The document provides a comprehensive history and overview of blood transfusion practices, highlighting key milestones, figures of blood collection, and the evolution of blood banks in Ethiopia. It emphasizes the importance of donor health assessment, safety measures, and complications associated with blood transfusions. Furthermore, it discusses various blood components, their uses, and the potential risks and benefits of transfusion procedures.

1. Blood transfusion
By Amanuel Aychew
Moderator: Dr. Yohannes
30th Hidar 2009 EC

2. History
• In1628 William Harvey discovered the blood is in the circulatory system
• In 1665 the 1st successful blood transfusion dogdog by R.Lower
• In 1667 LambHuman by R. Lower but 10 yrs later it was prohibited
• In1818 British Obstetrician the 1st successful human transfusion for the dx
of PPH
• In 1900 Karl Landsteiner an Austrian physician discover the 3 human blood
groups A, B &C later on C changed to O
• In 1932 the 1st blood bank in Leningard hospital
• In 1939 Rh blood grouping was established by Philip Levine

3. • In Africa even though there are few studies it is reported that the 1st
blood transfusion occur in 1920’s and rapidly increased after 1945
In Ethiopia
National blood transfusion service was established in 1969 by Eth.
Red cross society.
In 2010 there were 12 regional blood bank with 52% hospital
coverage
In 2014 , 24 regional blood banks serving 8-12 hospitals in 100 km
radius  90% coverage

4. • Important numerical figures
Total number of units collected in 2004 was 24000 units /annum
in 2013 increased to 95,500 units/annum
Proportion of voluntary donation in 2012 was only 10%
in 2014 increased to 92.1%..................achieving WHO’s 80%

5. Definition
• The transfer of blood or blood components from the donor to the
recipient
Sources of the blood
Autologus Allogenic
Blood
salvage
Predeposite
Pre-op
dilutional 1) Blood is expensive and scarce resource
2) Blood transfusion is by itself risky for
health

6. Appropriate and inappropriate blood tss
• Safety and effectiveness of blood tss. Is dependant on
1) Supply of safe blood and blood products
2) The appropriate clinical use
Blood tss is unnecessary in case of
1. Blood is unnecessarily given to rise the Hb level
2. Transfusion of whole blood in case IV fluid replacement is safer
3. Blood is very expensive, scarce resource
Risks Benefits

7. Principles of clinical transfusion
• Transfusion should be prescribed when the benefit out weights the
risk.
• Have clear indication and record it.
• Clinician should aware of transfusion-transmissible infections.
• Patient’s Hb value, although important it shouldn’t be the only
deciding factor to transfuse.
• Patient with acute blood loss is 1st resuscitated by IV fluids next blood
tss would be assessed.

8. Who is going to donate???
Donor health& risk assessment
• Any sign of debility, under nutrition, pallor, jaundice, cyanosis,
dyspnea, intoxication from alcohol and other drugs should be
assessed
• P/E Wt, V/S
• Venepuncture site should be examined
If pt don’t fit the general assessment he/she will be deffered (Donor
deferral)

9. 1. Age
• Lower limits in many countries is 18 yrs
• Upper limit 60 to 70yrs
2. Donor appearance on inspection
• No cough, not be febrile
• R/o malnuitrition and any debilitating conditions
• Sound mental status
3. Minor illnesses
• Ha, malaise pain, fever, diarrhea (s/s of acute infection)
• Defer for 14 days

10. 4. Weight
• Atleast 45 kg to donate 350ml blood
• 50 kg to donate 400ml
• No defined upper body weight limit
5. V/S
• PR 60-100
• Body Temp.not more than 37.6 oC
• B.P100-140/60-90
Should not more than 13%
of the total body mass

11. 6. Donor’s Iron status
• Hb♀12.5g/dl
♂13.5g/dl
• Interval of donation ♀16 wks
♂12wks
7. Fluid intake & fooddrinking 500ml water immediately before tss
8. Pregnancy, lactation and menstruating females
9. Female donorrisk of TRALI on the recipient
DIID is the feared
complication

12. • Donor medical hx
Pt under Tx for Anemia
Hemoglobinopathies
Thrombocytopenia
IHD, MI, Arrhythemia
HTN+ Renal disease
Chronic or recurrent respiratory disease
DM who require insulin
thyrotoxicosis
Autoimmune disorders
Hematological malignancy
Defer the pt either
permanently or
temporarly

13. • Transfusion-transmitted infections (TTI) and donor’s risk assessment
Viral infections
Protozoal infections
Bacterial infections
Prion diseases
High risk behaviors
Multiple sexual act
Iv drug abuse
Detention in the prisons
Tattooing, piercing
Infection markers are
assessed in the
Laboratory eg. Ag or Ab
Assess
from the
Hx

14. Typing and cross matching
• Serologic compatibility for ABO and Rh is routinely.
• Rh –eve must receive only from Rh -eve
• In emergency case we can use O negative
Typing and cross matching is difficult in
1. Autoimmune hemolytic anemia
2. pts who have been multiple times transfused
3. Dextran administration before typing

18. Blood components
• It has literally cellular and plasma components.
CELLULAR COMPONENTS
1) Banked whole blood
• Very common type
• Shelf life of 6wks age of RBC inflammatory response & MOF
• All clotting factors are stable except factor V and VIII
• Hemolysis is rare
↑ed shelf life
stay
↓ed ADP & 2,3-
diphosphoglycerate
↓ed O2
transport

19. 2) Fresh whole blood
• Blood that is administered with in 24hrs of donation
• It has greater coagulation activity
• Advanced technologies to test infectious disease made it to be the
best to use
• Can improve outcomes of pts with trauma –associated coagulopathy

20. 3) Packed RBC and frozen RBC (RBC concentrate)
• This are product of choice for most clinical practices.
• Removing the supernatant plasma after centrifugation excess
plasma will be removed.
• It ↓ the rxn caused by plasma components.
• Preferred to be used in previously sensitized person.
NB packed RBC and frozen RBC are not used in the emergency.
Freezing the
RBC
↑ATP & 2,3-
diphosphoglycerate
concentration
↑ed viability of
RBC

21. 4) Leukocyte-reduced and Leukocyte-reduced /washed RBC
• WBC free blood preparation filtration that removes WBC 99.9%
• If necessary with additional saline washing
• Removal of WBC can prevent
all febrile non-hemolytic rxns
alloimmuniztion to HLA-1
CMV transmission
platelet transfusion refractoriness
• In most westerns currently the standard of blood cell transfusion
But predispose to
post-op infection
and MOF

22. 5) Platelet concentration
• Used in conditions that result thrombocytopenia
• 1unit of PC is 50ml-60ml
• PC is capable of transmitting infectious disease and inducing allergic
rxn
• Single unit and pooled unit

23. Plasma components
1) Fresh-frozen plasma
• It is prepared from freshly donated blood
• It is the only source of factor V and vit-k dependent factors
• Best outcome if used in trauma-associated coagulopathies
• Infection risk: Capable of transmitting any agent present in cells or
plasma

24. …FFP
• Indications:
• As an alternative to Factor VIII for tx of:
von Willebrand Factor (von Willebrand’s disease).
Factor VIII (haemophilia A).
• Liver disease, Warfarin, depletion of coag factors…
• As a source of fibrinogen in acquired coagulopathies; e.g. DIC.
• Can be used in isolated Factor XIII deficiency.

25. 2) Cryoprecipitate
• FFP but resuspended in 10-20ml plasma
• From single pack or more than 6 donor pack
3) Liquid plasma
• No liable coag factors
4) Virus inactivated plasma
• Methylene blue or UV inactivation to ↓ risk of HIV, HCV, HBV
• Expenssive
• For HAV, Parvo B-19 the inactivation is less effective

26. Other…
Human polymerized Hemoglobin (PolyHeme)
• O2 carrying resuscitation fluid
• PolyHeme is a temporary oxygen-carrying blood substitute made
from human hemoglobin
• Immediately available
Advantageof PolyHeme
absence of blood typing Ag
prolonged period of storage
no transfusion-transmitted infections (TTI)

27. Disadvantage
shorter half life in the blood
potential to ↑CVS problems

28. Indications of blood transfusion
1)To replace acute or major blood loss
Hemorrhagic shock
Major surgeries
Extensive burns
2)To Tx anemia
chronic loss
RBC destruction
Hemorrhoids
Bleeding disorders
Chronic PUD

29. Complications of Transfusion

33. Non-hemolytic rxns
• Febrile non-hemolytic rxns are ↑ in Temperature >1 oC
• Fairly common about 1%
• Postulated cause
preformed cytokines in donated blood and reciepent’s antibodies
reacting
• Pre-Tx by Paracetamol is helpful
• G –eve bacteria like Yersinia and Pseudomonas common cause

34. Non hemolytic…
Clinical presentation
• Fever Hemorrhagic manifestations
• Chills
• Tachycardia
• Hypotension, GI symptoms
Mng’t
• Discontinue the blood and send for culture
• O2 administration
• Adrenergic blockers
• Antibiotics
Prevention avoidance of outdated platelet
- Hemoglobinuria
- Hemoglobinemia
- DIC

35. Allergic rxns
• Relatively frequent 1% of all transfusion
• Mild and consists of
rash & urticaria
fever with in 60-90min after transfusion
• Sometimes anaphylactic shock
Mang’t
Administration of Antihistamines
In serious cases use Epinephrine or Steroids

36. Respiratory complications
• It is associated with circulatory overload
• It can occur in rapid infusion of blood, plasma expanders, crystalloids
which is severe in 1) older pts
2)underlying heart disease
• Central venous pressure must be monitored whenever large amount
of fluid is administered
• Overload s/s ↑ed venopressure
Dyspnea on P/E
Cough Auscultation Rale is noticed
Hypoxia
Tx Diuresis + slowing
the rate of blood
administration

37. Syndrome of Transfusion related acute lung
injury (TRALI)
• It is non-cardiogenic pulmonary edema related to transfusion
• s/s are similar to circulatory overload
• However TRALI is accompanied by chills, rigor, fever & bilateral
pulmonary infiltrate on chest X-ray 1-2hrs after transfusion
• Etiology unknown
Mang’t
Discontinue the blood + provision of pulmonary supports
1) Anti-HLA antibodies in the transfused
blood
2) Multiparity of the donor

38. Hemolytic rxns
1) Acute
• Occur with the administration of ABO incompatible blood {CFR=6%}
• Occurs with is the 1st , 24hrs
• There is intravascular RBC destruction
hemoglobinemia
hemoglobinuria
Ag-Ab
complex
Activation of
complement sys.
& factor XII
DIC
Acute renal
insufficiency

39. 2) Delayed
• Occur 2-10th day after transfusion
• Extravascular hemolysis
• Mild anemia
• Indirect hyperbilirubinemia (unconjugated)

40. Transmission of disease
• Malaria
• Chagas disease
• Brucellosis
• Syphilis (very rare)
• HIV-1 & hcv
• HAV rarely

41. What is currently new?????
• Artificial blood transfusion may be reality by 2017 …. University of
Bristol London UK
• With this new method, scientists hope they’ll produce
“limitless” supply of type-O red blood cells
free of diseases and able to be transfused into any pt
• Blood and Transplant used stem cells from adult and umbilical cord
blood to create a small volume of manufactured red blood cells.
http://www.sctpn.net/1viralvoice/blog/2015/07/25/artificial-blood-transfusion-may-be-reality-by-2017-
science-technology-on/

42. Remember …
• World blood donor’s day is celebrated every year on 14th June
• On the day of birthday anniversary of Karl Landsteiner June 4, 1868
• In 2012 “every blood donor is a hero”
• In 2013 “Give the gift of life”
• In 2014 “safe blood for saving mothers”
• In 2015 “Thank you for saving my life”

43. This year
“2016” the
motto will be
Thank you

44. References
• F. Charles Burnicardi/Schwartz’s principles of surgery 9th Edition
• WHO /Update Ethiopia progress in 2014/ March2015
• Guidelines on assessing Donor suitability for blood donation/ WHO
2012
• The clinical use of blood handbook WHO geneva
• History of Blood transfusion in Sub-Saharan Africa
• EPHTI surgery Debub university