfused patients
like thalassaemic
 Prevention of recurrent
Febrile Non- haemolytic
transfusion reaction
(FNHTR)
 CMV negative blood
To prevent
transfusion related
Graft vs Host disease
Irradiated PRBC
Irradiated by using cesium
137 source
A dose of 2500Gy
Donor T-cell
lymphocytes
are
damaged
 Intrauterine transfusion
 Highly immunosuppressed
 Infants undergoing
Exchange transfusion
 Units from First degree
blood relatives
ASH - Red blood cell transfusion 2016

23. Component Content Characteristics Indications
Platelets Platelets 22 ℃ for up to 5
days with
constant
agitation
 Prophylactic use:
-Severe thrombocytopenia
:<10,000 without risk factors
:<20,000 with risk factor(like fever)
-Maintaining platelet count >50,000 in pre-op
patient
-Platelet function defects (inherited and acquired)
-In massive transfusion (maintain PC >50,000)
 Therapeutic use:
Bleeding when thrombocytopenia is considered
major factor
PLATELETS
WHO – The Clinical use of Blood 2005
NACO : Standards for blood bank and blood transfusion services 2007

24. PLATELETS
 Express ABO antigens
 Will get best increment with ABO compatible platelets
 Can be given across ABO gp
 DO NOT express Rh antigens
 Can give regardless of Rh type
 However, platelets contain a small amount of RBCs
Rh-negative woman of child-bearing age
should receive Rh-negative platelets

25.  If Rh positive platelets are needed to be transfused to
be Rh neg patient of child bearing age group, consider
anti D prophylaxis:
 Dose – 300 IU IM stat
 Sufficient to cover 5 adult therapeutic doses within 6 weeks
period
 Subcutaneous route should be considered in severely
thrombocytopenic patients
BCHS Guidelines anti-D prophylaxis 2014.
PLATELETS (CONT.)

26. PLATELETS
Feature RDP SDP
Cost Cheaper Expensive
Collection Easy Expertise needed
on equipment
Time Less More
Anticoagulant side effect
to donor
Not present Present
Exposure of recipient Many donor Single donor
Volume 40-90 ml/bag 200-240 ml/bag
Increases platelet count 5000-10000 30,000-50,000
WHO – The Clinical use of Blood 2005
NACO : Standards for blood bank and blood transfusion services 2007

27. PLATELETS (CONT.)
 Transfusion rate – 2-5 ml/min.
 Must not be refrigerated before transfusion
(reduces platelet function)
 Transfuse as soon as possible because of the risk of
bacterial proliferation
WHO – The Clinical use of Blood 2005
NACO : Standards for blood bank and blood transfusion services 2007

28. PLATELET CONTRAINDICATIONS
 Asymptomatic thrombocytopenia
 Idiopathic Autoimmune Thrombocytopenic purpura (ITP) –
unless bleeding
 Thrombotic Thrombocytopenic purpura (TTP)
 Haemolytic uremic syndrome
 Heparin induced thrombocytopenia
 Surgery or invasive procedures with >50,000/ul – no
prophylactic platelet transfusion
WHO – The Clinical use of Blood 2005
WHO – Clinical Transfusion Practice Guidelines 2007

29. PLASMA (pale yellow fluid)
One unit of plasma (180-300 ml)
- amount of plasma obtained
from centrifugation of 1 unit of
whole blood
It contains nearly normal levels
of all factors except factor VIII,
fibrinogen.
Storage – indefinitely at -180 C
Not commonly used

30. Component Content Characteristics Indications Contraindications
Fresh frozen
plasma
All
plasma
proteins
and
clotting
factors
 200-300ml
 At -18℃ or
lower for up
to 1 year
 Initial dose :
10-15 ml/kg
 Multiple Clotting factor
deficiency (DIC, Liver
disease, Massive
transfusion , TTP)
 INR>1.6 with active
bleeding
 PT/aPTT>1.5 times
 Immediate reversal of
warfarin
 Hereditary angioedema
 Prolonged INR in
absence of bleeding
 Blood volume
expansion
 Hypoproteinaemia
 As a source of
immunoglobulins
FRESH FROZEN PLASMA (FFP)
WHO – The Clinical use of Blood 2005
NACO - Standards for blood bank and blood transfusion services 2007
Plasma separated from whole blood within 6hr of collection and rapidly frozen to -250c

31. CRYOPRECIPITATE
Cold insoluble plasma proteins, precipitate in FFP when it is thawed at 1-60c, then
centrifuged, collected and refrozen
Component Content Characteristics Indications
Cryoprecipitate • Fibrinogen:150-
300mg/pack,
• Factor VIII:80-100
IU/pack,
• vWF,
• Factor XIII and
fibronectin
1.Fibrinogen deficiency (<80-
100 mg/dl)
2.Haemophilia A
3.Von Willebrand’s disease
4.Factor XIII deficiency
5.DIC
WHO – The Clinical use of Blood 2005
NACO - Standards for blood bank and blood transfusion services 2007

32. FFP AND CRYOPRECIPITATE
 Must normally be ABO compatible to avoid risk of hemolysis in recipients.
 Before use, thawed in water at 30-370c.
 Once thawed, stored at 2-60c.
 Labile factors rapidly degrade, use within 6 hr of thawing.
 Should ideally be of same group as the recipient
 FFP of a different ABO group is acceptable providing that it does not have
high titre of anti-A or anti-B activity
 No anti-D prophylaxis is required if a RhD-negative woman receives RhD-
positive FFP or cryoprecipitate
RCOG Green-Top Guidelines No. 47 May 2017

33. FACTOR VIII CONCENTRATE
 Partially purified factor VIII prepared from large pools
of donor plasma
 One freeze dried vial contains 250 IU
 Stored at 2-60c.
 Indication:-
 Treatment of hemophilia A
 Treatment of vWD
 Alternatives: Cryoprecipitate
FFP

34. RECOMBINANT ACTIVATED FACTOR VII
(NovoSeven)
 rFVIIa used to stop active bleeding in hemophilia patients with
antibodies to factor VIII
 Single dose of rFVIIa at 90-120microgm/kg iv over 3-5 min,
induce immediate hemostasis
 Mechanism of action- binds tissue factor (TF) and activates
factor X directly
 Expensive drug (a 2.4 mg vial currently costs about Rs.80000
in India)

35. WHEN TO START TRANSFUSION AFTER
RECEIVING BLOOD COMPONENTS
Component Start infusion Complete
PRBC Within 30 min(of release from
refrigerator)
NOT RELATED WITH THE TIMING
OF RECEIVING THE BAG
Within 4 hours
PLATELETS Immediately Within 30 min
FFP/CRYOPRECIPITATE As soon as possible after thawing Within 30 min

36. ORDERING BLOOD COMPONENTS
DETERMINE WHAT
Before transfusion, we must determine WHAT
 Whether required
 How much required
 Actual component required
 Time of duration of transfusion

37. ORDERING BLOOD COMPONENT
SAMPLE REQUIREMENTS
 For blood group: 2-3 ml blood
in EDTA tube
 For cross match: 3-5 ml blood
in EDTA tube
 For IUT - 3 ml mother’s sample
in EDTA vial.
Label the samples
immediately to avoid
incidents of ‘wrong blood
in patient’

38. SAMPLE SPECIFICATIONS IN OBSTETRICS
 All women should have their blood group and antibody status
checked at booking and repeat antibody status at 28 weeks
of gestation
 Group and screen samples used for provision of blood in
pregnancy - less than 3 days old
 In a woman at high risk of emergency transfusion, e.g.
placenta praevia, group and screen samples should be sent
once a week to exclude or identify any new antibody
formation and to keep blood available if necessary
RCOG Green-Top Guidelines No. 47 May 2017

39. ORDERING BLOOD COMPONENT
TESTING DONE AT BLOOD BANK
 Routine cases – Blood grouping, Antibody screen, Cross-matching is done
takes 3-4 hours
 Emergency cases – Blood grouping, Crossmatching is done
 Immediate cases – Only blood grouping is done or O neg is released
NACO – Transfusion Therapy

40. THE CROSS-MATCH
 Donor RBCs are mixed with recipient serum
 Test is performed in three phases - takes
about 45 minutes
 Phase 1 The Immediate Phase(Ig M)
 Phase 2 The Incubation Phase
 Phase 3 The Antiglobulin Phase (Ig G)

41. ORDERING BLOOD COMPONENT
BLOOD REQUEST FOR INTRA-UTERINE TRANSFUSION
For IUT, We need blood with following specifications:
 O neg
 Leuco reduced
 Irradiated (to prevent transfusion associated GVHD)– to be used within 24
hours of irradiation
 Plasma reduced (with HCT 75-80%)
 Negative for antibodies to CMV
 Preferably less than 5 days old (to avoid hyperkalemia)
Joint UK Blood Transfusion and Tissue Transplantation Services Professional
Advisory Committee – Handbook of Transfusion Medicine 2014

42. TIME REQUIRED FOR RELEASE OF UNITS
 Uncross-matched Group O-neg RBCs - < 5 minutes
 Uncross-matched type specific RBCs – ~ 15 minutes
 Cross-matched RBCs – 1 hour
 Full ABO type, screen & cross-match – 2-3 hour
 FFP – 30-45 minutes for thawing
 Cryoprecipitate – 15 minutes for thawing

43. PRE TRANSFUSION CHECKLIST
Check on blood bag
• Label
• Leakage
• Hemolysis
• Clot
Check label
• Patient’s name and UHID
• Blood group
• Expiry date
• Component ordered

44. Check blood
group
Match name and UHID
with patient’s record
Check unit
number Check date
of expiry
Blood Bag Label Compatibility Label

46. CONSENT FOR BLOOD TRANSFUSION
 Valid consent - where possible prior to blood
transfusion
 In emergency - retrospective consent
 Reason for transfusion and consent
discussion should be documented
 In case of refusal - documentation and option
of autologous transfusion
RCOG Green-Top Guidelines No. 47 May 2017

47. IS THERE NEED FOR WARMING BLOOD
BEFORE TRANSFUSION ???
 There is no need of warming blood in
elective transfusion
 Ideal warming method is using warmer
machine
 Warm blood is required in :
 Large volume rapid transfusion
 Exchange transfusion in infants
 Patients with clinically significant cold agglutinins
 Transfusing in OTs where ambient temperature is 18℃
Blood components must NOT be warmed by methods such as
putting the pack into hot water or in microwave oven , etc.

48. BLOOD TRANSFUSION(BT) SET
 Specific for transfusion
 Peripheral or central access both can be used
 Primed with normal saline or blood component
 170-200 micron filter
 Most frequent recommendations – to change
every 4 units or 12 hourly
 Platelet concentrate should not be transfused
with BT set already used for other component
Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee – Handbook of Transfusion
Medicine 2014

49. VENOUS ACCESS
Blood Product IV Access(Gauge)
Red blood Cells
(Rapid transfusion)
16, 18 G
Red blood Cells
(Routine transfusion)
20 , 22 G
Other blood products 20 ,22 G
Infusion Therapy Standards of Practice 2016

50. MASSIVE TRANSFUSION PROTOCOL (MTP)
MASSIVE TRANSFUSION IS DEFINED AS
 Transfusion of >4 units PRBC in 1hour when ongoing need is
foreseeable
 Replacement of >50% blood volume in 4 hours
 Transfusion of >10 PRBC in 24 hours
Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee – Handbook of
Transfusion Medicine 2014

51. ACOG SAFE MOTHERHOOD INITIATIVE
 Massive Transfusion Protocol was introduced as safe motherhood
initiative by ACOG in 2015, updated in 2019
ACOG Safe Motherhood Initiative – updated Jan 2019

52. ACOG SAFETY BUNDLE FOR OBSTETRIC
HEMORRHAGE
ACOG Safe Motherhood Initiative – updated Jan 2019

53. MTP (CONT.)
 MASSIVE TRANSFUSION PROTOCOL (MTP) should be
used in critically bleeding patients anticipated to
require massive transfusion
 Mortality is high in massive transfusion
LETHAL TRAID:
1. Acidosis
2. Coagulopathy
3. Hypothermia

54. ACOG Safe Motherhood Initiative – updated Jan 2019

55. ACOG Safe Motherhood Initiative – updated Jan 2019

56. MASSIVE TRANSFUSION PROTOCOL
 Some protocol driven transfusion studies have shown 1:1:1
ratio of PRBC : FFP : Platelets as optimal
 Shown to improve survival, reduce hospital/ ICU stay,
decrease ventilator rates, reduce patient care costs
Surgical Critical Care Evidence Based Medicine Guidelines Committee Feb 2017

57. Trikha A, Singh PM. Management of major obstetric haemorrhage.
Indian J Anaesth 2018;62:698-703

58. Recognize blood loss and trigger MTP
Take baseline samples for CBC, clotting screen, ABG, Blood
group and crossmatch
Optimize intrinsic coagulation : Avoid hypothermia
Use tranexamic acid 1 gm bolus iv
• Use O neg units until patient’s group is known
• Use group specific blood as soon as available
MTP Pack 1:1:1
BLEEDING?
Stopped Deactivate
MTP
Continued
Until lab results are
available:
Repeat MTP
If lab results are available:
Give components guided by
lab values
MONITOR
(every 60 min or as
required)
• Full blood count
• Coagulation
screen
• Arterial blood
gas
AIM FOR
• Temp >35℃
• pH>7.2
• Base excess<-6
• Lactate<4mmol/L
• Ionized
Ca>1.1mmol/L
• PT/APTT<1.5xnor
mal
• INR≤1.5
• Fibrinogen>1 g/L

59. SHOCK IN OBSTETRICS
Severity of
Shock
ACS class Signs/Symptoms Blood loss Remarks
None Class I None <750 ml
(<15%)
Mild Class II Tachycardia(100-120bpm)
mild hypotension
Respiratory rate : 20-30 bpm
750-1000 ml
(15-30%)
Volume replacement
with
crystalloid/colloid
Moderate Class III Tachycardia(120-140 bpm)
hypotension(SBP-80-100 mm hg)
Respiratory rate :30-40 bpm
Oliguria(5-15 ml/hr)
Anxiety, confusion
1500-2000 ml
(30-40%)
Transfusion
Severe Class IV Tachycardia(>140 bpm)
hypotension(SBP<80 mm hg)
Respiartory rate : >35 bpm
Anuria
Confusion, lethargy,
>2000 ml
(>40%)
Transfusion

60. MAXIMUM SURGICAL BLOOD ORDER
SCHEDULE (OBSTETRICS AND GYNECOLOGY)
 It is a mechanism to maximise usage of blood and minimise wastage in
elective surgery (institute specific)
 It can reduce workload of unnecessary cross match
Procedure Action
 Termination of pregnancy G&S
 LSCS uncomplicated G&S
 LSCS complicated XM 2 units
 Placenta praevia XM 2-4(repeat weekly)
 APH/PPH XM 2
 Manual removal of placenta XM2
 Ectopic pregnancy XM 2
 XM= crossmatch
 GS=ABO/Rh group and antibody screen.

61. Procedure Action
 Dilatation and curettage G&S
 Hysterectomy (simple) G&S
 Hysterectomy (complex) XM 2-4 units
 Pelvic LAD XM 4 units
 Myomectomy XM 2 units
 Hydatiform mole XM 2 units

62. AUTOLOGOUS BLOOD TRANSFUSION
 Autologous blood transfusion is the collection
of blood from a single patient and re-transfusion back to
the same patient when required.
 Types:
1. Pre-operative autologous donation
2. Acute Normovolaemic hemodilution
3. Intra-operative cell salvage (IOCS)
Joint UK Blood Transfusion and Tissue Transplantation Services Professional
Advisory Committee – Handbook of Transfusion Medicine 2014

63. AUTOLOGOUS BLOOD TRANSFUSION
Pre-operative autologous
donation
Acute Normovolaemic
Hemodilution
Intra-operative cell salvage
In patients
- with rare blood groups
- with multiple blood group
antibodies
- patients who refuse to
consent to donor blood
transfusion
 Max 4 donations at least 7 days
apart
 Should not be done within 72
hours of surgery, weight is <50
kg, Hb <11 g/dl
 Several units of blood are
collected in donation packs
immediately before surgery (in
OT)
 Patient’s blood volume is
maintained by simultaneous
infusion of crystalloids and
colloid fluids
 Reinfused at the end of
surgery or if significant
bleeding occurs
 Blood lost during surgery is
filtered and aspirated into a
reservoir and anticoagulated
with heparin or citrate.
 Must be transfused to the
patient within 4 hours of
processing
 NOT TO BE DONE if:
-bowel contents contaminate
the operation site
-bacterially infected surgical
field
-surgery for malignant disease
Joint UK Blood Transfusion and Tissue Transplantation Services Professional
Advisory Committee – Handbook of Transfusion Medicine 2014

64. IS THERE A ROLE OF INTRA-OPERATIVE CELL
SALVAGE (IOCS)?
 Recommended in following situations:
 Anticipated blood loss is great enough
to induce anaemia
 Blood loss expected to exceed 20% of
estimated blood volume
 Useful in major traumatic or
obstetric haemorrhage
 Where IOCS is used during caesarean
section in Rh neg ICT neg women and
cord blood group is confirmed as RhD
pos (or unknown), a minimum dose of
1500 IU anti-D should be administered
following the reinfusion of salvaged
red cells
RCOG Green-Top Guidelines No. 47 May 2017

65. MONITORING THE PATIENT DURING TRANSFUSION
 Pre transfusion vital monitoring –
within 60 min of start of transfusion
 Monitor vitals 15 min after start of
each unit
 Post transfusion vital monitoring –
within 60 min of end of process
 If a reaction is suspected
 Observe for any new symptom
NICE guidelines 2013

66. TRANSFUSION REACTIONS
DELAYED
NON-INFECTIOUS
IMMUNE NON-IMMUNE
ACUTE DELAYED ACUTE
INFECTIOUS
• Virus
• Bacteria
• Parasite
• Prion
• Haemolytic
• Febrile, non
haemolytic
• Urticarial
• Anaphylactic
• TRALI
• Alloimmunization
• Haemolytic
• TGvHD
• Post transfusion
purpura
• Transfusion
associated sepsis
• Hypotension
• TACO(Transfusion
ass. Circulatory
overload)
• Air embolus
• Non immune
haemolysis
• Hypocalcemia
• Hypothermia
Iron
overload

67. INCIDENCE OF TRANSFUSION REACTIONS

68. TRANSFUSION REACTIONS
Acute
Complications
Delayed
Complications
• Occur within 24 hours of transfusion
• Classified as :
 Cat 1 – mild reactions
 Cat 2 – moderately severe
reactions
 Cat 3 – Life-threatening
• After 24 hours of transfusion

69. DELAYED TRANSFUSION REACTIONS
WHO – The Clinical use of Blood 2005

70. TRANSFUSION REACTION
 In case of suspected transfusion reaction:
 Immediately stop the transfusion
 Check vital signs
 Provide immediate patient care
 Maintain iv access but do not flush the tubings

71. TRANSFUSION REACTION (CONT.)
 Re-perform the pre-transfusion checklist, documents &
observations
 Inform blood bank staff & send the following to blood bank:
• Complete transfusion reaction report form
• Blood bag with BT set
• Post transfusion samples
 In case of suspected bacterial contamination : send cultures
both from the patient as well as blood bag at the bedside
immediately

72.  Unnecessary transfusion can be avoided in the following
ways –
 Prevention, Early diagnosis and Treatment of Anaemia
 Pre-operative optimization of the patient
 If Crystalloid/Colloid replacement can be given(as in
early stages of shock)
HOW CAN RISK ASSOCIATED WITH
TRANSFUSION BE AVOIDED???

73. SAFE TRANSFUSION – RIGHT BLOOD, RIGHT
PATIENT, RIGHT TIME AND RIGHT PLACE
 Avoid unnecessary and inappropriate
transfusions
 Preventable incidents of ‘wrong blood into
patient’
 The identity check between patient and
blood component is crucial
 At every stage excellent communication
and good documentation( by the use of
electronic transfusion management systems
and barcode technology)
 Non-essential ‘out of hours’ requests for
transfusion and overnight administration of
blood should be avoided
Joint UK Blood Transfusion and Tissue Transplantation Services Professional
Advisory Committee – Handbook of Transfusion Medicine 2014

74. PRACTICAL ASPECTS OF TRANSFUSION
 Blood transfusion must not take place unless medical
person is available on site at the commencement of each
unit
 Avoided at late hours unless urgent
 Never add other medications
 Use at least 20 ml of Normal Saline (0.9%) to flush lines
before and after administering blood components when
other drugs or fluids are administered
 Do not use 5% Dextrose (cause lysis of red cells)

75. TAKE HOME MESSAGE
 There should be appropriate use of blood products
 Only needed component should be transfused
 Platelets should ideally be group and RhD compatible
 FFP of a different ABO group is acceptable
 Valid consent
 Pretransfusion checklist should be followed
 Hb level is not the only deciding factor for transfusion
 Clinicians should be aware of risks of transfusion
 Monitor transfusion properly