Blood transfusion involves collecting blood from a donor and administering it to a recipient. It can involve whole blood, packed red blood cells, plasma, platelets, or blood fractions. Blood transfusion is indicated for acute blood loss, anemia, burns, or prior to surgery. Complications can include infections, reactions, congestive heart failure, and iron overload from multiple transfusions. Alternatives to donor blood include autologous blood collection prior to elective surgery, intraoperative blood salvage, artificial oxygen carriers, and erythropoietin to increase red blood cell counts. Massive transfusions of over half the patient's blood volume may be needed for major trauma or surgery.

1. Blood transfusion
DR. MD. SHERAJUL ISLAM
FCPS (SURGERY), FACS(USA)
ASSISTANT PROFESSOR, SURGERY
SHEIKH SAYERA KHATUN MEDICAL COLLEGE

3. Blood
Blood is a connective tissue in liquid form
It is considered to be the fluid of life as because it
supplies oxygen to various parts of the body

4. Functions of Blood

5. Composition of Blood

6. Composition of Blood

7. ABO Blood groups

12. DEFINITION
Blood transfusion is the transfusion of the whole blood
or its component such as blood cells or plasma from
one person to another person

13. Blood Transfusion
Transfusion is simply the transplantation of a tissue
consisting of a suspension of cells in a serum
Blood transfusion involves two procedures
• Collection of blood from donor
• Administration of blood to the recipient

14. Types of Blood transfusion
 Allogenic Blood transfusion(someone else blood)
 Autogenic Blood transfusion(own blood)
 Exchange Blood transfusion

15. Indications
• Acute blood loss following trauma
( >15% of total body volume in otherwise healthy individuals)
• During major surgeries
• Following burns
• In septicaemia

16. Indications
• As a prophylactic measure prior to surgery
• Whole blood is given in acute blood loss
• Packed cells are given in chronic anaemia
• Blood fractions are given in ITP, haemophilias

17. Donor Criteria
• Donor should be fit without any serious diseases like HIV1,
HIV2 ,hepatitis infections and malaria
• Weight of donor should be more than 45 kg

18. Collection of Blood
 Blood is collected in a sac containing 75 ml of CPD (Citrate
Phosphate Dextrose) solution and stored in special refrigerators
at 4 degree Celsius
 CPD blood lasts for 3 weeks

19. In stored blood
1. RBC’s last for 3 weeks
2. WBC’s are destroyed rapidly
3. Platelets also get reduced in 24 hours
4. Clotting factors are labile and so their levels fall quickly

20. Blood Fractions
1. Packed cells/Packed red blood cells
• It is obtained by centrifuging whole blood at 2000-2300 g for
15-20 minutes
• It is used in chronic anaemias, in old age, in children
• It minimises the cardiac overload due to transfusion
• It can be stored for 35 days at 1°C-6°C

21. Blood Fractions
2. Plasma
• It can be stored for 35 days at 1°C-6°C
• This is obtained in the same way as packed cells by
centrifugation
• It is indicated in burns, hypoalbuminaemia, severe
protein loss

22. Blood Fractions
plasma
It can be fractionalised into different fragments:
a. Human albumin: 4.5% is obtained after repeated
fractionations and can be stored for several months in liquid
form at 4°C
b. Fresh frozen plasma (FFP): Fresh plasma obtained, is rapidly
frozen and stored at–40°C
It contains all coagulant factors
1 unit of FFP increases the clotting factors levels by 3%
It can be stored for 2 year

23. Blood Fractions
plasma
 Rhesus D positive FFP can be transfused to Rhesus D negative
female
Uses: • Severe liver disease with abnormal coagulation function
• Congenital clotting factor deficiency
• Deficiency following warfarin therapy, DIC, massive
transfusion

24. Blood Fractions
plasma
 c. Cryoprecipitate: When fresh frozen plasma is allowed to
thaw at 4°C, visible white supernatant layer develops and is
called as cryoprecipitate which is rich in Factor VIII and
fibrinogen
It is stored at minus 40°C and can be kept for 2 year
 d. Fibrinogen: is obtained by organic liquid fractionation of
plasma and is stored in dried form
It is very useful in DIC and afibrinogenaemia
It has risk of transmitting hepatitis

25. Blood Fractions
 3. Platelet rich plasma:
 It is obtained by centrifugation of freshly donated blood at 150-200 g for 15-
20 minutes
•4. Platelet concentrate:
it is prepared by centrifugation of platelet rich plasma at 1200-1500 g for 15-
20 minutes
Used in thrombocytopenia and drug (aspirin, clopidogrel) induced
haemorrhage
5. Prothrombin complex concentrate (PCC) are derived from pooled plasma
which contains factors II, IX and X; used in emergency reversal of warfarin
therapy in uncontrolled haemorrhage

26. Blood transfusion
 After grouping and cross matching, 540 ml of blood is
transfused in 4 hours (40 drops per minute), using a filtered
drip set
 One liter of blood contains 350 mg of Iron
 Normal excretion of iron is 1 mg/day
 Iron overload can occur after many transfusions
 Iron excretion can be increased by desferrioxamine infusion

27. Complications of blood transfusion
1. Congestive cardiac failure
2. Transfusion reactions
• Incompatibility. Major and minor reactions with fever,
rigors, pain, hypotension
• Pyrexial reactions due to pyrogenic ingredients in the
blood
• Allergic reactions
• Sensitisation to leukocytes and platelets
• Immunological Sensitisation

28. Complications of blood transfusion
3. Infections
hepatitis HIV infection
Bacterial infection Malaria transmission
Epstein barr virus infection Cytomegalo virus infection
Syphilis, Yersinia Babesia microti infection
Trypanosoma cruzi infection
4. Air embolism
5. Thrombophlebitis

29. Complications of blood transfusion
6. Coagulation failure
Dilution of clotting factors
DIC
Dilutional thrombocytopenia occurs in patients with massive blood
transfusion
7. Circulatory overload causing heart failure
8. Haemochromatosis in patients with CRF receiving repeated blood
transfusions

30. Complications of blood transfusion
9. Citrate intoxication causes bradycardia and hypocalcaemia.
For every four units of blood 10 ml of 10% calcium chloride or
gluconate should be infused intravenously
10. Iron overload

31. BLOOD SUBSTITUTES
• Human albumin 4.5%
There is no risk of transmitting hepatitis
• Dextrans
are useful to improve plasma volume
They are polysaccharides of varying molecular weights

32. DEXTRAN
A. Low molecular weight dextran (40,000 mol wt.) (Dextran 40,
Rheomacrodex)
Dextran 40 is very effective in restoring blood volume immediately
But small molecules are readily excreted in kidney and so effect is
transitory
It may be useful in prevention of sludging in kidney and hence renal shut
down
B. High molecular weight dextran (Dextran 110 and Dextran 70) Less
effective but long acting and so useful to have prolonged effect

33. Precautions:
1. Blood samples for blood group and cross matching should be taken
before giving dextrans as it interferes with rouleaux formation of red cells
2. Dextrans also interfere with platelet function and so may precipitate
abnormal bleeding
3. Total volume of Dextrans should not exceed 1000 ml.
• Gelatin, in a degraded form of mol. wt. 30,000S, is used as a plasma
expander. Up to 1000 ml of 3.4-4% solution containing anions and cations
is given intravenously—Haemaccel.

34. MASSIVE BLOOD TRANSFUSION
• It is defined as replacement or transfusion of blood equivalent to
patient’s blood volume in < 24 hours corresponding to that particular
age (In adult it is 5-6 litres, in infants it is 85 ml/kg body weight)
Or single transfusion of blood more than 2,500 ml continuously
• Massive transfusion is used in severe trauma associated with liver,
vessel, cardiac, pulmonary, pelvic injuries. Often it is required during
surgical bleeding (primary haemorrhage on table) of major surgeries.

35. Adverse effects of massive transfusion
a. Severe electrolyte imbalance (hypocalcaemia, hyperkalaemia, acidosis)
b. Coagulopathy—altered platelet and coagulation factors
c. Citrate toxicity
d. Hypothermia
e. Poor oxygen delivery
f. Infections
g. Incompatibility and transfusion reactions
h. ARDS

36. AUTOLOGOUS BLOOD TRANSFUSION
 An healthy individual with no infection and haematocrit of
> 30% can predonate blood few weeks prior to any
elective surgeries which in turn can be used at the time of
surgery

37. RECYCLED BLOOD
 In major surgeries if there is significant blood loss, then
patient’s bled blood is carefully sucked out through a sterile
system and is filtered and reused again to the patient. This will
reduce the number of transfusions

38. ARTIFICIAL BLOOD
1. Perfluorocarbon (Fluosoleda)
abiotic substitute as synthetic oxygen carrier
It has got high affinity for O2
It is inert
It is biocompatible
2. Stroma free haemoglobin
biomimetic haemoglobin based substitute
3. Chelates which reverse bound O2
Intraoperative–salvage of blood: On table blood is collected, washed,
filtered and transfused
Used in trauma

39. ERYTHROPOIETIN
 Injection 1000-3500 units preoperatively also used to increase
the RBC count
 It is used in CRF patients who are on haemodialysis
 It is given twice weekly but it is costly