This document provides an overview of blood groups, blood components, and blood transfusion. It defines key terms like blood, blood products, and blood transfusion. It describes the major blood groups like ABO and Rh, and the process of cross-matching. It discusses components of blood like red cells, platelets, fresh frozen plasma, and cryoprecipitate. It covers topics like blood donation, transfusion reactions, and alternatives to transfusion. Overall, the document provides a comprehensive overview of blood and transfusion medicine.

1. Blood groups,Blood
components and Blood
Transfusion
PRESENTER
Dr Bimalesh Kumar Gupta
MS ORL-HNS resident
Bir Hospital ,NAMS

2. Contents
• Background
• Definitions
• Blood groups and cross match process
• Planning for surgery
• Concept of Maximum surgical blood ordering system (MSBOS)
• Blood components
• Blood preservatives
• Blood donation
• Blood transfusions and reactions
• Alternatives to blood transfusion
• Massive blood transfusion
• Jehovah's witness
• References

3. Background
• Human blood replacement therapy was accepted in
late 19th century.
• This was followed by introduction of blood grouping by
Landsteiner who identified the major A,B & O groups in
1900,resulting in widespread use of blood products in
World war 1.
• Levine and Stetson in 1939 followed with the concept
of Rh grouping.
• Whole blood was considered the standard in
transfusion in late 1970s when component therapy
began to take prominence.

4. Definitions
• Blood: Blood is a body fluid that delivers necessary
substances such as nutrients and oxygen to the cells
and transport metabolic waste products away from
those same cells.In vertebrates,it is composed of blood
cells suspended in the blood plasma.
• Blood products: A blood product is any therapeutic
substance prepared from human blood .This includes:
whole blood ,blood components and plasma
derivatives.

5. Definitions continued
• Blood transfusion: The transfer of blood or blood
components from one person ( the donor) into the
blood stream of another person ( the
recipient).Blood Transfusion may be done as a life
saving manoeuvre to replace blood cells or blood
products lost through bleeding or due to
depression of the bone marrow.

6. Blood groups
• More than 300 blood groups with 23 being
clinically significant.
• Most important: ABO and RhD groups ( because of
their association with hemolytic transfusion
reactions and hemolytic disease of new born)

7. Blood groups cont'd.

8. ABO group
• First recognised by Landsteiner in 1901
• Most important blood group system because of the
presence of naturally occurring anti A and anti B
antibodies which develops in first month of life.
• Consists of 3 allelic genes A,B and O.
• Each of these responsible for production of
antigens on the surface of RBC.

9. ABO blood groups
• ABO incompatible transfusions very serious
because anti A and anti B antibodies are IgM
antibodies causing intravascular hemolyis.
• Due to activation of coagulation and cytokines.
• Blood group - O commonest (47%)
• Blood group - AB is rarest (3%)
• Universal donor - O negative
• Universal recipient - AB

10. Rh negative pregnancy
• Rh D negative mother ,developing an antibody as a
result of carrying Rh D positive fetus.
• Antenatal administration of anti D for the
prevention of Rh D immunization in pregnancy and
post partum .
• Imperative rule :All Rh D -ve women of child
bearing age only receive Rh D -ve blood
components.

11. Rh System
• Discovered by Landsteiner and Weiner in 1940.
• RhD +ve (85%)and RhD -ve
• Rh antibodies are IgG antibodies causing
extravascular hemolysis.
• Donot occur naturally but as a result of
sensitisation secondary to transfusion or
pregnancy.

12. Cross matching
• Compatibility testing
• First step : Blood grouping , fast ,takes about 15
minutes
• Second step : Antibody screen( done to identify any
clinically significant red cells antibodies) :takes
about 45 minutes.
• full cross match duration :60 minutes and involves
testing of patient's plasma against a sample of
donor red cells to be transfused.

13. Planning for surgery
• Many operations don't need transfusion of blood.
• Important in elective surgical procedures to
optimise the patient Hemoglobin level prior to
surgery to minimise the need of transfusion.
• If evidence of anemia - should be investigated and
treated preoperatively.( Oral and IV iron
preparations)

14. Maximum surgical blood ordering
system ( MSBOS)
• In surgical procedures ,requiring transfusion
• Agreement between Surgical team and transfusion
laboratory
• Specificied number of units of blood components
,reserved routinely - on basis of evidence based
practice.
• Recommended aim : crossmatched/
transfused=<2:1

15. Blood preservatives
• Ensure the viability and stability of the products
• To inhibit the growth of microorganisms
• To prevent clotting of blood product
• Blood : anticoagulant-preservative solution :1:7 of
the volume of collected blood
• 63 ml for 450 ml collection

16. Blood preservatives cont'd
• Citrate: Calcium chelating agents,prevents
coagulation by interfering with calcium dependent
steps in coagulation cascade.
• Citrate dextrose: dextrose provide nutrient to
redcells
• CPDA-1: improved ATP synthesis ,longer shelf life
(35 days) ,dis adv: uric acid stones
• CPDA-2 : contains more glucose than CPDA-1.

17. Blood preservatives cont'd
• Saline -adenine- glucose- Mannitol (SAG-
M):maintains 83% viability after 35 days of storage
• Mannitol acts as membrane stabiliser and reduces
hemolyis to acceptable levels.
• Platelet additive solution :Tyrode's medium

18. Blood components
• Whole blood composed of number of components.
• Separated during blood processing in transfusion
centers.
• Mainly blood components include Red cells
,platelets and plasma.
• Plasma components include FFP, Cryoprecipitate
and plasma for fractionation ( Albumin,factor
VIII,IX,Ig)

19. Blood components cont'd

20. Whole blood

21. Whole blood
• 450ml of whole blood contains: 450 ml of donor
blood ,63ml anticoagulant preservative solution
• Hb approx. 12g%
• Hematocrit:35-45%
• Unit of issue : referred as UNIT or PACK
• Storage +2 to +6 degree centigrade in approved
blood bank fitted with temperature chart and
alarm

22. Whole blood cont'd
• Transfusion should be started within 30 mins of
removal from refrigerator.
• Administration: Must be ABO and RhD compatible
with the recipient
• Never add medication to a unit of blood
• Complete transfusion within 4 hours of
commencement.

23. Whole blood cont'd
• Indications :
• Red cell replacement in acute blood loss with
hypovolemia
• Exchange transfusion
• Patients needing red cell infusions where red cell
concentrates or suspension not available
• Contraindications:(Risk of volume overload)
• Chronic anemia and incipient cardiac failure

24. Red cell concentrates
• Also called packed red cell or plasma reduced blood
• 150-200 ml red cells from which most of the plasma
removed
• Hb approx (20g/100ml)
• Storage temperature : same as whole blood
• Indications : Replacement of red cells in anemic
patients.
• Use with crystalloid replacement fluids or colloid
solution

25. Red cell concentrates cont'd
• Administration:same as whole blood
• To improve transfusion flow ,normal saline (50-
100ml ) may be added using a Y pattern infusion
set..
• 1 unit of Red cell concentrates elevates the Hb level
by 1 g% and hematocrit by 3%

26. Red cell suspension
• 150-200 ml red cells with minimal residual plasma
to which +/- 100 ml normal saline ,adenine ,glucose
,mannitol solution (SAG-M).
• Hemoglobin:15g/100 ml
• Hematocrit:50%-70%
• Unit of issue : 1 donation (unit or pack)

27. Red cell suspension
• Indications: same as red cell concentrates
• Administration: same as whole blood.

28. Platelet concentrates
• Single donor unit in a volume of 50-60 ml of plasma
should contains at least 55×10^9 platelets .
• Unit of issue: single donor unit and pooled unit.
• Single donor unit : platelets prepared from 1
donation
• Pooled unit: platelets prepared from 4 to 6 donor
units 'pooled' into 1 pack to contain an adult dose
of at least 250×10^9 platelets

29. Platelets concentrates

30. Platelets concentrates cont'd
• Storage : upto 72 hours at 20 - 24 degree
centigrade ( with agitation)
• Longer storage increases the risk of bacterial
proliferation and septicemia in the recipient.
• Indications : Treatment of bleeding due to
thrombocytopenia and platelets function defects.
• Also prevention of bleeding due to
thrombocytopenia in case of bone marrow failure

31. Platelet concentrates cont'd
• Dosage : 1 unit of platelet concentrates/ 10 kg body
weight
• In a 60 kg adult ,4-6 single donor units containing at
least 240×10^9 platelets should raise the platelet
count by 20-40 ×10^9/.
• Administration:as soon as possible..within 4 hours
...risk of bacterial proliferation
• 4-6 units of platelet concentrates should be infused
through a fresh standard blood administration set.

32. Platelet concentrates cont'd
• Complications :Febrile non hemolytic and allergic
urticarial reactions
• Especially in patients receiving multiple
transfusions.

33. Fresh Frozen plasma
• Derived from whole blood through centrifugation.
• Rich in coagulation factors.
• must be ABO compatible because of presence of
anti A and anti B in the plasma.
• Indications: Coagulation factor deficiency
• Coagulopathy associated with liver disease,massive
hemorrhage and DIC.

34. FFP cont'd
• Usual dose :12-15 ml/ kg
• Response of FFP monitored by measuring the
patient's PT and aPTT..
• FFP frozen at -25 degrees to maintain the activity of
Coagulation factors and can be stored for 36 months.
• When requested ,it must be thawed ( takes about 30
mins)
• Once thawed can be stored at 4 degrees for 24 hours.

35. Solvent detergent plasma
• Prepared from more than 1000 donation pools of
plasma.
• Undergoes pathogenic inactivation including
bacteria and viruses such as Hep B and Hep C and
HIV.
• As it is pooled ,the concentration of coagulation
factors is more standardized.
• Recommended for TTP.

36. Cryoprecipitate
• Made from thawing FFP at 4degree centigrade.
• Rich in fibrinogen,factor VIII and Von willebrand
factor .
• Used as a source of fibrinogen especially in massive
hemorrhage where fibrinogen concentration less
than 1.5 g /L.
• Recommended dose : 2 pools of 5 units( 1 unit per
5-10 kg body weight .

37. Cryoprecipitate cont'd
• Stored at -25 degree centigrade .
• Shelf life of 36 months .
• Once thawed ,it must be used within 4 hours.

38. Anticipated blood loss(ABL)
• Calculated by simple mathematical equation
• ABL={EBV×(Hi- Hf) }/Hi
• Where EBV - estimated blood volume
• Hi- initial hemoglobin
• Hf- final Hemoglobin

39. Estimated blood volume
• Premature neonates - 95ml/kg
• Full term neonates- 85ml / kg
• Infants- 80 ml/kg
• Adult men - 75 ml / kg
• Adult women - 65 ml / kg

40. Blood transfusion cont'd

41. Blood donation
• Extensive screening of altruistic,unpaid volunteers has
been a major factor in the provision of safe blood .
• Criteria for blood donation:
• Age:17-65 years
• Weight:50 kg ( minimum)
• Male donors : can donate 4 times a year (Hb level
13.5g%)
• Female donors: can donate 3 times a year ( Hb level
12.5 g%)

42. Blood donation criteria
• Donor must be in a sound health condition.
• Shouldn't have cold,flu,sore throat,cold sore,stomach
bug or any other infection.
• If done tattoo or piercing ,can't donate blood for at
least 6 months.
• If any minor dental procedure ,wait for 24 hours
• Major dental procedure ,wait for a month.
• Travel history ( endemic mosquito borne infections)
• At risk sexual activity ( within past 12 months ):
deferred.

43. Blood donation criteria cont'd
• Deferred permanently :positive test for HIV ,have ever
injected recreational drugs .
• Donor with acute infection should not donate .
• However ,if antibiotics course completedfor viral and
bacterial infection ,can donate.
• Aspirin users ,can donate whole blood but not platelets
concentrates .
• Blood pressure( upper limit 180/100mm Hg can donate).
• Pregnancy ( wait for 6 weeks post partum to donate)

44. Procedure of blood donation
• Throrough cleaning of the skin at the needle entry point .
• A large bore needle (16G ) used for puncturing the vein .
• Blood is collected into a sterile bag containing
anticoagulant and preservative.
• Labelling of donor details.
• Transportation to a blood center for processing purpose.
• Whole blood is filtered and then separated into its blood
components.

45. Advantages of filteration
• Eliminates leucocytes,which are associated with several
complications of transfusion.
• For example: Febrile non hemolytic transfusion
reactions ,HLA alloimmunisation and transmission of
cytomegalovirus .
• Leucocyte depletion was introduced as a variant
Creutzfeldt- Jakob disease(vCJD) risk reduction measure
.
• From each unit of blood donated ,red cells ,
platelets,fresh frozen plasma and cryoprecipitate can
be obtained

46. Screening for infectious agents

47. Blood transfusion
• Process of transferring blood or blood products into
one's circulation intravenously.
• Used for various medical/ surgical conditions to
replace lost components of the blood.
• Involves several steps like ensuring the quality of
blood products, compatibility and safety to the
recipient.

48. Indications of blood transfusion

49. Transfusion trigger and
Transfusion target
• Transfusion trigger :Means the value of hemoglobin
below which the blood transfusion is indicated.
• Transfusion target : Means the value of hemoglobin
achieved after the red cell transfusion.
• Rule of 10/30: achieve Hb level of 10g/dL and
hematocrit 30%.

50. Transfusion reactions
• All transfusion associated reactions / errors- should
be reported to transfusion labs/ hospital
transfusion committee.
• Then they report to national haemovigilance
scheme ,SHOT( serious hazards of transfusion).
• Transfusion monitoring : before transfusion,after 15
mins and end of transfusion.

52. Acute transfusion reactions
• Present within 24 hours of transfusion.
• Categorised into severe and less severe .
• Severe: Immediate hemolytic transfusion
reaction,Bacterial contamination,
Anaphylaxis,TRALI,TACO
• Less severe:FNHTR,Mild allergic reaction

53. Delayed Transfusion Reactions
• Delayed hemolytic transfusion reaction
• Post transfusion purpura
• Transfusion associated graft verses host disease.

54. Immediate hemolytic transfusion
reaction(IHTR)
• Most severe transfusion reaction.
• Acute hemolyis secondary to destruction of donor
RBC by IgM complement fixing antibodies present
in the recipient serum,usually antiA and /or antibB.
• Antibodies- causes rapid intravascular destruction
of donor RBC

55. IHTR cont'd
• Can also result in activation of coagulation and
release of cytokines- causes renal failure and DIC.
• Features: pain at infusion site,chest and back pain,
hypotension and hemoglobinuria.
• Mortality : can be as high as 10%.

56. Bacterial contamination
• Rare but may be fatal
• Patient becomes acutely unwell ,pyrexial,
hypotensive and may develop septic shock.
• Check for appearance of contents of transfused
components- clots or purple discoloration of red
cells, platelets may have clumped or green
discoloration.

57. Bacterial contamination contd
• Blood cultures: should be taken immediately and
patient commenced on broad spectrum antibiotics.
• Components: returned to the transfusion
laboratory for microbiological testing and informed
about possible contamination.

58. Transfusion associated acute lung
injury ( TRALI)
• Typically occurs after transfusion of platelets or FFP.
• Commonest cause of severe morbidity and
mortality after transfusion.
• Due to anti leucocyte antibodies in donor plasma
reacting with recipient's neutrophils, monocytes
and pulmonary endothelium.

59. TRALI cont'd
• Severe hypoxia- may develop immediately or latest
within 6 hours of transfusion
• Associated with hypotension and bilateral lung
infilterates.
• Treatment: high flow oxygen and ventilator support
( if required)

60. Transfusion associated circulatory
overload(TACO)
• Common in older patients and those with history of
cardiac disease.
• Defined as acute or worsening pulmonary edema
within 6 hours of transfusion.
• Features: dyspnoea, tachycardia,
hypertension,positive fluid balance

61. TACO cont'd
• Treatment:stopping transfusion, administering
oxygen and diuretics..
• Can be avoided by careful assessment of risk
factors and appropriate measures like
coadministration of diuretics and single unit
transfusion in frail adults.

62. Febrile non hemolytic transfusion
reactions ( FNHTR)
• Very common transfusion reaction.
• Associated with the recipient's anti leucocytes
antibodies.
• It's incidence has been reduced since the
implementation of lecocyte reduction blood
components.

63. FNHTR cont'd
• Features: pyrexia accompanied by rigours,nausea
and muscle pain
• Managed by Paracetamol and slowing of
transfusion ( mild-temp 38 degrees )@and
discontinuation of transfusion( if temp more than
39 degrees)

64. Mild allergic reaction
• Urticarial reactions to donor plasma proteins can
be treated by slowing of transfusion and
administration of antihistamines.
• If repeated reactions occur and donot respond to
antihistamines- washed red cells or platelets
transfusion ( washed in saline to remove plasma
proteins)should be given .

65. Delayed hemolytic transfusion
reaction(DHTR)
• Occurs in those who had previously transfused or
have a previous pregnancy and result from
alloantibodies eg Rh,k cell,Duffy
•
• Reexposure to antigen results in secondary immune
response ( IgG)and consequently extravascular
hemolyis of transfused red cells,usually a few days
after the transfusion.

66. DHTR cont'd
• Features : jaundice , hemoglobinuria,fever and
fatigue.
• Investigation: Hb drop,positive DCT,and elevated
bilirubin.
• Renal failure may also be a feature

67. Post transfusion purpura
• Severe thrombocytopenia ( <10×10^9/L, 7-12 days
post transfusion.
• Severe bleeding .
• Usually occurs in previously pregnant or transfused
females who are HPA-1a antigen negative and who
develop high levels of HPA- 1a after transfusion.
• Treatment- high dose IV Ig.

68. Transfuy associated graft verses host
disease (TA- GVHD)
• Rare but fatal complications
• Caused by donor lymphocytes engrafting in the
recipient and mounting an immune response
against the Transfusion recipient.
• Features: fever ,rash , diarrhoea,jaundice and BM
failure ,can occur upto 30 days post Transfusion.

69. TA-GVHD cont'd
• Immunocompromised patient at risk like inherited
immunodeficiency,HIV , recipient of chemotherapy
like fludarabine and post BM transplant.
• Important to identy and provide gamma irradiated
blood compy for prevention of TA- GVHD.

70. Alternatives to blood transfusion
• Multidisciplinary approach
• "Patient's blood management" concept
• Preoperative anemia management ( Iron therapy
and treat the underlying cause before surgery)

71. Approach to the management of
acute Transfusion reaction

72. Acute normovolemic
hemodilution
• Blood is removed immediately prior to surgery
,often post anesthesia and returned post
operatively of if significant bleeding occurs .
• Patient's blood volume maintained by
administration of crystalloid or colloid fluids .

73. Cell salvage
• Can be used intraoperative or post operatively.
• Intraoperative- blood lost during surgery ,aspirated
in to a collection resorvoir and filtered to remove
any debris.
• Treated with heparin to prevent clotting
• Collected blood is centrifuged ,washed and
reinfused via leuco reduction filter in a closed and
automated system within 4 hours

74. Post operative cell salvage
• Blood is collected from wound drains and filtered
or washed before it is reinfused via a closed
automated system.

75. Tissue sealants
• Biological agents derived from human or animal
clotting products such as thrombi,fibrinogen ,and
calcium
• Directly applied to the bleeding point and fibrin clot
occurs
• Commonly used in accidents and ED.

76. Tranexamic acid
• Antifibrinolytic drug
• Inhibits the conversion of plasminogen to plasmin
,hence hinders fibrinolysis.
• Inexpensive ,given orally ,IV,also topically ,mouth
was preparation for any minor oral cavity bleeds .

77. Massive blood transfusion (MBT)

78. Indications of massive blood
transfusion
• Polytrauma
• Major surgeries
• Gastrointestinal bleeds
• Obstetrics hemorrhage

79. Complications of massive blood
transfusion
• Immediate and delayed
• Immediate : problems secondary to volume
resuscitation ( inadequate or overzealous )
• Dilutional problems( dilutional coagulopathy and
interstitial edema)
• Problems related to Transfusion of large volume of
stored blood( citrate toxicity, hyperkalemia,
hypothermia, hypomagnesemia,acidosis)

80. Late complications of MBT
• Respiratory failure( TRALI)
• SIRS
• Sepsis
• Thrombotic complications

81. Jehovah's witness
Donot accept red cell Transfusion ..religious beliefs/
doctrines.
However ,these days most of JW's accept cell
salvaged blood provided the blood is returned to
them without the break in the circuit .

82. References
• Scott Brown's Otorhinolaryngology and Head and
Neck surgery,8th edition
• https://www.who.int/bloodsafety/transfusion_serv
ices/ClinicalTransfusionPracticeGuidelines
• https://www.ncbi.nlm.nih.gov/books/NBK499824/
• Harrison's principles of internal medicine,20th
edition

83. • "Female give life by giving birth and The Male can
also give a life by donating blood"
• THANK YOU !!!