blood and blood products for transfusions and their way of preprations.

1. Blood And Blood
Products
Presentation at Department of Anesthesia
Dr. Bishal Sapkota
Resident MDGP &EM
IV Batch, PAHS
Moderator: Assist. Prof Dr. Manisha Pradhan

2. World blood donor day 14th june.
•“Give blood and keep the world beating”.

3. Blood And Blood Products
• Blood is the connective tissue consisting of plasma and cellular
components.
• Average human has 5 litres of blood i.e., 8% of total body weight.
• It is a transporting fluid that carries vital substances to all
parts of the body.

5. Properties Of Blood
• Colour:
Oxygen-rich blood : scarlet red bright crimson
Oxygen-poor blood : purple red
• pH: 7.35–7.45
• Temp: 38˚C or 100.4˚ F
• Viscosity: 5 times more viscous than water

6. Functions Of Blood

7. Blood Groups & Typing

8. CROSS MATCHING
 AKA test tube transfusion
 Blood matching - direct compatibility test
 donor RBC to recipient serum

9. DONOR CRITERIA
F:11.5g/dl
M:12.5g/dL
45 kg
S: 110-160
D: 70-96
37.5
60-100 bpm
REGULAR

10. PRE TRANSFUSION TESTING
 HEPATITIS B
 HEPATITIS C
 HIV-1&2
 SYPHILIS
 MALARIA
 ABO
 RHESUS D

11. Blood Transfusion
Blood transfusion can be defined as the transfusion of the whole blood or
its components from one person to the other.
(Or)
Transfusion is simply the transplantation of a tissue consisting of a
suspension of cells in a serum.
It involves the collection of blood from the donor and administration of
the blood to the patient

12. Blood Transfusion
Blood for transfusion is safe when :
 Donated by a carefully selected, healthy donor
 Free from infections
 Processed by reliable methods of testing, component
production, storage and transportation
 Transfused only upon need and for the patient’s health
and well being

13. Things To Be Noted
• Type and volume of each unit transfused
• Donation number
• Blood group of each unit transfused
• Time at which the transfusion of each unit commenced
• Signature of the individual responsible for administration of the blood
• Monitor the patient before, during and on completion of the
transfusion
• Time of completion of the transfusion
• Transfusion reaction, if any and its management

14. Precautions To Be Taken During Blood
Transfusion
o Use of Sterile Apparatus.
o Blood bag should be checked
o Temperature of blood to be transfused must be same as
body temperature.
o Transfusion rate must be slow in order to prevent increase
load on heart.
o Care full watch on the recipients condition for 10 mins

15. BLOOD TRANSFUSION
Indications
1. Blood loss:
– Bleeding
– Trauma
2. Inadequate production:
– Diseases such as thalassemia,
leukaemia
3. Excessive destruction of cells:
– Disease
– Mechanical

16. TRANSFUSION STRATEGY & TRIGGER
 indications and triggers. Based on studies to date, there are two
strategies :
a) In 1988, liberal strategy - National Institutes of Health Consensus
Conference, perioperative < Hb 10 g/dL and Hct 30% transfusions
a) Restrictive Strategy - Hb level below 7 g/dL

17. Peri OP Blood Transfusion

18. Blood transfusion
Estimated Blood Volume( EBV):

20. Rationale of Blood transfusion
• Right blood product
• Right dose
• Right time
• Right reasons

21. Prevention Is Better Than Cure
Perioperative blood loss and anaemia
 reducing blood lost at surgery through minimizing trauma, improving
mechanical haemostasis
 Limiting phlebotomy to essential diagnostic tests, using
microsample laboratory techniques; and giving antifibrinolytics,
such as EACA or tranexamic acid (
 Early dx and treatment of anemia like IDA

22. BLOOD SALVAGE

23. Phlebotomy
 The maximum volume of blood that may be collected is <15 %
of body weight
 About 350- 450 ml is taken each time
 The withdrawal of blood takes 10-15 mins

24. Apheresis
• separating - cellular & soluble components of blood
• whole blood centrifuged to obtain components ( RBCs,
platelets, plasma based on specific gravity).
• required component is collected & rest is returned to
the donor
• Selective collection of RBCs/WBCs/platelets is called
cytapheresis
• plasmapheresis- Selective collection of plasma

25. BLOOD PRODUCTS
Red Cell Concentrate
Platelet Concentrate
Granulocyte Concentrate
Fresh Frozen plasma
Cryoprecipitate
Cryo poor plasma
Stored plasma
Albumin
Immunoglobulin
Coagulation Factors
Plasma Derivatives
Plasma Components
Cellular Components
BLOOD

26. Whole Blood
• Whole blood = Donor blood + Anticoagulant
• 1 Unit – 350 ml ; Anticoagulant (CPDA) - 49 ml
• Rich - coagulation factors
• Hct - 45%
• Stored at 2 - 6 ˚c
• Shelf life - 35 days / 5 wks
• acute blood loss in major surgeries > 15%
blood loss

27. Whole Blood
INDICATIONS CONTRAINDICATIONS
• Acute blood loss with
hypovolaemia
• Exchange transfusion
- severe anaemia at birth
- severe hyperbilirubinaemia
• Massive transfusion
• Cardiovascular bypass surgery
• Risk of volume overload in
patients with:
 Chronic anaemia
Incipient cardiac
failure

28. PRBC
• Platelets and plasma are removed
• I unit - 330ml
• Increases Hb by 1 g/dl
• Hct – 65 - 75%
• Shelf life - 35 days
• Stored at 2 - 4 ˚C in SAG-M ( Saline, adenosine, glucose, mannitol )
• Older: CPD (CITRATE-PHOSPHATE-DEXTROSE)
• Increase oxygen carrying capacity

29. Indications Of Red Cell Concentrate
• Trauma – acute blood loss > 20%
• Anaemia
• Thalassemia
• Sickle cell disease

30. Platelets Concentrate
• Platelet rich plasma
• Stored at – 20 to 24 ˚c ( Room temperature)
• Shelf life – 5 days
• I unit = 15 – 20 ml
• 1 unit Increases platelet count by 5000-
10,000/L
• Reduces incidence of bleeding

31. Platelets Concentrate
INDICATIONS CONTRAINDICATIONS
• Thrombocytopenia
• Drug induced Haemorrhage
• Prevention of spontaneous
bleeding with counts < 20,000
• Idiopathic autoimmune thrombocytopenic
purpura (ITP)
• Thrombotic thrombocytopenic purpura
(TTP)
• Untreated DIC
• Thrombocytopenia associated with
septicaemia, or in cases of hypersplenism

32. Plasma Products
• Fresh frozen plasma
• Cryoprecipitate
• Factor VIII concentrate
• Factor IX concentrate
• Albumin
• Prothrombin complex concentrate (PCC)
• Anti-thrombin concentrate
• Gammaglobulins

33. Fresh Frozen Plasma
 Plasma collected from single donor or by apheresis and
frozen within 8 hours of collection.
 1 Unit – 200 - 250ml; 3% increase in CF
 Contains clotting factors (Fibrinogen, Anti thrombin ,
Proteins C and S) , albumin and immunoglobulin.
 Stored at - 40 to - 50˚c
 Shelf life – 2 years
 Acellular-does not transmit intracellular infections

34. Indications Fresh Frozen Plasma
 First line therapy for treatment of coagulopathic haemorrhage
 Single clotting factor deficiency
 Multiple clotting factors deficiencies - DIC
 Massive transfusions
 Warfarin overdose
 Haemorrhagic disease of neonates
 TTP

35. CRYOPRECIPITATE
Produced by controlled thawing FFP
10-20ml PACK
•FIBRINOGEN: 150-300 mg
•FACTOR VIII : 80-120 U
•VWF : 80-120 U
•Stored at (-30)°C
•Shelf life – 2 years
 Poled units (10 DONATIONS) - Raise fibrinogen by 1g/L

36. INDICATIONS OF CRYOPRECIPITATE
• 1st choice for DIC
• Von Willebrand’s disease
• Fibrinogen deficiency

37. FACTOR VIII
CONCENTRATE
• Indications:
– Hemophilia
• Problems:
– Allergic reactions
– Hyperfibrinogenemia after
massive doses
FACTOR IX
CONCENTRATE
• Indications:
– Acute bleeding and perioperatively in
Christmas disease
• Problems:
– Allergic reactions

38. Autologous blood
• Collection / infusion of client’s own blood
• Can be collected weekly as long as client’s
• Upto 3 weeks before surgery
• Hct - 45%
• Stored at 2 - 6 ˚c
• Shelf life - 35 days

39. BLOOD COLD CHAIN
DONATED WHOLE BLOOD OR PLASMA
PREPARATION OF COMPONENT RED CELL
TRANSPORT BOX AT +20 TO +24 FOR MAX.6hrs
PLASMA PLATELET
QUARANTINE STORAGE BLOOD REFRIDGERATOR
+2 TO +6
BLOOD REFRIDGERATOR
+2 TO +6
PLASMA FREEZER
-30 OR LOWER
PLASMA FREEZER
-30 OR LOWER
PLATELET AGITATOR
+20 TO +24
PLATELET AGITATOR
+20 TO +24
TRANSPORT BOX
+2 TO + 10
TRANSPORT BOX
LESS THAN -20
TRANSPORT BOX
+20 TO +24
BLOOD RECIPIENT(PATIENT)
STOCK STORAGE
HOSPITAL BLOOD BANK

40. Duration for transfusion

41. Massive Blood Transfusion
• Replacement of a blood volume equivalent within 24 hours.
 >10 units within 24 hours
 Transfusion > 3 units in 1 hour
 Replacement of 50% of blood volume in 3‐4 hours
 A rate of loss >150 ml/hour

42. Uses of massive blood transfusion
Severe trauma associated with
 Liver injury
 Vessel injury
 Cardiac injury
 Pulmonary injury
 Pelvic injury

43. Complications of massive transfusion
 Coagulopathy
 Hypocalcaemia
 Hyperkalaemia
 Hypokalaemia
 Hypothermia

44. Blood substitutes
• Also called artificial blood or blood surrogate
• A substance used to mimic and fulfill some functions of
biological blood
• Aims to provide an alternative to blood transfusion
• Two types
 Biomimetic
 Abiotic

45. • Biomimetic substitutes mimic the standard oxygen-carrying
capacity of the blood and are
haemoglobin based.
• Abiotic substitutes are synthetic oxygen carriers and are
currently primarily perfluorocarbon based.

46. Complications of blood transfusion
Adverse reactions of blood transfusion can be classified into :
 Immunological complications
 Non immunological complications
Based on duration taken for the symptoms to occur they can be classified as:
 Acute
 Delayed
They can also be classified as
 Non infectious complications
 Infectious complications

47. Complications of blood transfusion
ACUTE (<24 HRS) DELAYED (>24HRS)
IMMUNOLOGIC NON IMMUNOLOGIC IMMUNOLOGIC NON
IMMUNOLOGIC
• Hemolytic
reaction
• Febrile non-
hemolytic reaction
• Urticaria
• Anaphylactic
reaction
• TRALI
• Septic
• Circulatory overload
•Metabolic
•Hypocalcemia
•Hyperkalaemia
•Metabolic alkalosis
•Air embolism
•Hemoglobinaemia,
Hemoglobinuria
•Hemolytic
reaction
•Post transfusion
purpura
•Graft vs host
disease
•Infection
•Iron overload

48. TRANSFUSION RELATED ACUTE LUNG INJURY
[TRALI]
previously known as pulmonary hypersensitivity reaction
• Pathophysiology :
 transfusion of antibodies and/ or other non immunologic
mediators to a susceptible patient
 The most frequently implicated antibodies are human leukocyte
antigen (HLA) class I, HLA class II, and human neutrophil antibodies
(HNA)5,7; these antibodies activate the leukocytes, which bind to the
endothelium in the lungs, causing endothelial injury and edema

49. Treatment Of TRALI
 immediate cessation of the transfusion
and stabilization of the patient are critical.
 Respiratory support may range from
supplemental oxygen to intubation.
Steroids have not been proven to be
beneficial.
 TRALI reactions usually resolve over the
course of a few days with only supportive
measures being needed

50. Transfusion Associated Circulatory Overload [TACO]
most common high-morbidity transfusion reaction
risk of TACO increase with
including older age, renal disease, cardiac disease, positive fluid balance,
and critically ill status
Pathophysiology :
• too much fluid is added to the system too quickly (or in volumes that
cannot be tolerated) for the transfusion recipient.
• Pulmonary Edema And Respiratory Distress

51. Difference Between TRALI And TACO

52. Treatment Of TACO
 transfusion still running - should be stopped immediately
 Some case improve with simply stopping the infusion
 some form of respiratory support, at least temporarily
 Diuretics; decrease in circulatory volume relieves cardiovascular
stress, improving the pulmonary edema
 TACO can be prevented ,patients at risk of fluid overload at
increased risk of TACO and should be transfused at a slow rate

53. References
1. Guyton And Hall Textbook Of Physiology 14th Edition
2. Morgan & Mikhali’s 6th Edition
3. MILLERS anesthesia 7th edition
4. https://nrcs.org/donate-blood/#can-i-donate
5. Uptodate
6. Hand book of transfusion medicine; 5th edition ,UK blood services
7. WHO official site .

54. THANK YOU