BLOOD COMPONENT THERAPY AND TRANSFUSION REACTIONS

Blood
 It is the fluid that circulates through the heart, arteries, capillaries, veins and carries the nutrients and oxygen to the body cells

Functions of Blood
    O2 transportation Removal of CO2 Transport of nutrients Transport of waste products

Blood elements
 Cellular component  Fluid component

Cellular part
Normal range Erythrocyte Leucocytes Life span M 4.75-5.5 million/cmm 120 days 4.75F 4.8-5.1 million/cmm 4.84000-11,000/cmm 400010 hr in peripheral blood 4~5 days in tissue 10 days

Platelets

250,000-500,000/cmm 250,000-

Fluid parts
    Coagulation factors Antibodies Albumin hormones

? Blood component therapy

 Donated blood is separated into various component and specific component therapy is more effective and safe than whole blood.  Component therapy helps in making better use of blood.

Donor

Whole blood

Separation of cellular plasma components by centrifugation

Red cell concentrate (PCV)

Plasma

Frozen within 6 hrs

centrifugation

Albumin 5% Immunoglobulin

Fresh frozen plasma Slowly defrost and removal of supernatant cryoprecipitate Platelet concentrate ( PRP )

Available blood components

Components Major therapeutic effects volume, RBC mass RBC mass Indications

Whole blood

Acute and severe hemorrhage -acute anemia -chronic anemia -Bone marrow failure -thrombocytopenia with hemorrhage -Factor v, fibrinogen deficiency -DIC

PCV

Fresh Blood (within 36 hr of withdrawal from the donor

Platelets Factor v Fibrinogen

Fresh Frozen Plasma (FFP)

Plasma All the clotting factors Factor VIII Platelet

-massive transfusion -liver disease -ITP Hemophilia -thrombocytopenia without hemorrhage < 50,000/cmm *<75000 abnormal bleeding *<30,000 spontaneous bleeding -massive blood transfusion hypofibrinogenomia burns -severe hypoproteinaemia In renal and liver disease -after large volume paracentesis

Cryoprecipitate Platelet rich plasma (PRP)

Fibrinogen

Fibrinogen

Serum albumin 5% Plasma volume Serum albumin 20% Plasma proteins

Blood group
 Discovered by Landsterner in 1900  Differentiated into 4 distinct groups on the basis of antigens

ABO system
 This is blood group system because of naturally acquired IgM anti-A and anti-B antibodies antiantiBlood group O A B AB Antigen in RBCs Antibodies in plasma Nil Anti-A, anti-B Anti- antiA B A and B Anti-B AntiAnti-A AntiNil

Rh system
 This is blood group system because of high frequency of development of IgG Rh(D) antibodies in the Rh D negative individuals after exposure to Rh positive red cells following blood transfusions or during pregnancy  3 pairs of allele genes D & d, C & c, E & e  Presence or absence of D antigen determines the individual is Rh D positive or negative

Rh D positive Rh D negative

85% 15%

Rh incompatibility
 Sometimes seen when a Rh negative mother carries a Rh +ve foetus.  Mother develops anti-Rh antibody during the antiperiod following delivery.  Next pregnancyantibodies from mother pregnancy pass from placenta into the foetus, can cause hemolytic disease of the newborn

Blood transfusion
 The safety of blood transfusion depends upon meticulous attention before, during and after the transfusion.  Prevention of severe hemolytic transfusion reactions almost all of which involve the ABO system

Indications
 To restore and maintain normal blood volume  To correct severe anemia  To correct bleeding and coagulation disorders

Selection and cross-matching of crossblood for transfusion

 ABO and RhD group of recipient is determined  Donor blood of same ABO and RhD as the recipient selected  Recipients serum is crossmatched against the donor red cells

Transfusion reactions complications)

 Immunological  Non immunological

Immunological
 Alloimmunizationrisk of immunization by Alloimmunization many antigens on the red cells, leucocytes, platelets, plasma proteins. --doesnt usually cause clinical problems on --doesnt first transfusions

Incompatibility

Red cells
 Immediate hemolytic transfusion reactions because of complement activation by Ag-Ab Agreaction, usually due to IgM antibodies. --donor cells are agglutinated by pre-exsting --donor preantibodies. --occurs in even <100ml of blood or cells --occurs transfusion  Signs: fever upto 103 F, lumbar pain, dyspnoea, wheezing, hypotension, renal failure.  Diagnosis: confirmed by hemoglobinuria

 Delayed hemolytic transfusion reaction: destruction of transfused cells by IgG antibodies.  Signs: anemia and jaundice 1 wk after

Leucocytes and platelets

 Non-hemolytic (febrile) transfusion reactions Nondue to anti-leucocyte antibodies in the antirecipients against the transfused leucocytes leading to release of pyrogens.  Signs: fever upto 103 F, flushing, chills and rigor, post transfusion purpura

Plasma proteins
 Urticaria and anaphylactic reactions

Management
 STOP TRANSFUSION ALWAYS  Re-checking of blood bag Re Re-cross matching and send new blood Resample of recipient to exclude hemolytic transfusion reaction  If hemolytic transfusion reaction is suspected, rapid infusion of mannitol 20% 100ml in an attempt to promote diuresis

 Rapid administrationof RL solution and alkalinization by sodium bicarbonate infusion in an attempt to washout free hemoglobin present in the tubules and decrease renal tubular damage.  Medicationssteroids (hydrocortisone), Medications adrenaline, anti-allergic drug avil anti( according to clinical manifestation)

NonNon-immunological complications

Transmission of infections Hepatitis C Hepatitis B ( 1 ml of blood infected contains 109 HBV particles ) HIV ( 1 ml of infected blood contain 50 HIV) Malaria Toxoplasmosis etc. ii. Blood contaminated with bacteria and toxins fever upto 103 F, intense flushing, hypotension iii. Circulatory overload

i.

iv. Coagulation defect: thrombocytopenia, DIC -- massive blood transfusion ( transfusion of volume of blood greater than the recipients blood volume in less than 24 hrs) -- for every 5 unit of blood-1 unit of fresh blood bloodtransfusion -- for every 3 unit of whole blood1 unit FFP blood

v. Citrate intoxication and decreased ionized Ca++( hypocalcaemia) -- during massive transfusion in elderly or osteoporotic patients where inadequate storage of calcium -- calcium gluconate prior to whole blood transfusion for every 2 unit of whole blood

vi. Hyperkalaemia In stored blood - Concentration of 2-3 DPG in cells decreased which 2reduces amount of O2 they can deliver to tissue Loss of cell membrane integrity due to hypoxia Potassium continue leaks from the erythrocytes - May cause sudden cardiac arrest

vii. Acidosis --Normal PH of blood 7.4 --Normal --2 weeks old blood 6.5 --2 viii. Iron overload ix. Hypothermia x. Thrombophlebitis xi. Air embolism

Autologous transfusion
 Preoperative  Intraoperative

 Preoperatively : donation of 2-4 units of 2blood ( 1 unit/week)

Intraoperatively
 Removal of 1-2 units of whole blood during 1induction of anesthesia with replacement of crystalloids reducing the hematocrit to 25-30% 25 Collected blood is transferred later.  Blood loss during operation aspirated, mixed with anticoagulant and using device ( solotrans) filtration done and again transferred to patients contraindication: infection and contamination with malignant cells

Emergency transfusion
 Non-crossmatched blood group O, Rh Nonnegative is transfused, but always take pretransfusion sample so that retrospective cross match can be performed.