Blood transfusion is done to replace lost blood through bleeding or increase blood counts in anemic patients. It involves collecting blood from healthy donors, testing the donor and recipient blood for compatibility, and transfusing compatible blood or components. Complications can include immunologic reactions like hemolytic transfusion reactions from ABO incompatibility, transfusion-related lung injury, or allergic reactions. Non-immunologic risks are circulatory overload, infections, air embolism, or iron overload. Proper donor selection, compatibility testing, and component preparation can help reduce risks, but complications still occur in some transfusions.

1. BLOOD
TRANSFUSION
AND ITS
COMPLICATIONS
Dr.Vinisha.S.Pousya
1st MDS
Department of Oral Pathology
22-02-2021

2. CONTENTS
• Introduction
• Indications of blood transfusion
• Donor selection
• Collection of blood
• Compatibility testing
• Cross matching
• Blood components
• Complications of blood transfusion

3. INTRODUCTION
• Blood transfusion is the process of receiving BLOOD PRODUCTS into
one’s circulation intravenously.
• Blood transfusion is usually done as a life saving maneuver to replace
blood cells or blood products lost through severe bleeding, during
surgery when severe blood loss occurs or to increase the blood count in
anemic patient

4. ALLOGENIC
BLOOD
TRANSFUSION
AUTOGENIC
BLOOD
TRANSFUSION
B
L
O
O
D
T
R
A
N
S
F
U
S
I
O
N

5. INDICATIONS OF BLOOD TRANSFUSION
• Acute blood loss following trauma
• During major surgeries
• Following burns
• In septicemia
• In chronic anemias
• In ITP , Hemophilia's

6. Composition of Blood
PLASMA – 55%
Straw colored
fluid
ALBUMINS, GLOBULINS,
FIBIRNOGEN
REGULATORY &
PROTECTIVE
PROTEINS
HORMONES,
ANTIBODIES,
ENZYMES
INORGANIC
SUBSTANCES -
0.9%
SODIUM CHLORIDE,
COPPER,
CALCIUM,MAGNESIUM,
POTASSIUM, LEAD,
BICARBONATE, IODINE, IORN
ORGANIC
SUBSTANCE
WASTE MATERIALS
NUTRITIVE MATERIALS
CELLS – 45%
WBC, RBC, PLATELETS OR
THROMBOCYTES

7. DONOR SELECTION
• Donor selection is based on medical history and few routine physical
examinations such as weight, blood pressure, temperature and
hemoglobin.
Types of donors
Professional
Replacement
Voluntary

8. • Donor should be healthy
• Age : 18 years and above
• Weight : Should be >45kgs
• Blood pressure should be normal and not a diabetic
• Time interval between each blood donation should be 3 months
• No skin disease at the phlebotomy site
• It is important to know whether the patient has history of diseases like
hepatitis, AIDS, syphilis and if so blood should not be obtained from
them.

9. COLLECTION OF BLOOD
• Blood collection is done under asepsis conditions using a sterile plastic bag
with anticoagulant
Donor lying on a couch
, sphygmomanometer
Cuff is applied to the
upper arm venipuncture
site is prepared.
15g needle is
introduced into the
median cubital vein.
450 ml of blood is
collected in a sac
containing 50ml of CPD
solution and will be
stored at 4o Celsius.

10. In the plastic bag in which blood will be collected will be mixed gently and
periodically with anticoagulants preservative solutions.
Functions of various chemicals used in anticoagulant-preservative
solution
Chemicals used Function
Citrate Prevents clotting by chelating calcium
Sodium bisphosphonate Buffers the end product of glycolysis
(lactic acid)
Dextrose Needed for ATP generation for
viability of red cells
Adenine Substrate for red cells synthesis of
ATP
The different anticoagulant preservative solutions are :
- Citrate phosphate dextrose (CPD)
- Citrate phosphate dextrose adenine (CPDA-1)
- Acid citrate dextrose (ASD)

11. COMPATIBILITY TESTING
Before transfusion of any blood or its components it is essential to know
whether they are compatible with the recipient’s blood. This is achieved
by performing various test and procedures known as compatibility testing.
It includes:
• Review of patient’s past blood bank history and records (if earlier done)
• ABO and Rh typing of the recipient and donor.
• Antibody screening test for recipient’s and donor serum
• Cross matching

12. • ABO and Rh groupings may be done by slide method, tube method or
tile method using specific antisera and red cells. Detection of incomplete
antibodies in the serum and red cells is detected by indirect Coomb’s
and direct Coomb’s test respectively.
• Indirect Coomb’s test- This is used to detect the presence of
incomplete antibodies in the serum. Eg: Rh antibodies or antibodies in
autoimmune hemolytic anemia.
• Direct Coomb’s test- It is done to find out whether the cells are already
sensitized by an incomplete antibody in vivo.

14. CROSS MATCHING
• It is the final check of ABO compatibility between donor and recipient. It
will detect the presence of any antibodies in the patients serum that will
react with the donor serum when transfused.

15. BLOOD COMPONENTS
• It is possible to separate different components of blood from a single
unit of whole blood. These components can be used individually to help
more than one patient with many purposes.
• Eg: Red cells can be transfused to an anemic patient and plasma for a
burns patient.

16. WHOLE BLOOD
PACKED CELLS OR RED
CELLS CONCENTERATE
PLATELET
CONCENTERATE
PLATELET-RICH PLASMA
FRESH PLASMA OR
PLATELET POOR PLASMA
CRYOPRECIPITATE
FRESH FROZEN PLASMA
SECOND CONFIGURATION
FIRST CONFIGURATION

17. Whole blood
Whole blood is unseparated blood containing
• 450 ml of donor blood
• 50 ml of anticoagulant-preservative solution
• Hematocrit 35-45%
• Stored between 2-6o C in a blood bank refrigerator
• Transfusion should be started within 30 mins of removal from the
refrigerator and completed within 4 hrs of commencement because
changes in the red cell metabolism may occur.

18. Packed red cells
Packed red cells are cells that are spun down and concentrated
• One unit of packed red cells is approx. 330 ml and has a hematocrit of
50-70%
• They are stored in a SAG-M (Saline-adenine-glucose-mannitol) solution
to increase their shelf life to 5 weeks at 2-6o C.

19. Platelet concentration
Platelet can be obtained by the process called platelet apheresis.
Indications for platelet concentrate transfusion:
• Severe thrombocytopenia
- Immune mediated- autoimmune thrombocytopenia
- Secondary to bone marrow failure Chemotherapy induced
• Abnormal platelet Leukemia
• Disseminated intravascular coagulation
• Surgical or invasive procedures done in thrombocytopenic patients

20. Fresh frozen plasma
• Fresh frozen plasma is prepared by freezing the plasma and contains plasma
proteins and all coagulation factors that include albumin, protein C and S,
antithrombin and von Willebrand factor.
Indications:
• Patients on anticoagulant therapy
• Antithrombin deficiency
• Coagulopathy of liver diseases
• Vitamin K deficiency
• DIC

21. Cryoprecipitate
• It is a supernatant precipitate of fresh frozen plasma and is rich in factor
VIII and fibrinogen.
• It is stored at -300 C with a shelf life of 2 years.
Indications:
- Patients with low fibrinogen
- VIII factor deficiency (hemophilia-a)
- Von Willebrand disease
- DIC

22. COMPLICATIONS OF BLOOD TRANSFUSION
TRANSFUSION
REACTIONS
IMMUNOLOGIC
TRANSFUSION
REACTION
NON-
IMMUNOLOGIC
TRANSFUSION
REACTION

23. Immunologic transfusion reaction
1. Hemolytic transfusion reactions – they are
immediate or delayed, intravascular or extravascular
-The very rapid cell destruction
associated with intravascular haemolysis
is usually due to ABO incompatibility.
-Symptoms include : restlessness anxiety
flushing chest or lumbar pain, tachycardia
and nausea followed by shock and renal failure.

24. • Extravascular haemolysis is more often due to immune antibodies of the
Rh system.
The clinical manifestations are relatively less severe and usually consist
of malaise and fever but shock and renal failure may rarely occur.
Some patients develop delayed reactions in which the patient develops
anaemia due to destruction of red cells about a week after transfusion.
Such delayed reactions are generally the result of previous transfusion or
pregnancy.

25. 2. Transfusion related acute lung injury-TRALI
• . This is an uncommon reaction resulting from transfusion of donor
plasma containing high levels of anti-HLA antibodies which bind to
leucocytes of recipient.
• These leucocytes then aggregate in pulmonary micromutation and
release mediators of increased vascular permeability resulting in acute
pulmonary oedema and signs and symptoms of respiratory failure.

26. 3. Other allergic reactions
• Febrile reaction- which is usually attributed to immunologic reaction
against white blood cells, platelets or IgA class immunoglobulins.
• Patients with antibodies against IgA molecule sometimes develop
anaphylactic shock on transfusion of blood from other human subjects.
• Allergic reactions such as urticaria may occur.
• Transfusion-related graft-versus-host disease mediated by donor T
lymphocytes may occur.

27. Non-immune transfusion reactions
MASSIVE
TRANSFUSION
CIRCULATORY
OVERLOAD
TRANSMISSION
OF INFECTIONS
AIR EMBOLISM
TRANSFUSION
HEAMOSIDEROSI
S
THROMBOPHLEBI
TIS

28. REFERENCES
• Davidson’s Principle & Practice Of Medicine, 21st Edition-2010
• The Who Handbook Of The Clinical Use Of Blood – Who Blood
Transfusion Safety Geneva - 2007
• Robins & Cotran-Textbook of Pathology
• Essentials of Pathology for dental students-Harsh mohan.

29. THANK YOU !