Blood & BLOOD TRANSFUSION

Blood Product: Any therapeutics substance Product: prepared from human blood. Whole Blood: non separated blood collected in to Blood: an approved container containing an anti coagulant preservative solution. Blood Components: Components: 1. Constituent of blood, separated from whole blood such as;
   

Definitions:

Red cell concentrated Red cell Suspension Plasma Platelet concentrated

2. Plasma or platelet collected by aphaeresis 3. Cryoprecipitate prepared from fresh frozen plasma, rich in factor VII and fibrinogen.

Blood Transfusion:- Red blood cell Transfusion:

transfusion are given to raise the HCT level in patients or whole blood to replace losses after acute bleeding. Red cell compatibility testing is essential before transfusion in order to; - Ensured that transfused red blood cell
is compatible with the anti bodies in the recipient, particularly anti-RhD. anti-

- Avoid stimulating the production of new

red cell anti body in the recipient, particularly anti-RhD. anti-

- All pre-transfusion test procedures preshould provide the following information about both the unit of blood and patient:

. ABO group . RhD . Presence of red cell anti body that

could cause hemolytic in the recipient.

All healthy normal adult of group A, group B and group O have anti body in their plasma against the red cell type (antigen) that they have not inherited.
  

Group A individual have anti body to group B Group B Group O &B Group AB do not have anti body to group A or B

A A

These anti body are usually of Igm & IgG class are normally able to hemolysis (destroy) transfused red cell.

Plasma and components of plasma.



In plasma transfusion group AB plasma can be given to patient of any ABO group because it contain neither Anti A nor Anti B Anti bodies. Means 1. Group AB Plasma (no anti bodies) can be given to any ABO group patient. 2. Group A plasma (anti B ) can be given to group O and A patient. 3. Group B plasma (anti A ) can be given to group O and B patient. 4. Group O plasma (anti A and anti B ) can given to group O patient only.

RhD red cell antigen

Red cells have many other antigens; the most important is the RhD antigen. Single unit of RhD positive red cell transfused to an RhD negative person will usually provoke production of anti RhD anti body. This can cause!


Hemolytic disease of new born in subsequent pregnancy. Rapid destruction of later transfusion of RhD positive red cell.

Other red cell antigen

There are many other antigens on the human red cell each of which can stimulate production of anti body if transfused in to a susceptible recipient. This antigen system includes:includes:   

Rh system : RhC,c,E,e, Kid Duffy Lewis

These anti bodies can also cause sever reaction to transfusion. transfusion.

Screening for transmissible diseases: diseases:

is important such as
 Hepatitis  HIV  Syphilis  Malaria  Chagas

B&C

disease  Cyto megallovirus (CMV)

Choices Types of blood transfusion When a blood transfusion is contemplated, packed red blood cells rather than whole blood should be given primary consideration.  The transfusion of whole blood should require evidence of its need that is hypovolemic shock.


Whole Blood
     

About 450 ml donor blood (1 unit) 63 ml anticoagulant preservative solution. Hemoglobin 12 g|100 ml HCT 35-45 % 35No functional platelet No labile coagulation factor (V&VIII)

Infection Risk: Risk: not sterilized capable of transmission any agent present in cell or plasma which has not been detected by routine screening for transfusiontransfusiontransmissible infection, includes HIV hepatitis B&C, other hepatitis virus, syphilis, malaria etc.

Storage: Storage:- B\n 20co and 60co approved blood bank Transfusion should be started within 30 minute to removal from refrigerator. Indication:Indication:- Red cell replacement in acute blood losses with hypovolumia.
 

Exchange transfusion. Patient needing red cell transfusion where red cell concentrate or suspension are not available.

 Contraindications:- Risk of volume over

load in patient with :: Chronic anemia  Incipient cardiac failure  Increased infused ammonia, potassium and other acid products. Impeding cardiac failure decompensation, hepatic cirrhosis, uremia, acute burn, anemia associated with bone marrow failure, debilitated, aged may be complicated by whole blood transfusion. compatible with the recipient.  Never add medication to unit of blood  Complete transfusion within 4 hrs of commencement.

 Administration :- Must be ABO and RhD

Red cell concentrates (packed red cell)

  

150150-200 ml red cells from which most of plasma have been removed. Hemoglobin 20 g|100 ml not less than 45 gm per unit. HCT 55%- 75% 55%-

  

Risk:Risk:- Infection Same as whole blood Storage: Storage: - Same as whole blood Indication:Indication:- Replacement of red cell in anemic patient.


Use with crystalloid replacement fluid or colloid solution in acute blood loss. To improve transfusion flow normal saline (50(50100ml) may be added using Y pattern infusion set.

Administration:Administration:- Same as whole blood



Advantage of packed Red cell transfusion

1. 2.

3. 4. 5.

6.

Diminish likelihood of congestive heart failure. Less infused ammonia, potassium and other acid products, Fewer allergenic proteins. Possible reduction in hepatitis Decrease chance of ISO sensitization which could complicate future pregnancy and\or and\ transplantation Greater safety when non specific blood is required.

LeukocyteLeukocyte-depleted Red cell

 

A red cell suspension or concentrate by filtration through a leukocyte- depleting filter. leukocyteLeucocytes depletion significantly reduce the risk of transmission of cytomegalovirus. cytomegalovirus.

Indication:Indication:- Minimize white cell immunization in pts receiving repeated transfusion but, to achieve this all blood component given to the pt must be leukocyte depleted.


Reduce risk of CMV transmission in special situation. situation.

Platelet concentrated
  

(Prepared from whole blood donation) Storage up to 72 hr at 20-24oc 20Longer storage increased the risk of bacteria proliferation and septicemia in recipient. Thrombocytopenia . Platelet function defect Prevention of bleeding due to thrombocytopenia such as in bone marrow failure.

Indication: Indication:- Treatment of bleeding due to:

  

FRESH FROZEN PLASMA



 

The plasma separated from one whole blood donation within 6 hr of collection and then rapidly frozen -25co or colder. Contains normal plasma level of stable clotting factor , albumin and immunoglobulin. Factor VII level at least 70% of normal fresh plasma Usual volume of pack is 250-300 ml. 250Smaller volume pack may be available for children. Infection risk is very low risk if treated with methyl \ Ultra violet light in activation.

Indication: Indication: - Replacement of multiple coagulation factor deficiencies. Example  Warfarin (anticoagulant) over dose  Depletion of coagulation factor in patient receiving large volume transfusion.  Disseminated intravascular coagulation\DIC \ coagulation\  Thrombosis thrombocytopenic purpura

Cryoprecipitate
 

Prepared from fresh frozen plasma by collecting the precipitate formed during controlled at positive 4co and re-suspending it in 10-20 ml plasma. re10Containing about half of the factor VIII and fibrinogen in the donated whole blood eg factors VIII : 80-100IV(Pack fibrinogen:150-300 mg) 80fibrinogen:150packed

Indication :- As an alternative to factor VIII :concentrate in the treatment of inherited deficiencies of:of:   

Von willebrand factor . Factor VIII (hemophilia A) Factor XIII As source of fibrinogen in acquired coagulapathies : eg. DIC.

Adverse effect of blood transfusion

Acute complication of transfusion.



Reaction occur during or shortly after (within 24 hrs) of the transfusion.

1. Mild Reaction
* Signs * Symptoms Localized -pruritis(itching) -Coetaneous rxn - Urticatia - Rash

* Possible causes

- Mild hypersensitivity

2. Moderately severe reactions

Signs -Flushing -Urticaria - Rigors - Fever - Restlessness - Tachycardia Symptoms - Anxiety Pruritus Possible causes - hypersensitivity moderate--sever - Febrile non haemolytic

- palpitation reaction - Mild dyspnoea antibodies to white blood cell - Headache platelet, - Anti body to protein including IgA - Possible contaminating with Pyrogen or bacteria.

1. Immediate management to mild reaction 1.1. Slow the transfusion 1.2. Administer anti histamine Im(eg chlorpheniramine 0.1 mg /kg) 2. Immediate management for moderately sever reaction 2.1. Stop the transfusion :Replace the infusion set and keep IV line open with normal saline. 2.2. Notify the responsible for the pt and the blood bank immediately. 2.3. Administer anti histamine Im and paracetamol 2.4. Give corticosteroid and broncho dilated if there are anaphylactoid. 2.5. Collect urine for next 24 hrs for evidence of haemolysis and send to laboratory.

3-Life threating Rxn

Signs -Rigor symptom -anxiety cause -acute intravascular hemolytic

-fever -chest pain -restlessness Resp.distress -bacterial conta/n -hypotension loin pain -fld overload Fall SBP -head ache -anaphylaxis in 20% -dyspnea -lung injury -tachycardia -hgb uiria -DIC

Immediate management for life threatening reaction

- Maintain air way and give high flow oxygen by mask - Stop transfusion replace the infusion and keep IV line open with normal saline. - - Infuse normal saline (initially 20-30 ml/kg) to maintain systolic BP. If hypotensive give over 5 minutes and elevate patients leg - Give Adrenaline/as 1:1000 solution / - Give IV corticostriod and Bronchodilator if there are anaphylactoid feature/ eg broncho spasm, stridor/. - Give diuretic eg/frusemide 1mg/kg - If bactrerimia suspected (rigor,fever, collapse) start broad-spectrum Antibiotics.

Delayed Complication of transfusion 1. Sign and symptoms Sign appears 5-10 days after transfusion Fever Anemia Jaundice Occasionally hemoglobinuria. 2. Sever , Life threatening delayed haemolytic transfusion reaction with shock, renal failure and DIC.

Complications - Delayed haemolytic reaction

Presentation Treatment -5-10 days post transfusion - Usually no Rx - Fever - If hypotension and - Anemia oliguria, rx- as IV hemlysis - Jaundice - 5-10 days post transfusion - High dose steroid - increased bleeding tendency - High dose IV - Thrombocytopenia. Immunogulobin - plasma exchange - cardiac & liver failure - Prevent with Iron In transfusion dependent binding agent eg. Patient. Desferrioxamine

- Post transfusion purpura

- Iron over load

Reference:
1.

The clinical use of blood- hand book WHO , Blood bloodtransfusion safety. Geneva. 2. Management of Blood Transfusion service WHO Geneva 1990 3. Principle of and practices of surgery 4th edition

Thank you !!