The document provides a history of blood transfusion from early attempts in 1492 when the blood of three boys was used in an unsuccessful transfusion for Pope Innocent VIII, to Richard Lower's first successful animal-to-animal transfusion in 1665. It discusses the development of using animal blood for human transfusion and the progression to modern component therapy. Key events and discoveries regarding donor selection criteria, screening tests, blood typing, storage of blood products, and the use of platelet and plasma components are summarized.

2. BLOOD TRANSFUSION: HISTORY

3. Pope Innocent VIII

4. FIRST HISTORICAL ATTEMPT
 Of blood transfusion was in 1492.
 Pope Innocent VIII sank into a coma.
 The blood of three boys was infused into the dying pontiff
(through the mouth).
 The boys were ten years old, and had been promised a
ducat(kind of gold coin) each.
 However, not only did the pope die, but so did the three
children.

5. HISTORY
 China, 1000 BC
 The soul was contained in the blood.
 Egyptians bathed in blood for their health.
 Pliny and Celsus describe Romans drinking the blood of
fallen gladiators to gain strength and vitality and to cure
epilepsy.
 Taurobolium, the practice of bathing in blood as it cascaded
from a sacrificial bull, was practiced by the Romans.

6. RICHARD LOWER
1665, THE FIRST AUTHENTIC BLOOD TRANSFUSION
(ANIMAL TO ANIMAL).
HE KEPT EXSANGUINATED DOGS ALIVE BY CONNECTING THE CAROTID
ARTERY→JUGULAR VEIN OF THE RECIPIENT DOG WITH A QUILL.

7. FIRST BLOOD TRANSFUSION
•1665 conducted by Richard Lower, an Oxford physician
started as dog-to-dog experiments and proceeded to animal-to-human
over the next two years.
•Lower (1665)

8. Animal to Human Transfusion
Early lamb blood transfusion

9. WHAT IS NEW SCENARIO
Transfusion practice has come a long way from
animal to human transfusion to today’s practice
where we have artificial blood coming out of shelf
.
 Though it is expensive but at present we can
select the component desired by patient
according to his illness.

10. FOR BETTER MANAGEMENT WE SHOULD STRICTLY
MAINTAIN
 Proper selection of donor.
 Screening of donor.
Compatibility testing.
 Rational use of blood component therapy.
Transfusion and monitoring

11. DONOR SELECTION
 Criteria for donation: a healthy person with
Age:>18 yrs <60 yrs.
weight:>48kg but for
whole blood for component preparation
>60kg
Hb>12.5 gm/dl

12. WHO CAN NOT DONATE
o The person is unhealthy and thus cannot tolerate the
hemodynamic stress.
 Hematocrit value < 34
 A blood bank or a camp organized by a blood bank is not
available
 Suffering from any of the following:
HepatitisB,C, HIV/AIDS, syphilis, Malaria.
(MALARIA- the blood is not to be taken for six months.)

13. WHO CAN NOT DONATE
H/O of Jaundice during the past one year.
H/O major surgery in past 6 months.
Patient is currently suffering from a malignant
disease, active TB. or epilepsy.
Women when pregnant or lactating.
Professional donors.

14. WHY VOLUNTARY DONATION?
 Only half of the requirements of blood in India is
generated by voluntary donation (30 Lac units are
donated against the 60 Lac unit requirement).
 As per the Supreme Court ruling, since January 01,
1998 blood shall be accepted only from voluntary
donors.
 No blood bank can utilize professional (paid) donors for
collection of blood.
Indian Journal for the Practising Doctor

15. • Banning the professional donors in
blood donation has good impact
though resulting in
"scarcity of blood" and encouraging
grey areas in marketing in
private Blood Banks

16. NO REPLACEMENT REQUIRED FOR
Thalessemic Pts.
 HIV positive pts.
 Destitute pts. like shishugrah.
Hemophilic pts.

17. HEALTH EDUCATION ASPECTS OF BLOOD DONATION:
Human blood has no natural or synthetic
substitute, so it has to be donated by other
human beings.
A healthy adult can donate blood
every 3-4 months.
 Every male has a surplus of 27ml /Kg and
every female 16ml /Kg in excess of the normal
requirements.
 Thus every person can donate @ 8ml/kg body
weight. (8x45=360ml) at one sitting
every 3 months.

18. HEALTH EDUCATION ASPECTS OF BLOOD DONATION:
 Blood donation- no discomfort or weakness
during or after donation.
 Replacement starts immediately after donation,
and is complete within 12 weeks.
 No chances of acquiring infection
from donating blood as the entire procedure is
sterile.
Voluntarily donated blood is healthy for
recipients.
 Professional donors are themselves
unhealthy.

19. PRACTICE POINT:
 If weight of the person is 60 kg, his total blood
volume (80x60) will equal 4800 ml.
A 20% volume loss (960 ml), can be tolerated
and needs only plasma expanders.
 However, pts with 30% volume loss (1440 ml):
require blood transfusion.
Indian Journal for the Practising Doctor

20. SENDING THE REQUISITION FORM AND BLOOD
SAMPLE OF PATIENT
 Correct identification of the pt.
 Sample into the type of sample tube required by the blood
bank.
 Label the sample tube clearly and accurately
at the pt’s bedside the moment sample is being taken.
 Labeling includes:
patient’s name.
Hospital registration no.
Patient’s ward.
Date.
Signature of person taking sample.
These should match with medical records.

21. PRE-TRANSFUSION TESTS
 Serological tests:- Blood grouping-ABO
- Irregular antibody screening
- type and cross-match.
o Transfusion transmitted disease tests:
HIV
HBV
HCV
VDRL
MP
NAT

22. WHAT IS NAT?
 Nucleic Acid Amplification Test is highly sensitive test for
detection of the virus.
 This is done by amplification of the genetic materials by
over a billion folds.
 NAT is a direct test for presence of Viral Genetic material
in the blood.

23. CLOSING THE WINDOW ON VIRAL INFECTION
 Detection of HIV-1
11 days 22 days
 Detection of HCV
23 days 98 days
 Detection of HBV
34 days 56 days

24. BLOOD TYPING AND SCREENING
To ensure that a person who needs a transfusion
will receive compatible blood with his or her own;
and
 That clinically significant antibodies are identified
if present.

26. OBJECTIVES OF B.T & COMPONENT THERAPY
Restoration of blood volume
Enhance the O2 carrying capacity of blood
Maintain Homeostasis
– Platelet
– Coagulation Factors
– Fresh blood
– FFP or Appropriate component

27. BLOOD
Blood is a vital and life saving fluid.
Can neither be manufactured in factories,
nor substituted with blood of any other
creature.
But
 Direct transfusion of infected blood can lead
to transmission of various diseases like
hepatitis, syphilis, malaria and HIV.

28. SAFE BLOOD
Blood that is
free of transmissible diseases,
Compatible with the recipient.
Stored optimally.

29. BEFORE TRANSFUSION WE MUST DETERMINE
WHAT FOR ANY PROCEDURE
Whether required
How much required
Actual component required
Time of duration of transfusion

30. Components

31. BLOOD PRODUCTS(1)
Blood-cells products
-whole blood
-packed red blood cells
-leukocyte-poor (reduced) red
cells
-washed red blood cells
-random-donor platelets
concentrates

32. BLOOD PRODUCTS(1)
•Single-donor platelets
concentrates.
•Irradiated blood products
(red blood cells and platelets
concentrates)
•Leukocyte (granulocyte)
concentrates

33. BLOOD PRODUCTS(2)
Plasma products
• fresh-frozen plasma (FFP)
• cryoprecipitate
• factor concentrates (VIII,
IX)
• albumin
• immune globulins

34. UNMODIFIED COMPONENTS
CELLULAR -PRBC
-PLATELETS
-GRANULOCYTES
PLASMA -FFP
-CRYOPRECIPITATE
-FRACTIONETED COMP
(FACTOR VIII AND IX)

35. MODIFIED PRODUCTS
•IRRADIATED
-PRBC
-PLATELETS
-GRANULOCYTES
•LEUCOCYTE DEPLETED
-PRBC
-PLATELETS
•SALINE WASHED
-PRBC
-PLATELETS

36. WHICH COMPONENTS
From one unit of whole blood one can make
•PRBC
•Platelet pack(random donor)
•Fresh plasma
•Granulocyte pack
•Fresh plasma →frozen at -30°C→FFP
•Pooled plasma→ components
Cryoprecipitate
Albumin
Gamma globulins
Anti-D globulins
Plasma proteins

37. STORAGE AND SHELF LIFE
PRODUCT VOLUME INDICATIONS/
STORAGE
Red Blood Cells
(RBC)
SALINE WASHED
PRBC
250 mls red cells
100 ml SAGM
~ CPD
02 transport
Hct. 75 ± 5%
1-6 oC ~ 42 days
24hrs once packed.
24 hrs
Platelets
SDP(single
donor,apheresis)
Buffy coat derived (4
donors, 1 plasma)
200-300 ml
(NO ALIQUOTES)
300x109platelets/unit
Thrombocytopenia/
Dysfunctional Platelets
20-22oC x 5 days
Constant agitator.
WHOLE BLOOD 450+63 MLS(>60KG)
350+49 MLS
BLOOD LOSS
1-4˚C
35-42 DAYS

38. PRODUCT VOLUME INDICATION
STORAGE
Fresh Plasma
(FP) ↓
FFP
100 - 150 ml/unit
100-120 ml/unit in SMS
Hosp
1-6°C,35-42days.
Hypoproteinemia.
All coagulation factors
-20oC x 12 months
Cryoprecipitate
NOT AVAILABLE IN
SMS HOSPITAL
10-15ml/unit VWF 80 I.U.
VIIIc :80-120 I.U.
Fibrinogen > 150 mg
XIII
-30°C ,1 yr
Albumin
Granulocyte pack
(available)
Variable
50 ml/unit
Volume expansion
Room temp
24 hrs.

39. Solution Purpose Whole blood
or Red cell
Storage Period
Additive Concentrations
( per 100 ml )
Performances
CPD Anticoagulant
and storage of
Blood
21 days Sodium Citrate (dihydrate)....2.63g
Citric Acid (monohydrate)...0.299g
Dextrose (monohydrate).......2.55g
Monobasic Sodium
Biphosphate (monohydrate).0.222g
Prevents coagulant of blood
as Citrate ion chelates
Calcium
Nutrition source for red cell
Adjusts pH
CPDA 1 Anticoagulant
and storage of
Blood
35 days Sodium Citrate (dihydrate).....2.63g
Citric Acid (monohydrate)....0.299g
Dextrose (monohydrate).........2.9g
Monobasic Sodium
Biphosphate (monohydrate).0.222g
Adenine...........................0.02
75g
Prevents coagulant of blood
as Citrate ion chelates Calcium
Nutrition source for red cell
Adjusts pH
Supports to maintain ATP
level in red cells
SAGM Red cell
Preservation
42 days Dextrose (monohydrate)......0.900g
Sodium Chloride...................0.877g
Adenine...........................0.0169g
D-Mannitol.........................0.525g
Nutrition source for red cell
Adjusts osmotic pressure
Supports to maintain ATP
level in red cells
Supports integrity of red cell
membrane (to avoid
haemolysis)

40. Whole Blood
Contents
•RBC’s
•WBC’s
•Platelets
•Plasma
•Clotting factors

41. WHOLE BLOOD
 Stored at 1-4˚C
 Shelf life of 35-42 days.
 First 4-6 hrs -100% of all the components.
Changes with time
 Platelets fall to less than 1% by 4-48hrs.
 Labile clotting factors V and VIII also disappear in same
time.
• other clotting factors II,VII,IX,X thereafter.
• K+ level ↑,ATP level ↓
• 2-3DPG and PH ↓ especially after 5-7 days of storage.

42. RECONSTITUTED WHOLE BLOOD
PRBC suspended in AB Rh-VE plasma used with
platelets if required.
 10cc/kg body weight of whole blood will raise
Hct by 3-5% and Hb by 1 to 1.5 gm%.

43. STORAGE OF FRESH BLOOD PRODUCTS
 Fresh blood products should never be stored in
clinical areas.
 All products should begin administration
within 30 minutes of collection from blood
bank or returned to blood bank for correct
monitored storage.
 All Fresh blood products need to be
administered within four hours of the
product bag being spiked.

44. WHY NOT WHOLE BLOOD AND
WHY COMPONENTS?
 More than 6 important components
in each Unit of whole blood.
 Each component has a specialized function.
 All functions are not deranged in all the patients
and so
 All the components are not required all the time.

45. WHY NOT WHOLE BLOOD AND
WHY COMPONENTS?
Blood is always in short supply.
Making components from one unit of whole
blood will satisfy the needs of more than
one patient from the same unit of blood.

46. WHY NOT WHOLE BLOOD AND WHY
COMPONENTS?
 Whole blood will lead to harmful effects:
plasma overload
Lymphocyte mediated toxicities
Allosensitization etc.
 Some components-effective as component only
eg: platelets which are otherwise destroyed in stored
whole blood.
 Some components-better given as components
eg: clotting factors.
 Level can be achieved at much higher level or even 100%
by giving concentrates of such factors, than by giving
whole blood or even FFP.

47. Indications
Acute loss of whole blood.
Exchange transfusion in infants for
hemolytic anemia of the newborn.

48. ADVANTAGE
 All components.
DISADVANTAGE
 Side effects due to plasma and lymphocytes as
their level remains almost 100% till last date of
storage.
 Simply wastage of components not required.

50. BLOOD TRANSFUSION
Attention：
 Double Check: Name, Type and Cross-match
 Storage Time: Citrate Phosphate Dextrose
Acidic Citrate Dextrose
21D, 35D
 Pre-heat
 Observation during / after Transfusion：

51. BLOOD WARMERS
 Consider warming red blood cells in the following
circumstances:
-Patient's receiving massive transfusion
-The hypothermic patient requiring transfusion
-Exchange transfusion.
 Beigler blood warmers must only be used.
 Blood should NEVER be warmed via a microwave,
immersion in water or by placing it on heat
generating machinery.

53. Blood Component Preparation
“ A little goes a long way”

54. RED CELL TRANSFUSIONS: INDICATIONS AND
TRIGGERS

55. RED BLOOD CELLS -
DESCRIPTION:
Whole blood is collected into an anticoagulant then
centrifuged to separate the red cells from the
plasma.
 The plasma is then expressed from the whole
blood bag and the remaining red blood cells
(RBC) are filtered.
 85% of the original RBC volume will remain after
filtration.
A typical unit has a volume of 240-340 mL and a
hematocrit of 80%.

56. Plastic Blood Bags and Component Separation

57. PACKED RED BLOOD CELLS (PRBC)
 PRBC contains packed red cells in 22-50% of original
plasma.
 Has nearly 100%of polymorphonuclear cells and
lymphocytes but has less than 10% platelets and clotting
factors.
 Ideal Hct for PRBC is 70-75%. It should not be too tightly
packed.
 For newborns while doing exchange transfusion,Hct can be
adjusted to 50-55% using additional FFP or albumin.
Indian journal of practical pediatrics

58. ADVANTAGE
 Low volume-no circulatory overload.
Less plasma –so less citrate related toxicity.
DISADVANTAGE
 More viscous-flow with difficulty through pediatric IV lines.
 Shelf life is 24 hrs, once packed.
 Significant amount of plasma and leukocytes so Toxicity
related to them:
Allergic reactions
NHFTR
Allosensitization
GVHD

60. A SINGLE UNIT of blood is rarely, if at all,
is of any benefit to the recipient and carries
all the risks associated with blood
transfusion.

61. INDICATIONS:PRBC
 Commonest indication:-
chronic transfusion dependent anemia:
Thalessemias,
Sickle cell disease,
Congenital dyserythropoietic anemia,
Diamond Blackfan syndrome,
Fanconi’s anemia,
Aplastic anemia,
Chronic renal failure,
Cancer pts,
Sideroblastic anemia etc.

62. INDICATIONS
 Episodic transfusions for acute hemolysis
G6PD deficiency,
Malaria,
Autoimmune hemolytic anemia,
 Rarely, if at all, used in nutritional anemia
-severe anemia with impending cardiac
failure.
 Has associated cardio-respiratory disease.
 Before surgery.
Indian journal of practical pediatrics

63.  Most oftenly misused
as Top-ups in pts with nutritional anemia or
before surgery to keep Hb>10gm%
 It is counterproductive as it can lead to
immunosupression of recipient and
delay in healing.

64. INDICATIONS IN NEWBORNS
 Any cause of bleeding.
 Iatrogenic blood loss especially-sick pre-terms
 Anemia of prematurity:
when baby has poor sucking, apneic spells, poor
weight gain, and Hb<7gm%.
 Very sick neonates usually have associated
sepsis, acidosis, DIC, bleeding, and anemia
and will need support with PRBC, platelets and
FFP.

65. •INDICATION FOR TRANSFUSION IN ANEMIC
PATIENTS
• Decision to transfuse based on clinical condition
rather than a given level of hemoglobin.
• chronic stable anemia - probably unjustifiable if the
hemoglobin level is above 7g per 100ml
•Symptomatic anemia
(dizziness,weakness, shortness of breath),
underlying cardiac, pulmonary, or vascular
disease.

66. GUIDELINES FOR PAEDIATRIC RED CELL
TRANSFUSION(NELSON,S TEXT BOOK)
CHILDREN AND ADOLESCENTS
ACUTE LOSS OF >25% CIRCULATING BLOOD VOLUME
HB<8GM/DL IN PERIOPERATIVE PERIOD
HB<13 GM/DL AND SEVERE CARDIOPULMONARY
DISEASE
HB<8GM/DL AND SYMPTOMATIC CHRONIC ANEMIA.
HB <8GM/DL AND MARROW FAILURE.

67. INFANTS WITHIN FIRST 4 MONTHS OF LIFE
Hb<13g/dl and severe pulmonary disease.
-ventilation
Hb<10g/dl and moderate pulmonary disease.
high flow oxygen(CPAP)
Hb <13g/dl and severe cardiac disease.
(Cyanosis, CCF)
Hb<10 g/dl and major surgery.
Hb<8 g/dl and symptomatic anemia

70. IRON DEFICIENCY ANEMIA
 Rapid hematologic response with iron therapy.
Transfusion indicated only when
anemia is very severe Hb<4gm (nelson)

71. WITH CHRONIC ANEMIA,
 Children compensate well and may be asymptomatic
despite low haemoglobin levels.
 Treated successfully with oral iron alone, even at
haemoglobin levels of <5 g/dl.
 Factors other than haemoglobin concentration
to be considered in the decision to transfuse RBCs
(1)Patient's symptoms, signs, and functional capacities;
(2) Presence of cardio-respiratory, vascular, and central
nervous system disease;
(3)Cause and anticipated course of the anemia; and
(4) alternative therapies, such as recombinant human
erythropoietin (EPO) therapy, which is known to
reduce the need for RBC transfusions and to improve
the overall condition of children.

72. HEALTHY PREMATURE INFANTS
Physiologic anaemia- no therapy.
 Ensure diet of the infant- essential nutrients for
normal haematopoiesis, especially folic acid and
iron.
 Premature infants feeding well and growing
normally rarely need transfusion unless
iatrogenic blood loss has been significant.
• Healthy premature infants-Hb< 6.5 g/dl.(nelson)

74. FRESH V/S STORED RBCS
The traditional use of relatively fresh RBCs
(<7days of storage)has been halted in many
centers in favour of diminishing donor
exposure by using a single unit of RBCs to
obtain aliquots for transfusing each infant
throughout its permitted duration of storage
(currently 42 days).
 Neonatologists who insist on transfusing only
fresh RBCs generally are fearful of the rise in
the plasma potassium (K') level that occurs in
RBC units during extended storage.

75.  After 42 days of storage,
plasma K* levels are approximately 50 mEq/L (0.05
mEq/ml) a value that at lst glance, seems
alarmingly high.
However, the actual dose of K* transfused in the
extracellular fluid is tiny.

76. THALLASSEMIA PTS
A transfusion program generally requires monthly
transfusions, with the pre-transfusion haemoglobin
level >9.5 and<10.5 g/dl.
 In patients with cardiac disease, higher pre-transfusion
haemoglobin levels may be beneficial.

77. PRECAUTIONS
 Pts with chronic transfusion dependent anemia
need SPECIAL PRECAUTIONS:
 Detailed blood grouping should be done before first
blood transfusion-minor blood group
incompatibility.
 Always use coomb’s negative cross-matched blood
 Best is to use washed PRBC and if affordable,WBC
filtered PRBC to decrease leuko-contamination.

78.  Meticulous record of pre and post-transfusion
Hb should be kept to see for transfusions
and suspect hypersplenism.
 Chelation should be started once serum
ferritin is more than 1000 ng/ml

79. PRECAUTIONS
Regular check-ups for
1.Plasma borne infections,
2.LFTs
3.Serum ferritin levels
o Lastly all these pts should receive
hepatitis-B vaccine before their first
transfusion.

81. PATIENT AND DONOR RBC SELECTION BY ABO AND RH TYPE
Patient Donor
A A, O
B B, O
AB A, B, AB, O
O O
Rh(+) Rh(+), Rh(-)
Rh(-) Rh(-)

82. RED BLOOD CELLS –
CONTRAINDICATIONS:
RBC : should not be used:
when anemia can be corrected with
specific medications, e.g., iron, B12,
folic acid, erythropoietin, etc.
for volume replacement.

87. WHY LEUCODEPLETION
 Donor lymphocytes do not serve much purpose but can
lead to major side effects.
 Antibodies can develop against lymphocytes and platelets
and leads to NHFTR.
 Activated lymphocytes can release Cytokines like IL-
2,TNF during storage, which can also cause NHFTR.
 NHFTR is especially a problem for patients
needing recurrent transfusions.

88.  Lymphocytes lead to allo-sensitization and
subsequent graft rejection in prospective
candidates for bone-marrow transplants.
 Lymphocytes bear intracellular pathogens and
can transmit infections like HIV,HTLV,EBV,CMV
etc.
 Lymphocytes can lead to pulmonary toxicities
like ARDS.
 In surgical pts lymphocytes can lead to
immune suppression and delay healing.

89.  Hence all these components can lead to all the
above-mentioned lymphocyte mediated toxicities.
 Ideally all the transfusion should be leuco-depleted
especially in patients needing recurrent
transfusions and in immuno-compromised
hosts.

90. METHODS OF LEUCODEPLETION
1.WBC filters:
• 3rd generation WBC filters are highly efficient.
 Efficacy is 99.5%
 They contain fiber mesh to which the WBC stick and get
filtered. when used during collection itself they will
remove lymphocytes at source and hence prevent release
of cytokines on storage.
 They can also be used at the bedside while transfusing
the blood.
ADVANTAGE:
 high efficacy
 Simplicity to use.

91. DISADVANTAGE:
 High cost
 Inability to prevent TAGVHD.
 Each filter costs Rs.600-700/- and is not reusable.
 Ideally all transfusion should be given
using filters especially if patient needs recurrent
transfusions or develops NHFTR.

92. 2.WASHED CELLS
 Washing with saline or blood processor not only
removes WBC but also plasma.
• Efficacy of WBC removal is 90% and that of plasma is
99%.
• Hence it not only will reduce NHFTR, allosensitization
toxicities related to WBC but will also
reduce allergic reactions to plasma proteins.
• Preparation is simple.
DISADVANTAGE:
• Not very effective in leucodepletion and cannot prevent
TAGVHD.
• It needs cold centrifuge to prepare washed cells.

93.  All red cell transfusions should be given using
at least washed cells and preferably with WBC
filters in pts needing recurrent transfusions and
those with NHFTR or allergic reactions.
 Washed platelets from mother are given to a baby
suffering from allo-immune thrombocytopenia.
3.gamma-irradiation:
• TAGVHD can be prevented only with gamma-irradiation
of blood.

94. DISADVANTAGE:
 Need for sophisticated irradiator and chances of
membrane leak of the cells irradiated and
increased K+ levels.
• Hence blood should be irradiated just before infusion
Or else supernatant plasma should be removed
before transfusion

95.  Ideally all blood should be irradiated where there is
risk of TAGVHD.
This includes:
 Transfusion in newborns especially pre term <1200gms
 Intrauterine transfusion.
 Pt with primary or secondary immunodeficiency.
 Organ transplant recipients
 Transfusion given to a normal person from a
first degree relative donor

96. 4.FROZEN CELLS
 RBC can be frozen at -70°C and be kept for 5-7yrs.
 Once thawed should be used within 24 hrs.
 Efficacy for leucodepletion is 90% and plasma depletion is
99%.
 Hence it reduces toxicities related to both lymphocytes
and plasma.

97. ADVANTAGE
 Availability in emergency where one can use o-ve
frozen cells in AB–ve plasma.
• One can collect blood from CMV negative donors.
• HLA matched donor or rare blood group donor and
freeze it for future use.
• Lastly autologous blood collected for surgery can be
frozen and used in future, if surgery gets postponed for
some reasons.
DISADVANTAGE:
• Needs sophisticated instruments to prepare and store.
• Extremely costly.
• It cannot prevent TAGVHD.

98. PLATELETS TRANSFUSIONS

99. PLATELETS
-DESCRIPTIONS:
o Prepared from a random unit of whole blood collected in
CP2D anticoagulant solution.
o Suspended in a small amount of the original plasma.
o A unit contains at least 55 x 109 platelets suspended in
50-55 mL of plasma.
o Platelets may also be obtained by apheresis

100. TYPES OF PLATELETS
 RANDOM DONOR
 SINGLE DONOR
 PLASMA DEPLETED PLATELETS
 WASHED PLATELETS
 WBC FILTERED
 UV OR GAMMA IRRADIATED
 PLATELETS FROM SPECIFIC DONOR:
CMV NEGATIVE OR HLA-MATCHED DONOR.

101. PLATELETS
Contents
 Platelets
 WBC’s
 Plasma
 PRBC

102. PLATELETS TRANSFUSIONS
 Platelets stored at 20 to 24°C on constant agitator.
 It should be transported quickly and infused rapidly over
20-30 minutes to prevent loss of platelets due to
aggregation.
 Should use only ABO/Rh identical compatible donor.
 In emergency one can use incompatible donors though the
efficacy may be less than expected.

103. PLATELETS-FUNCTION:
 Prevent bleeding of injured blood vessel walls by
forming an aggregate at the site of injury.
 Participate in blood coagulation, inflammation and
wound healing.
 The transfusion of platelets to a patient with
thrombocytopenia or bleeding should
produce a rise in the platelet count and
control bleeding.

104. PLATELETS -
INDICATIONS:
o Bleeding due to severely decreased production or
abnormal function of platelets.
 Prophylacticaly to patients with rapidly falling or low
platelet counts, less than 10 x 109/L (10,000/uL),
secondary to bone marrow failure, cancer or
chemotherapy.
 Postoperative bleeding with platelet count less than 50
x 109/L (50,000/uL).

105. RANDOM DONOR PLATELETS
 Also called PLATELET PACK
 Derived from SINGLE UNIT of whole blood.
 Contains 5-6×10¹º in 50-60ml of plasma per pack.
 One unit per 10 kg will raise platelet count
by 20,000 to 30,000/cmm.
 ADVANTAGE
Less costly and easily available.
DISADVANTAGE
 Expose recipient to more no of donors.
 One cannot use specific donor like CMV negative or HLA
matched

106. PLATELETS APHAERESIS
SDP: collected from a single donor via aphaeresis using cell
separator and are suspended in plasma.
Also called platelet concentrate.
Volume: 150-300mL (actual volume is specified on the
label)
Platelet Count: >150-500 x 109/unit.
(Equivalent to 3-10 single donations.)

107. ADVANTAGE:
o More concentrated hence more effective.
 Exposing recipient to only a single donor.
 One can use same donor again after 2-3 weeks.
 One can select specific donor.
DISADVANTAGE:
 Extremely costly.
Needs sophisticated equipments.
Donor has to wait for longer periods in blood bank.

108. CRITERIA TO TRANSFUSE:
 Usually given to those with thrombocytopenia due
to decreased production than to those with
increased destruction.
 Platelet transfusion are given when they have
significant mucosal bleeds.
 Only skin bleeds do not warrant platelet transfusion,
but such patients should be closely monitored for
any further mucosal bleeds.
IJPP

109. PROPHYLACTIC PLATELET TRANSFUSION
 Always controversial
 Child with thrombocytopenia usually do not bleed unless the
platelet count fall <50,000.
Decision when to transfuse is hence based on basic
disease, type of thrombocytopenia, platelet count, and
presence of associated coagulation abnormalities.
Well child –prophylactic transfusion with count<5,000-
10,000/mm3.
Sick child-transfusion given with count <10-20,000.
Before surgery-<30,000 but eye surgery<50,000.
Massive hemorrhage<30,000.as most of the platelets are
non-functional platelets of stored blood.

110. GUIDELINES FOR PEDIATRIC PLATELET
TRANSFUSION
CHILDREN AND ADOLESCENTS
 PLTs<50,000 and bleeding.
 PLTs<50,000 and invasive procedure.
 PLTs<20,000 and marrow failure and hemorrhagic
risk factors.
 PLTs<10,000 and marrow failure without
hemorrhagic risk factors.
 PLTs at any count but with PLT dysfunction plus
bleeding or an invasive procedure.

111. GUIDELINES FOR PEDIATRIC PLATELET
TRANSFUSION
INFANTS WITHIN FIRST 4 MO OF LIFE
 PLTs<100,000 and bleeding.
 PLTs<50,000 and an invasive procedure.
 PLTs<20,000 and clinically stable.
 PLTs <100,000 and clinically unstable.
 PLT at any count, but with PLT dysfunction plus
bleeding or an invasive procedure.

112. Patient’s
ABO
Group
Platelet Product Group
First
Choice
Second
Choice
O O
A A B
B B A
AB AB B or A

113. INDICATIONS :PLATELETS
 Platelet transfusions are given for thrombocytopenia
or for platelets dysfunctional disorders.
1.DECREASED PLATELETS PRODUCTION:
Bone marrow failure - Aplastic anemia
-Fanconi anemia
-TAR syndrome
-other constitutional
hypoplastic anemia.
Bone marrow infiltration -leukemias and
metastatic cancers.
Bone marrow suppression-fulminant infections
Indian journal of practical pediatrics

114.  2.INCREASED CONSUMPTION OF PLATELETS:
DIC
NEC
HUS
TTP
Good platelet recovery at 1 hr after transfusion,
but not at 24 hrs suggesting consumption.
3.INCREASED PLATELET DESTRUCTION:
 Immune or non-immune .
 Post-transfusion purpura, auto-immune disease, ITP, allo-immune
disease of newborn.
 Non-immune: drugs and infections
 Platelet transfusion is NOT EFFECTIVE
in this group as they will be immediately destroyed after
transfusion

115.  However ,in life-threatening bleeding like
intracrainial hemorrhage one may give platelet
packs just to tide over crisis till splenectomy is done
or IVIG is administered.
 Allo-immune thrombocytopenia of newborn:
Washed mother´s platelets are given to the baby.
 4.HYPERSPLENISM:Platelet transfusion may not
be effective as they will be immediately removed
from circulation into enlarged spleen.
5.DILUTIONAL THROMBOCYTOPENIA:
When massive amount of whole blood is used.
Requires additional platelet transfusion

116. 6.Platelet –dysfunction: various congenital and
acquired platelet functional disorders
may present with significant bleeding .
o If local measures fail to control bleeding transfusion
will be required.
o One should use platelets sparingly as allo-sensitization
may prevent good recovery in future
after a number of transfusions are given.
o One can use HLA matched platelets in such cases.

117. Platelet transfusion efficacy:
 One unit of RDP per 10 kg body wt increase platelet count
by 20,000 to 30,000/cmm.
 SDP is 5-7 times more efficacious than RDP.
 Efficacy of platelet transfusion depend upon:
Source, type, storage, collection and administration will
affect the efficacy.
Pre-transfusion count, fever, sepsis, size of liver and spleen,
presence of antibodies or consumption coagulopathy and
drugs taken by recipient.
CLINICALLY one can judge efficacy by looking at the
cessation of bleeding.

118. PLATELETS –
CONTRAINDICATIONS:
 Bleeding is unrelated to decreased numbers or
abnormal platelet function.
 Consumption of platelets, in
Thrombotic Thrombocytopenia Purpura (TTP)
Idiopathic Thrombocytopenia Purpura (ITP),
Unless the patient has a life threatening
hemorrhage.
o Untreated DIC.
o Thrombocytopenia associated with septicemia,untill
treatment has commenced or in cases hypersplenism.

119. PLATELET INCUBATOR
Stored with constant
agitation

120. Recycle Life through a Platelet Aphaeresis Donation
Recycle Life through a Plateletpheresis Donation
This is John A. Zendt, a Moody Gardens Employee donating platelets
and plasma.
Do you want to become an Apheresis Donor?

121. GRANULOCYTES
 Patients with severe uncontrollable infection.
Congenital or acquired neutropenia.
 Usually reserved for neutropenic pts with fulminent
sepsis not controlled by antibiotics and antifungal
ANC<300 in newborn,
<100 in infants and
<500 in immunocompromised host.
 It should always be used along with antibiotics and
antifungal.

122. GRANULOCYTES
 Granulocytes in newborns -partial exchange with
fresh whole blood to replace granulocytes.
DOSE:10-15ml/kg body wt.
 Can be repeated 12-24 hrly for 4-6 days.
 It is to be stored at room temperature and to be
used within 24 hrs.
 It has all side-effects related to plasma and
lymphocytes.
 Should be used ABO/Rh compatible donor.

123. FRESH FROZEN PLASMA - FFP
DESCRIPTION:
 Platelet poor plasma obtained at the end of centrifugation
while making components is frozen within 4-6 hrs
at -30ºC to make FFP.
 It can be obtained from a whole blood donation
(approx. 250 mL) or by apheresis (approx. 500 mL).
 Shelf life is one year.
 FFP contains all plasma proteins including albumin,
gamma-globulins and a normal concentration of fibrinogen and
the labile coagulation factors VIII and V.

124. FRESH FROZEN PLASMA -
DESCRIPTION:
 One unit of FFP has 150cc-200cc of plasma and
1ml of plasma contains approx 1 unit of each
clotting factor.
 One can use 10-15 cc/kg body weight of FFP every
12 hrly.
 Hence one cannot raise factor levels beyond a
certain limit without leading to volume overload.

125. FRESH FROZEN PLASMA –
INDICATIONS:
 The majority of clinical situations for which FFP is
currently used do not require FFP.
 Pt presenting with bleeding for the first time
where the diagnosis is uncertain as to which
factor is deficient.
Massive transfusion with a demonstrated
deficiency of Factor VIII and V, otherwise
frozen plasma is adequate.
 Exchange transfusion in neonates.

126. FRESH FROZEN PLASMA –
INDICATIONS:
 Mainly used to replace clotting factors.
 Where multiple factors need to be replaced
liver disease, DIC,TTP
Warfarin anticoagulant overdose.
Pts receiving large volume of whole blood.
Antithrombin III deficiency
 In reconstitution of whole blood along with PRBC or to
adjust hematocrit of PRBC for exchange transfusion in
newborn.
 Lastly FFP is useful to prevent and treat coagulopathy due
to L-asperagenase in cancer pts.
 Hemophilia ,it is better to use factor concentrate.

127. FRESH FROZEN PLASMA
 As FFP contains plasma, it can lead to
allergic reactions, anaphylaxis in IgA deficient
patient and can transmit all the plasma borne
infections.
 Hence albumin should be used as a volume expander as it
is much safer.
 Similarly albumin and not FFP should be used to replace
proteins or albumin.
 If pt need both volume expansion as well as clotting
factors like in DIC, sepsis, NEC etc. one can use
FFP.
 In small babies, it can lead to hemolysis if it contains
high levels of antibodies against recipient’s blood
group antigen

128. FRESH FROZEN PLASMA -
CONTRAINDICATIONS:
 Should not be used when
coagulopathy can be corrected more effectively with
specific therapy, such as
vitamin K, cryoprecipitate, or
Factor VIII concentrates.
Same infectious disease risk as whole blood.
 Should not be used when the blood volume can be
replaced with other volume expanders such as 0.9%
sodium chloride, lactated ringer’s, albumin.

129. CRYOPRECIPITATE (CRYO)
DESCRIPTION:
 Cryoprecipitate is prepared by thawing fresh frozen
plasma at a temperature between 1°C and 6°C.
 After centrifugation, the supernatant plasma is
removed and the insoluble cryoprecipitate is refrozen.
 On average, each unit of cryoprecipitate contains 80
IU or more Factor VIII (FVIII:C) and at least 150 mg of
fibrinogen in 5-15 mL of plasma.

130. CRYOPRECIPITATE (CRYO)
INDICATIONS:
 Source of fibrinogen or Factor XIII.
 It may be used as a source of Factor VIII only when
inactivated fractionation products or recombinant Factor VIII
are not available.
 Fibrinogen and fibronectin are present.

131. CRYOPRECIPITATE (CRYO)
CONTRAINDICATIONS:
 Should not be used unless results of laboratory studies
indicate a specific haemostatic defect.
 Specific factor concentrates are preferred.

132. CRYOPRECIPITATE (CRYO)
Cryoprecipitate Pooling Cryoprecipitate

133. PRE-TRANSFUSION CHECKS
Patent IV access and is ready to receive the transfusion.
 Check medical orders: product type,
special requirements and administration
requirements.
Checks prior to administration of the blood product:
 Patient identification- Name, DOB and UR on the
blood transfusion record, blood product and tag
and on the patient's wrist band.

134. PRE-TRANSFUSION CHECKS
• If parent or guardian or child of appropriate
developmental age,
include them in the patient identification
checking product.
 Blood product for any signs of leakage,
clots or abnormal colour.
 Complete documentation:
sign, date, start and finish time.
• Blood Transfusion Record and file in the
patient's medical record.

135. PRINCIPLES OF BLOOD COMPONENT THERAPY
• Beware of the indications, risks and benefits.
 The cause of the deficiency should be identified.
 Alternatives to transfusion considered.
 Only the deficient component should be replaced.
 The product should be as safe as possible.
 Informed consent and documentation should be part
of the process

136. SAFE ADMINISTRATION OF BLOOD
 Involve following:
1.accurate identification of patient.
2.correct labeling of blood sample for pre-transfusion
testing.
3.After receipt from blood bank proper storage in
the clinical area upto time transfusion is given.
4.A final patient identity check to ensure the
administration of the right blood to the right
pt.

137. RISK TO THE PATIENT FROM BLOOD
TRANSFUSION
 With the highest levels of standards, working
sophistication, best of equipments and trained
personnel there are inherent risks in blood
transfusion.
 Some are preventable and on some there is no
control.
 With the present day methods there are almost
negligible technical errors.
Most of the errors are clerical and result from
disregard to the standard procedures.

138. COMMON RISKS TO PATIENT
 Blood meant for one pt transfused to another pt.
 Blood pack which has been infected.
 Heating or freezing of the blood.
Transfusion transmitted diseases.
 Adverse reaction to the blood transfusion.

139. DOCUMENTATION AND MONITORING
Document vital signs 1 hr prior to
administration.
Immediately after commencement.
Minimum of 15 minutes after starting.
Hourly until transfusion is completed.
20-60 minutes following completion of
transfusion.

140. CARE OF TRANSFUSED PATIENTS
o Must be undertaken for each unit transfused.
o Monitoring- adverse effects of transfusion closely during
the first 15 minutes as a minimum take.
o Record vital signs:
Temperature, Pulse, Respiration and
Blood Pressure
 Before commencement
 5 minutes after commencement
 On completion
 More frequent observations particularly in
unstable/unconscious patients.

141. TRANSFUSION REACTIONS
REACTION ACUTE
(WITHIN 24 HRS)
DELAYED
(onset within days or
months)
IMMUNE MEDIATED Hemolytic Hemolytic
Febrile non-hemolytic alloimmunisation
Allergic Post-tr purpura
Anaphylactic TAGVHD
TR-acute lung injury Immunomodulation
NON-IMMUNE MEDIATED Bacterial contamination Infections-HBV,HCV
Circulatory overload HIV-1&2
Hyperkalemia Syphilis
Thrombophlebitis Malaria
Iron-overload

142. TRANSFUSION REACTIONS
Febrile Reactions
• Incidence：2%
• Chills, Fever 39-40.C
• Headache, Sweatiness
• Nausea, Vomiting, Flushing
• 15min-1hr

143. TRANSFUSION REACTIONS
•Febrile Reactions ：
 Immuno-reaction ：
 Endo-toxins：
 Contamination or Hemolysis：
•Treatment：
 Analyze possible reasons：
 Stop Transfusion ：
 General Support：

144. TRANSFUSION REACTIONS
•Anaphylactic reactions：
• Urticaria
• Abdominal cramps
• Dyspnoea
• Vomiting
• Diarrhea

145. ANAPHYLACTIC REACTIONS：
•Reason：
 Immuno-reaction： IgE
 Hereditary Immunoglobulin： IgA
•Treatment：
 Administer antihistamines
 Administer epinephrine, diphenhydramine, and
corticosteroids：
 Support airway and circulation as necessary：

146. TRANSFUSION REACTIONS
Hemolytic transfusion reactions
• Burning at the intravenous (IV) line site
• Fever, Chills, Dyspnoea
• Shock
• Cardiovascular Collapse
• Hemoglobinuria, Hemoglobinemia
• Renal Failure
• DIC

147. HEMOLYTIC TRANSFUSION REACTIONS
•Reasons：
 ABO incompatibility
 Rh Incompatibility
 Non-immune Hemolysis
 Immune Hemolysis

148. •Treatment：
 Stop Transfusion as soon as reaction is suspected
 Check the name, type and cross-match
 Urine Exam
 Renal Protection
(Aggressive Fluid Resuscitation, Furosemide)
 DIC Monitor

149. COMPONENT TRANSFUSION：
• Saving blood source
• Less likely carrier of transmitted diseases
• Shortage of quality blood
• Greater shelf life than whole blood
• Helping to make blood safer by filtration
• Infusing regardless of ABO type in some blood
products
give only essential/desired blood component

152. HAEMOVIGILANCE
 Set of surveillance procedures from the collection
of blood to the follow-up of recipients for any
untoward effect in order to prevent them in future.
 Notification of transfusion-incidents by the French
health authorities became a legal obligation.
 The concept was introduced in 1993 when the
Blood Transfusion Safety Act in France was
adopted.

153. HAEMOVIGILANCE
The parties (or institutions) include all
blood establishments, treating
physicians, transfusion committees,
and consumers (recipients).
The process of 'haemovigilance' is already
operational.

154. Blood Safety
•Blood Safety Programme in India was initiated in
1989-90.
• Which subsequently became an integral part of the
National AIDS Control Program (NACP)
•The WHO recommends that all donated blood should
be tested for HIV/AIDS with either ELISA or
RAPID /SIMPLE test.
•Besides, it is mandatory to test blood for hepatitis,
syphilis, and malaria.

155. INDIA MARCHES TOWARDS SAFER BLOOD
TRANSFUSION!
 Now in INDIA the blood donation by professional donors is
banned.
• Voluntary blood donation is encouraged.
• Screening of blood is compared as on 1991-92 (Mar-Apr)
and 1996-97.
• Donors are screened for syphilis (VDRL), HBV
(HBsAg), HIV (ELISA & W Blot) and malaria (MP).
.

156. INDIA MARCHES TOWARDS SAFER BLOOD TRANSFUSION!
• Recipients tested for HIV after 6 months of
•In 1996-97: 8 VDRL+,
19 HBsAg+
6 HIV+.
No malaria+.
transfusion.
• 1991-92 : 64- VDRL+
51- HBsAg+
2 -HIV+.
No malaria+.

157. India marches towards safer blood
transfusion!
 There is reduction in VDRL+ and HBsAg+.
 But the increase in HIV positivity reflects the
progression of seroconversion in the
general population.
CONCLUSION: Comparatively in 1996-97 the
donor samples contain less infectivity and
less contamination.

158. THANKS