This document provides information about blood transfusions, including: - The main blood groups (A, B, AB, O) and Rh factor (+/-) which determine blood type. - Indications for transfusions including acute blood loss, anemia, surgery, and burns. - Potential complications of transfusions including febrile reactions, allergic reactions, hemolytic reactions, infections, and transfusion-related acute lung injury. - Massive transfusions can cause complications like coagulopathy, electrolyte abnormalities, and citrate toxicity. - Alternatives to transfusions discussed include human albumin, gelatin, dextran, and hydroxyethyl starch.

1. BLOOD
TRANSFUSIONS
Dr. Neeraj Kumar Jain
Deptt. Of General
Surgery

2. Objectives
• Blood Groups
• Indications
• Donor Criteria & Collection of Blood
• Complications
• Massive Transfusion
• Blood Substitutes 2
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3. Overview
• It is a procedure in which a patient
receives a blood product through an
intravenous line.
• It is the introduction of blood
components into the venous
circulation.
• Process of transferring blood-based
products from one person into the
circulatory system of another.

4. BLOOD GROUPS
4

5. Types of blood
groups
• There are more than 20 genetically
determined blood group systems known today
•The AB0 and Rhesus (Rh) systems are the
most important ones used for blood
transfusions.
5

6. ABO blood grouping
system
• There are
four different
kinds of blood
types:
• A, B, AB or O
(null).
6

7. Blood
Types
• Each person has one of the following
blood types: A, B, AB, or O.
• O can be given to anyone but can only
receive O, so called as Universal Donor.
• AB can receive any type but can only be
given to AB, so called as Universal
Recipients.
• Also, every person's blood is either
Rh-positive or Rh-negative.
7

9. The ABO blood
groups•The table shows the four ABO phenotypes ("blood
groups") present in the human population and the genotypes
that give rise to them.
9
Blood
Group
Antigens
on RBCs
Antibodies in Serum Genotypes
A A Anti-B AA or AO
B B Anti-A BB or BO
AB A and B Neither AB
O Neither Anti-A and anti-B OO

10. The Rhesus (Rh)
System
• Well, there's another antigen to be
considered always - the Rh antigen.
• Some of us have it, some of us don't have.
• If it is present, then blood is RhD positive,
if not it's RhD negative.
• So, for example, some people in group A
will have it, and will therefore be classed
as A+ (or A positive).
• While the ones that don't, are A- (or A
negative).
• And so it goes for groups B, AB and O.
10

11. • According to above blood grouping systems, you
can belong to either of following 8 blood groups:
11

12. History Of Blood
Transfusion
• 1492 – Pope Innocent VIII
• 1628 – William Harvey
• 1665 – Richard Lower
• 1667 – Jean – Baptiste Denis
• 1670 – France
• 1829 – James Blundell
• 1900 – Karl Landsteiner
• 1914 – Albert Hustin
• 1926 – British Red Cross
• 1939 – Rhesus system

13. India’s First Blood Bank
• School of Tropical Medicine,
Kolkatta
• By SIR. UPENDRANATH
BRAHMACHARI
• Chairman of Bengal Red Cross
Society.

14. CROSS
MATCHING
• DONOR’S R.B.C +
• RECIPIENTS SERUM +
• COOMB’S REAGENT

15. Blood Donor
Criteria
• Age – 17 – 65 ( New upto 60 )
• Wt - > 45 kg
• Hb - > 13 M / > 12 F
• Fit without serious diseases – HIV /
Hepatitis & Malaria
• A person can donate blood every 90
days (3 months).

16. Collection &
Storage
• Bag – 75ml CPD
• Stored – Special Ref. - 4Deg C. +/-
2Deg C
• Shelf Life of CPD Blood - 3 wks
• R.B.C’s - 3 wks
• W.B.C – Rapidly Destroyed
• Platelets – Reduced in 24 hrs
• Clot. Factors – Labile – Levels fall

17. Blood Donation
• 475ml Blood + 63ml Anticoagulant
• Post – Transfusion Purpura
• Red cells + Optimal Additive solution
• SAGM
• Expiry date = 35 days
• One unit of blood raises the haemoglobin
concentration by approximately 1g/100 ml

18. Indications
• Acute blood loss – Due to Trauma.
• Chronic Anemia.
• Major Operative procedures
• As a Prophylactic measure to
Surgery
• Severe Burns
• Blood Dyscariasis

19. Transfusion Trigger
• The decision to transfuse any patient for a
given indication must balance the risks of not
transfusing.
• RBC transfusion not indicated when Hb>10g/dl
• Transfuse Criteria
- < 6g/dl -
- 6 - 8g/dl -
Benefit from Transfusion
Unlikely to benefit – absence of
bleeding
- > 8g/d l - Not indicated

20. COMPLICATIONS
IMMEDIATE
Immunological
- Febrile / non
haemolytic
- Allergic /Anaphylaxis
- Haemolytic TR
- TRALI
Non- Immunological
- Congestive Cardiac Failure
- Infection
- Air Embolism
- Thrombophlebitis
- TACO

21. Febrile Non Haemolytic Transfusion
Reaction
• Defined to be a rise in temperature
of 1 °C or more and >=38 °C,
within few hours of transfusion with
Chills & Rigors.
• Due to cytokines in the blood itself
and/or pyrogens in the transfusion
apparatus.

22. Allergic / Urticarial Transfusion
Reaction
• Most common usually due to allergies
to specific proteins in the donor’s
plasma.
• Mild – Trt – Steroids & Antihistamines.
• For severe (anaphylaxis), unit is
discarded. New washed RBC’s and
platelets are used.

23. Acute Haemolytic Reaction
• Transfusion of an incompatible blood
component. { ABO incompatibility }
• A disaster, almost always preventable.
• Most often due to ABO mismatch due
to a clerical error (i.e., the wrong blood
and/or the wrong recipient).
• Intravascular destruction – ARF & DIC

24. Acute Haemolytic Reaction
• Features - fever, hypotension, NV,
tachycardia, dyspnea, chest or
back pain, flushing & anxiety
• Post-op site: diffuse bleeding
• Trt - Fluids, diuresis and
transfusion support for bleeding

25. Transfusion Related Acute Lung Injury [
TRALI ]
• Due to donor plasma containing an antibody,
usually against the patient's HLA or leukocyte
specific antigens.
• The donor antibodies cause these neutrophils
to release toxic products and thus produce
ARDS.
• Features - Dyspnea, hypotension and fever
typically begin 30 minutes to 6 hours after
transfusion
• chest x-ray shows diffuse non-specific
infiltrates , “white out”

26. Infections
• Bacterial infection – Due to faulty
storage.
• Serum hepatitis.
• HIV Infection
• Malaria transmission
• Viral – EBV / CMV
• Syphilis / Yersinia

27. Transfusion Associated Cardiac Overload
[ TACO ]
• 1% of Transfusions are Complicated by
TACO.
• Features – Dyspnoea, hypertension,
crepitations & low O2 Sat.
• Risk of volume overload / respiratory
distress especially in small / elderly pt.
• Largely avoidable by careful attention to
fluid balance.

28. Delayed Complications
• Delayed Haemolytic TR
• Post – Transfusion Purpura
• Transfusion related graft versus host
disease { TGVH }
• Immunosuppression
• Iron overload – Multi transfused
recipients

29. Delayed Haemolytic Transfusion Reaction
• Previously sensitized to an antigen
through transfusion or pregnancy.
• Can result in symptomatic or
asymptomatic hemolysis several days
(2-10 days) after a subsequent
transfusion.
• These present with flu-like symptoms,
recurrent anemia and jaundice.

30. Transfusion-associated graft-
versus-host disease (TA-GVHD)
• Donor T-cells attack host tissues.
• Symptoms occur within 1-4 weeks.
• Rare but always fatal.
• Features – Pancytopenia / Rash / Liver
dysfunction.
• Difficult to treat.
Skin manifestation of GVHD
Generalized swelling, erythroderma and bullous
formation

31. Massive Blood
Transfusion
• Replacement Or Transfusion of blood
= pt’s blood volume within 24 hours [ In
normal adult – 10 units or 5-6 L ]
> 2500ml
OR
• Single transfusion
continuously

32. MBT - Complications
• Coagulopathy
• Hyperkalemia / Hypocalcaemia
• Citrate toxicity
• Hypothermia
• Infections
• Incompatibility & Transfusion reactions
• ARDS / DIC

33. Blood
Substitutes
DEXTRAN
• Most Widely Used
• Polysaccharides - ↑ Plasma volume
• Leuconostoc Mesenteroides Bacteria
• Low Mol.Wt (40,000 mol.wt )
• High Mol.Wt (70,000)
• Massive Transfusion – Impair Coag.
33

34. Blood
Substitutes
Human Albumin – 4.5%
• Plasma fractionation – Albumin Extract
• No risk - Hepatitis
• Can be used daily
• Expensive
34

35. Blood
Substitutes
Gelatin
• Haemaccel - Plasma Expander
• 30% Remains - Intravascular
Hydroxethystarch
• Contains – Starch / NaOH / Ethylene
Oxide
• Lasts – 6 hrs
35

37. 1. Which of the following is not a
delayed complication of blood
transfusion ?
• A TRALI
• B TG-VH
• C Post – transfusion purpura
• D Iron overload

38. 2. Which of the following is not a
complication of massive blood
transfusions ?
• A Coagulopathy
• B Hypercalcemia
• C Hyperkalemia
• D Hypothermia.

39. 3. The first successful
documented human transfusion
was done by - ?
• A Karl Landsteiner
• B James Blundell
• C Richard Lower
• D Jean – Baptiste Denis

40. 4. Shelf life of CPD
Blood is
-
• A 7 days
• B 14 days
• C 21 days
• D 28 days

41. 5. One of the following is not a Blood
substitute -
• A Hydroxystarch
• B Haemaccel
• C Human albumin
• D LMW – Dextran

42. Observing / Monitoring the Patient During a Blood / Blood
Component Transfusion is part of safe transfusion
Rigors
Haemoglobinuri
a
Tachycardia Hyper /
HypotensionPyrexia
Nausea /
vomiting
Breathlessness /
coughing Restlessness
Agitation
Confusion
Chest, abdominal,
muscle, bone or loin
pain
Flushing
Urticaria -
Itchy rash
Headache
Collapse
Generally feeling
unwell

43. blood and blood transfusions 43

44. PRE-TRANSFUSION
RESPONSIBILITIES
• Assess laboratory values
• Verify the medical prescription.
• Assess the client’s vital signs, urine
output, skin color and history of
transfusion reactions.
• Obtain venous access. Use a
central catheter or at least a 20-
gauge needle, if possible.
blood and blood transfusions 44

45. • Obtain blood products from a blood bank;
transfuse immediately.
• With another registered nurse, verify the
patient by name and number, check blood
compatibility and note expiration time.
• Administer the blood product using the
appropriate filtered tubing.
blood and blood transfusions 45

46. • Remain with the patient during
the first 15-30 minutes of the
infusion.
• Infuse the blood product at the
prescribed rate.
• Monitor vital signs.
blood and blood transfusions 46

47. World Blood Donor Day-June 14th

48. THANKS