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BLOOD
TRANSFUSIONS
Dr. Murali. U. M.S; M.B.A.
Prof. of Surgery
D.Y.Patil Medical College
Mauritius.
Objectives
• Blood Groups
• Indications
• Donor Criteria & Collection of Blood
• Complications
• Massive Transfusion
• Blood Substitutes 2
*Image via Bing
Overview
• It is a procedure in which a patient
receives a blood product through an
intravenous line.
• It is the introduction of blood
components into the venous
circulation.
• Process of transferring blood-based
products from one person into the
circulatory system of another.
BLOOD GROUPS
4
Types of blood groups
• There are more than 20 genetically
determined blood group systems known today
• The AB0 and Rhesus (Rh) systems are the
most important ones used for blood
transfusions.
5
ABO blood grouping system
• There are
four different
kinds of blood
types:
• A, B, AB or O
(null).
6
Blood Types
• Each person has one of the following
blood types: A, B, AB, or O.
• O can be given to anyone but can only
receive O, so called as Universal Donor.
• AB can receive any type but can only be
given to AB, so called as Universal
Recipients.
• Also, every person's blood is either
Rh-positive or Rh-negative.
7
Blood transfusion
The ABO blood groups
• The table shows the four ABO phenotypes ("blood
groups") present in the human population and the genotypes
that give rise to them.
9
Blood
Group
Antigens
on RBCs
Antibodies in Serum Genotypes
A A Anti-B AA or AO
B B Anti-A BB or BO
AB A and B Neither AB
O Neither Anti-A and anti-B OO
The Rhesus (Rh) System
• Well, there's another antigen to be
considered always - the Rh antigen.
• Some of us have it, some of us don't have.
• If it is present, then blood is RhD positive,
if not it's RhD negative.
• So, for example, some people in group A
will have it, and will therefore be classed
as A+ (or A positive).
• While the ones that don't, are A- (or A
negative).
• And so it goes for groups B, AB and O.
10
• According to above blood grouping systems, you
can belong to either of following 8 blood groups:
11
History Of Blood Transfusion
• 1492 – Pope Innocent VIII
• 1628 – William Harvey
• 1665 – Richard Lower
• 1667 – Jean – Baptiste Denis
• 1670 – France
• 1829 – James Blundell
• 1900 – Karl Landsteiner
• 1914 – Albert Hustin
• 1926 – British Red Cross
• 1939 – Rhesus system
India’s First Blood Bank
• School of Tropical Medicine,
Kolkatta
• By SIR. UPENDRANATH
BRAHMACHARI
• Chairman of Bengal Red Cross
Society.
CROSS MATCHING
• DONOR’S R.B.C +
• RECIPIENTS SERUM +
• COOMB’S REAGENT
Blood Donor Criteria
• Age – 17 – 65 ( New upto 60 )
• Wt - > 45 kg
• Hb - > 13 M / > 12 F
• Fit without serious diseases – HIV /
Hepatitis & Malaria
• A person can donate blood every 90
days (3 months).
Collection & Storage
• Bag – 75ml CPD
• Stored – Special Ref. - 4Deg C. +/-
2Deg C
• Shelf Life of CPD Blood - 3 wks
• R.B.C’s - 3 wks
• W.B.C – Rapidly Destroyed
• Platelets – Reduced in 24 hrs
• Clot. Factors – Labile – Levels fall
Blood Donation
• 475ml Blood + 63ml Anticoagulant
• Post – Transfusion Purpura
• Red cells + Optimal Additive solution
• SAGM
• Expiry date = 35 days
• One unit of blood raises the haemoglobin
concentration by approximately 1g/100 ml
Indications
• Acute blood loss – Due to Trauma.
• Chronic Anemia.
• Major Operative procedures
• As a Prophylactic measure to
Surgery
• Severe Burns
• Blood Dyscariasis
Transfusion Trigger
• The decision to transfuse any patient for a
given indication must balance the risks of not
transfusing.
• RBC transfusion not indicated when Hb>10g/dl
• Transfuse Criteria
- < 6g/dl - Benefit from Transfusion
- 6 - 8g/dl - Unlikely to benefit – absence of
bleeding
- > 8g/d l - Not indicated
IMMEDIATE
COMPLICATIONS
Immunological
- Febrile / non
haemolytic
- Allergic / Anaphylaxis
- Haemolytic TR
- TRALI
Non- Immunological
- Congestive Cardiac Failure
- Infection
- Air Embolism
- Thrombophlebitis
- TACO
Febrile Non Haemolytic Transfusion
Reaction
• Defined to be a rise in temperature
of 1 °C or more and >=38 °C,
within few hours of transfusion with
Chills & Rigors.
• Due to cytokines in the blood itself
and/or pyrogens in the transfusion
apparatus.
Allergic / Urticarial Transfusion
Reaction
• Most common usually due to allergies
to specific proteins in the donor’s
plasma.
• Mild – Trt – Steroids & Antihistamines.
• For severe (anaphylaxis), unit is
discarded. New washed RBC’s and
platelets are used.
Acute Haemolytic Reaction
• Transfusion of an incompatible blood
component. { ABO incompatibility }
• A disaster, almost always preventable.
• Most often due to ABO mismatch due
to a clerical error (i.e., the wrong blood
and/or the wrong recipient).
• Intravascular destruction – ARF & DIC
Acute Haemolytic Reaction
• Features - fever, hypotension, NV,
tachycardia, dyspnea, chest or
back pain, flushing & anxiety
• Post-op site: diffuse bleeding
• Trt - Fluids, diuresis and
transfusion support for bleeding
Transfusion Related Acute Lung Injury
[ TRALI ]
• Due to donor plasma containing an antibody,
usually against the patient's HLA or leukocyte
specific antigens.
• The donor antibodies cause these neutrophils
to release toxic products and thus produce
ARDS.
• Features - Dyspnea, hypotension and fever
typically begin 30 minutes to 6 hours after
transfusion
• chest x-ray shows diffuse non-specific
infiltrates , “white out”
Infections
• Bacterial infection – Due to faulty
storage.
• Serum hepatitis.
• HIV Infection
• Malaria transmission
• Viral – EBV / CMV
• Syphilis / Yersinia
Transfusion Associated Cardiac Overload
[ TACO ]
• 1% of Transfusions are Complicated by
TACO.
• Features – Dyspnoea, hypertension,
crepitations & low O2 Sat.
• Risk of volume overload / respiratory
distress especially in small / elderly pt.
• Largely avoidable by careful attention to
fluid balance.
Delayed Complications
• Delayed Haemolytic TR
• Post – Transfusion Purpura
• Transfusion related graft versus host
disease { TGVH }
• Immunosuppression
• Iron overload – Multi transfused
recipients
Delayed Haemolytic Transfusion Reaction
• Previously sensitized to an antigen
through transfusion or pregnancy.
• Can result in symptomatic or
asymptomatic hemolysis several days
(2-10 days) after a subsequent
transfusion.
• These present with flu-like symptoms,
recurrent anemia and jaundice.
Transfusion-associated graft-versus-host
disease (TA-GVHD)
• Donor T-cells attack host tissues.
• Symptoms occur within 1-4 weeks.
• Rare but always fatal.
• Features – Pancytopenia / Rash / Liver
dysfunction.
• Difficult to treat.
Skin manifestation of GVHD
Generalized swelling, erythroderma and bullous
formation
Massive Blood Transfusion
• Replacement Or Transfusion of blood
= pt’s blood volume within 24 hours [ In
normal adult – 10 units or 5-6 L ]
OR
• Single transfusion > 2500ml
continuously
MBT - Complications
• Coagulopathy
• Hyperkalemia / Hypocalcaemia
• Citrate toxicity
• Hypothermia
• Infections
• Incompatibility & Transfusion reactions
• ARDS / DIC
Blood Substitutes
DEXTRAN
• Most Widely Used
• Polysaccharides - ↑ Plasma volume
• Leuconostoc Mesenteroides Bacteria
• Low Mol.Wt (40,000 mol.wt )
• High Mol.Wt (70,000)
• Massive Transfusion – Impair Coag.
33
Blood Substitutes
Human Albumin – 4.5%
• Plasma fractionation – Albumin Extract
• No risk - Hepatitis
• Can be used daily
• Expensive
34
Blood Substitutes
Gelatin
• Haemaccel - Plasma Expander
• 30% Remains - Intravascular
Hydroxethystarch
• Contains – Starch / NaOH / Ethylene
Oxide
• Lasts – 6 hrs
35
Blood transfusion
1. Which of the following is not a delayed
complication of blood transfusion ?
• A TRALI
• B TG-VH
• C Post – transfusion purpura
• D Iron overload
2. Which of the following is not a
complication of massive blood transfusions ?
• A Coagulopathy
• B Hypercalcemia
• C Hyperkalemia
• D Hypothermia.
3. The first successful documented human
transfusion was done by - ?
• A Karl Landsteiner
• B James Blundell
• C Richard Lower
• D Jean – Baptiste Denis
4. Shelf life of CPD Blood is -
• A 7 days
• B 14 days
• C 21 days
• D 28 days
5. One of the following is not a Blood substitute -
• A Hydroxystarch
• B Haemaccel
• C Human albumin
• D LMW – Dextran
Observing / Monitoring the Patient During a Blood / Blood
Component Transfusion is part of safe transfusion
Rigors
Haemoglobinuria
Tachycardia Hyper /
HypotensionPyrexia
Nausea /
vomiting
Breathlessness /
coughing Restlessness
Agitation
Confusion
Chest, abdominal,
muscle, bone or loin
pain
Flushing
Urticaria -
Itchy rash
Headache
Collapse
Generally feeling
unwell
blood and blood transfusions 43
PRE-TRANSFUSION
RESPONSIBILITIES
• Assess laboratory values
• Verify the medical prescription.
• Assess the client’s vital signs, urine
output, skin color and history of
transfusion reactions.
• Obtain venous access. Use a
central catheter or at least a 20-
gauge needle, if possible.
blood and blood transfusions 44
• Obtain blood products from a blood bank;
transfuse immediately.
• With another registered nurse, verify the
patient by name and number, check blood
compatibility and note expiration time.
• Administer the blood product using the
appropriate filtered tubing.
blood and blood transfusions 45
• Remain with the patient during
the first 15-30 minutes of the
infusion.
• Infuse the blood product at the
prescribed rate.
• Monitor vital signs.
blood and blood transfusions 46
World Blood Donor Day-June 14th
THANKS

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Blood transfusion

  • 1. BLOOD TRANSFUSIONS Dr. Murali. U. M.S; M.B.A. Prof. of Surgery D.Y.Patil Medical College Mauritius.
  • 2. Objectives • Blood Groups • Indications • Donor Criteria & Collection of Blood • Complications • Massive Transfusion • Blood Substitutes 2 *Image via Bing
  • 3. Overview • It is a procedure in which a patient receives a blood product through an intravenous line. • It is the introduction of blood components into the venous circulation. • Process of transferring blood-based products from one person into the circulatory system of another.
  • 5. Types of blood groups • There are more than 20 genetically determined blood group systems known today • The AB0 and Rhesus (Rh) systems are the most important ones used for blood transfusions. 5
  • 6. ABO blood grouping system • There are four different kinds of blood types: • A, B, AB or O (null). 6
  • 7. Blood Types • Each person has one of the following blood types: A, B, AB, or O. • O can be given to anyone but can only receive O, so called as Universal Donor. • AB can receive any type but can only be given to AB, so called as Universal Recipients. • Also, every person's blood is either Rh-positive or Rh-negative. 7
  • 9. The ABO blood groups • The table shows the four ABO phenotypes ("blood groups") present in the human population and the genotypes that give rise to them. 9 Blood Group Antigens on RBCs Antibodies in Serum Genotypes A A Anti-B AA or AO B B Anti-A BB or BO AB A and B Neither AB O Neither Anti-A and anti-B OO
  • 10. The Rhesus (Rh) System • Well, there's another antigen to be considered always - the Rh antigen. • Some of us have it, some of us don't have. • If it is present, then blood is RhD positive, if not it's RhD negative. • So, for example, some people in group A will have it, and will therefore be classed as A+ (or A positive). • While the ones that don't, are A- (or A negative). • And so it goes for groups B, AB and O. 10
  • 11. • According to above blood grouping systems, you can belong to either of following 8 blood groups: 11
  • 12. History Of Blood Transfusion • 1492 – Pope Innocent VIII • 1628 – William Harvey • 1665 – Richard Lower • 1667 – Jean – Baptiste Denis • 1670 – France • 1829 – James Blundell • 1900 – Karl Landsteiner • 1914 – Albert Hustin • 1926 – British Red Cross • 1939 – Rhesus system
  • 13. India’s First Blood Bank • School of Tropical Medicine, Kolkatta • By SIR. UPENDRANATH BRAHMACHARI • Chairman of Bengal Red Cross Society.
  • 14. CROSS MATCHING • DONOR’S R.B.C + • RECIPIENTS SERUM + • COOMB’S REAGENT
  • 15. Blood Donor Criteria • Age – 17 – 65 ( New upto 60 ) • Wt - > 45 kg • Hb - > 13 M / > 12 F • Fit without serious diseases – HIV / Hepatitis & Malaria • A person can donate blood every 90 days (3 months).
  • 16. Collection & Storage • Bag – 75ml CPD • Stored – Special Ref. - 4Deg C. +/- 2Deg C • Shelf Life of CPD Blood - 3 wks • R.B.C’s - 3 wks • W.B.C – Rapidly Destroyed • Platelets – Reduced in 24 hrs • Clot. Factors – Labile – Levels fall
  • 17. Blood Donation • 475ml Blood + 63ml Anticoagulant • Post – Transfusion Purpura • Red cells + Optimal Additive solution • SAGM • Expiry date = 35 days • One unit of blood raises the haemoglobin concentration by approximately 1g/100 ml
  • 18. Indications • Acute blood loss – Due to Trauma. • Chronic Anemia. • Major Operative procedures • As a Prophylactic measure to Surgery • Severe Burns • Blood Dyscariasis
  • 19. Transfusion Trigger • The decision to transfuse any patient for a given indication must balance the risks of not transfusing. • RBC transfusion not indicated when Hb>10g/dl • Transfuse Criteria - < 6g/dl - Benefit from Transfusion - 6 - 8g/dl - Unlikely to benefit – absence of bleeding - > 8g/d l - Not indicated
  • 20. IMMEDIATE COMPLICATIONS Immunological - Febrile / non haemolytic - Allergic / Anaphylaxis - Haemolytic TR - TRALI Non- Immunological - Congestive Cardiac Failure - Infection - Air Embolism - Thrombophlebitis - TACO
  • 21. Febrile Non Haemolytic Transfusion Reaction • Defined to be a rise in temperature of 1 °C or more and >=38 °C, within few hours of transfusion with Chills & Rigors. • Due to cytokines in the blood itself and/or pyrogens in the transfusion apparatus.
  • 22. Allergic / Urticarial Transfusion Reaction • Most common usually due to allergies to specific proteins in the donor’s plasma. • Mild – Trt – Steroids & Antihistamines. • For severe (anaphylaxis), unit is discarded. New washed RBC’s and platelets are used.
  • 23. Acute Haemolytic Reaction • Transfusion of an incompatible blood component. { ABO incompatibility } • A disaster, almost always preventable. • Most often due to ABO mismatch due to a clerical error (i.e., the wrong blood and/or the wrong recipient). • Intravascular destruction – ARF & DIC
  • 24. Acute Haemolytic Reaction • Features - fever, hypotension, NV, tachycardia, dyspnea, chest or back pain, flushing & anxiety • Post-op site: diffuse bleeding • Trt - Fluids, diuresis and transfusion support for bleeding
  • 25. Transfusion Related Acute Lung Injury [ TRALI ] • Due to donor plasma containing an antibody, usually against the patient's HLA or leukocyte specific antigens. • The donor antibodies cause these neutrophils to release toxic products and thus produce ARDS. • Features - Dyspnea, hypotension and fever typically begin 30 minutes to 6 hours after transfusion • chest x-ray shows diffuse non-specific infiltrates , “white out”
  • 26. Infections • Bacterial infection – Due to faulty storage. • Serum hepatitis. • HIV Infection • Malaria transmission • Viral – EBV / CMV • Syphilis / Yersinia
  • 27. Transfusion Associated Cardiac Overload [ TACO ] • 1% of Transfusions are Complicated by TACO. • Features – Dyspnoea, hypertension, crepitations & low O2 Sat. • Risk of volume overload / respiratory distress especially in small / elderly pt. • Largely avoidable by careful attention to fluid balance.
  • 28. Delayed Complications • Delayed Haemolytic TR • Post – Transfusion Purpura • Transfusion related graft versus host disease { TGVH } • Immunosuppression • Iron overload – Multi transfused recipients
  • 29. Delayed Haemolytic Transfusion Reaction • Previously sensitized to an antigen through transfusion or pregnancy. • Can result in symptomatic or asymptomatic hemolysis several days (2-10 days) after a subsequent transfusion. • These present with flu-like symptoms, recurrent anemia and jaundice.
  • 30. Transfusion-associated graft-versus-host disease (TA-GVHD) • Donor T-cells attack host tissues. • Symptoms occur within 1-4 weeks. • Rare but always fatal. • Features – Pancytopenia / Rash / Liver dysfunction. • Difficult to treat. Skin manifestation of GVHD Generalized swelling, erythroderma and bullous formation
  • 31. Massive Blood Transfusion • Replacement Or Transfusion of blood = pt’s blood volume within 24 hours [ In normal adult – 10 units or 5-6 L ] OR • Single transfusion > 2500ml continuously
  • 32. MBT - Complications • Coagulopathy • Hyperkalemia / Hypocalcaemia • Citrate toxicity • Hypothermia • Infections • Incompatibility & Transfusion reactions • ARDS / DIC
  • 33. Blood Substitutes DEXTRAN • Most Widely Used • Polysaccharides - ↑ Plasma volume • Leuconostoc Mesenteroides Bacteria • Low Mol.Wt (40,000 mol.wt ) • High Mol.Wt (70,000) • Massive Transfusion – Impair Coag. 33
  • 34. Blood Substitutes Human Albumin – 4.5% • Plasma fractionation – Albumin Extract • No risk - Hepatitis • Can be used daily • Expensive 34
  • 35. Blood Substitutes Gelatin • Haemaccel - Plasma Expander • 30% Remains - Intravascular Hydroxethystarch • Contains – Starch / NaOH / Ethylene Oxide • Lasts – 6 hrs 35
  • 37. 1. Which of the following is not a delayed complication of blood transfusion ? • A TRALI • B TG-VH • C Post – transfusion purpura • D Iron overload
  • 38. 2. Which of the following is not a complication of massive blood transfusions ? • A Coagulopathy • B Hypercalcemia • C Hyperkalemia • D Hypothermia.
  • 39. 3. The first successful documented human transfusion was done by - ? • A Karl Landsteiner • B James Blundell • C Richard Lower • D Jean – Baptiste Denis
  • 40. 4. Shelf life of CPD Blood is - • A 7 days • B 14 days • C 21 days • D 28 days
  • 41. 5. One of the following is not a Blood substitute - • A Hydroxystarch • B Haemaccel • C Human albumin • D LMW – Dextran
  • 42. Observing / Monitoring the Patient During a Blood / Blood Component Transfusion is part of safe transfusion Rigors Haemoglobinuria Tachycardia Hyper / HypotensionPyrexia Nausea / vomiting Breathlessness / coughing Restlessness Agitation Confusion Chest, abdominal, muscle, bone or loin pain Flushing Urticaria - Itchy rash Headache Collapse Generally feeling unwell
  • 43. blood and blood transfusions 43
  • 44. PRE-TRANSFUSION RESPONSIBILITIES • Assess laboratory values • Verify the medical prescription. • Assess the client’s vital signs, urine output, skin color and history of transfusion reactions. • Obtain venous access. Use a central catheter or at least a 20- gauge needle, if possible. blood and blood transfusions 44
  • 45. • Obtain blood products from a blood bank; transfuse immediately. • With another registered nurse, verify the patient by name and number, check blood compatibility and note expiration time. • Administer the blood product using the appropriate filtered tubing. blood and blood transfusions 45
  • 46. • Remain with the patient during the first 15-30 minutes of the infusion. • Infuse the blood product at the prescribed rate. • Monitor vital signs. blood and blood transfusions 46
  • 47. World Blood Donor Day-June 14th