Blood transfusion

BLOOD TRANSFUSION
Presenter – Dr. Pranjal S Jain

CONTENTS
 Introduction
 Blood
 Types
 Blood products
 Administration
 Complication
 Summary
 Conclusion
 Discussion
5/17/2021 BLOOD TRANSFUSION 2

INTRODUCTION
Blood transfusion is the procedure of transferring blood or
blood components from one person into the blood stream of
another person. Transfusion is life saving procedure to replace
blood cells or blood products lost through bleeding or some
other reasons.
Blood transfusion is a routine medical procedure . In these
procedure two phases are important first one is collection of
blood from donor and second is administration of blood to the
recipient.

History
William Harvey's in 1628 discovered the blood circulates
through the body in one direction. By the end of 17th century,
physicians using quills as needles and silver pipes to transfer
blood from donor to recipient, but the donor usually animal.
James Blundell started using human blood to replace blood lost
in the early 1800s. Physicians Karl Landsteiner set out to figure
out why some blood transfusion patients lived and others died, a
line of inquiry that led him to discover the ABO blood type
groups in 1901. it was Landsteiner ground-breaking work that
helped classify blood into one of four categories ( A, B, AB and
O)

Blood
 Blood is a connective tissue in fluid form.
 It is also called “fluid of life, fluid of growth, fluid of health”.
 Properties :-
1. colour:- Red
2.Volume:- Average 5lit, in new born it is 4.5lit
3.Reaction and pH:- Slightly alkaline and pH 7.4
4.Specific gravity:- 1.052 to 1.061
5.Viscocity:- 5 times more viscous than water

Types of blood transfusion
1. Allogeneic blood transfusion
2. Autogenic blood transfusion
3. Exchange blood transfusion

Allogeneic blood transfusion
Allogeneic transfusion occurs when a donor and recipient are
not the same person.
Indication:-
Both elective and emergency situations.
Advantages:-
Can be life saving when your own blood is not available.
Disadvantages:-
There is a risk of disease transmission , allergic reaction.

Autogenic blood transfusion
Reinfusion of patient΄s own blood or blood components.
Types-
1. Pre-deposit:- 2 - 5 units of blood may be donated over 2 – 3
weeks before surgery.
2. Pre-operative haemodilution :- Just before surgery, 1-2 units
of blood are removed (orthopaedic surgery, plastic surgery)
3. Blood salvage :- Blood lost during surgery is collected, mixed
with anticoagulant solution, washed and re-infused.

Cont.…
Advantages:-
All risks involved in blood transfusion are avoided.
Disadvantages:-
May not acceptable to patient.

Exchange blood transfusion
 It is the procedure which involves removal of patients blood
completely and replacement with fresh blood or plasma of
the donor.
 It is also known as replacement transfusion.
 It is the life saving procedure carried out in conditions such as
severe jaundice, sickle cell anaemia, erythroblastosis fetalis
etc.

BLOOD PRODUCTS
Red cells Fresh frozen plasma Albumin
Platelets Cryoprecipitate Immunoglobulin
Coagulation factors
BLOOD
Cellular components Plasma components Plasma derivatives

Red cells Plasma FFP Cryoprecipitate

WHOLE BLOOD
 Whole blood provides both oxygen carrying capacity and
volume expansion.
 Whole blood stored at 4⁰C.
 It is the ideal component for patients who have sustained
acute haemorrhage of 25%
 Whole blood is not readily available since it is routinely
processed into components.
 Dose:- 10 ml/ kg body weight

PACKED RED BLOOD CELLS
 Each bag of packed cells contains approximately 250-300ml
with red cells concentration of 70%
 Indication:-
Hb 7% Trauma Delivery
Chemotherapy Sickle cell anaemia
 Each cell of packed cells increase haemoglobin by 1% and
haematocrit by 3%
 Dose:- 10 ml/ kg body weight

PLATELETS
 Each unit (50ml) should contain at least 5.5 × 10 ⁱ⁰ platelet
and each unit should elevate platelet count by 5 - 10,000
cells/ cu mm ( 20-40 × 10⁹/ L.) in a 70kg person.
 Platelets may be transfused prophylactically or for
therapeutic purposes.
 prophylactically platelet transfusion:-
Platelet count is < 10,000 cells/cu mm in oncology patient
Platelet count is < 5000 cells/ cu mm in leukaemia

 Platelets are usually given to the patient with
Thrombocytopenia or those with platelet dysfunction who are
bleeding or undergoing surgery and in patients with bone
marrow failure.
 Platelets must be transfused within 4hrs of commencement
of the infusion.

FRESH FROZEN PLASMA
 Plasma (150-300ml) stored in frozen form at 18 ͦC for 1yr
 It contains coagulation factor, plasma protein, antithrombin
 FFP must be transfused as soon as possible after thawing and
definitely within 24 hrs of thawing.
 A hanging unit must be transfused within 6hrs of
commencement of transfusion.
 Indication:- Actively bleeding
To correct coagulation factor deficiencies
Thrombotic thrombocytopenic purpura.
 Dose :- 10-20 ml/ kg weight

CRYOPRECIPITATE
 The FFP may be further treated to produce cryoprecipitate.
 Cryoprecipitate is a source of fibrinogen, factor VΙΙΙ and von
Willebrand factor.
 Indication:- Replcement of fibrinogen
Von Willebrand diseases
Haemophilia
 Dose :- 0.2 units/ kg body weight but usually 10 unit
 10 – 20ml contains Fibrinogen 150-300mg, factor VII & Von
Willebrand factor 80-120 U

PLASMA DERIVATIVES
Plasma may be pooled to derive specific protein concentrates
including albumin, immunoglobulin, coagulation factor
1.Albumin :- This is commonly prepared as 5% albumin and
20% albumin. Its stored at 2 ͦC to 25 ͦC
Indication :-
hypovolemic shock , burns
2.Immunoglobulin:- It is a concentrate of IgG fraction of
human plasma.
It is available as intramuscular grade and intravenous grade.

a)Intramuscular immunoglobulin :- prophylaxis for viral
infections like hepatitis A and measles.
b)Intravenous immunoglobulin :- Antibody deficiency
syndrome, recurrent infection, thrombocytopenic purpura.
3. Coagulation factors :- factors IX, X, VII
It is storage at 4 ͦC to 8 ͦC
Indication:-
Haemophilia A, B

NEED OF TRANSFUSION
Transfusion is needed in both elective and emergency condition
some of _
1. Anemia
2. Trauma
3. Hemorrhage
4. Surgery
5. Leukemia
6. Malaria
7. Dengue

Selection of donor
 Age :- Min:- 17 yr
 Body weight – 50 kg
 Hb:- MIN – 12 gm/dl
 Frequency :- Min 12 wks.
 No recent history of jaundice, malaria, typhoid
 Absence of hypertension, tuberculosis, diabetes and allergy.
 Donors on medication are not accepted for blood donation.

During donation:-
 Blood should not be collected empty stomach or should not
be dehydrated.
 Following donation donor should be offered sweetened drink
and asked to take a rest at least 1-2 hrs.
 Check the vital signs frequently before leaving the centre and
also observed for any giddiness, colour changes.

Storage of blood
 Donor΄s blood is collected in sterile container containing
anticoagulant solution.
 All the articles used for collection of blood must be sterile.
 All blood for transfusion must be stored in special blood bank
refrigerators controlled at 4 ͦC +/- 2 ͦC
 Blood kept at higher temperatures for more han 2hrs is in
danger of transmitting infection.
 Each donor unit should be labelled as –Name, date, time, ABO
grouping, Rh type, Date of drawing, Date of expiry, result for
test (hepatitis, syphilis).

Screening for infectious agents
 At each donation, the following mandatory tests are
performed
 Hepatitis B – HBsAg and Hepatitis C – anti HCV
 HIV – anti HIV 1 and 2
 Human T- cell lymph tropic virus
 Syphilis

Equipment
1. Blood unit
2. Blood unit administration set
3. Three way stopcock
4. Multi lead tubing
5. Pressure bag
6. Vital signs material
7. Gauze, syringe

Pre procedure
1. Take a consent.
2. Before a blood transfusion a technician tests your blood
type you have.
3. A 5ml blood sample should be collected into dry test tube
and then correctly and clearly labelled with patient details
and submitted to blood centre for testing.
4. Inform blood bank for product availability.
5. Fill up blood requisition form
6. Check blood pressure, pulse, temperature.
7. Check blood bag.

BLOOD GROUPS AND CROSS MATCHING
Blood groups Give blood to Receive blood from
A+ A+, AB+ A+, A-, O+,O-
B+ B+, AB+ B+, B-, O+, O-
AB+ AB+ EVERYONE
O+ O+, A+, B+, AB+ O+, O-
A- A+, A-, AB+, AB- A-, O-
B- B+, B-, AB+, AB- B-, O-
AB- AB+, AB- AB-, A-, B-, O-
0- EVERYONE O-

During transfusion
1. Before starting transfusion, it is vital to make the final
identity check.
2. The blood products should be commenced within 30min of
removal from the optimal storage conditions.
3. A needle is used to insert an intravenous line into one of
your blood vessels.
4. The procedure usually takes 1 to 4 hours.

5. For each unit of blood transfusion, monitor the patient
1. before starting the transfusion
2. 15 min after starting transfusion
3. at least every hour during transfusion
6. No medications or other additives should be given the same IV
route or should not be mixed with blood.
7. Watch for any complication throughout the procedure.

Duration time for transfusion
Blood product Start transfusion Complete transfusion
Whole blood /
PRBC
Within 30minutes of
removing from
refrigerator
4 hours (discard unit if these
period extended
Platelet
concentrate
Immediately Within 30 minutes
FFP As soon as possible after
thawing
Within 30 minutes
Cryoprecipitate As soon as possible Within 30 minutes

After transfusion
1. After blood transfusion your vital signs are
checked(temperature, blood pressure, heart rate)
2. The intravenous line is taken out.
3. May develop some bruising or soreness at the site of
insertion
4. May need blood tests that shows how your body is reacting
to transfusion.

ADVERSE REACTION
1.) Immune-mediated reactions
a.) Haemolytic reaction
b.) Non haemolytic reaction
2.) Nonimmunologic reactions
3.)Infectious complications
4.)Plasma protein reaction
5.)Massive blood transfusion complication
6.)Other complication
7.)Complication due to faulty technique

Sr.
no
Types Causes Symptoms Treatment
1. Major incomtibility
reaction
This is result of
mismatched blood
transfusion
Occurs due to
intravascular
haemolysis
1.Haematuria
2.Bilateral pain in
loins
3.Fever with chills
and rigors
4.Oliguria
1.Stop blood
2.Repeat
coagulation profile
3.IV fluids, Monitor
urine output
4.Furosemide 20-
40mg IV or
injection mannitol
20% 100ml IV
2. Minor incomtibility
reaction
Occurs due to
extravascular
haemolysis
Usually mild,
occurs at 2-21days
1.Malasia
2.Jaundice
3.Fever
Treatment is
supportive
Immune mediated reaction
1. Haemolytic complication
5/17/2021
BLOOD TRANSFUSION 35

2. Nonhaemolytic reaction
Sr.no Types Causes Treatment
1. Febrile reaction Due to sensitisation to WBCs or
platelets
20-40mm filter or
leucocyte deplete blood
2. Allergic reaction Allergy to plasma products Chlorpheneramine
malate 10mg IV
3. Transfusion related acute
lung injury
- Rare complication
- Occurs within 6hrs of
complication
- Symptoms is Mild dyspnoea
Acute respiratory distress
syndrome
Supportive therapy
5/17/2021 BLOOD TRANSFUSION
36

Sr. no Types Symptoms Treatment
4. Anaphylactic reaction Difficulty in breathing,
coughing, vomiting,
hypotension, loss of
consciousness, respiratory
distress, shock
1. Stopping transfusion
2. Administration of
adrenaline and
glucocorticoids.
5. Congestive cardiac failure Whole blood transfused
rapidly in patients with
chronic anaemia
-Slow transfusion
-Inj Furosemide 20mg IV
-Packed cell
transfusion(choice)

Infectious complication
1. Viral :- Hepatitis A, B, C, Retroviruses HIV -1, HIV – 2, HTLV –
1, HTLV- 2, herpes viruses,
2. Bacterial :- Salmonella, M. leprae, yersinia entercolitica
3. Spirochetal :- Syphilis
4. Parasitic :- Malaria, toxoplasma gondii
5. If incidence increases in case of multiple transfusion and in
emergency situations.
6. So, it is mandatory to screen the blood before transfusion.

Plasma protein reaction
1. Urticaria
2. Anaphylaxis (IgA deficiency in the recipient )

Massive blood transfusion complication
 Massive transfusion is the transfusion of blood equivalent or
more than the patient΄s own blood volume.
 Replacement of > 500ml over 5min
> ½ the patient΄s blood volume in 6hrs
> whole blood volume in 24hrs
 Massive blood loss may occur with trauma, PPH or during
major surgeries.

Cont.…
It leads to -
1. Circulatory shock
2. Hyperkalaemia
3. Hypocalcaemia

OTHER COMPLICATION
1.Hypothermia
2. Electrolyte Toxicity
a. Hyperkalaemia
b. Hypocalcaemia
3. Hemosiderosis (iron overloaded)
4. Hypotensive reaction

Complication due to faulty techniques
1. Thrombophlebitis ( inflammation of vein, associated with
formation of thrombus).
2. Infiltration and hematoma at the site of needle
3. Air embolism ( obstruction of blood vessel due to entrance
of air into the bloodstream )

Acute complication
1. Febrile non – haemolytic reactions
2. Allergic reactions
3. Septicaemia
4. Transfusion related acute lung injury
5. Hypothermia
6. Volume overload

Delayed complication
1. Transfusion associated Graft versus host disease.
2. Post transfusion Purpura
3. Hypokalaemia
4. Hepatitis
5. HIV
6. Syphilis
7. Malaria

Ayurvedic aspect
 According to Ayurvedic classical principle,
xÉuÉïSÉ xÉuÉï pÉÉuÉlÉÉ xÉÉqÉÉlrÉ uÉÚÎkSMüÉUhÉÇ..... Ι
U£Çü U£åülÉ.....Ι
Similarity of all substances is always the cause of increase,
Similarity brings unity, Similarity proposes similar purpose or
action.
 Whenever there is excessive loss of blood from body
raktabasti should be administrated.
U£åüU£åülÉSåÌiÉ xÉU£åüSÌiÉxÉÉrÉïqÉÉhÉå U£üoÉÎxiÉSåïrÉ: Ι

DISCUSSION
 Blood is a precious gift given by a donor.
 Blood donation is a easy and safe process. Depending upon
your height, weight you can give upto 2 units of blood
 Whenever there is a need of blood transfusion various blood
products are available.
 During blood transfusion various complication occurs so first
step is stop blood immediately and check vitals, observe urine
output and gives supportive treatment as per complication
occurs.

CONCLUSION
 Blood is a essential substance present in our body.
 Whenever there is a loss of blood due to any reason, blood
transfusion therapy is effective.
 Blood transfusion only done when there is necessary of
transfusion.
 Cross matching of blood is an mandatory process before
transfusion.
 Early transfusions used whole blood but modern medical
practice commonly used components of blood.
 Transfusion reaction should be identified and treated
immediately.

Blood transfusion

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