The presentation highlighted the principles of blood transfusion in surgical practice. It started with the historical perspective of blood transfusion and the physiology of blood. It then discusses the types of blood products, blood transfusions, and blood administration. Finally, it discusses the immediate and delayed complications of blood transfusions and blood substitutes.

1. Blood and Blood
Transfusion in Surgery
Dr Adewunmi Olayinka Lukman
Plastic Surgery Unit
UMTH

2. Outline
• Introduction
• Physiology of blood
• Blood transfusion
• Historical perspective
• Types of Blood products
• Types of Blood Transfusion
• Principles of Blood Transfusion
• Blood transfusion reaction
• Conclusion

3. Introduction
• Blood is a liquid connective tissue
• Blood is pump by the heart and carried in the blood vessels to the
body systems

4. Introduction
• Blood components
Cells – Bone marrow
Plasma – Liver, GIT, etc
• Cells
Erythrocytes
Leucocytes
Platelets

5. Introduction
• Plasma contained
Proteins – Albumins, globulin, ceruloplasmin
clotting profile
glucose, amino acids, minerals, fatty acids
etc

6. Blood Transfusion
• Blood transfusion is the process of transferring blood or blood-based
products from one person into the circulatory system of another or
same person.
• This is usually done as a lifesaving maneuver to replace blood cells or
blood product lost during surgery or other form of loss

7. History of blood transfusion
• 1492 – Pope Innocent VIII was made to drink blood from 10 yrs old
boys
• 1665 – Richard lower in Oxford conducted the first successful canine
transfusion
• 1667 – Jean-Baptiste Denis reports successful sheep-human
transfusion
• 1829 – James Blundell performs the first successful documented
human-human transfusion in a woman with post-partum hemorrhage

8. History of blood Transfusion
• 1900 – Karl Landsteiner discovers the ABO system
• 1914 – Belgian physician Albert Hustin performs the first non-direct
transfusion, using sodium citrate as an anti-coagulant
• 1926 – The British Red Cross institutes the first blood transfusion
service in the world
• 1939 – The Rhesus system is identified and recognized as the major
cause of transfusion reactions

9. Blood products
Whole blood
Packed cell
Fresh frozen plasma
Platelets concentrate
Factor VIII concentrate
Cryoprecipitate
Albumin protein

10. Blood products
• Whole blood – contained all component of blood
Acute blood loss(Hb<8g/dl) with symptoms/signs of blood loss
Tachycardia >100
Systolic BP < 30mmHg of normal
Diastolic BP > 60mmHg
Oliguria/Anuria
Mental state changes
Anticipated blood loss > 15%

11. Blood products
• Whole blood
Hemoglobin <10 g/dl in patients with known increased risk of
coronary artery disease or pulmonary insufficiency who
have sustained or are expected to sustain significant blood
loss

12. Blood products
• Packed red cell
Chronic anaemia – Malaria, SCD, etc

13. Blood products
• Fresh Frozen Plasma
• Coagulation factor deficiency with abnormal prothrombin time and/or
activated partial thromboplastin time
• Acquired deficiency related to
warfarin therapy
vitamin K deficiency
liver disease
massive transfusion
disseminated intravascular coagulation
• Also indicated as prophylaxis for the above if a surgical/invasive procedure
is planned

14. Blood products
• Platelet concentrate
• Recent (within 24 hours) platelet count <100,000/mm3 (for
prophylaxis)
• Recent (within 24 hours) platelet count <50,000/mm3 (microvascular
bleeding (“oozing”) or a planned surgical/invasive procedure
• Adult patients in the operating room who have had complicated
procedures or have required more than 10 units of blood and have
microvascular bleeding

15. Blood products
• Cryoprecipitate
• Thaw FFP at 4°C
• Contained Factor VIII, VWF, Fibrinogen, factor XIII and fibronectin
• Indications
Haemophilia
Von Willebrand disease
Afibrinogenamia
Massive transfusion

16. Principles of Blood Transfusion
• Indication
• Obtain informed consent
• Pre transfusion GXM
• Use of required component of blood
• Use group specific
• Pre transfusion vital signs
• Double checking of patient’s data
• Warm blood before commencement
• Avoid top-up transfusion

17. Types of blood transfusion
• Homologous/donor blood
• Autologous
Pre-op blood donation
Isovolemic Hemodilution
Intra-op blood salvage
post-op blood salvage

19. Complications of Blood transfusion
• Immediate
Febrile non-hemolytic transfusion reaction
Acute hemolytic transfusion reaction
Allergic/anaphylactic reaction
Bacteria contamination
Delayed hemolytic reaction
Transfusion associated acute lung injury (TRALI)

20. Complications of Blood transfusion
• Late
Delayed hemolytic reaction
Thrombophlebitis
Post transfusion thrombocytopenic purpura
Transfusion of infection/disease
Iron overload
Immunosuppression

21. Blood substitute
• No known substitute for blood at the moment
• Volume expanders
Crystalloids
Colloids
Synthetic gelatin colloids( hemaccel, gelofusine)
Hydroxyethyl starch preparations( hetastarch, pentastarch)

22. Blood substitute
• Oxygen-carrying blood substitute
Haemoglobin-based oxygen carriers (HBOC)
Perfluorocarbon-based oxygen carriers(PFBOC)

24. Conclusion
• Blood transfusion remains an invaluable therapeutic measure, but
utmost precautions must be taken to avoid the possible
complications.

25. •THANK YOU FOR
YOUR ATTENTION