Blood transfusions have evolved significantly since the first animal-to-human transfusion in 1665. Key developments include the discovery of blood groups by Landsteiner in 1901, which helped reduce transfusion reactions. Major risks of transfusion include febrile reactions, allergic reactions, respiratory complications like TRALI, and rare but serious events like hemolytic reactions and disease transmission. Proper screening and typing has made transfusions much safer, but complications remain a risk, especially with massive transfusions required for trauma patients. Researchers continue working on blood substitutes to reduce donor dependence and risks of allogeneic transfusion.

1. Blood Transfusion
Dr. Danny Joy
JR-3
General Surgery IV

2. History
• Richard Lower, 1665: animal to human transfusion

3. • James Blundell, 1818:
 Transfusion of human blood to treat PPH
• Karl Landsteiner:
 1901: discovered three blood groups O,A & B
 1930: Nobel Prize in Physiology and Medicine
• George Washington Crile:
 1906: first surgery using a direct blood transfusion

4. • William Stewart Halsted:
 One of the first blood transfusions in the United States
• Albert Hustin:
 first non-direct transfusion
 Sodium citrate anticoagulant
• Levine and Stetson:
 1939: Rh grouping

5. Typing and cross-matching
• Serologic compatibility for A, B, O, and Rh groups is established routinely
• Major cross-match: between the donors’ red blood cells and the recipients’
sera
• Administration of Rh-positive blood is acceptable if Rh-negative blood is
not available except in women of child bearing age-group
• In emergencies, O-negative blood may be transfused to all recipients
 Increased chance of hemolysis when >4 units transfused

6. • Autologous Transfusion:
 Hb>11, PCV>34
 First procurement 40 days prior, last 3 days prior
 Upto 5 units
 Intervals of 3-4 days
 Recombinant Human Erythropoietin (rHuEPO) may be used

7. Blood products
Banked whole blood:
• Less commonly used now
Red blood cells and Frozen red blood cells
• One unit 330 ml– stored in SAG-M solution
• Shelf life 42 days at 2-6°C
• Frozen red blood cells
 Cant be used in emergencies
 Preparation time is several hours
 For patients who are known to have been previously sensitized
 Red blood cell viability is improved
 ATP and 2,3-DPG concentrations are maintained

8. Leukocyte-Reduced and Leukocyte-Reduced/Washed Red Blood Cells
• Filtration process that removes about 99.9% of the white blood cells and
most of the platelets
 Prevents almost all febrile, nonhemolytic transfusion reactions
 Prevents alloimmunization to HLA class I antigens, platelet transfusion
refractoriness and cytomegalovirus transmission
Platelet Concentrates
• shelf life: 120 hours at 20-24°C
• One unit approx. 50mL
Fresh Frozen Plasma
• Usual source of the vitamin K-dependent factors
• Only source of factor V
• Shelf life: 5 days

9. Cryoprecipitate
• Rich in factor VIII and fibrinogen
• −30°C—two year shelf life
• Low fibrinogen states or factor VIII deficiency
Prothrombin complex concentrate
• Factors II, IX and X
• Factor VII may be included or produced separately
• Emergency reversal of warfarin therapy

10. Indications for blood transfusion
• Acute blood loss, to replace circulating volume and maintain oxygen
delivery
• Perioperative anaemia, to ensure adequate oxygen delivery during the
perioperative phase
• Symptomatic chronic anaemia, without haemorrhage or impending surgery

11. • Perioperative red blood cell transfusion criteria

12. • Surgical blood loss replacement:
 In patients with normal preoperative values, blood loss up to 20% of total
blood volume can be replaced with crystalloid or colloid solutions

13. Massive blood transfusion
• ≥10 U RBCs in 24 h
• RBC:FFP:platelets ratio of 1:1:1 is presently recommended
• Use of fresh blood also encouraged in patients with acute trauma requiring
significant transfusion needs
• Forms the basis of damage control resuscitation:
 Permissive hypotension
 Minimizing crystalloid-based resuscitation
 Immediate release and administration of predefined blood products (red
blood cells, plasma, and platelets)

17. Complications of blood transfusion
• 10% of all transfusions
• <0.5% serious complications
• Deaths exceedingly rare:
 Transfusion-related acute lung injury (TRALI) (16%–22%)
 ABO hemolytic transfusion reactions (12%–15%)
 Bacterial contamination of platelets (11%–18%)

18. Nonhemolytic Reactions
• Febrile, nonhemolytic reactions:
 Defined as an increase in temperature (>1°C) associated with a transfusion
 Approximately 1% of all transfusions
 Preformed cytokines in donated blood and recipient antibodies reacting with
donated antibodies
 Pretreatment with acetaminophen
• Bacterial contamination:
 Rare
 25% mortality

19. Allergic Reactions
• 1% of all transfusions
• Usually mildrash, urticaria, and flushing
• Rarely severeanaphylaxis
• More commonly associated with FFP and platelets
• Transfusion of antibodies from hypersensitive donors or the transfusion of
antigens to which the recipient is hypersensitive
• Treatment and prophylaxis- antihistamines
• Severe- steroids, epinephrine

20. Respiratory Complications
• Transfusion-associated circulatory overload (TACO)
 Rapid infusion of blood, plasma expanders, and crystalloids
 Rise in venous pressure, dyspnea, and cough, rales over lung base
 Diuretics, slowing rate of transfusion, minimizing fluids
• Transfusion-related acute lung injury (TRALI)
 Noncardiogenic pulmonary edema related to transfusion
 Transfusion of any plasma-containing blood product
 Within 1-2 hr—always within 6 hrs
 Symptoms similar to circulatory overload
 Accompanied by fever, rigors, and bilateral pulmonary infiltrates on chest
x-ray
 Stop transfusion+pulmonary suport

21. Hemolytic Reactions
• Acute:
 ABO incompatibility—fatal in 6%
 Hemolysis, DIC
 Hemoglobinuriaacute tubular necrosisrenal injury
• Delayed:
 2 to 10 days after transfusion
 Extravascular hemolysis, mild anemia and unconjugated hyperbilirubinemia
 Low antibody titer at the time of transfusion, but the titer increases after
transfusion as a result of an immune response

22. Transmission of Disease
• Malaria, Chagas’ disease, brucellosis, syphilis
• Cytomegalovirus (CMV)
• Hepatitis C and HIV-1: reduced dramatically after introduction of antibody
and nucleic acid screening
• West Nile virus
• Prion diseases

23. Complications of massive transfusion
• Coagulopathy
• Hypocalcaemia
• Hyperkalaemia
• Hypokalaemia
• Hypothermia
Treatment of coagulopathy:
• Treatment indicated only if there is active bleeding
• FFP if PT or PTT >1.5 times normal
• Cryoprecipitate if fibrinogen <0.8 g/L
• Platelets if platelet count <50 × 109/mL

24. Blood substitutes
Oxygen carrying blood substitutes:
• Biomimetic:
 Mimic the oxygen carrying capacity of blood—Hemoglobin based
Diaspirin cross-linked hemoglobin (DCLHb)= HemAssist (Baxter)
HBOC-201 (Hemopure, Biopure)
PolyHeme
Liposome encapsulated hemoglobin
• Abiotic:
 Synthetic oxygen carriers—Perfluorocarbon based
 Applications in partial liquid ventilation
 Linear relationship to the partial pressure of oxygen-needs high FiO2
 Oxygent, OxyFluor, Oxycyte, Dermacyte

25. References
• Bailey and Love Short Practice of Surgery, 26th edition
• Schwartz’s Principles of Surgery, 10th edition
• Sabiston Textbook of Surgery, 19th edition

26. Thank you