This document provides information about blood and blood components. It discusses the composition and properties of blood, the formation and types of red blood cells, white blood cells and platelets. It also describes the ABO and Rh blood group systems, cross-matching for transfusions, indications for transfusions of whole blood, red blood cells, platelets and plasma, and guidelines for administering transfusions.

1. Purbanchal Cancer Hospital
Blood &
Blood Transfusion
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2. BLOOD is a special type of fluid connective tissue
derived from mesoderm.
PROPERTIES OF BLOOD
•Color Bright red in arteries & dark red in veins
•Mass 8 % of the body mass
•pH Slightly alkaline (pH = 7.35 – 7.45)
•Taste Salty
•Temperature 38° C (100.4° F)
•Viscosity 3 – 4 times more viscous than water
•Volume 5 – 6 liter
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3. What is the Composition of Blood?
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5. The Anatomy of Red Blood Cells
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6. Red Blood Cell Composition
• Hemoglobin makes up 95% of RBC protein
• Globular protein composed of four subunits
• Each subunit contains:
• A globin protein chain
• A molecule of heme
• An atom of iron
• A binding site for one oxygen molecule
• Phagocytes recycle hemoglobin from damaged RBC
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7. RBCs Formation
Bone marrow
Stem
cells
Erythroblasts
Reticulocytes
Increased m
itotic rate
Accelerated
maturation
Release of eryth
ropoietin (EPO)
Tissue o
xygen le
vels dec
line
Tissue ox
ygen level
s rise
Improved ox
ygen conten
t of blood
Increased numbers of c
irculatingRBCs
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8. Figure 11-6
Bone marrow
1 of 7
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Stem
cells
Erythroblasts
Reticulocytes
Increased
mitotic rate
Accelerated
maturation
Release of eryth
ropoietin (EPO)
Tissue
oxygen
levels
decline
Tissue oxygen
levels rise
Improved oxygen
content of blood
Increased numbers of circulating RBCs
Figure 11-7(b)
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9. Tissue
oxygen
levels
decline
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Figure 11-7(b)
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10. Release of eryth
ropoietin (EPO)
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Tissue
oxygen
levels
decline
Figure 11-7(b)
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11. Bone marrow
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Stem
cells
Erythroblasts
Increased
mitotic rate
Release of eryth
ropoietin (EPO)
Tissue
oxygen
levels
decline
Figure 11-7(b)
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12. Bone marrow
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Stem
cells
Erythroblasts
Reticulocytes
Increased
mitotic rate
Accelerated
maturation
Release of eryth
ropoietin (EPO)
Tissue
oxygen
levels
decline
Figure 11-7(b)
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13. Bone marrow
Increased numbers of circulating RBCs
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Stem
cells
Erythroblasts
Reticulocytes
Increased
mitotic rate
Accelerated
maturation
Release of eryth
ropoietin (EPO)
Tissue
oxygen
levels
decline
Figure 11-7(b)
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14. Bone marrow
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Stem
cells
Erythroblasts
Reticulocytes
Increased
mitotic rate
Accelerated
maturation
Release of erythr
opoietin (EPO)
Tissue
oxygen
levels
decline
Tissue oxygen
levels rise
Improved oxygen
content of blood
Increased numbers of c
irculatingRBCs
Figure 11-7(b)
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15. Hemoglobin Recycling
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16. The Origins and Differentiation of
RBCs, Platelets, and WBCs
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17. WBCs
White Blood Cells (WBCs)
• Also called, leukocytes
• Defend the body against:
• Pathogens
• Toxins
• Abnormal cells
• Damaged cells
Hi
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18. WBC Properties
• Perform diapedesis—Push between cells to cross
blood vessel walls and enter the tissues
• Exhibit chemotaxis—Move toward specific che
micals released by bacteria or injured cells
• Consist of two groups:
• Granulocytes (cytoplasmic granules)
• Agranulocytes (no granules)
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19. Cell type Diameter Nucleus Cytoplasm Cytoplasmic
(µm) granules
Granulocyte 10‐14 Blue violet Blue Fine, closely
2‐6 lobes, connected by packed, violet‐
chromatin thread pink, not seen
Seen clearly through separately
cytoplasm Do not cover
nucleus
Neutrophil
Neutrophils
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20. Functions Neutrophils & macrophages
• Defend against infection
Degranulation
1. Chemoattraction
2. Rolling adhesion
3. Tight adhesion
4. Transmigration
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21. Eosinophil
Cell type Diameter Nucleus Cytoplasm Cytoplasmic
(µm) granules
Granulocyte 10‐15 Blue –violet Light pink‐ Large, coarse
2 lobes red Uniform sized
Lobes connected by Brick red –orange
thick chromatin strand Seen separately
Seen clearly through Do not cover
cytoplasm nucleus
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22. Basophil
Cell t
ype
Diamet
er (µm
)
Nucleus Cytoplasm Cytoplasmic
granules
Granulocyte 10‐15 Blue‐violet Bluish Large
S shaped Very coarse
Not clearly Variable sized
seen because Deep purple
overlaid with Seen separately
granules Completely fill the
center & cover
the nucleus
Granules contain
•Heparin
•Histamine, bradykinin, serotonin, eosinophil chemotactic factor
slow reacting substance
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23. Monocyte
Cell type Diameter Nucleus Cytoplasm Cytoplasmic
(µm) granules
Agranulocyte 12‐20 Pale blue violet Abundant No visible
Large single Frosty granules
Indented or Slate blue
horse shoe or Amount may
kidney shaped be larger than
that of nucleus
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24. Lymphocyte
Cell type Diameter Nucleus Cytoplasm Cytoplasmic
(µm) granules
Small 7‐9 Deep blue violet Hardly visible No visible
Lymphocye Single, large, round, Thin crescent of clear, granules
Agranulocy almost fills the cell light blue cytoplasm
te Condensed lumpy
chromatin , gives ink
spot appearance
Large 10‐15 Deep blue violet Large crescent of No visible
lymphocyte Single, large, round clear, light blue granules
Agranulocy or oval cytoplasm
te Central or eccentric Amount larger than
in small lymphocyte
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25. Life span
• Granulocytes: 4‐8 hours in circulation Another 4‐5 d in t
issues where they are needed
• Monocytes: 10‐20 hours in blood Months –years in
tissues as macrophages
• Lymphocytes: weeks‐months
Recirculate from the lymph nodes & other lymphoid areas
to blood and back again
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26. Platelets are
• Produced in the bone marrow
• Released from megakaryocytes as cytoplasmic fragments into the
blood
• Essential to clotting process
Hemostasis—Processes that stop the loss of blood from a damaged vessel.
Largely dependent on platelets and soluble proteins (clotting factors)
Platelets
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28. Vascular
• Local contraction of injured vessel
Platelet
• Platelets stick to damaged vessel wall
Coagulation
• Clotting factors in plasma form blood clot
Hemostasis
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29. Events in the Coagulation Phase of Hemostasis
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31. The Structure of a Blood Clot
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32. • First ever blood transfusion was made dog to dog by
British physician Richard Lower in 1665.
• Austrian immunologist Karl Landsteiner discovered the
ABO blood group System in 1901. In 1910 he won
Nobel prize for medicine for this discovery.
• In 1940- Karl Landsteiner and Alexander S Wiener report
another Rh blood group.
ABO blood group system
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33. Blood Type
• Determined by presence or absence of specific antigens
(agglutinogens) on outside surface of RBC
• Antigens are called A, B, and Rh
• Antibodies (agglutinins) in plasma react with foreign
antigens on RBCs
• RBCs clump and break open
• Anti-Rh antibody made after exposure to Rh-positive
blood cells
ABO blood types Relative frequency of different blood types:
• O 47% • A 41% • B 09% • AB 3% (World)
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34. Blood Types and Cross-Reactions
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35. Rh blood group system
▪The Rh factor, named for the rhesus monkey because it was first studied
using the blood of this animal.
▪85% of whites are D-positive & 15% are D-negative; over 99% of Asians are
D-positive.
▪Unlike the ABO antigens, the system has not been detected in tissues
other than red cells.
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36. Landsteiner’s Law
1. If a certain agglutinogen (Antigen) is present on the surface of
RBCs, the corresponding agglutinin (Antibodies) must be
absent in the plasma.
2. If a certain agglutinogen is absent on the surface of RBCs,
then corresponding agglutinin must be present in the plasma.
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37. Cross Matching
▪Cross Matching is a procedure performed prior to a blood
transfusion to detect incompatibilities between the donor
and recipient.
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38. BLOODTRANSFUSION, is the injection of a volume of blood obtained from a
healthy person (the donor) into the circulation of a patient (the recipient)
whose blood is deficient in quantity or quality.
Donated blood is usually subjected to processing after it is collected, and is
separated into blood component by centrifugation
Blood Transfusion
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39. A blood component is a constituent of blood, separated from whole blood,
such as:
Red cell concentrate
Plasma
Platelet concentrate
Cryoprecipitate, prepared from fresh frozen plasma; rich in Factor VIII and fibrin
ogen
A plasma derivative is made from human plasma proteins prepared under phar
maceutical manufacturing conditions, such as:
Albumin
Coagulation factor concentrates
Immunoglobulin
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40. To increase the oxygen capacity of blood by giving red cells.
To restore the blood volume to maintain effective tissue perfusion.
To replace platelets, coagulation factors and other plasma proteins.
Blood may be needed in the following circumstances:
Blood loss:
– Bleeding
– Trauma
Inadequate production:
– Diseases such as thalassemia, leukaemia
Excessive destruction of cells:
– Disease
– Mechanical
Indications for blood transfusion
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41. • Assess patient’s clinical need for blood
• Inform patient and/or relatives about proposed transfusion and record in patient’s notes
• Also record indications for transfusion in patient’s notes
• Select blood product and quantity required (i.e. whole blood/PRBC/FFP/PC) and comple
te request form accurately and legibly
• Obtain and correctly label a blood sample for compatibility testing
• When the blood product that was ordered arrives, transfuse it as soon as possible to avo
id having to store it. However, if the blood product is not used immediately, store it und
er the correct storage conditions
• Cross check the identity of the patient and the blood product:
– Patient and documentation.
– Blood / blood products.
Responsibilities of attending physician
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42. Storage of Blood
CPDA-1
Tri sodium citrate (g
)
26.35
Citric acid (g) 3.27
Dextrose (g) 31.90
Monobasic sodium
phosphate (g)
2.22
Adenine (g) 0.27
Distilled water (ml) 1000
Preservative (ml) / 1
00ml blood
14
Storage at 2-6 °C
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43. • Blood request form
• Blood samples
• Red cell compatibility testing
• Collection and receipt of blood
Administration of Blood Products
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44. Rates of transfusion
Adults Rate
Whole blood 150‐200 mL/hour
PRBC 100‐150 mL/hour
Platelets / plasma 150‐300 mL/hour
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45. Duration times for transfusion
Blood products Start transfusion Complete transfusion
Whole blood / PRBC
Within 30 minutes of
removing from refrigerator
≤ 4 hours
Discard unit if this period is exceeded
Platelet concentrate Immediately Within 30 minutes
FFP As soon as possible Within 30 minutes
Cryoprecipitate As soon as possible Within 30 minutes
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46. Use of medication at time of transfusion
It is generally not recommended to routinely use pre‐medication like
anti‐histamines, steroids or other medication before transfusion.
This practice may mask or delay the signs and
symptoms of an acute transfusion reaction and therefore delay
recognition and action to stop the transfusion
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47. Description:
450 mL whole blood in 63 mL anticoagulant‐preservative solution of which Hb will be
approximate 1.2 g/dL and haematocrit (Hct) 35‐45% with no functional platelets or
labile coagulation factors (V and VIII) when stored at +2°C to +6°C.
Whole Blood
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48. 1. One of the following:
a. Clinical signs and symptoms including, but not limited to: hypovolemia, hypoxia, syncope, dyspnea,
postural hypotension, tachycardia, Tachypnea, angina, transient ischemic attack or other symptoms
secondary to hemorrhage, trauma, surgery, hemolysis or other conditions, OR
b. Evidence of acute loss of 15% of total blood volume or >750 mL blood loss, OR
c. Hemoglobin of 7 g/dl or less for hospitalized hemodynamically stable adult patients
d. Other specific indications (e.g., chronic transfusion therapy program for Sickle Cell Disease to maintain
HbS below a specific threshold)
RED CELL TRANSFUSION
One unit of bloodmay be sufficient.
Post-transfusion hemoglobin or hematocrit may be measuredas soon as 15 minutes after the completion
of the transfusion
One unit of whole blood/PRBC can increaseHb by 1g/dL in an adult or Hct by 3%
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49. Stored blood less than 7 days old is termed “fresh blood”
Uses ( to avoid biochemical overload) to raise Hb:
- Renal and liver dysfunction.
- Patient requiring massive blood transfusion.
- Patient with raised plasma potassium due to extensive burns, or
Intravascular haemolysis.
- Neonate requiring exchange transfusion
Fresh Blood
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50. Indications
1. Actively bleeding patient
2. Preparation for an invasive procedure
a. Elective central venous catheter placement with a platelet count less than 20,000/mm3
b. Elective diagnostic lumbar puncture with a platelet count less than 50,000/mm3
c. Neurosurgery or ocular surgery with a platelet count less than 100,000/mm3
d. Most other major surgery with a platelet count less than 50,000/mm3
e. Neuraxial anesthesia, including the removal of epidural catheters with a platelet count
of less than 80,000/mm3
f. Percutaneous Liver Biopsy with platelet count of less than 50,000/mm3
Bone marrow suppression resulting in a platelet count of 10,000/mm3 or less
After rapid (within 6-12 hours) transfusion of large amounts of blood or per massive trans
fusion protocol
PLATELET TRANSFUSION
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51. 1. When bleeding is the result of a coagulation factor deficiency, or inhibitor,
anticoagulants, or von Willebrand's factor deficiency
2. When there is no evidence of platelet dysfunction and the platelet range is a
dequate for hemostasis
Contraindications
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52. Thawed Plasma is the same as Thawed Fresh Frozen Plasma except that it should n
ot be used to treat coagulation factor deficiencies of
factor V and factor VIII.
Dose guidelines: 10-15 mL per kg.
One unit of FFP is ~ 300 mLs.
A. Indications
1. Preparation for major bleeding or an urgent invasive procedure
2. Treatment of multiple coagulation factor deficiencies, e.g. liver disease, DIC
3. Massive transfusion protocol
4. Plasma infusion or exchange for thrombotic thrombocytopenic purpura,
other thrombotic microangiopathies, catastrophic antiphopholipid syndrome, and
for managing clotting factor depletion.
5. C1 Esterase Deficiency
Thawed fresh frozen plasma and/or thawed plasma for
transfusion
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53. Contraindications:
1. Prophylactic correction of INR <2 in a non-bleeding stable patient
2. Warfarin reversal without first trying Vitamin K or prothrombin complex concentrates
3. Reversal of anticoagulation induced by heparin, direct thrombin inhibitors or direct factor
Xa inhibitors
4. Volume expansion or colloid replacement
5. Protein source
6. Prophylaxis in multiply transfused patients who do not have a documented coagulation def
ect
Hemostatic factor content of factor V and VIII in a typical fresh frozen plasma unit are shown in
The following table:
Contraindications
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54. Convalescent plasma refers to blood plasma that is collected from
individual who have recovered from an infectious illness that is then
transfused to other patients who are ill with the same disease.
This type of passive antibody therapy has been used in the past to treat
new infectious diseases for which vaccines, monoclonal antibody therapy
or specific drug therapy has not yet been developed or identified
In 2020, this therapeutic modality has been used for patients ill with the
NOVEL coronavirus, SARS-CoV-2/COVID-19
CONVALESCENT PLASMA
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55. Cryoprecipitate is the insoluble protein precipitate that forms when fresh frozen plasma is
thawed at 1-6°C.
Each unit comes from a single donor.
Typically, five cryoprecipitate units are pooled together into a single bag.
Cryoprecipitate is an excellent source of Factor VIII:C (the Factor VIII procoagulant portion),
Factor VIII:vWF (von Willebrand’s factor), fibrinogen, and Factor XIII
Cryoprecipitate is used primarily for fibrinogen replacement and in the manufacturing
of fibrin sealants and glue.
Dosing (for any age)
• One individual unit of cryoprecipitate per 7 kg patient weight to increase fibrinog en by 100
mg/dL
• In an average 70 kg patient, 5 units ( one pool) will increase fibrinogen by about 5 0 mg/dL
CRYOPRECIPITATE TRANSFUSION
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56. Single units
1. Factor VIII: At least 80 IU/cryo unit
2. Fibrinogen: At least 150 mg/cryo unit, average is ~250mg/cryo unit
3. vWF ristocetin cofactor activity: ~170 units/bag
4. Factor XIII: ~60 units/bag
5. Fibronectin
Pools
1. Factor VIII: At least 400 IU/cryo pool
2. Fibrinogen: At least 750 mg/cryo pool, average is ~1250mg/cryo pool
3. vWF ristocetin cofactor activity: ~850 units/pool
4. Factor XIII: ~300 units/pool
5. Fibronectin
Composition:
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57. 1. Plasma Fibrinogen level below 100 mg/dL or dysfunctional fibrinogen and blee
ding or expected bleeding (or between 150-200 mg/dl in obstetric, neurosurgery
or trauma patients)2
2. Dysfunctional platelets – DDAVP (desmopressin) recommended initially
a. Congenital (e.g., platelet storage pool disease)
b. Acquired (e.g., uremia)
3. Factor XIII deficiency and bleeding or expected bleeding and recombinant produc
t or factor concentrate not available
4. Hemophilia A (Factor VIII: C deficiency) and bleeding or expected bleeding an
d recombinant product or factor concentrate not available in the following:
a. Prophylaxis prior to surgery/dental extraction DDAVP is preferred in mild form
(6-30% VIII:C levels)
Indications
any one of the following
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59. Adverse Effects of Transfusion
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60. If an acute transfusion reaction is suspected, stop the
transfusion immediately.
• If the reaction is severe or misidentification is confirmed on checking,
remove the needle.
If the reaction is mild, keep the IV line open with an
infusion of 0.9% sodium chloride.
• The severity of the reaction and the degree of morbidity is usually
related to the volume of blood transfused.
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61. Signs Symptoms Possible cause
Localized cutaneous:
Urticaria
Rash
Pruritus
Hypersensitivity
(mild)
Category 1: Mild reactions
Immediate management of Category 1: Mild reactions
 Slow the transfusion.
 Administer antihistamine IM.
 If no clinical improvement within 30 minutes or if signs and sympto
ms worsen, treat as Category 2.
 If improved, restart transfusion slowly.
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62. Signs Symptoms Possible cause
Flushing
Urticaria
Rigors
Fever
Restlessness
Tachycardia
Anxiety
Pruritus
Palpitations
Mild dyspnoea
Headache
Hypersensitivity
Category 2: Moderately severe reactions
Immediate management of Category 2: Moderately severe reactions
•
Stop the transfusion and keep IV line open with normal saline in another site.
Administer antihistamine IM and oral or rectal antipyretic.
• Avoid aspirin in thrombocytopenic patients.
Give IV corticosteroids and bronchodilators if there are anaphylactoid features (e.g. bro
ncho‐ spasm, stridor)
•
If clinical improvement occurs, restart transfusion slowly with new blood unit and obse
rve carefully.
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63. Signs Symptoms Possible cause
Rigor
Fever
Restlessness
Hypotension (fall of 20% in
systolic BP)
Tachycardia (rise of 20% in
heart rate)
Haemoglobinuria (Hb in urin
e)
Unexplained bleeding (DIC)
Anxiety
Chest pain
Pain along the transfusion line
Respiratory distress/shortness
of breath
Loin/back pain
Headache
Dyspnoea
Acute intravascular haemoly
sis
(mismatched blood transfusi
on)
Bacterial contamination and
septic shock
Fluid overload
Anaphylaxis
Transfusion related acute lun
g
injury (TRALI)
Category 3: Life‐threatening reactions
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64. Adverse reactions of BT
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65. Hemolytic Transfusion Reactions (HTR)
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68. THANK YOU
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