Dr. Ibrahim Taha Barzinji defines blood transfusion as the transfer of blood or blood components from a donor to a recipient. There are different types of blood transfusions including fresh blood transfusion, autologous transfusion, massive transfusion, and multiple transfusion. Blood can be separated into components including packed red blood cells, platelets, plasma, and cryoprecipitate. Proper pre-transfusion testing including blood typing and screening for diseases is important. Adverse effects of transfusion can be immune-mediated like hemolysis or non-immune mediated like bacterial contamination. Causes of transfusion reactions include clerical errors, technical errors, and contamination.

1. Blood Transfusion
Dr. Ibrahim Taha Barzinji
S.H.O. maxillofacial surgery

2. definition
Transfer of blood or blood components from one person
(donor) into another person (recipient)

3. TYPES OF BLOOD TRANSFUSION
 FRESH BLOOD TRANSFUSION
Blood less than 24 hours old from the time of collection
 AUTOLOGOUS TRANSFUSION
Blood collected from a patient for re-transfusion at a later time into the same individual
 MASSIVE TRANSFUSION
Number of units transfused in a 24 hours period exceeds the recipient’s blood volume
 MULTIPLE TRANSFUSION
Repeated transfusion of blood over a long period of time (months or year)

4. Indication of blood transfusion
 Many times, blood transfusion might not be without hazards, so the risk should be
weighed out against benefit.
 The dictum is - TO USE BLOOD PRODUCTS ONLY WHEN NO OTHER ALTERNATIVE IS
LEFT

5. BLOOD COMPONENTS
 Blood is centrifuged to separate the components

6. Types of blood component transfusion
1- Whole blood transfusion:
 A person may receive a whole blood transfusion if they have experienced a severe
traumatic hemorrhage and require red blood cells, white blood cells, and
platelets.
 No component has been removed
 Can be stored for up to 5 weeks
 Platelets, factor v and factor viii are greatly reduced due to storage
 Indicated when blood loss is more than 15% or after heavy RTA or gunshot
 Now almost not used

7. 2- packed Red blood cell transfusions
 Has Hematocrit up to 75%
 Transfusion of RBCs should be based on the patient's clinical condition.
 Indicated to treat anemia (e.g. thalasemia and sickle cell anemia) and blood loss
greater than 1,500 mL or 30 percent of blood volume or Hgb = 7 g/dl
 Reduced 2,3 DPG
 Frozen RBCs have better properties but not available at emergency situations

8. 3- Platelet transfusions:
 A platelet transfusion can help those who have lower platelet counts, such as
from chemotherapy or platelet function defects.
 Stored for up to 5 days at room temperature
 Recently concerns have increased about zika virus in platelet transfusion
 Platelet transfusion is indicated in major surgery usually at less than or equal to
50k per ml

9. 4- Plasma transfusions:
 Plasma contains all of the coagulation factors.
 stored at 1 to 6°C for up to five days
 Also Indicated for coagulopathic disorders
 It is the only source of factor V
 can be used for reversal of anticoagulant effects
 Or in a patient of 1.6 INR and undergoing major surgery

10. 5- cryoprecipitate
 Cryoprecipitate is prepared by thawing fresh frozen plasma and collecting the
precipitate.
 Cryoprecipitate contains high concentrations of factor VIII and fibrinogen.
 used in cases of hypofibrinogenemia,

11. PRE-TRANSFUSION TESTING
 ABO and Rh (D) blood grouping :
 Patient’s and donor’s blood sample
 Cross matching of blood sample:
 Major cross match- Pt’s serum + Donor cells
 Minor cross match- pt’s cells + Donor serum

13. PRE-TRANSFUSION TESTING (contd.)
 Screening for Transfusion transmitted diseases
(Donor Sample)
HIV 1 and 2 AIDS
HBsAg Hepatitis B
HCV Hepatitis C
Treponema pallidum Syphilis
Plasmodium species Malaria

14. ADVERSE EFFECTS (TRANSFUSION
REACTIONS) - Immune mediated
Acute
Onset <24 hours
Delayed
Onset within days/months
1. Hemolysis Hemolysis
2. Febrile reactions Alloimmunisation
3. Allergic Post transfusion purpura
4. Anaphylaxis Graft Vs Host disease
5. TRALI immunomodulation

15. ADVERSE EFFECTS (TRANSFUSION REACTIONS) –
Non-Immune mediated
Acute Delayed
1. Bacterial contamination HIV 1 & 2
2. Circulatory overload Hepatitis B & C
3. Chemical damage Syphilis
4. Thermal damage Malaria
5. Iron overload

16. CAUSES OF TRANSFUSION REACTIONS
 Clerical errors:
 Inadequate labeling
 Wrong blood issued
 Technical errors:
 Error in blood grouping & cross matching
 Incorrect interpretation of test results
 Others:
 Blood contamination during phlebotomy
 Blood infusion thru small bore needle
 Blood cooler to -30⁰C or warmed to > 42⁰ C
 Concomitant administration blood & drugs thru common set

17. Common symptoms of blood transfusion
reactions include:
 Fever and chills.
 Dizziness.
 Shortness of breath.
 Itching.
 Hypothermia
 Back pain.
 hypotension

18. REFERENCES
 Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion
requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials
Group [published correction appears in N Engl J Med. 1999;340(13):1056]. N Engl J Med. 1999;340(6):409–417.
 Lacroix J, Hébert PC, Hutchison JS, et al.; TRIPICU Investigators; Canadian Critical Care Trials Group; Pediatric
Acute Lung Injury and Sepsis Investigators Network. Transfusion strategies for patients in pediatric intensive
care units. N Engl J Med. 2007;356(16):1609–1619.
 King KE, Bandarenko N. Blood Transfusion Therapy: A Physician's Handbook. 9th ed. Bethesda, Md.: American
Association of Blood Banks; 2008:236.
 Klein HG, Spahn DR, Carson JL. Red blood cell transfusion in clinical practice. Lancet. 2007;370(9585):415–426.
 Ferraris VA, Ferraris SP, Saha SP, et al. Perioperative blood transfusion and blood conservation in cardiac
surgery: the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists clinical practice
guideline. Ann Thorac Surg. 2007;83(5 suppl):S27–S86.

19. REFERENCES (contd)
 Carless PA, Henry DA, Carson JL, Hebert PP, McClelland B, Ker K. Transfusion thresholds and other
strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev.
2010;(10):CD002042.
 Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets. Fresh-Frozen
Plasma, Cryoprecipitate, and Platelets Administration Practice Guidelines Development Task Force of the
College of American Pathologists. JAMA. 1994;271(10):777–781.
 Holland LL, Brooks JP. Toward rational fresh frozen plasma transfusion: the effect of plasma transfusion
on coagulation test results. Am J Clin Pathol. 2006;126(1):133–139.
 Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G; Italian Society of Transfusion Medicine
and Immunohaematology (SIMTI) Work Group. Recommendations for the transfusion of plasma and
platelets. Blood Transfus. 2009;7(2):132–150.

20.  https://pssjournal.biomedcentral.com/articles/10.1186/s13037-014-0041-6