- 80% of the world's population only has access to 20% of the world's safe blood supply. Providing safe blood can prevent up to 150,000 pregnancy-related deaths. - The main blood groups are ABO and Rh. The ABO system was discovered in 1901 and identifies the A, B, and O blood types. The Rh system identifies Rh+ and Rh- blood based on the presence of the RhD antigen. - Blood donations are tested for blood type and screened for transmissible diseases before use. Compatibility testing between donor and recipient blood is also required to prevent hemolytic transfusion reactions.

1. Internal medicine department
Khalid Yusuf El-zohryBy

2. 80%
of world’s populations has
access to only 20% of the
world’s safe blood

3. 150,000
pregnancy-related deaths
could be prevented by
access to safe blood

4. 50%
of donors are from
family and paid donors

5. One of the important discoveries, I believe is
“the realization that anemia is well tolerated”
providing blood volume is maintained.
Daniel J. Ullyot, M.D. (1992)

8. Basic Immunohematology
 An antigen is a substance capable of
stimulating the production of an
antibody and then reacting with that
antibody in a specific way.
 Antigens of the blood are called
agglutinogens.

9.  The three antigens on the red blood
cells that cause problems and are
routinely tested for are A, B, and Rh D.
 The human leukocyte antigen (HLA) is
located on most cells in the body
except mature erythrocytes.

10. ABO System
 The most important antigens in the blood
are the surface antigens A and B, which are
located on the RBC membranes in the
ABO system.
 This ABO system was developed in 1901
by Dr. Karl Landsteiner.

11. http://learn.genetics.utah.edu/units/basics/blood/types.cfm
Antigens are viewed as foreign
substances when they enter the body

12. HAEMOLYTIC REACTIONS

14. Rh System
• Scientists sometimes study Rhesus monkeys
to learn more about the human anatomy
because there are certain similarities between
the two species. While studying Rhesus
monkeys, a certain blood protein was
discovered. This protein is also present in the
blood of some people. Other people, however,
do not have the protein.
• The presence of the protein, or lack of it, is
referred to as the Rh (for Rhesus) factor.
• If your blood does contain the protein, your
blood is said to be Rh positive (Rh+). If your
blood does not contain the protein, your blood
is said to be Rh negative (Rh-).
A+ A-
B+ B-
AB+ AB-
O+ O-
http://www.fi.edu/biosci/blood/rh.html

15. Rh System
 There are approximately 50 Rh-related antigens; the
five principal antigens are D, C, E, c, and e.
 A person who has D antigen is classified as Rh
positive; one lacking D is Rh negative.
 A total of 85 percent of the population is classified
as D-Rh-positive
 There are no naturally occurring anti-D antibodies;
however, D antibodies build up easily in D-negative
recipients when stimulated with D-positive blood.

19. Rh-negative recipients should
receive Rh-negative whole blood,
and any blood components that
might contain RBCs should be
Rh negative.

20. HLA System
 The HLA antigen was originally identified on
the leukocytes, but it has been established that
HLA is present on most cells in the body.
 It is located on the surface of white blood cells,
platelets, and most tissue cells.
 HLA typing, or tissue typing, is important in
patients with transplants or multiple transfusions
and for paternity testing.

21.  The HLA system is important in
transfusion therapy because HLA antigens
of the donor unit can induce
alloimmunization in the recipient.
 HLA incompatibility is a possible cause of
hemolytic transfusion reactions, and
HLA antibodies as well as granulocyte- and
platelet-specific antibodies have been
implicated in the development of
nonhemolytic transfusion reactions.

22.  Methods used to decrease HLA
alloimmunization include HLA matching
and leukocyte depletion of the donor unit.
 Patients receiving multiple transfusions are
at particular risk for developing
complications related to leukocytes, such
as sensitization to leukocyte antigens,
nonhemolytic febrile reactions,
transmission of leukocyte-mediated
viruses, and graft-versus-host disease

23. Antibodies
 Antibodies within the blood system are
proteins that react with a specific antigen.
 The antibodies anti-A and anti-B are
produced spontaneously in the plasma after
birth and usually form in the first 3 months
of life.
 An antibody has the same name as the
antigen with which it reacts. For example,
anti-A reacts to antigen A.

24.  The naturally occurring antibody in the
blood, which occurs within the
inherited blood group, is from the class
of antibodies called immunoglobulin
mu (IgM).

25. Testing of Donor Blood
 The ABO group
 The Rh type
 All donor blood must be tested to
detect transmissible disease
 Each unit must be appropriately
labeled

27. Compatibility Testing
 Recipients of transfusions must be tested
for ABO and Rh grouping. In addition,
antibody screening and compatibility
testing must be performed.
 Previous exposure to an antigen by
pregnancy or transfusion may have
caused the recipient to develop an
antibody against an antigen.

28.  Compatibility testing is performed between
the recipient’s plasma and the donor’s
RBCs
 Blood from the donor and recipient are
mixed and incubated under a variety of
conditions and suspending media.
 If the recipient’s blood does not
agglutinate the donor cells, compatibility is
indicated.

29. Blood Preservatives
 The solutions in the blood collection bag have a
dual function: as anticoagulant and as RBC
preservative.
 Citrate is used in all blood preservatives as an
anticoagulant.
 Citrate binds with free calcium in the donor’s
plasma. Blood will not clot in the absence of free
or ionized calcium.
 Citrate prevents coagulation by inhibiting the
calcium-dependent steps of the coagulation
cascade.

30.  Preservatives provide proper nutrients to
maintain RBC viability, function, and
metabolism. In addition, refrigeration at 1 to 6 C
preserves RBCs and minimizes the proliferation
of bacteria.
 In 1971, citrate-phosphate-dextrose (CPD)
became a common preservative for blood.
 Citrate–phosphate dextrose–adenine (CPDA-1)
was licensed in 1978, which lengthens the shelf-
life of the blood to 35 days at 1 to 6 C

31.  Additive red cell preservative system
additive solution (AS) contains sodium
chloride, dextrose, adenine, and other
substances that support red cell survival
and function up to 42 days.

32. Blood Donor Collection Methods
 Homologous: transfusion of any blood
component that was donated by someone other
than the recipient.
 Autologous: the collection, storage, and
delivery of a recipient’s own blood.

34. Criteria for selection of donors
 Brief health history, including illnesses, surgeries,
drugs and medications, and immunization
information.
 Screening for diseases
 Stable vital signs
 Age (18-55 years)
 Weight > 50 kg
 No evidence of skin lesions at site of venipuncture

35.  Adequate venous access for venipuncture
 Has not donated blood or plasma within
the last 8 weeks
 Hemoglobin and hematocrit of at least
12.5 g/dL and 38 percent in males and
12.0 g/dL and 36 percent in females
 Autologous Donation: The last donation
should be at least 72 hours and preferably
1 week before an operation to avoid
hypovolemia during surgery.

37. Blood Component Therapy

38. Blood Component Therapy
 Blood is a “liquid organ” with functions as
extraordinary and unique as those of any other
body organ.
 A total of 55 percent of blood is plasma (fluid);
the remaining cellular portion (45%) is made
up of solids: RBCs, WBCs, and platelets.

39. Blood Component Therapy
 Whole Blood
 Packed Red Blood Cells
 Leukocyte-Reduced RBCs
 Irradiated Blood products
 Platelets
 FFP
 Cryoprecipitate

40. Whole Blood
 Whole blood is composed of RBCs,
plasma, WBCs, and platelets.
 The volume of each unit is
approximately 500 mL and consists of
200 mL of RBCs and 300 mL of
plasma, with a minimum hemoglobin
level of 38 percent.

41. Whole blood is never
a “preferred”
treatment

42. Uses of Whole Blood
 Most whole blood units are now used to
prepare valuable separate RBC and
plasma components to meet specific
clinical needs.
 A unit of whole blood increases RBC
mass, which provides oxygen-carrying
capacity and provides plasma for blood
volume expansion.

43.  When whole blood has been stored for
more than 24 hours, degeneration of
some of its components occurs, resulting
in nonviable platelets and granulocytes.
 In addition, levels of factor V and factor
VIII decrease with storage.
 Therefore, a whole blood transfusion
would not provide a therapeutic platelet
transfusion or replace several clotting
factors.

45. In an adult, 1 Unit of whole
blood increases the
hemoglobin by about 1 g/dL
or the hematocrit by about 3 to
4 percent

46. Whole Blood
 Administration
 Amount: Volume of 500 mL
 Usual rate: 2 to 4 hours
 Administration set: Straight or Y type with 170- to
260-micron filter or microaggregrate recipient set
 Compatibility
 Whole blood requires type and crossmatching and
must be ABO identical.

47. Red Blood Cells
 Red blood cell units are prepared
by removing 200 to 250 mL of
plasma from a whole blood unit.
 Each unit contains the same RBC
mass as whole blood, as well as 20
to 30 percent of the original plasma,
leukocytes, and some platelets.

48.  The advantages of RBCs over whole
blood are decreased plasma volume in
an RBC unit and decreased risk of
circulatory overload.
 Another advantage is that because
most of the plasma has been removed,
less citrate, potassium, ammonia, and
other metabolic byproducts are
transfused.

49. Uses
 Red blood cells are used to improve the
oxygen-carrying capacity in patients
with symptomatic anemia.
 The administration of RBCs should be
considered only if improvement of the
RBC count cannot be achieved by
nutrition, drug therapy, or treatment of
the underlying disease.

50.  Criteria for transfusion are based on
multiple variables, including hemoglobin
and hematocrit levels, patient symptoms,
amount and time frame of blood loss,
and surgical procedures

51. Administration
 Administration of RBCs is used for an
operative blood loss of more than 1200
mL.
 An operative blood loss of less than 1000
to 1200 mL can be replaced by crystalloid
or colloid solutions rather than with RBCs

52. Transfuse RBCs
 Hypovolemia due to acute blood loss:
hypotension and tachycardia not corrected
by volume replacement.
 Hgb less than 7 g/dL
 Symptomatic anemia in a euvolemic patient
(angina, syncope, congestive heart failure,
transient ischemic attacks, dyspnea,
tachycardia)

53. Do not transfuse RBCs:
 For volume expansion
 In place of a hematinic
 To enhance wound healing
 To improve general well being

54. Administration summary
 Amount of component: 250 to 300 mL
 Usual rate: 1.5 to 2 hours; maximum 4
hours

55. Compatibility
 RBCs require typing and
crossmatching before being transfused
into a recipient.
 The unit of PRBC does not have to be
ABO identical, but it must be ABO
compatible.

56. Leukocyte-Reduced Red Blood Cells
 Leukocyte-poor RBCs are grouped in a category
referred to as modified blood products.
 A unit of whole blood contains more than 1 to
10 x 109 WBCs. Such products are the result of
removing the number of leukocytes in whole
blood to 5 x 108, while retaining approximately
80 percent of the RBCs.
 The leukocyte-reduced component will have
therapeutic efficacy equal to at least 85 percent
of that of the original component

57. Uses
 Leukocyte-reduced components are
indicated for the prevention of recurrent
febrile, nonhemolytic transfusion reactions.
 These components may be beneficial in
preventing HLA alloimmunization and in
reducing transfusion-related
immunomodulation.

59. Irradiated Blood Products
 When blood products are exposed to a
controlled measure of radiation, it causes the
donor lymphocytes to become incapable of
replication.
 Products such as cryoprecipitate or fresh frozen
plasma do not need to be irradiated.

60. Uses
 Prevention of graft-versus-host disease
(GVHD)
 Patients with acute leukemia and
lymphoma
 Bone marrow or stem cell transplant
recipients
 Patients with immunodeficiency
disorders

61.  The shelf life of irradiated red blood
cells is limited to 28 days because
irradiation damages the cells and
reduces their viability.
 Platelets and granulocytes are not
damaged, so their shelf-life is not
affected

63. Granulocytes
 Granulocyte concentrations are prepared
by leukapheresis from a single donor.
 Each unit contains granulocytes and
variable amounts of lymphocytes, platelets,
and RBCs suspended in 200 to 300 mL of
plasma.

64. Uses
 Patients with congenital WBC
(granulocyte) dysfunction
 Acquired neutropenia
 Treat patients with severe infections
that are unresponsive to conventional
antibiotic therapy.

65.  Administration of granulocytes is accompanied
by a high frequency of nonhemolytic febrile
reactions. These side effects can be managed
with the use of diphenhydramine, steroids, and
nonaspirin antipyretics and by slowing the
transfusion rate.
 The transfusion should not be discontinued
unless severe respiratory distress occurs. The
concentrate must be infused within 24 hours
after collection; to achieve maximal clinical
effect, it should be delivered as soon as possible

66. Compatibility
 Donor blood must be ABO and Rh compatible
because a unit of granulocytes is usually heavily
contaminated with RBCs.
 Generally transfusion therapy is delivered for at
least 4 consecutive days.

68. Platelets
 Platelets are fragments of megacaryocytes,
They are responsible for hemostasis.
 Platelets live up to 12 days in the blood, do
not have nuclei, and are unable to
reproduce.
 They contain no hemoglobin.
 Normal platelet counts are 150,000 to
300,000/L.

69.  Platelets can be supplied as either random-
donor concentrates or single-donor
concentrates.
 Platelet concentrates (random donor) are
prepared from individual units of whole
blood by centrifugation.
 The platelets are stored at room
temperature 20 to 24 C for 5 days with
constant, gentle agitation to maintain the
viability of the platelets.

70.  Single-donor platelet pheresis products
are collected from a single donor, and all
unneeded portions of the donor’s blood
are returned back to the donor.
 A single pheresis unit is equivalent to 6 to
8 U of random donor platelets

71.  The use of a single-donor unit has the
obvious advantage of exposing the
recipient to fewer donors and is ideal
for treating patients who have
developed HLA antibodies from
previous transfusions and have
become refractory (unresponsive) to
random-donor platelets.

72. One platelet concentrate
should raise the recipient’s
platelet count 5000 to 10,000.
The usual dose is 6 to 10 U
random or 1 unit pheresis

73. Uses
 Platelets are administered to control or
prevent bleeding from platelet
 deficiencies resulting in
thrombocytopenia or for the
presence of
 functionally abnormal platelets.

74. Indications for platelet transfusion
include:
 Less than 80,000 to 100,000/L
Neurosurgery or ophthalmic procedures
After cardiopulmonary bypass, intra-
aortic balloon pump placement
Massive transfusions

75.  Less than 60,000 to 80,000/L
Surgery
 Less than 50,000/L
Active bleeding, DIC, invasive
procedure in cirrhosis, liver biopsy

76.  Less than 20,000/L
Bone marrow aspiration and biopsy
 Platelet count less than 10,000/L
Stable heme-oncology patient

77. Do NOT transfuse platelets
 To patients with idiopathic autoimmune
thrombocytopenic purpura (ITP) (unless
there is life-threatening bleeding)
 Prophylactically with massive blood
transfusions
 Prophylactically after cardiopulmonary
bypass

78. Administration
 Amount: 30 to 50 mL/U; usual dose 6 to 8 U
 Usual rate: 1 U in 5 to 10 minutes as tolerated
 Administration set: Component syringe or Y drip
set; tubing should be rubber free to prevent
platelets from sticking; use 0.9 percent sodium
chloride as primer.
 Platelet concentrates may be pooled before
administration or infused individually; after they are
pooled, platelets should be transfused within 4 hours

79. Compatibility
 Preferably, platelets should be ABO
compatible; however, when ABO compatible
platelets are unavailable, mismatched platelets
may be given.
 Crossmatching is not required.
 Rh matching is also preferred required.
 Standard pretransfusion compatibility testing is
not done for platelets.

80. Prophylactic medication with
antihistamines; antipyretics
may be needed to decrease the
incidence of chills, fever, and
allergic reactions

81. Plasma and Fresh Frozen Plasma

82. Plasma and Fresh Frozen Plasma
 Plasma is the liquid portion of the blood and lymph
in which nutrients are carried to body tissues and
wastes are transported to areas of excretion.
 It is colorless, thin, aqueous solution (91 percent
water) that contains chemicals (bile pigments,
bilirubin, electrolytes, enzymes, fats, and hormones),
protein (7 percent), carbohydrates (2 percent), and
serum.
 Plasma does not contain RBCs.

83.  Fresh frozen plasma (FFP) is prepared
from whole blood by separating and
freezing the plasma within 8 hours of
collection.
 FFP may be stored for up to 1 year at 18C
or lower.
 FFP does not provide platelets, and loss of
factors V and VIII

84. Uses
 Liquid plasma is indicated to replace plasma
proteins lost from injury.
 Fresh frozen plasma is primarily used to
provide replacement coagulation factors.
 It is indicated for patients with multiple
coagulation factor deficiencies secondary to
liver disease, DIC, and the dilutional
coagulopathy resulting from massive volume
load or volume replacement.

85.  FFP may also be used for coumarin
drug reversal when time does not
permit reversal by stopping the drug or
administering vitamin K.
 Patients with other rare deficiencies,
such as antithrombin III deficiency
and thrombotic thrombocytopenia
purpura, may also benefit from FFP.

86. Administration
 Plasma is administered at a rate of 200 mL/h.
 Medications and diluents must never be added
to plasma.
 Fresh frozen plasma must be thawed in a 30 to
37C water bath with gentle agitation.
 The thawing process takes up to 30 minutes, and
the FFP should be transfused after thawing or
within 6 hours.

87.  FFP must be delivered through a standard
blood filter. It can be infused as fast as the
patient tolerates or condition indicates.

88. Transfuse FFP:
 PT greater than 19 or PTT greater than
53
To correct coagulation factor
deficiencies in a bleeding patient with
multiple coagulation factor deficits (e.g.,
liver disease, DIC, massive transfusion)
Prior to an invasive procedure

89.  Warfarin overdose or vitamin K
deficiency, when correction of
coagulopathy is needed within 12 to
24 hours
Bleeding patient or in a patient with high
risk of bleeding
Before an invasive procedure

90.  Replacement fluid in TTP
 Replacement in factor V and XI
deficiencies

91. Do NOT transfuse FFP:
 For volume expansion
 As a nutritional supplement

92. Compatibility
 Compatibility testing is not required except to
identify the recipient’s ABO group to ensure
that A or B antibodies present in the plasma are
compatible with the recipient’s RBCs.
 If the recipient’s blood type is not known, group
AB can be safely given.

93.  Rh matching is not required.
 The amount of antibody present in a single unit
of FFP is not clinically important.

94. Cryoprecipitate
 Cryoprecipitate is the insoluble portion of
plasma that remains as a white precipitate after
FFP is thawed at 4C under special conditions.
 Cryoprecipitate has a shelf life of 1 year
 It contains concentrated factor VIII: C; factor
VIII: vWF (von Willebrand factor); fibrinogen;
and factor XIII

95. Uses
 Hypofibrinogenemia – fibrinogen less than 100
mg/dL
 Massive transfusion
 Congenital deficiency
 Acquired deficiency (e.g., DIC)
 Factor VIII deficiency
 Uremia with bleeding unresponsive to
nontransfusion therapy (dialysis, desmopressin)
 Dysfibrinogenemia (dysfunctional fibrinogen)

96. Administration
 Cryoprecipitate is thawed before being
transfused and must be used within 6 hours.
 Cryoprecipitate should be administered through
a standard blood filter.
 Amount: 10 to 15 mL of diluent added to
precipitate (3 to 5 mL) unit; usual dose 6 to 10 U
 Usual rate: 1 to 2 mL/min

97. Compatibility
 Compatibility testing is not done, but the
cryoprecipitate should be ABO compatible with
the patient’s RBCs because a very small volume
of plasma is present.
 If the patient’s blood group is not known, group
AB is preferred, but any group can be given in
an emergency because the plasma volume is
small.
 Rh matching is not required.

98. Pack of pooled cryoprecipitate

99. Recombinant Factor VIII
 Uses
 Hemophilia (factor VIII or IX deficiency)
 Administration
 Usually administered by bolus infusion in home care
environment.
 The package contains the vial of lyophilized (freeze
dried) product and vial of diluent
 Store in refrigerator or at room temperature; shelf-
life up to 2 years.

100. Albumin
 Albumin is a plasma protein that supplies 80
percent of plasma’s osmotic activity.
 Normal serum albumin is composed of 96
percent albumin and 4 percent globulin and
other proteins.
 It is available as a 5 or 25 percent solution.

101. Plasma Protein Fraction (PPF)
 Plasma protein fraction (PPF) is a similar
product to albumin.
 It contains about 83 percent albumin and 17
percent globulins.
 PPF is available only in a 5 percent solution.

102. Uses of Albumin and PPF
 Plasma protein fraction and 5 percent albumin
are isotonic solutions and therefore are
osmotically equivalent to an equal volume of
plasma.
 Both are used primarily to increase plasma
volume resulting from sudden loss of
intravascular volume as seen in patients with
hypovolemic shock from trauma or surgery

103.  The plasma derivatives lack clotting factors
and other plasma proteins and therefore
should not be considered plasma
substitutes.
 Neither component will correct nutritional
deficits or chronic hypoalbuminemia.

104.  The 25 percent albumin is hypertonic and is five
times more concentrated than 5 percent
albumin.
 The 25 percent albumin is used to draw fluids
out of tissues and body cavities into
intravascular spaces.
 This solution must be given with caution.
 Principal uses for 25 percent albumin include
plasma volume expansion, hypovolemic shock,
burns, and prevention and treatment of patients
with cerebral edema.

105. Administration
 Albumin and PPF are supplied in glass bottles.
 Albumin, 5 and 25 percent, may be given as
rapidly as the patient tolerates for reduced blood
volumes.
 Amount: 5 percent solution 250 mL; 25 percent
solution 50 to 100 mL.
 Usual rate: 5 percent solution: 2 to 4 mL/min;
25 percent solution: 1 mL/min

106. Compatibility
 ABO or Rh matching and compatibility testing
are not necessary for these components because
antigens and antibodies are not present in these
products.

108. ‫للر‬ ‫بمرشح‬ ‫الدفع‬ ‫قررت‬ ‫اإلسالمية‬ ‫الجماعة‬ ‫لو‬،‫ئاسة‬
‫د‬ ‫هو‬ ‫المرشح‬ ‫كان‬ ‫لو‬ ‫حالة‬ ‫في‬.‫الظواهرى‬ ‫أيمن‬
‫المسلمي‬ ‫بأيمنات‬ ‫يحلف‬ ‫أوباما‬ ‫هيطلع‬ ‫ساعتها‬‫كلها‬ ‫ن‬
‫دخلت‬ ‫ما‬ ‫عمرها‬ ‫اسماعيل‬ ‫أبو‬ ‫حازم‬ ‫والدة‬ ‫إن‬
‫أمريكا‬.