1. Blood transfusions can be indicated for both elective and emergency situations such as anemia, hemorrhage, surgery, and trauma. 2. The ABO and Rh blood group systems are the most important to screen for due to the risk of hemolytic transfusion reactions from naturally occurring antibodies. 3. Whole blood can be stored for 35 days while components like packed red blood cells and platelets have shorter storage times and are preferred to minimize changes during storage.

1. Blood Transfusion Dr. Tanuj Paul Bhatia

2. Indications Elective transfusion - Correction of anemia before surgery - In preparation for major surgeryEmergency transfusion - Hemorrhage Post Traumatic

3. Operative/Post operative

4. Spontaneous Blood GroupingMore than 400 antigen systems have been identified.Expressed on red cell membranes.Such antigens capable of interacting with serum antibodies in recipient.HOWEVER, only a small proportion have potential to cause clinically significant hemolysis.

5. ABO systemSystem of sugar residue antigens.MOST IMPORTANT ANTIGEN SYSTEM WHY?IgMPresence of naturally occuringIgM antibodies in the serum

6. They occur spontaneously.Are directed against A and/or B antigens that the individual’s own red cells do not carry.Can cause fatal reactions by causing lysis of incompatible red cells within intravascular compartment.

8. Rhesus systemAntibodies are IgG type.These are induced antibodies and not naturally occuring.Require a past exposure to cause reactions e.g. Previous blood transfusions or exposure to fetal red cells during pregnancy.

9. Mainly cause red cell destruction in RE system i.e. Extra vascular hemolysis.Consists of 47 antigens.c, C, D, e and E are most important. Rh positive = D antigen presentRh negative = Absent D antigen

10. Other blood group systemsMany other systemsMost likely to be implicated in hemolytic transfusion reactions areKell,

11. Kidd, and

12. Duffy.Cross-matchingBlood routinely grouped according to ABO and Rhesus systems.After matching donor and recipient blood groups, cross matching is done.Donor RBC are incubated with recipient’s serum to look for evidence of hemolysisMacroscopic evidence

13. Microscopic evidencePhysiology of stored bloodSeveral metabolic and functional changes occur.Easily compensated by an individual with moderate hepatic, renal or bone marrow function.Blood is stored at 4-8 C mixed with anticoagulant, most commonly CPD-A (citrate-phosphate-dextrose-adenine).

14. Red cell changesDepletion of ATP and 2,3 DPG.RBC become rigid and less effective in oxygen delivery to tissues. White cell and platelet changesNo useful function in blood stored for more than 24 hrs.Coagulation factorsV, VIII and XI fall in 24 hrsIX and X become ineffective in 7 days.

15. Biochemical changesBecomes acidoticBecomes hyperkalemicDue to spontaneous red cell lysisReadily compensated except in seriously compromised patients and massive transfusion.MicroaggregatesGranulocyte –platelet aggregates start to form within 24 hrs of storage.Can form pulmonary microemboli .Thus BT set should have an appropriate filter.

16. Whole blood and component therapy

17. Whole blood Fresh whole bloodRich in all blood elements including coagulating factors.Stored whole bloodLooses many properties as explained.CPD-A blood can be stored at 4-8 C for 35 daysCPD blood for 21 days

18. Whole blood(contd.)Indication - Acute , active blood loss with hypovolaemia- Exchange transfusionContraindication - Riskof volume overload : Chronic anaemia Incipient cardiac failure1 unit increases Hb by about 1.4 g/dl

19. Packed red cellsUnits with red blood cells and some plasma

20. With anticoagulant like CPD-A

21. Hematocrit is 75% to 80%

22. Indication- Replacement of red cells inanaemic patients. - Use with crystalloid or colloid solution in acute blood loss. Dosage 10 - 15 ml / kg

23. Fresh frozen plasmaContains approx. 200 ml of plasma.Frozen within hours to preserve the level of coagulation factors.Stored at -40 C, has a shelf life of 6 months.Should be thawed for 30 minutes in waterbath before admi.To be given within 30 min after thawing.

24. FFP(contd.)IndicationsCoagulopathieseg. Due to liver disease.DIC

25. CryoprecipitatePrepared from FFP by thawing and separating and refreezing jelly like precipitate.Enriched with factor VIII, Fibronectin and Fibrinogen. Volume is about 20 ml. Indicated in patients with Hemophillia, uncontrollable hemmorhage and DIC.

26. Platelet concentratesEach unit of platelets are suspended in 30-50 ml of plasma .5 to 6 such units are combined to make a ‘Pool of platelets’ to raise platelet count by atleast 30 x 10⁹/l in a 70 kg man.The only blood product not kept refrigerated, stored at 22 C under gentle agitation.Shelf life is less than 5 days.Indicated in DIC, Dengue fever, Bone marrow failure.

27. Transfusion reactions(Hazards of transfusion)‘Reaction’ = ‘Any unwanted effect of blood transfusion’Doctor should always be sure that transfusion is absolutely necessary and consider alternatives.Upto 1 L of blood loss can safely be restored with crystalloids alone if bleeding has stopped .

28. 1. Immediate and life threateningProfound intravascular haemolysis,Air embolism,Circulatory overload,Complications of massive blood transfusion.

29. 2. Immediate but not life threateningSevere extravascularhemolysis,Febrile reactions,Atopic reactions.

30. 3. Late reactionsDelayed immune mediated hemolysisLocal reactionsTransmission of infection

31. Hemolytic reactionsFortunately rareCause = transfusion of mismatched blood due to clerical or technical error.Always check labels on blood bags as well as patients blood group before starting transfusion.Signs and symptomsPain at infusion siteShortness of breathChest painFacial flushing, vomitingFever and rigors

32. Hemolytic reactions(contd.)Patient may go for shock, renal failure, DIC and jaundice.RxStop transfusion immediatelyMaintain venous access and saline infusionInjchlorpheniramine 10 mg iv given statSteroidsInsert urinary catheterManagement of complications

33. Febrile reactions and minor allergic reactionsNonhemolytic febrile reactions and minor allergic reactions are the most common transfusion reactions.Each occurring in 3-4% of all transfusions.Nonspecific symptoms of fever, chills, and malaise.RxStop transfusionInj CPM 10 mg iv Send to lab for re-crossmatching

34. Complications of massive blood transfusionMassive transfusion is defined as the replacement of more than one-half of the blood volume within a 24-hour period .Or replacement of 10 units of blood over the course of a few hours .

35. Complications are…Volume overload,Hypothermia,Coagulopathy,Hyperkalemia,Metabolic acidosis,

36. Transmission of infectionHIVHBVHCVSyphilisAll donors and all of donated blood is to be screened for the above.

37. THANK YOU