BLOOD TRANSFUSION

1. BLOOD TRANSFUSION
DR RASHMI

2. INDICATIONS
Blood transfusion is a life saving measure and should be carried
out when it is absolutely essential. Common situations in which
blood transfusion is indicated are:
1. Blood loss. Severe blood loss is the most important indication
for blood transfusion.
2. For quick restoration of haemoglobin in patients with
severe anaemia which is required in situations like pregnancy
and emergency surgery.

3. INDICATIONS
3. Exchange transfusion is required in haemolytic disease
of newborn.
4. Blood diseases like aplastic anaemia, agranulocytosis, leukaemias,
haemophilia, purpura and clotting defects may require blood
transfusion.
5. Acute poisoning, e.g. carbon monoxide poisoning

4. DONOR
• Donor refers to a person who donates the blood and the person who receives
blood is a recipient.
• Precautions to be taken while selecting a donor are:
Donor should be healthy and aged between 18 and 60 years.
Pregnant and lactating mothers preferably should not donate blood
Donor should be screened to exclude the diseases which are spread through
blood such as AIDS, viral hepatitis, malaria and syphilis.
Haemoglobin and packed cell volume (PCV) of the donor should be within
normal range. Its approximate concentration is tested

5. UNIVERSAL DONOR
• Blood of the individuals with blood group
• O does not contain any agglutinogen. So when this blood
is transfused to a person with any blood group (A, B, AB
or O), theoretically its RBCs will not be agglutinated.
• Because of this fact, an individual with blood group O is
called universal donor.
• However, practically this term is no longer valid, as it
ignores the complications produced by existence of Rh
factor and other blood group systems.

6. UNIVERSAL RECIPIENT.
• Blood of an individual with blood group AB does not
contain any agglutinins.
• So, theoretically when such an individual receives blood
from the individual with any blood group (A, B, AB or O),
there should be no transfusion reaction.
• Because of this fact an individual with AB blood group is
called universal recipient.
• However, practically this term is no more valid because it
ignores the complications produced by the existence of Rh
factor and other blood group systems.

7. AUTOLOGOUS BLOOD TRANSFUSION
• Autologous blood transfusion refers to
transfusion of an individual’s own blood
which has been withdrawn and stored.
• Autologous transfusion is done under the
following situations:
-For elective surgery, a self-predonation is a
common practice in some hospitals.
-During surgery, the cell-saver machine when
used sucks up the blood from the wound,
recycles it and returns it to the patient’s body

8. STORAGE OF BLOOD FOR TRANSFUSION
• One unit of blood (420 mL) can be collected from a donor at a time
under all aseptic measures.
• An individual can safely donate one unit of blood every 6 months.
Acidcitrate-dextrose (ACD) mixture (120 mL) is added to blood
and is stored in sterile container.
• Contents of ACD mixture are: –
Acid citrate (monohydrous), 0.48 g,
– Trisodium citrate, 1.32 g,
– Dextrose 1.47 g and
– Distilled water 100 mL

10. • Dextrose (glucose) present in ACD mixture
provides energy for maintenance of sodium–
potassium pump activity.
• Anticoagulant activity is provided by the
citrates present in the ACD mixture which also
decreases the pH of blood. The blood can be
stored under above conditions up to 21 days.

11. • The RBCs in the stored blood swell up due to the following
changes as a result of decreased cell metabolism in cold storage.
– Loss of intracellular K+, which increases plasma K+ concentration
from 4–5 mEq/L to 20–30 mEq/L,
– Increase in intracellular Na+ from 12 mEq/L to 30–40 mEq/L –
Increase in intracellular water content. Because of the above changes
the RBCs become more spherocytic and their haemoglobin in
hypotonic solution increases. Such cells may rupture in vitro even in
0.8% NaCl solution. With reference to Na+ and K+ content, volume,
shape and saline fragility, the RBCs become normal within 48 h of
transfusion.

12. • WBCs and platelets in stored blood are virtually absent
after 24 h of storage. Therefore, stored blood is not a
suitable medium for transferring WBCs and platelets to a
recipient.
• After transfusion of stored blood, 80% RBCs survive for
24 h and thereafter surviving cells are destroyed at a rate of
1% per

13. PRECAUTIONS TO BE OBSERVED DURING BLOOD
TRANSFUSION
1. Absolute indication should always be there for the
transfusion of blood.

14. 2.CROSSMATCHING
• Crossmatching should always be done before the blood transfusion. For
it blood is collected from donor as well as recipient. Plasma and RBCs
are separated in each.
The crossmatching involves two steps:
• major and minor crossmatching.
• Major crossmatching involves mixing of donor’s cells with recipient’s
plasma. This is called major crossmatching because of the fact that when
mismatched blood is transfused in a recipient, the donor’s cells get
agglutinated as against their agglutinogen there is sufficiently high
concentration of agglutinins in the recipient’s plasma..

15. • Minor crossmatching involves mixing of recipient’s cells with
donor’s plasma. This is called minor crossmatch due of the fact that
reaction of donor’s plasma and recipient’s cells usually does not
occur or is very very mild on giving mismatched blood transfusion
because:
• Firstly, the donor’s plasma in the transfusion (about 250 mL) is
usually so diluted by the much larger volume of recipient’s blood
(about 5 L) that it rarely causes agglutination even when the titre of
agglutinins against the recipient’s cell is high, and Secondly,
donor’s agglutinins are also neutralized by soluble agglutinogen
which are found free in the recipient’s body fluid.

16. 3. Rh +ve blood should never be transfused to Rh -ve person. It is
particularly must for females at any age before menopause, because
once she is sensitized by the Rh antigen, the anti-D antibodies are
formed and she will not be able to bear a Rh +ve fetus. In other
words, Rh +ve transfusion may make a woman permanently
childless.
4. Donor’s blood should always be screened for diseases which are
spread through blood, such as AIDS, hepatitis B, malaria and
syphilis.
5. Blood bag/bottle should be checked for the name of recipient and
blood group on the label before starting the blood transfusion

17. 6. Blood transfusion should be given at slow rate. If rapid transfusion
is given, citrate present in stored blood may cause chelation of
calcium ions leading to decreased serum calcium level and tetany.
7. Proper aseptic measures must be taken during transfusion of blood.
8. Careful watch on recipient’s condition is must for the first 10−15
min of starting the transfusion and from time to time later

18. HAZARDS OF BLOOD TRANSFUSION
1.Circulatory overload due to hypervolaemia may occur following blood
transfusion when the transfusion is rapid specially in patients with cardiac
diseases.
2 Transmission of blood-borne infections such as AIDS, viral hepatitis,
malaria, syphilis, etc. may occur to recipient from the infected donor.
3. Pyrogenic reaction characterized by fever and chills may occur probably
due to destruction of leucocytes and platelets by antibodies against them.
4. Allergic reactions such as skin rashes and asthma may occur if donor
blood contains substances to which patient is allergic.

19. • 5.Hyperkalaemia may occur after excessive transfusion because K+
concentration in stored blood is high. Owing to leakage of K+ from
the RBCs into the plasma.
• 6. Hypocalcaemia producing tetany may occur following massive
transfusion of citrated blood.

20. 7.Mismatched transfusion reactions.
Mismatched transfusion reaction is the most serious and potentially fatal hazard
of blood transfusion. It is characterized by showing effects of inter-group blood
transfusion:
Agglutination of donor’s red blood cells in the recipient circulation Tissue
ischaemia occurs due to blockage of certain vessels by the agglutinated cells.
Soon patient complains of violent pain in back or elsewhere and tightness of
chest.
Haemolysis of agglutinated red cells occurs rapidly releasing large amount of
haemoglobin in circulation (haemoglobinaemia).

21. • Haemolytic jaundice may occur due to excessive formation of
bilirubin from haemoglobin released by haemolysed RBCs.
• Renal vasoconstriction is caused by toxic substances released from
the haemolyzed RBCs.
• Circulatory shock occurs due to loss of circulating red cells and
release of toxic substances leading to fall in arterial blood pressure
and decreased renal blood flow.
• Haemoglobinuria occurs when total free haemoglobin becomes
more than that can bind with haptoglobin (plasma protein binding
haemoglobin).
• The extra free haemoglobin leaks through glomerular membrane
and is passed in urine producing haemoglobinuria

22. • Renal tubular damage. If urine is acidic and glomerular filtration is slow,
the free haemoglobin passing through glomeruli is precipitated in the
tubules as acid haematin. This obstructs the lumen of tubules producing
renal tubular damage.
• Acute renal shut down (anuria) sets in ultimately due to the combined
effects of renal vasoconstriction, circulatory shock, hypotension and
renal tubular damage.
• Acute renal shut down usually occurs within a few minutes to few hours
after transfusion of mismatched blood and continues. Uraemia
(increased nitrogenous substances and potassium in the body) results due
to acute renal failure, soon producing coma and death.