Blood transfusion

1. BLOOD
TRANSFUSION
AND ITS
COMPLICATION

2. BLOOD
Blood - specialized bodily fluid
•delivers nutrients/oxygen to cells
•transports waste products away
Considered a specialized form of connective tissue,
given its origin in the bones
Presence of potential molecular fibers in the form
of fibrinogen.

3. TYPES OF BLOOD PRODUCTS
● Whole Blood
● Packed Cells
● White Cells
● Platelets
● Fresh Frozen Plasma
● Cryoprecipitate
● Other Components

4. WHOLE BLOOD
Typically combined with an anticoagulant during the collection process, but is
generally otherwise unprocessed
Contents
• RBC’s
• WBC’s
• Platelets
• Plasma
• Clotting factors depending on storage time

5. All around the world, most countries have stopped giving whole
blood to the patients for the following reasons:
• More likely carrier of diseases
• Frequency of serious shortages of blood, it is considered
imprudent to use whole blood
Most patients require only one particular component.
• Better patient management by giving only the necessary
component

6. Utilizing normal blood storage techniques, blood products
have a greater shelf life than whole blood
Blood filtration and other techniques help to make blood
safer
Blood products can often be infused regardless of ABO
blood group.

7. PACKED CELLS
Obtained by spinning down whole blood
Contents
• RBC’s
• 20% Plasma
Indications
• Replace Hb and O2 carrying capacity with less volume usually for
Hb<7g
• Severe anemia, blood loss > 10 – 15%, CHF
1 gram of Hb is equivalent to 3 HCT percentage points.
Each unit of PRBC in an adult is expected to raise the HCT by 3 points

8. PLATELETS
Platelets - stored at room temperature. Heat or cold storage will render
platelets inactive
Require continuous gentle agitation
Can be stored at the blood center for up to five days
When received for transfusion, both pooled and apheresis platelets will
expire in less than four hours
Dose: 1 unit per 10 kg body weight (each unit should raise count by
5000 – 10000/uL)

9. Indications
1. Arrest/ prevent bleeding in patients with qualitative or
quantitative defects
• Qualitative defects such as in sepsis, renal failure, use of
aspirin/ antiplatlet agents
2. Prior to operation where platelet < 50000/uL
3. DIC, massive transfusion

10. FRESH FROZEN PLASMA
Contents
• Complete profile of Clotting factors
• Fibrinogen
• Prothrombin
• Albumin
• Globulins
Stored at -30C. Should be thawed to body temperature when to
use

11. Indications:
• Urgent reversal of anticoagulation/ or known factor deficiency
• After replacement of more than one blood volume
• Elevated PT/APTT
• 1 unit FFP ~ 200 – 250 mL. 4 – 8 units of FFP are required
to produce clinically significant increase in serum levels of
clotting factor

12. CRYOPRECIPITATE
Contents
• Rich in fibrinogen, contains factors VIII, XIII, von Willebrand and
fibronectin
Indications
• Hemophilia A
• Fibrinogen deficiency
• Factor XIII deficiency
• Massive transfusion
• DIC (dose: 1 unit cryoprecipitate per 10 kg BW, at least 6 units are
required)

13. CRYOSUPERNATANT ‘LIVER PLASMA’
Factors II, VII, IX, and X (vitamin K dependent factor), albumin
and IG
Indications
• Urgent reversal of warfarin therapy/overdose
• Prolonged PT or APTT in patient who is bleeding as a result of
liver disease or DIC

14. BLOOD
COMPONENT
CONTENTS VOLUME
SHELF LIFE**
Red cells (AS-1) RBC w/ appx. 25 mL of plasma; 100 mL
of saline; additive solution (adenine,
mannitol). Hct 60%
340 mL 42 days 4o C
Platelet
concentrate
Platelets; includes some WBC; 50 mL of
plasma, a few RBC (Hct less than .005)
50 mL 5 days 20o C
Platelet apheretic Platelets; includes some WBC; 300 mL
of plasma; a few RBC
300 mL 5 days 200 C
Fresh frozen
plasma
Plasma proteins, all coagulation factors,
complement
225 mL 1 year 18o C
Cryoprecipitate 150 mg of fibrinogen, at least 80 units of
factor VIII, von Willebrand factor, factor
XIII, fibronectin
15 mL 1 year 18o C

15. BLOOD
TRANSFUSION
Blood must be typed prior to administration
ABO Antigens
• A Antigen - Type A
• B Antigens - Type B
• A and B Antigens - Type AB
• No Antigens - Type O

16. Rh Factor
• 85% of Population
• Rh Positive
• 15% of Population
• Rh Negative
• Rh Negative patients produce Rh antibodies only if exposed
to Rh Positive blood

17. Erythroblastosis Fetalis
• Rh Negative mother exposed to Rh Positive fetal blood during
delivery
• Mother produces Rh Antibodies
• Antibodies cross placenta during subsequent pregnancy
• Fetal blood hemolyses
Prevented by administration of Rhogam to mother

18. BLOOD
TRANSFUSION
Blood must be typed prior to administration
ABO Antigens
• A Antigen - Type A
• B Antigens - Type B
• A and B Antigens - Type AB
• No Antigens - Type O

19. BLOOD TRANSFUSION
● IV catheter 18g or larger
● No fluid other than saline
● Two persons confirm ABO/Rh
● Counsel patient properly prior to transfusion
● Consent by patient and doctor

20. 12. Consent for Blood Transfusion
Blood transfusion is meant to benefit the patient.
Nevertheless, it carries with it various risks to the health of the patient including
infectious disease agents (e.g. HIV, hepatitis, syphillis), transfusion
reactions and even risk of transfusing wrong blood, which can be fatal.
Thus coupled with the decision to transfuse, the medical personnel in
charge of the patient also bears the responsibility to explain the
benefits, risks and alternatives to transfusion therapy and to ensure
that the patient understands the material discussed.
Other than in an emergency situation, the patient should be given an
opportunity to ask questions, and his/her informed decision should be
documented.

21. If the patient is unable to give consent, a responsible family member
might
be asked to do so. If no family member is available or if in an
emergency the need for transfusion leaves no time for consent, it is
prudent to note this in the patient’s medical notes. ( Refer Chart XVII )
It is essential that you provide this information in a timely manner that
is understood by the patient, and that you ensure this information is
understood.

22. COMPLICATIONS

23. 1. FEVER/ FEBRILE
NON-HAEMOLYTIC TRANSFUSION
REACTIONS (FNHTR)
Most common reaction
Donor WBC incompatibilities
Management :
• Stop transfusion if severe
• Antipyretics if mild – T PCM

24. 2. URTICARIA
It is caused by the degranulation of the mast cells in the skin and
subsequent release of histamine.
typical urticarial reaction consists of circumscribed areas of
cutaneous oedema and itching. It usually occurs within minutes of
transfusion without fever or other adverse findings.

25. a) The transfusion may be temporarily interrupted while an
antihistamine (Chlorpheniramine 10 mg by slow intravenous
injection) is administered. If urticaria is the only symptom noted,
the transfusion may then be resumed.
b) In a patient who has developed extensive urticaria or a
confluent total body rash during transfusion, it would be prudent to
discontinue the transfusion even if symptoms have responded to
Treatment.
c) For recipients who have had a severe or frequent minor
urticaria following transfusion, administering oral antihistamine
(Chlorpheniramine 8 mg) 30 minutes before transfusion may be
helpful.

26. 3. ANAPHYLACTIC REACTION
Defined as an immediate generalized hypersensitivity reaction
due to activity of IgE antibodies or the presence of anti-IgA in
patients with congenital deficiency of IgA.
It is a rare but life-threatening complication.
- generalized flushing
- urticaria
- Cough/ broncho-spasm/ dyspnoea/ respiratory distress
- Vomitting/ diarrhoea/ abdominal pain
- Arrythmia/ hypotension/ syncope and can progress to loss of
consciousness/ shock
- rare cases, death.

27. Treatment of Anaphylaxis
1. Stop the transfusion immediately.
2. Maintain venous access with 0.9% saline.
3. Maintain airway and give oxygen; Salbutamol nebuliser can also be
given.
4. Give Adrenaline 0.5-1.0 mg IM, and repeat every 10 minutes according
to blood pressure and pulse until improvement occurs.
5. Give Chlorpheniramine 10-20 mg by slow intravenous injection.

28. 4. TRANSFUSION-RELATED ACUTE
LUNG INJURY
(TRALI)
A very severe type of transfusion reaction is the acute, sometimes
fatal, pulmonary reaction termed as TRALI.
The pathophysiology is due to the transfusion of
leucocyte antibodies in the donor that react with the recipient’s white blood cell.
This condition should be suspected in a patient with:
1. Fever
2. non-productive cough
3. hypotension,
4. Tachypnoea
5. dyspnoea
6. non-cardiogenic pulmonary oedema within 4 hours of initiating the transfusion.

29. a) Patients suspected to have TRALI should be managed
in an ICU setting in which oxygen therapy and assisted
ventilation are often required. Intravenous steroids may be
helpful.
b) The blood bank must be informed so that the implicated
donor can be deferred.

30. 5. VOLUME OVERLOAD
Signs/Symptoms
• Cough
• Chest pain
• Dyspnea
• Distended neck veins
• Coarse creps
• Frothy sputum

31. Management
• Slow infusion
• Diuretics
• Vasodilators

32. Acid/Base Imbalance
- Banked blood gradually acidifies
Hypothermia
- Inadequate warming during transfusion
Viral Hepatitis
- Risk rises with each unit

33. BLOOD AND PRODUCTS
Blood should be used responsibly and carefully
Appropriately used can save lives
Over transfusion and wrong use is a waste of resources and put
patients at risk of complications
Always consult if unsure of indication