A PowerPoint presentation outlining the physiology of blood transfusion, and clinical precautions to take in preventing and managing blood transfusion reactions.

1. BLOOD TRANSFUSION
Dr. Boluwatife Afolabi (BDS, Ibadan)

2. OUTLINE
 Introduction
 Definition
 Historical Background
 Blood Components
 Blood Groups
 The Rhesus Factor
 Blood Group Compatibility
 Classification of Blood Transfusion
 Fractions of Blood in Use
 Blood Donation and Donor Selection
 Storage
 Blood Transfusion Order
 Principles of Blood Transfusion
 Complications of Blood Transfusion
 Conclusion
 References
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3. INTRODUCTION
 The adult human has about 4-6 litres of blood in
circulation throughout the body.
 Among several other functions, the primary role of blood
is to transport oxygen to various parts of the body.
 Blood is made up of several cells which float around in a
liquid called plasma.
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4. DEFINITION
 Blood transfusion is the transfer of whole blood or blood
components intravenously into one’s circulatory system.
 The person receiving blood is known as the recipient while
the person donating blood is known as the donor.
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5. HISTORICAL BACKGROUND
 1492: Pope Innocent VII received the first recorded blood transfusion in
history, it was unsuccessful.
 1628: William Harvey (a British physician) is credited with the discovery of
blood circulation.
 1665: Richard Lower performed the first successful blood transfusion
(animal-to-animal)
 1818: James Blundell human-to-human blood transfusion for a man with
gastric carcinoma.
 1901: Karl Landsteiner discovered blood groups A, B, C now known as blood
groups A, B, O.
 1907: Reuben Ottenberg and Schultz conducted the first blood grouping and
cross-matching.
 1914-1918: Oswald Hope Robertson established the first blood depot (blood
bank)
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6. BLOOD COMPONENTS
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7. BLOOD COMPONENTS
BLOOD
Plasma (55%)
Cells (45%)
*Erythrocytes
*Leukocytes
*Thrombocytes
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8. BLOOD GROUPS
 Classification of blood is based on the presence or absence of
inherited antigenic substances on the surface of red blood cells
(RBCs).
 These antigens may be proteins, carbohydrates, glycoproteins or
glycolipids, depending on the blood group system.
 The ABO blood group system is the most important blood group system
in human blood transfusion.
 Based on the presence or absence of antigen A and antigen B, blood is
divided into four groups:
• A
• B
• AB
• O
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9. BLOOD GROUPS
 Blood with antigen A belongs to ‘A’ group. This blood has β-antibody in
the serum.
 Blood with antigen B and α-antibody belongs to ‘B’ group.
 If both the antigens are present, the blood group is called ‘AB’ group
and the serum of this group does not contain any antibody.
 If both antigens are absent, the blood group is called ‘O’ and both α
and β antibodies are present in the serum.
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10. BLOOD GROUPS
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11. THE RHESUS FACTOR
 The rhesus blood type (named after the rhesus monkey) was first
discovered in 1937 by Karl Landsteiner and Alexander S. Wiener.
 When red blood cells containing Rh factor are injected into a person
whose blood does not contain the Rh factor, anti-Rh agglutinins
develop slowly, reaching maximum concentration of agglutinins about
2-4 months later.
 If a Rh-negative person has never before been exposed to Rh-positive
blood and is now transfused with Rh-positive blood, the following may
occur:
• No immediate reaction.
• anti-Rh antibodies develop in sufficient quantities slowly over time.
 Subsequent transfusion of Rh-positive blood into the same person who
is now already sensitized may result in a severe transfusion reaction.
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12. THE RHESUS FACTOR
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13. BLOOD GROUP COMPATIBILITY
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14. CLASSIFICATION OF BLOOD TRANSFUSION
1. Homologous (allogenic) blood transfusion: Blood transfusion with
blood donated from another compatible donor of the same specie.
2. Autologous blood transfusion: Blood transfusion with blood gotten
from the same person.
Types of autologous blood transfusion:
 Preoperative Autologous Blood Donation (PABD)
 Acute Isovolemic Hemodilution (AIVH)
 Intraoperative Blood Salvage
 Postoperative Blood Salvage
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15. FRACTIONS OF BLOOD IN USE
1) Whole blood:
Indications
• To restore blood volume in cases of sudden loss of 25% or more of blood
volume.
• Patient undergoing exchange blood transfusion (EBT).
• Patients who continue to bleed after receiving 4 units of packed red blood
cells.
• Patients requiring cardio-pulmonary bypass.
*Its use is now limited except in hospitals and areas where facilities for producing blood fractions are not available.
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16. FRACTIONS OF BLOOD IN USE
2) Red Cell Concentrates: Whole blood is centrifuged at 3000 revs/min and the
supernatant plasma is removed.
Indications
• Chronic Anaemia
• Cardiac Failure
3) Washed Red Blood Cells: This is obtained by continuous flow washing.
Indications
• Severe allergies
• Patients awaiting transplantation
• Patients with repeated febrile transfusion reaction
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17. FRACTIONS OF BLOOD IN USE
4) Platelet Concentrate: It is the precipitate obtained when platelet rich plasma is
centrifuged at 3000rev/min. Platelet rich plasma is the supernatant plasma after
whole blood is centrifuged at 1000rev/min.
Indications
• Severe thrombocytopaenia
5) Fresh Frozen Plasma: It is the supernatant liquid portion that is separated and
rapidly frozen by immersion in a mixture of carbon-dioxide and ethyl alcohol
within 8 hours of collection when fresh blood is centrifuged at 3000rev/min.
Indications
• Deficiencies in coagulation factors
• Emergency treatment of warfarin overdose and Vitamin K deficiencies.
• Treatment of thrombotic thrombocytopaenic purpura
• Treatment of disseminated intravascular coagulation
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18. FRACTIONS OF BLOOD IN USE
6) Cryoprecipitate: The precipitate formed when fresh frozen plasma is allowed
to thaw at 4°C and the supernatant plasma removed. It is rich in factors VIII,
factor XIII, fibrinogen and Von Willebrand Factor.
Indications
• Haemophilia
• Von Willebrand disease
• Disseminated intravascular coagulation
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19. BLOOD DONATION AND DONOR SELECTION
 Measures to protect the donor
• All donors should be healthy adults between 18-65years.
• Weight should be above 50kg.
• Hb should be >13g/dl for Men.
• Hb should be >12g/dl for Women.
• Minimum donation interval of 12 weeks.
• Maximum of 3 donations per year.
• Pregnant and lactating women are excluded.
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20. BLOOD DONATION AND DONOR SELECTION
 Measures to protect the recipient
• Careful donor selection
• Donor deferral/exclusion
• Screening for:
i. HbsAg
ii. HCV
iii. Syphilis
iv. Chagas disease
v. Malaria
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21. BLOOD DONATION AND DONOR SELECTION
 Indefinite deferral
• History of Hepatitis B/C infection
• History of IV drug abuse
• History of Chagas disease
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22. BLOOD DONATION AND DONOR SELECTION
 12 months deferral
• History of syphilis or gonorrhea
• History of recent tattoo
• Hepatitis B immunoglobin prophylaxis
• Potential donors who have undergone ear
piercing/acupuncture
• Rabies vaccination
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23. STORAGE
 Standard blood bag contains 450±45 mls blood with 60 mls of anticoagulant
preservative.
 Blood is stored at 2-6°C
 Anticoagulants include:
• Heparin- 24 hours
• Acid-Citrate-Dextrose (ACD)- 21 days
• Citrate-Phosphate-Dextrose (CPD)- 28 days
• Citrate-Phosphate-Dextrose-Adenine (CPDA)- 35 days
• Saline-Adenine-Glucose-Mannitol (SAGM)- 42
*Note: Leucocytes and platelets not viable after 24 hours of storage.
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24. BLOOD TRANSFUSION ORDER
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25. COMPLICATIONS OF BLOOD TRANSFUSION
1) Immediate/Delayed reactions
2) Immune/Non-immune complications
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26. Immediate Reactions
1) Febrile non haemolytic transfusion reaction: It is quite common and most times
it is due to incompatibility between antigens on the donor’s white cells and
antibodies in the recipient’s plasma leading to the release of pyrogens. It may also
be due to endotoxins and pyrogens in the transfusion set or blood.
Clinical Features
•Rigor and fever
•Nausea and vomiting
•Flushing
•Tachycardia
Management
•Stop transfusion temporarily
•Exclude haemolytic reactions, septicaemia or malaria
•Give Paracetamol/Aspirin to bring down the temperature
Prevention
•Future transfusion should be with leukocyte depleted blood products
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27. Immediate Reactions
2) Allergic reactions: It occurs in 2% of transfusions. It is common in patients
receiving repeated transfusion. It is due to allergens, usually plasma protein in the
donor plasma and so is less likely to occur with packed red cells.
Clinical features
•Urticaria
•Myalgia/Arthralgia
•Bronchospasm
•Oedema of the face and larynx
•Chest pain
•Hypotension
•Abdominal cramps
•Diarrhoea
•Shock.
•Pyrexia
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28. Immediate Reactions
Management
•Stop the transfusion
•Give steroid and anti-histamine
•If symptoms are severe, adrenaline should be administered intravenously.
Prevention
•During future transfusion, patient should have pre-medication with
antihistamines before transfusion or be given plasma free components e.g.
washed packed RBC for treatment of anaemia
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29. Immediate Reactions
3) Haemolytic Reactions: This is the most serious complication of blood
transfusion and it is usually due to ABO incompatibility.
Clinical Features
•Pain along the vein being used for transfusion
•Headache
•Rigors and fever
•Dyspnoea
•Pain in the loin
•Jaundice
•Shock
•Haemoglobinuria
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30. Immediate Reactions
Management
•Blood transfusion should be stopped and a sample is taken from the remainder
and the patient’s blood for further grouping and cross matching. Besides, clerical
checks should also be done.
•Some blood should be taken for culture as bacterial contamination may be the
cause of the symptoms.
•Diuresis should be established to flush the renal tubules of haemoglobin and
prevent blockage.
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31. Immediate Reactions
4) Circulation Overload: It usually occurs in patients with congestive cardiac
failure, chronic anaemia or renal disease.
Clinical Features
•Dyspnoea, orthopnoea
•Cyanosis
•Cough, frothy sputum
•Raised JVP
•Rapid and weak pulse
Management
•Transfusion is stopped and patient is propped up
•IV Frusemide is administered to remove the excess fluid
•Emergency phlebotomy is done to remove excess blood
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32. Delayed Reactions
1) Thrombophlebitis: It follows
•Injury to the vein by the needle or cannula
•Spasm of the vein caused by cold blood.
•Prolonged use of the same vein
•Leakage of blood around the vein
•Sepsis
Clinical Features
•Pain, redness, tenderness, thickening of the vein
•Pyrexia
Management
•Analgesics are administered for the pain
•The affected limb is rested
•A sample is taken form the tip of the needle or cannula for culture and sensitivity
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33. Delayed Reactions
2) Delayed Haemolysis: This delayed red cell haemolysis follows stimulation and
production of antibodies which at the time of cross matching were too low in
concentration to be detected.
3) Platelet antibodies: Usually occurs 7-14 days after transfusion. It is due to
formation of antibodies to the transfused platelets.
Clinical Features
•Petechiae haemorrhage
•Bleeding from mucus membranes
Management
There is usually spontaneous recovery
•In severe cases give prednisolone or IV immunoglobulin
•You may need to do a plasmaphoresis
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34. Delayed Reactions
4) Transfusion of diseases: Viral hepatitis (B,C,D), Malaria, Syphilis,
Cytomegalovirus infection, Human Immunodeficiency virus, Trypanosomiasis,
Toxoplasmosis(protozoan), Infectious mononucleosis, Brucellosis(bacterial).
5) Micro aggregates: Degeneration of leukocytes and platelets form aggregates,
which may cause pulmonary micro embolism, with resulting pulmonary
insufficiency. It occurs more commonly after massive transfusion. The use of
micro-filters reduces the incidence.
6) Immunosuppresion: Natural Killer cells and T lymphocytes’ blastogenic
activities are reduced while suppressor T lymphocytes activity is enhanced.
7) Transfusion Haemosiderosis
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35. CONCLUSION
 Blood is a powerful and important therapeutic agent in
surgery, especially maxillofacial surgery.
 It’s important to have a sound knowledge on the rational
use of blood (and blood components) in patients.
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36. Dr. Boluwatife Afolabi 36

37. REFERENCES
 Badoe E.A; Principles and Practice of Surgery, 4th edition
 Ganong W.F; In Review of Medical Physiology
 https://www.slideshare.net/Drkabiru2012/blood-transfusion-in-surgery
 https://www.slideshare.net/rosesrred90/blood-transfusion-16397094
 https://www.slideshare.net/UthamalingamMurali/blood-transfusion-42999457
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