Crossmatch & Transfusion Procedure Hospital

The first successful transfusion of human blood was performed in 1818 by a British
obstetrician, Dr James Blundell, who drew blood from the patient’s husband and, to prevent
the blood from coagulating ex vivo, infused it directly into the patient
BLOOD TRANSFUSION
Blood transfusion begins with
collecting whole blood from a donor using a
preservative-anticoagulant combination
(typically citrate phosphate dextrose or
citrate phosphate dextrose adenine-1).
The blood is then tested for transfusion-
transmitted diseases, separated into its
specific components, and then transfused
as clinically indicated.
Zomorrodi A, Picciola EA, Hotwagner DT. Determining the Need for Blood Transfusion. [Updated 2023 Jun 8]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

• storing blood and blood components at appropriate temperatures and conditions;
developing appropriate procedures for further processing of the blood and blood
components prior to transfusion – for example, pooling, washing and irradiation,
where applicable;
• appropriate pre-transfusion testing of patients and cross-matching to ensure
compatibility of the blood component to be transfused maintaining appropriate
records to ensure that blood components can be traced to their recipients and
from recipients back to their donors;
• documenting and investigating nonconformities and deviations related to the
handling of blood and blood components;
• quarantining of blood and blood components that are under investigation by the
blood establishments/banks and hospitals;
• reporting adverse events and reactions that are related to the quality of blood
components to the blood establishments/banks;
• investigating, evaluating and documenting all adverse transfusion reactions;
• ensuring the appropriate use of blood and blood components by clinicians
THE BLOOD TRANSFUSION SYSTEM
World Health Organizatiom

COMPLICATIONS OF BLOOD TRANSFUSION
Bates, I., & Owusu-Ofori, S. (2009). Blood Transfusion. Manson's Tropical Diseases, 229–234.
https://doi.org/10.1016/B978-1-4160-4470-3.50018-5

BLOOD TYPE AND CROSS MATCH
To avoid a transfusion reaction, donated blood must be compatible with the blood of the
patient who is receiving the transfusion. The donated RBCs must lack the same ABO and Rh
D antigens that the patient's RBCs lack
Before transfusion
Blood type Cross match
the recipient's blood type is determined,
their ABO type and Rh D status
may still be incompatible because it contains other
antigens that are not routinely typed but may still
cause a problem if the recipient's serum contains
antibodies that will target them
to ensure that the donor RBCs actually
do match against the recipient's serum
Dean L. Blood Groups and Red Cell Antigens
[Internet]. Bethesda (MD): National Center for
Biotechnology Information (US); 2005. Chapter 3,
Blood transfusions and the immune system.
Available from:
https://www.ncbi.nlm.nih.gov/books/NBK2265/

CROSS MATCH
To perform a cross match, a small
amount of the recipient's serum is mixed
with a small amount of the donor RBCs
Dean L. Blood Groups and Red Cell Antigens [Internet]. Bethesda (MD): National Center for
Biotechnology Information (US); 2005. Chapter 3, Blood transfusions and the immune
system. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2265/
If the proposed transfusion is
incompatible, the donor RBCs are
agglutinated by antibodies in the
recipient's serum.

RED BLOOD CELLS
Packed red blood cells (RBCs) are prepared from whole blood by removing approximately 250 mL
of plasma.
One unit of packed RBCs should increase levels of hemoglobin by 1 g per dL (10 g per L) and
hematocrit by 3 percent.
Indication :
• Acute sickle cell crisis (for stroke prevention)
• Acute blood loss of greater than 1500 mL or 30% of blood volume
• Patients with symptomatic anemia if they cannot function without treating the anemia
• When a patient has a hemoglobin level less than or equal to 10 g per dL and hematocrit level
less than or equal to 30 %
Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications.
Am Fam Physician. 2011 Mar 15;83(6):719-24. PMID: 21404983.
A single unit of packed red blood cells is roughly 350 mL and contains about 250 mg of iron

RED BLOOD CELLS
• Storage: designated temperature controlled
refrigerator 4 ±2 oC
• Shelf life: 35 days
• Dose: 4ml/kg (equivalent to 1 unit per 70kg
adult) typically raises Hb concentration by
about 10g/l
• All red cell units should be transfused within 4
hours of removal from designated temperature
controlled storage
Guidelines for blood transfusion :

Post-operative patients
In haemodynamically stable post-operative surgical patients, the trigger for transfusion is Hb ≤ 8 g/dl
or presence of symptoms of inadequate oxygen delivery (chest pain of cardiac origin, orthostatic
hypotension or tachycardia unresponsive to fluid resuscitation, or congestive heart failure). QoE:
High; SoR: Strong
Patients with neurotrauma or neurological diseases
 In patients with traumatic brain injury, the target Hb should be 7-9 g/dl; and in those with
additional evidence of cerebral ischaemia the target Hb should be >9 g/dl. QoE: Low; SoR: Weak
 In patients with subarachnoid haemorrhage the target Hb should be 8-10 g/dl. QoE: Low; SoR:
Weak
 In patients with an acute ischaemic stroke the Hb should be maintained above 9 g/dl. QoE: Low;
SoR: Weak
Yaddanapudi, S., & Yaddanapudi, L. (2014). Indications for blood and blood product transfusion. Indian
journal of anaesthesia, 58(5), 538–542. https://doi.org/10.4103/0019-5049.144648

Patients in the intensive care unit
 In critically ill normovolaemic patients transfusion is considered at a Hb level of ≤7 mg/dl with a
target of 7-9 g/dl, unless specific co-morbidities or acute illness-related factors modify clinical
decision-making. QoE: Moderate to High; SoR: Strong
 During the early resuscitative phase of severe sepsis if there is evidence of inadequate oxygen
delivery to the tissues (central venous oxygen saturation <70%, mixed venous oxygen saturation
<65% or lactate concentration >4 mmol/L), blood transfusion is considered to achieve a target
Hb of 9-10 g/dl. QoE: Low; SoR: Weak
 In the later phases of severe sepsis, the guidelines are similar to those for other critically ill
patients with target Hb of 7-9 g/dl. QoE: Low; SoR: Weak
 Blood transfusion should not be used to assist weaning from mechanical ventilation if the Hb is
>7 g/dl. QoE: Very low; SoR: Weak

Patients with cardiac disease
 In haemodynamically stable patients with cardiovascular disease transfusion is considered for
Hb ≤ 8 g/dl, or the presence of symptoms of inadequate oxygen delivery. QoE: Moderate; SoR:
Weak
 In critically ill patients with stable angina, Hb should be maintained >7 g/dl. Transfusion to a Hb
of >10 g/dl has uncertain benefit. QoE: Moderate; SoR: Weak
 In patients suffering from acute coronary syndrome, the Hb should be maintained at >8-9 g/dl.
 Restrictive transfusion strategy (trigger Hb: 7-8 g/dl) is recommended for patients with coronary
artery disease. QoE: Low; SoR: Weak

PLASMA
Plasma contains all of the coagulation factors.
Fresh frozen plasma infusion can be used for
reversal of anticoagulant effects.
Thawed plasma has lower levels of factors V
and VIII and is not indicated in patients with
consumption coagulopathy (diffuse
intravascular coagulation)

PLATELET
indicated to prevent hemorrhage in patients
with thrombocytopenia or platelet function
defects
Contraindications to platelet transfusion
include thrombotic thrombocytopenic purpura
and heparin-induced thrombocytopenia.
One unit of apheresis platelets should
increase the platelet count in adults by 30 to
60 × 103
per μL (30 to 60 × 109
per L).
Spontaneous bleeding through intact
endothelium does not occur unless the platelet
count is no greater than 5 × 103
per μL (5 ×
109
per L)

PLATELET
In Neonates, transfusing 5 to 10 mL per kg of
platelets should increase the platelet count by
50 to 100 × 10
3
per μL (50 to 100 × 109
per L).

PLATELET
• Storage: temperature controlled 22 ± 2 °C – with
continuous gentle agitation
• Platelets must not be refrigerated
• Shelf life: 5 days (In certain controlled circumstances 7
day platelets may be supplied)
• Platelet concentrates should not be transfused through
administration sets which have already been used to
administer other blood components
• The infusion should be commenced as soon as possible
after the component arrives in the clinical area

CRYOPRECIPITATE
Cryoprecipitate is prepared by thawing fresh
frozen plasma and collecting the precipitate
Cryoprecipitate contains high concentrations
of factor VIII and fibrinogen
Each unit will raise the fibrinogen level by 5 to
10 mg per dL (0.15 to 0.29 μmol per L), with
the goal of maintaining a fibrinogen level of at
least 100 mg per dL (2.94 μmol per L)
The usual dose in adults is 10 units of pooled
cryoprecipitate.

WHOLE BLOOD
There has been increasing interest in using low titer group O whole blood (LTOWB) in military and
civilian trauma, and there is evidence to show that it saves lives.
LTOWB provides all of the components of blood (RBCs, platelets, and plasma with fibrinogen) and
provides a balanced resuscitation addressing oxygen needs and coagulopathy in a single bag of
blood.
The transfusion of up to 4 units of whole blood has been shown to be safe.
Zomorrodi A, Picciola EA, Hotwagner DT. Determining the Need for Blood Transfusion. [Updated 2023 Jun 8]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
The whole blood has a critical titer of anti-A and anti-B of less than 50 to 200

Platelet Transfusion In Thrombocytopenic
Patients for Phacoemulsifications
Thrombocytopenia is a common risk factor for surgery. In phacoemulsification cataract surgery, it
can cause serious periocular or intraocular hemorrhage, and leads to severe complications.
Lee, Tsung—Han. Et al. 2014. The use of platelet transfusion in thrombocytopenic patients for phacoemulsification.
Taiwan Journal of Ophtalmology. Vol.04. No.1. Pp 52-55
In order to better control the intraoperative bleeding, platelet transfusion in patients with
thrombocytopenia is commonly carried out in some major operations
The normal platelet count range is around 150,000–400,000/μL, and the threshold of 20,000/μL for
prophylactic transfusion is widely accepted to prevent spontaneous bleeding.
For patients undergoing invasive procedures, an optimal platelet count of >50,000/μL has also
been suggested.

Platelet Transfusion In Thrombosytopenic
60 years old man with refractory cytopenia with multilineage
dysplasia who had undergone phacoemulsification for his
right eye. The platelet level is 5000/µL, 12-unit platelet
transfusion was administered 2 hours prior to the surgery. The
surgery was performed smoothly without any complication
After the operation, his postoperative Day-1 follow-up
revealed a favorable wound condition in his right eye with
minimal subconjunctival hemorrhage, but without periorbital
ecchymosis, hyphema, or even choroid hemorrhage
Preoperative
Postoperative day 1
CASE 1

Platelet Transfusion In Thrombosytopenic
70 years old female with steroid refractory severe idiopathic
thrombocytopenic purpura who had undergone splenectomy.
Her platelet level was 6000 / µ, then 12-unit platelet
transfusion 2 hours prior to the operation was given.
On postoperative Day 1, mild subconjunctival hemorrhage of
her right eye was observed when the wound dressing was
changed Then at her 1-month follow-up clinic, the
subconjunctival hemorrhage in her right eye regressed, and
the BCVA of her right eye improved from 0.07 to 1.0. There
was no bleeding-associated adverse event reported or found
on ocular examination
Preoperative
Postoperative day 1***
CASE 2
Preoperative
1-month
postoperative

Transfusion in Sickle Cell Retinopathy Surgery
Proliferative sickle retinopathy is characterized by the development of peripheral retinal
neovascularization, vitreous hemorrhage, and tractional or combined tractional-rhegmatogenous
retinal detachment
Chen, R. W., Flynn, H. W., Jr, Lee, W. H., Parke, D. W., 3rd, Isom, R. F., Davis, J. L., & Smiddy, W. E. (2014).
Vitreoretinal management and surgical outcomes in proliferative sickle retinopathy: a case series. American journal of
ophthalmology, 157(4), 870–875.e1. https://doi.org/10.1016/j.ajo.2013.12.019
The earliest surgical series for proliferative sickle retinopathy was published prior to the era of
vitrectomy and reported a high rate of anterior segment ischemia, prompting some surgeon to
recommend preoperative exchange transfusion and avoidance of an encircling scleral buckle
Proliferative sickle retinopathy remains a challenging ocular condition, and anterior segment
ischemia is a possibility even with modern surgical techniques and in the absence of scleral
buckling or muscle detachment

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