Blood transfusion, PowerPoint presentation, physiology, and pathology

1. BLOOD TRANSFUSION
By Dr Seema
JR-2
Physiology department
GMC Amritsar

2. •According to the World Health Organization (WHO), a blood transfusion
is a procedure that involves transferring blood or blood components
from a donor to a recipient's bloodstream.
• Blood transfusions are often performed to replace blood cells or blood
products that have been lost due to bleeding or bone marrow depression.
•Blood transfusions are necessary when the body doesn't have enough
blood to function properly.
Introduction

3. Human red cells contain numerous surface proteins called blood group
antigens.
Depending on the antigens present on red cell membrane, the
corresponding antibodies are usually absent in the plasma of that
individual.
This forms the physiological basis of blood groups and principle of blood
transfusion.
PRINCIPLE OF BLOOD TRANSFUSION

4. This law states that if a particular agglutinogen is present on the red
cell membrane of an individual, the corresponding agglutinin must be
absent in his plasma.
Secondly If the agglutinogen is absent in the red cells, the
corresponding agglutinin must be present in the plasma.
Landsteiner’s Law

5. • This law holds good for ABO system.
• However, the second part of the law does not apply for Rh and many
other blood group systems as there are no naturally occurring
agglutinins in these systems.

6. There should be an absolute indication for Blood transfusion as it is
a Life saving measure.
1. Acute blood loss –trauma,ruptured ectopic pregnancy,during
surgery etc
2. Chronic anemia - thalassemia and sickle cell disease.
3. Bone marrow failure , in Leukemia , Aplastic anemia ,
myelodysplasia ,Bone marrow infiltration by neoplastic cells.
4. Purpura –platelets are transfused.
5. Clotting disorders or coagulopathies (fresh frozen plasma is
transfused). In hemophilia, cryoprecipitate of factor VIII is given.
6. Preparation for surgery and during surgery.
7. Burns.
8. Kidney and Liver diseases
Indications for Transfusion :

7. i) Selection of appropriate donor
ii) ABO and Rh typing
iii) Cross matching
iv) Antibody screening of the patient (to detect the
presence of clinically significant antibodies).
Blood Transfusion should always include:

8.  Healthy donors free from transfusion-transmissible diseases
 Ideally, the age of the donor should be 18 years or above and preferably
should not be above 60 years.
 Donor should be voluntarily willing to donate blood.
 The hemoglobin status of the donor should be estimated.There should be
minimum of 12 g% Hb in female, and 13 g% Hb in male donors.
 Donor must be screened for HIV, syphilis, hepatitis,and protozoal
infections like malaria, filaria etc.
Selection of Appropriate Donor

9. ABO incompatibility causes immediate reactions and may even kill the
persons. The Rh incompatibility causes delayed reactions.
• Therefore, ABO and Rh compatibility must be ensured before any
transfusion. This is done by cross matching.
It is the most important for blood transfusion as ABO agglutinogen’s
are highly antigenic.
It is important to note Rh positive blood should never be transfused to a Rh
negative recipient.
ABO and Rh Compatibility

10. • ABO antigens appear at sixth week of intrauterine life.
• Their Concentration rises slowly to reach a significant level at puberty
and reaches maximum at 15–17 years of life.
•Therefore, for collection of blood for blood transfusion, the age of the
donor should be minimum of 15 years.
Why ABO Compatibility testing is important ?
• There are more than 30 blood group systems and 400 antigens in
human beings.
• Many of them have cold antibodies that do not react at body temperature.
Therefore, only few of them are immunologically active.

11. Cross-Matching
For ABO Rh compatibility testing we perform Cross-Matching.Hence, cross-
matching should always be done to eliminate the possibilities of any form
of mismatching.
Two type of cross matching are performed:
1)Major Cross Matching
2) Minor Cross Matching

12. Major Cross-Matching
In major cross-matching, the cells of the donor are directly matched
against the plasma of the recipient to look for any mismatch.
As it is important to ensure that antibodies present in the recipient’s plasma
do not harm the donor’s red cells. this cross-matching is called major cross-
matching
.

13. Minor Cross-Matching
In this donor’s plasma is checked against the red cells of the recipient.
• This is not so important because small volume of the donor’s plasma is
diluted in a large volume of the recipient’s plasma.
Therefore, the agglutinin titer of donor’s plasma becomes insignificant.
Antibody Screening of the Patient
The patient who receives transfusion, his serum should be screened for
various antibodies like autoantibodies that may react against the donor’s
cells and cause hemolysis.

14. Therefore, their blood cells on transfusion to any individual do not cause
agglutination reaction. Hence, blood group O –Ve can be given to any
individual.
• Universal Recipient The blood group AB positive (AB group and Rh
+Ve) individuals are considered to be the universal recipient because
their plasma contains no antibodies.
• Therefore they can safely receive blood from any one as they do not
cause agglutination reaction against any blood cells.
• Universal Donor The blood group O negative (O group and Rh –Ve)
persons are considered to be the universal donor because their red cells
contain no antigens.

15. Blood Collection and Storage
Collection of Blood
Usually, 350 ml of blood is collected from a single donor at a time. The
blood mixes with 50 to 70 ml of anticoagulant consisting of citrate,
phosphate and dextrose (CPDA-1).
Storage of Blood
Blood is stored in the blood bank at 4°C.
• Stored blood for transfusion should ideally be used within 2 weeks of
storage.
• However, blood should not be used if it is stored for more than 3 weeks,
because gross hemolysis occurs after this period.

16. STORAGE OF DIFFERENT COMPONENT’S OF BLOOD
1) PRBCs (Packed Red Blood Cells) - Used for immediate correction of
anemia , blood loss from surgery or trauma.
Stored at 2-6 degree centigrade for 35 days with CPDA1 solution, with SAG-M
(saline-adenine-glucose-mannitol) solution its self life increase up to one
week more.
In a blood bank ,different components of blood are seperated and stored for
various medical needs . Each components are stored at specific temprature to
maintains there viability and effectiveness. These components are :

17. 3)Fresh Frozen Plasma - The liquid part of blood used to treat liver disease,
clotting disorder, and to support patients with massive blood loss or
trauma. Stored below -40 degree centigrade upto one year.
4)Cryoprecipitate - Contains clotting factors and used to treat bleeding
disorder like hemophilia, fibrinogen deficiency. Stored at a temperature
of -18 degree centigrade or lower.
2) Platelets - Essential for patients with bleeding and clotting disorders or
those undergoing chemotherapy,
Stored at 20-24 degree centigrade for upto 5 days in a platelets agitator at
60 horizontal movements per minute to avoid clumping of platelets.

21. How we get different components of blood from whole blood ?
•We use centrifugation machine for component separation

22. Multibags for component separation

25. Changes in stored blood
The changes that occur are mainly due to reduction of metabolism of cells
due to cold storage.The changes are:
1. Increase in Na+ and decrease in K+ concentration in the red cells occurs
due to decreased active transport of ions across the cell membrane.
2. At low temperature, Na+ -K+ pump activity is grossly decreased , This
results in net increase in the total base and water of the cell.
3. The inhibition of Na+ -K+ pump increases intracellular sodium
concentration that causes water to enter the cell by endosmosis. Cells swell
and become more spherocytic causes spontaneous hemolysis.

26. 4.Leucocytes and platelets almost totally disappear within 24 to 48 hrs of
storage.
5. The ATP content in the cell decreases and inorganic PO4 concentration
increases due to imbalance between phosphorylation and
dephosphorylation processes in the cell.
6. Blood should never be used after 30 days of storage

27. Within 24 hours of transfusion, the cell metabolism greatly increases.
• Consequently, the sodium is extruded from the cells and the potassium is
drawn back into the cells.
• The volume, shape, and fragility of the red cells come back to normal within
24 to 48 hours.
• Red cells show 80% of survival 24 hours after transfusion if the transfusion
is given within 14 days of storage of the blood.
. The survival rate greatly decreases if the blood is stored for more than 2
weeks.
Changes in Stored Blood after Transfusion

28. Hazards of Blood Transfusion
Blood transfusion, even in ideal condition carries risks of adverse reactions.
Mostly, transfusion reactions occur due to human error.
I) Mismatched Transfusion: When an incompatible blood is transfused, the
mismatched transfusion reaction occurs immediately.
• The reaction is primarily due to agglutination of donor’s red cells followed by
their hemolysis.
• This is called acute hemolytic transfusion reactions. Usually, it occurs due to
ABO incompatibility.
The severity of the reaction depends on the degree of hemolysis.

29. The complications of mismatched transfusion are:
- 1. Shivering and fever (febrile reactions)
- 2. Hemoglobinemia and hemoglobinuria
- 3. Jaundice
- 4. Acute renal failure Renal failure occurs due to:
- i) hemoglobin casts blocking the renal tubules and damaging the tubules,
- ii) release of toxic substances from the lysed red cells causes renal
vasoconstriction, and
- iii) circulatory shock.
- 5. Hyperkalemia (due to release of potassium ions from red cells). This
may cause cardiac arrest in diastole.

30. II Due to Faulty Techniques of Giving Blood:
Due to wrong method of transfusion, following complications may arise.
•Thrombophlebitis: This is a common complication in those who receive
repeated transfusions.
• Air Embolism: Air enters the venous circulation and gets lodged at the
outlet of the right ventricle and blocks the flow of blood to the lungs.
• Death may occur in severe cases.
• Use of plastic bags has reduced this complication.

31. III Due to Massive Transfusion:
This occurs when more than 10 units of blood are given within 24 hours or
when the total blood volume is exchanged within 24 hours.
• This leads to circulatory overload.
• Cardiac arrhythmias and even sometimes cardiac arrest occur due to high
potassium level in the stored blood.
IV Febrile Reaction:
The patient feels cold and may get rigor due to rise in body temperature. This
occurs mainly due to presence of pyrogens in the transfusion apparatus.

32. IV Allergic Reactions: This is less frequent and is characterized by
itching, erythema, nausea, vomiting, and in severe cases may cause
anaphylactic reactions.
VI Transmission of Diseases:
1. Hepatitis
2. 2. Malaria
3. 3. AIDS
4. 4. Syphilis

34. THANK YOU