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Donor Selection

brochures, and other visual aids to assure that


the basic messages of donors are consistently
and effectively communicated

Pre-Donation Process

Pre-donation Counseling

Pre-donation Interview, Education


and Counselling
The donor must be assured that
information concerning his medical and
social history shall be treated as highly
confidential and shall not be discussed
even with his relatives or friends

1.
2.
3.
4.

Post-donation Counseling
1.
2.

In addition, the following minimum


information shall be given to the donor

The importance of truthfulness in his


medical and social
Donors rights and responsibilities
Potential
donation-related
complications
Importance of maintaining a healthy
lifestyle
Means of self-deferral

Voluntary self-exclusion

Confidential
(CUE)

unit

Knowledge of HIV & other TTIs


Risk history assessment
Donation information
Psychosocial factors & knowledge

3.

4.

Giving the donor enough time to grasp


the information
Giving the donor enough time &
opportunity to ask questions
Helping the donor cope with the
emotional & practical impact of a
confirmed (+) result especially for HIV
Offering options for continued care for
infected & their families, sexual contact
through referral to appropriate health
facilities

Donor Selection
Donor screening encompasses the:

exclusion

Alternate testing sites for those at risk


or for those who want to be treated
The risk of the blood donation
The tests that are going to be done and
why
The steps to be followed when test
results are known
The uses of their blood
Health care during and after donation,
including care of venipuncture site
Post-donation follow-up

BCU (Blood Center Unit) shall provide the


necessary
leaflets,
information
sheets,

Medical history requirements for


the donor
Physical examination
Serologic testing of the donor

Technical Standard
1.
2.
3.
4.
5.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Basic Qualification of the Potential Blood


Donor:

HIV
HBsAg
HCV
Malaria
Syphilis

ISBT

HIV1 and HIV2


HTLV1 and HTLV2
HBsAg
HCV
Malaria
Syphilis
CMV
West Nile Virus
Yersenia enterolitica
Staph / Strep
T. cruzi
Babesia necrotic
CJD

Good health
Age: 17 y.o. (Henry), 16-17 y.o.
(Harmening)
New donor: 16-60 y.o. before 61st
birthday
Regular donor: up to 70 y.o. before
71st birthday
Body weight of 110 lbs. or 50 kgs.
Maximum of 10.5 ml/kg
Temperature 37.5oC or 99oF
Pulse
50-100
beats/minute
(no
pathologic cardiac abnormalities) low
pulse rate for athletes (high exercise
tolerance)
Blood
pressure
180 mmHg/100
mmHg
Technical
Standard
(160
mmHg/<100mmHg)
Hemoglobin 12.5 g/dL and 38 %
hematocrit (1.053 copper sulfate
solution)
Female: 125 g/L-minimum
175 g/L-maximum
Male:
135 g/L-minimum
185 g/L-maximum
No evidence of alcohol intoxication
Venipuncture sites should be free of
lesions
No evidence of parenteral drug abuse

Deferral

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1.

2.
3.
4.
5.
6.
7.

8.
9.
10.
11.
12.
13.
14.
15.

High risk history for aids


-men who have sex with another
men anytime since 1977
-Hemophiliacs
-Intravenous drug uses
-Persons who have engage in sex
for money or drugs anytime since 1977
Confirmed (+) lab test for HIV
Symptoms of AIDs
History of viral hepatitis after age 11
Confirmed (+) test for Hepatitis B
surface antigen
(+) anti-HB core on more than one
occasion
Past or present clinical or laboratory
evidence of infection with HCV, HTLV, or
HIV
Confirmed (+) test for HCV antibody,
HTLV or HIV
History of cancer
Hematologic malignancies
Chemotherapeutic agents administered
for malignancies
Chronic cardiac, pulmonary, liver or
renal disease
Bleeding tendencies (deficiencies)
Who have taken Tegison (Psoriasis)
History of babesiosis or Chagas disease

Three (3) years


1.
2.
3.

One (1) year


1.
2.
3.
4.

5.

6.
7.
8.
9.
10.
11.
12.
13.

Temporary (while the condition exists)


1.
2.
3.
4.
5.

6.

7.

Active diseases under treatment such


as cold, flu, TB
Uncontrolled diseases of the heart,
lungs, kidney, liver, GIT
Pregnancy 12 months deferral if
receive during pregnancy
Acute febrile illness about 2-3
weeks after febrile episode
Previous
donation

previous
donation of 200 ml and 450 ml is from
6-8 weeks or longer respectively
Major operation/blood transfusion
12
months
after
operation
or
transfusion
Skin lesions at venipuncture site
after skin lesion have completely
healed tooth extraction 1 year

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Immigrant, refugee or citizen coming


from an area endemic for malaria
After a diagnosis of malaria, 3 years
after becoming asymptomatic
Use of acetritin (soriatane)

14.
15.

After HBIg administration


After therapeutic rabies vaccination
Rape victims
Health care workers with percutaneous
or mucous membrane exposure to
blood or body fluids
Patients who have received blood,
blood components, blood derivatives or
human tissues known to be a source of
blood borne pathogens
Close contact with a patient of viral
hepatitis
Tattoo (incarceration for more than 72
hours)
Sexual contact with a prostitute or
persons high risk group of AIDs
After exposure to or bite of a rabid
animal
Intranasal use of cocaine
History of syphilis/gonorrhea
Skin piercing 1 year after the incident
Exposure to a close household contact
with hepatitis 1 year after exposure
Incarceration for more than 72 hours
Residents of non-endemic areas who
travel areas endemic for malaria

1.
2.
3.

2 weeks

After whole blood donation

Six (6) weeks (1 & months/ 12 months


deferral if the woman receives transfusionduring her pregnancy

Following delivery of a baby

One (1) moth

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After vaccination with live attenuated


viral/bacterial vaccines such as
1. Oral typhoid
2. Oral polio
3. Measles (rubella)
4. Mumps or yellow fever
5. BCG

48 hours

Whole blood donation deferred after


hemapheresis (aspirin), piroxicam

Ticlopidin-7 days deferral or 6 months


May donate anytime if without vaccine
associated symptoms like fever, DPT, DT, polio
vaccine, injectable Hepatitis, cholera, typhoid,
paratyphoid, typhus and influenza vaccines
Recent alcohol intake (2-3 bottles) 12 hours
after last intake
Hazardous occupational/Hobbies

Two (2) months

German measles (rubella)


Varicella
zoster
(chicken
pox)
vaccination
After cessation of the drugs Accutane
(acne treatment) finasteride (benign
prostatic hyperplasia)

Entail an interval of not less than 12 0


between donation and returning to the
occupation or hobby

16 weeks

Double unit red cell apheresis

12 months

Women who have had sex with men


who have had sex with another man,
even once since 1977

No Deferral
Immunization
with
recombinant
vaccines
toxoids or dead organisms if asymptomatic
including primary prophylaxis against the
following if the donor is symptom-free & febrile:
Antrax, Paratyphoid, Cholera, Diptheria,
Pneumococcus, Hep. A, HBV, influenza,
lyme disease, polio, pertussis, plague,
rabies
1 year
Rocky mountain, spotted fever tetanus and
typhoid injection

ABO/Rh typing
Antibody screening
Transfusion
Transmitted
diseases
testing:
Syphilis
Hepatitis B, C
Malaria
HIV-1, HIV-2
HTLV-1, HTLV-2
T. cruzi antibodies (chagas
disease)
West Nile virus
CLD, prions

Frequency of Donation

It becomes critical to verify that the vaccines


was given for primary and not post exposure
prophylaxis and approval by the director maybe
considered when unclear, in a case basis

Every 12 weeks Philippine National


Blood Services Policy (PNBSP)
Male 6 standards donations/ 1 year
Female 4 standards donations may
have be taken/ 1 year
Note:
weight,
dietary
habits,
hemoglobin value

Quantity of Donation

450 ml or +/- 10 % (405 ml to 495 ml)


exclusive of anticoagulants
Blood Preservation

Phlebotomy
1.
2.

3.
4.
5.

6.

Donor is placed in the suprine position


(on a flat bed/ donor chair)
Donor bag sample tubes and donor
record should be properly identified and
labelled before drawing blood
Venipuncture site should be free of skin
lesions
Tourniquet is applied on the upper arm
above the antecubital venipuncture site
The prospective area is released and
then skin overlying the chosen is
prepared using an antiseptic technique
Removal of blood is done using a
sterile, closed container system and a
single venipuncture

ACD

CPD

Improvement on ACD
Less acidic than ACD, improved cell
viability
Better preservative of ATP
Less citrate ions, less citrate toxicity

Adenine

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Increases the shelf life of stored RBCs

Mannitol

Prolongs the shelf life of RBC, prevent


lysis during storage

Hemovigilance

Term used to describe the noting of all


adverse incidents related to blood
transfusion from the time of donative to
the time of transfusion

Anticoagulants: whole blood 1-60C


1.
2.
3.
4.
5.
6.

CPD
CPD-A1
CP2D
CPD-AS (adsol)
Heparin
ACD

21 days
35 days
21 days
42 days
2 days
21 days

Donor Reactions

Vasovagal reaction, slow heart rate <60


/bpm (common adverse reaction)
Dizziness, diaphoresis, pallor, nausea,
vomiting and fainting
Hyperventilation
Hematoma, accidental arterial puncture
Arteriovenous fistula formation
Pseudo aneurysm of brachial artery,
compartment syndrome
Neurologic injury
Infection at the venipuncture site
Thrombophlebitis
Myocardial infection, stroke
Irritative reactions or allergic reactions
due to adhesive tape or antiseptic
solution
Pallor, nausea, fainting, accidental
arterial puncture, stroke

Post Donation Instruction

Blood Processing Tests

BLOODBANK

1st to be discovered
Citrate the acid provides the correct pH,
dextrose provides nutrition for cell
metabolism

No smoking for more than 10

Drinking more than the usual amount of


fluids (>8-10 glasses a day)
Avoid lifting heavy weights/strenuous
activities for 240
Leaving the Band-Aid for a minimum of
4 hours
Applying pressure for 2-5 minutes. On
the
venipuncture,
in
case
of
reoccurrence of bleeding
Lying down with legs elevated, if the
donor feels dizzy/light headed

donation,
blood
component
therapy, blood cell serology and
blood transfusion therapy.
Operationally
divided:

Donors for apheresis shall meet the


criteria for ordinary WB donation
Special attention shall be given to the
ff. conditions:
o Abnormal bleeding episodes
o Adverse reactions to previous
donation
o Adequacy of venous access

CBC
Total Protein estimate
Protein analysis
o Total serum or plasma CHON
o Electrophoresis
o Quality
of
single
CHONs
especially albumin and IgG
Total CHON should not be less than
60g/L

is

Whole
Blood
(vein)

Blood Transfusion

Is the administration of whole blood or


component to replace blood loss
through trauma, surgery or disease.

Hemapheresis

Whole blood is removed from an


individual,
anticoagulated
and
separated into components
A process of removing normal/abnormal
constituents from circulating blood
Example: polycythemia vera
General term for blood collection

Removal of harmful cellular or plasma


factors

Apheresis

Is
a
multidisciplinary
specialty
encompassing all aspects of blood

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lymphocytes

Whole
Blood

granulocytes
erythrocytes
Blood components

Autologous Transfusion

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Removing whole blood from an


individual manipulating the removed
blood

A recipient receives his/her own blood


prevention of transfusion transmitted
diseases
Elimination of alloimmunization
Alloimmunization of Graft versus Host
Disease (GVHD)
Erythropoietic stimulation
A safest blood a recipient can receive
No need to crossmatch and screening

Intraoperative Salvage

Therapeutic hemapheresis

Transfusion
Medicine

Remaining
components

Types of Transfusion:

Laboratory Examination (at least 1 year)

Medicine

platelets

1. Blood centers
Recruits and collect blood from donors
and manufactures and distribute blood
components
2. Transfusion services
Perform pretransfusion compatibility
testing,
select and issue blood
components for patients and provide
medical support

Apheresis Donor

Transfusion

plasma

A system whereby blood is aspirated


from the operation field and then
transfused to the patient
Transfusion is done directly using a
filter or washed blood to remove
surgical debris, phospholipids, activated
complement and tissue activators
Using decreasing manner of saline
Monitor first 15 minutes, observe
Undertaken and trained expert

Directed Transfusion

Anticoagulant
added

Patient directly solicits blood from


family and friends
Entire process is based on false
assumption that blood donated by
family and friends is safer than that of
regular volunteer donor population

Emergency Transfusion

Massive Blood Transfusion

When a volume equivalent to patients


blood volume is transfused within a 24
hour period
Transfusion of 16-20 units (10 units
Harmening) of RBCs. 20 units ISBT

Neonatal Transfusion

To replace blood for laboratory tests


and to treat anemia of prematurity
Small aliquots of donor blood from a
collection log to a transferred from the
collection bag to a satellite bag or
transfer bag
Blood can be withdrawn from the
collection bag or transfer bag using an
injection site coupler and needle and
syringe or a sterile docking device and
syringe
Unit must be less than 7 days old (1421 days old in some institution) to
reduce hyperkalemia and to maximize
2, 3 DPG (3 days Harmening and ISBT)

Removes
unbound
IgG
antibody,
bilirubin and antibody coated RBC
Corrects anemia and replaces fetal RBC
the adult RBC which have better
release of O2 to the tissues

Patients
who
are
rapidly
or
uncontrollably bleeding may require
immediate transfusion
Group O RBCs are selected
Group O (-) if patient is a female of
child bearing age
A Rh (-) male can be switched to Rh (+)
if few O (-) units are available / if
massive transfusion is required

Transfusion in Oncology

Irradiated blood components to avoid


Transfusion Associated Graft Versus
Host Disease (TA-GVHD)
For cancer patient
Irradiated
means
less
cause
transmission of disease

Speed of Transfusion

Exchange Transfusion

15 drops = 1 mL
60 drops/minute, 60/15 x 60= 240 mL
of blood can be transplanted in 1 hour
1 unit can be transfused in 2 hours or
450-500 cc done in 2 hours

Slow infusion (7.5-8 drops) within 4


hours
Infusion must not beyond in 4 hours

Blood warmers

Used to warm down and minimize the


coldness
Causes hypotension if cold
If no blood warmers, stand for 5-15
minutes
1st 15 mins. Slow drop
Used to avoid arrhythmia / death of
patient
Maintained @ 40-42oC

Centrifugation Speed

5000 rcf for 5 minutes Packed RBC or


Platelets
concentration.
Then
centrifugation is at room temperature
(20-24oC)
5000 rcf for 7 minutes Cryoprecipitate
cell free plasma (heavy spin)
2000 rcf for 3 minutes Platelet Rich
Plasma (light spin)

TAKE NOTE:

Vital sign
Blood pressure
Temperature
Hematocrit and Hemoglobin
Urine output
Coagulation status

Blood Components
Type
Whole Blood

Description
Clinical Indication
A product in which all of the red cells and Massive transfusion where both red cell mass and
most of the plasma from the original
plasma volume are required
Replacement of the O2 carrying capacity and
unit remain
maintenance of the intravascular bleeding
Red Blood Cells packed RBC with reduced plasma volume to increase O2 carrying capacity of blood in patients

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Volume
540 mL

Shelf Life
CPD 21 days, CPD A1
35 days @ 1-6oC

260 mL

CPD 21 days, CPD A1

with acute/chronic anemia


maybe prepared from whole blood by
overnight
sedimentation
or
by who are symptomatic (syncope, dyspnea) or at high
risk for end organ damage (subcritical coronary
centrifugation using heavy spin
Atherosclerosis)
Red Blood Cells RBCs with reduced plasma volume and an
in Additive
additional 100 mL of additive solution
solution
same as whole blood or packed RBC
(AdenineSaline)
Washed RBC
prevention of recurrent or severe allergic reactions
(no plasma)
neonatal intrauterine transfusion
prevention of anaphylactic reaction in IgA deficient
patients
Frozen
removes >90% of WBC
alternative to Cytomegalo virus-seronegative unit
Deglycerolized no plasma
emergencies
RBC
long term preservation of RBC units with Decreases febrile transfusion reaction
rare phenotype or autologous RBC units
Leukocyte
Decreases thee risk of alloimmunization to HLA
reduced RBC
antigens on leukocytes
(3log filtration)
Decreases febrile non-hemolytic transfusion reaction
Reduce the risk of CMV infection
Decrease immunomodulation and may decrease the
risk of prior transmission in B lymphocytes
Two Unit RBC two RBC are divided into two separate same indications as packed RBC
Apheresis
RBC units of equal volume
similar to packed RBC
Random Donor
bleeding due to quantitative or qualitative platelet
Platelet
disorders
Concentrate
prophylaxis in severely thrombocytopenic patients
(below 5,000-10,000/uL)
Single Platelet platelets in approximately 250 mL of Indications similar to random donor platelets
plasma to maintain pH above 6.2
Leukocyte
platelets, random donor or pheresis
As per random donor or pheresis platelets
Reduced
Bedside filtration is done immediately When additional prevention of alloimmunization to HLA
Platelets
before transfusion (3log filtration)
antigens or reduction of CMV infection risk is desired

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35 days @ 1-6oC

340 mL

42 days @
1-6oC

180 mL

24 hours @
1-6oC

250 mL

10 years @ -65oC to
-200oC and 24 hours @ 16oC after washing

Volume
similar to
original unit

Similar to original unit


when closed system used

320 mL

1 year @ 1-6oC

50-70 mL

5 days with constant


gentle agitation ad 4
hours after pooling
platelets
5 days @ 20-24oC with
constant gentle agitation
Similar to original
component when closed
system used

200-400 mL
Volume
similar to
original
component

Granulocytopenia with persistent fever or infection


(<500 neutrophils/ uL)
Not responding to aggressive antibiotic or antifungal
therapy for 48 hours in patients whose bone marrow
function is expected to recover

200-300 mL

24 hours @ 20-24oC

all coagulation factors, complement and When specific coagulation factor deficiency where
other plasma proteins
coagulation factors are not available
Bleeding due to multiple coagulation factor deficiency
(liver failure, DIC, Coumadin toxicity)
Cryopoor
component
remaining
after Used in patients with hemolytic uremic syndrome,
Plasma
cryoprecipitate is prepared
thrombotic thrombocytopenic purpura
minimal concentration of fibrinogen factor
VIII and vWF
Cryoprecipitate
Congenital or acquired deficiencies of fibrinogen and
factor XIII deficiency
Used in vWF and hemophilia A when virus inactivated
factor concentrates are not available
Maybe beneficial in bleeding due to uremic platelet
dysfunction not responding to desmopressin,
estrogens
factor XIII deficiency, unresponsive to dialysis
Factor VIII
available in several degrees of purity
moderate to severe hemophilia
(Lyophilized) All products are lyophilized
Fractionation of pooled donor plasma

200-260 mL

1 year @ -18oC

200 mL

Same as FFP 1 year -18oC


or below

10-15 mL

1 year @ -18oC and below


and 6 hours after thawing

25 mL of
sterile
diluent for
reconstituti
on
25 mL of
sterile
diluents for
reconstituti
on

2 years @ 2-8oC

Volume per
manufacture
rs
directions
200 mL

2 years @ 2-8oC

Granulocyte
Pheresis

Granulocytes and other WBC

Fresh Frozen
Plasma

plasma derived and recombinant proteins Plasma derived factor IX complex is used to treat
are available
hemophilia B and patients with inhibitors to VIII and
Factor IX complex: Factor II, VII, IX and
IX
other proteins
Factor IX, human purified by immuno
affinity chromatography from pooled
human plasma contains other traces of
proteins
Recombinant Factor IX
Antithrombin Prepared from pooled human plasma by Treatment for prophylaxis of thrombic events in patient
III Concentrate
modified cold ethanol fractionation
with congenital antithrombin deficiency (DIC, heparin
resistance, sepsis, deep vein thrombosis, pulmonary
embolism)
Solvent/Deterg plasma similar to contents as in FFP
S/D treatment of plasma is to inactivate lipid
ent Treated
Minimal content of high-molecular weight
enveloped viruses (HIV/HCV)
Plasma
similar to FFP
vWF
Donor Plasma as in FFP, stored and released for similar to FFP
Retested
use after donor has been retested
Factor IX

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200-260 mL

2 years @ 2-8oC

1 year @ -18oC from


manufacturing
1 year @ -18oC

Frozen Plasma

negative for all viral markers after 112


days or more, allowing window period
infections to seroconvert
lower risks of viral transmission than FFP
Albumin
250-500 mL
5 years @ 2-10oC
96% albumin, 4% other plasma proteins
Indications are controversial, if in increases colloid
Prepared by cold ethanol fractionation
oncotic
pressure,
maintaining
blood
volume
transiently
Hemolysis reported to occur when it is diluted in water
and infused in the same line as RBCs
Indicate adverse result when used in critically ill,
trauma or elderly patients
contraindicated on dehydrated patients
Flushing, urticaria, chills, fever and headache may
occur
Plasma Protein contains 83% of albumin and 17% similar albumin
250-500 mL
3 years below 30oC
Fraction
hypotension may occur when given at males over
globulin
10ml/min
Immunoglobuli Mostly IgG antibodies, traces of IgA and Primary humoral immunodeficiency, ITP, bone marrow
10-200 mL
3 years @ 2-80C
n Intravenous
IgM
transplant and pediatric HIV infections
Prepared from pooled human plasma by It was gained acceptance in the treatment of Guillaincold ethanol fractionation
Barres Syndrome
Rh
1 mL
1 years @ 2-8oC
IgG anti-Rho, full dose is 300 ug, minidose Prevention of Rh alloimmunization of Rh (-) individual
Immunoglobuli
is 50 ug
exposed to the D antigen
n
Used to prevent HDN
Fibrin Sealant Fibrinogen, human thrombin, aprotinin Adjunct to hemostasis in cardiopulmonary by pass
and calcium chloride
surgery
Topical
application
under
direct Sealing anastosommes, treatment of spleen injuries
Adjunct to surgical methods of hemostasis
visualization
Occurrence of Reactions and Fatality

Any unfavorable transfusion related


Episodes
event occurring in a patient during /
Transfusion
after transfusion of blood component
1. Acute hemolytic reaction (1:25, 000)
2. Delayed hemolytic transfusion reaction

An irreversible event that carries


Rates of Risks
(1 : 2, 500)
potential benefits and risks to the
3.
Noncardiogenic
pulmonary
edema
patient

Non hemolytic febrile transfusion


(TRALI)
(1
:
1,
000)
reaction (NHFTR1-2%)
4. Transfusion Associated-Graft Versus

Allergic (1-2%)
Host Disease (TA-GVHD) and related
donor
(1 : 7, 000)
5. Transfusion Associated-Graft Versus
Host Disease (TA-GVHD) and unrelated

Immediate
hemolytic
transfusion
donor (1: 39, 000)
reaction
&
Delayed
hemolytic
transfusion reaction (1 : 6, 000)

Fatal immediate (1 : 100, 000)

Transfusion
Reaction

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*Extravascular Hemolysis

Errors
Associated
Reaction
1.
2.
3.
4.

with

Transfusion

Improper specimen Identification


Improper Patient Identification
Antibody Identification error
Crossmatch procedure error

Hemolytic Transfusion Reaction

Can occur either at the time of


transfusion (immediate) or a few days
3-7 days after transfusion (delayed)

HTR often occurs:

Transfusion of ABO incompatible RBCs


Transfusion
of
plasma
containing
products (plasma and platelets)
Maybe physically or chemically induced

Immediate
Hemolytic
Reaction (IHTR)

Transfusion

Occurs very soon after the transfusion


of incompatible RBCs
RBCs are rapidly destroyed releasing
Hemoglobin and RBC stromata into the
circulation
Reaction period varies from 1-2 hours
sign & symptoms can occur within
minutes after starting the transfusion
Anti-A, anti-Kell, anti-Jka and anti-Fya are
the common antibodies causing IHTR

Immune mediated IHTR can destroy RBCs by


one of two mechanisms:
*Intravascular Hemolysis

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Type

Intravascular Hemolysis

Description

Extravascular Hemolysis

Types of DHTR

1. Secondary
(anamnestic)
response
to
transfused RBCs
Occurring 3-7 days
from the time to
transfusion to cause
extravascular
hemolysis

2. Primary
Alloimmunization
Patient has no past
history of pregnancy,
transfusion
or
transplant

Febrile Nonhemolytic
Transfusion Reaction

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Sign and Symptoms Clinical Work


Therapy and Prevention
Up
Immediate Hemolytic Transfusion Reaction (IHTR)
Intravascular RBC lysis releases IHTR usually observed in conscious Monitor patient for DIC, hypotension & acute renal
Hemoglobin, RBC stromata and patient:
failure
Manitol is used to reduce renal diuresis and to
cellular enzymes manifesting
prevent renal failure
hemoglobinemia
and -Fever with or without chills
-Oliguria with complete recovery
IV fluid used to treat hypotension and vasoactive
hemoglobinuria
Kidney: damage to sclera of the -Death with sustained hypotension
drugs
Component therapy for patients with bleeding
-Coagulopathy haptoglobin
glomerulus, cortex and tubules
Liver: damage to hepatic portals
diathesis/coagulation abnormalities
Extravascular IHTR does not require therapeutic
and hepatocytes may occur
intervention vital signs, coagulation status and
Characterized by antigen-antibody Extravascular IHTR
renal output should be monitored
complex formation in RBCs -usually mild and not life threatening
All policies and procedures should be followed to
incomplete
activation
of
*fever
ensure proper patient identification, sample
complement
*unexpected anemia
collection, labelling unit identification, handling and
*chills
correct transfusion at the bedside
*decreased haptoglobin
*jaundice
*other S&S pp.339
Delayed Hemolytic Transfusion reaction (DHTR)
Mostly often the result of an Mild complement is not activated, no Renal function can be supported with IV fluid
Symptomatic amnesia should be treated with RBC
amnestic response in a patient
intravascular hemolysis
transfusion
who
has
previously
been Most commonly manifested by mild
fever or fever with chills and Sign and symptoms of hemolysis or DIC should be
sensitized
by
transfusion,
monitored to reduce the risk of renal failure
moderate jaundice
pregnancy or transplant
History previous transfusion, pregnancies, transplant
Clinical sign and symptom are Oliguria and DIC are rare
Blood specimens should be sent to the
and transfusion reaction should be taken
usually mild
Severe DHTR cases and fatalities
blood
bank
for
post-transfusion
reaction investigation
are uncommon
for
hemoglobin,
coagulation
Unexpected
or
unexplained Test
studies and renal function should be
decreases in hemoglobin or
done
hematocrit
values
following
transfusion
should
be
investigated as a possible DHTR
Maybe associated with bone
marrow transplantation and HLA
(HLA: class 1 and 2, MHC)
Immediate Nonhemolytic Transfusion Reaction (INTR)
Occurs about 1 % of transfusions Fever with or without chills, rarely Leukocyte-reduced blood components are indicated
Most commonly encountered type
hypotension
(primary cause of FNHTR: leukocyte antibodies)
Symptoms are mild and benign, Laboratory or bedside filtration, washed RBCs,
of transfusion reaction
Any 1C or greater temperature inc
occasionally pronounced pallor
deglycerolized are indicated
reactions
may
include Anti-pyretics (aspirin/acetaminophen) can be used
above the patients baseline Severe

Page 10

Allergic Transfusion
Reaction *uticarial

Anaphylactic and

Anaphylactoid Reaction

BLOODBANK

temperature during or within 24


hours after transfusion
1C temperature rise associated
transfusion
and
having
no
medical explanation other than
blood component transfusion
(AABB)
1C inc above to patients baseline
pretransfusion
temperature
during or within hours after the
end of transfusion
Caused by leukocyte antibodies
present in the patients plasma
Commonly reported as FNHTR

If clinical sign and symptoms


appear
within
minutes
of
exposure the allergic reaction is
of immediate hypersensitivity
type
Histamine is the primary indicator
of the allergic response, another
are the leukotrienes
ETIOLOGY
Donors plasma has a foreign CHON
(allergen) with which IgE or IgG
or both antibodies on the
patients plasma react
The donors plasma has regains IgG
or IgE or both that combine with
allergens in the patients plasma
Immediate hypersensitivity type of

immune response
Anaphylaxis can range from mild
urticarial (hives) and pruritus to
severe shock and death
Attributed
to
IgA
deficiency,
patients who have developed
anti-IgA
from
transfusion
/
pregnancy
Any organ can be involved (lungs,
blood vessels, nerves, skin and
GIT)
DISTINGUISHING FEATURES OF
ANAPHYLACTIC
AND

Page 11

hypotension, cyanosis, tachycardia,


tachypnea, dyspnea, cough, limited
fibrinolysis and transient leukemia
Past medical history for transfusion,
transplantation, pregnancy and drug
therapy is important for accurate
diagnosis
Transfusion should be stopped, IV lines
should be kept open

Mild and not life threatening

Local erythema (redness) and pruritus


(itching)
Hives (raised from red Welts)

Rarely
severe
with
angioneurotic
edema,
laryngeal
edema
and

bronchial asthma
Identify the manifestations on allergic
reaction aminophylline, epinephrine
or corticosteroid maybe given
Temporary
cessation
of
blood
component transfusion

ANAPHYLACTIC

Patients deficient in IgA who have class

specific IgA antibody


Sudden onset with cough, dyspnea,
nausea,
emesis,
bronchospasm,
flushing of the skin, chest pain,
hypotension,
abdominal
cramps,

diarrhea

for premedication before transfusion

Anti-histamine (Benadryl) for mild reactions


Washed RBC, platelets is to be transfused history the
reported allergic reaction
Premedication with anti-histamine before transfusion
For
severe
allergic
reaction,
aminophylline,
epinephrine or corticosteroid maybe given
Temporary
cessation
of
blood
components
transfusion

Stop the transfusion and do not restart transfusion of


the blood component
IV lines should be given with NSS
Give epinephrine immediately
For
severe
reactions,
corticosteroids
or
aminophylline maybe indicated
Vital signs must be stabilized
Plasma should be removed from the blood
component before infusion
ANAPHYLACTOID
Patients having normal levels IgA but Transfuse blood compound lacking IgA
limited type sensitive anti-IgA that
reacts
with
light
chain
(kappa/lambda) of the donors IgA
Less severe characterized by urticaria,

ANAPHYLACTOID
periobital swelling, dyspnea and
perilangyngeal edema
Fever is absent
Sign and symptoms occur after Serum sample of the patient can be
immunoelectrophoresed
to
transfusion of just few ml of
determined
IgA
levels
or
plasma or plasma containing
immunodiffusion to identify subclass
blood components
Antibody
Noncardiogenic
Cause is not well understood TRALI is characterized by chills, cough,
Pulmonary Reaction
(*idiophatic)
fever, cyanosis, hypotension, inc
(TRALI)
Most
consistent
finding
is
respiratory distress
*Noncardiogenic
leukocyte
antibodies
in Mild resolving after a few days severe
Pulmonary Edema (NCPE)
donor/patient plasma
rapidly progressive pulmonary failure
- Leukocyte antibody in donor / Sera from donor and patient should be
*Transfusion-Related
patient plasma could initiate
*Acute Lung Injury
tested for anti-leukocyte antibodies
complement
mediated
(TRALI)
pulmonary endothelial injury
Pulmonary
- Anti-leukocyte antibodies could
*Hypersensitivity
react with leukocytes to trigger
Reaction
the complement system to
*Allergic Pulmonary
produce C3a and C5a
Edema
*this would cause tissue basophils
and
platelets
to
release
histamine
and
serotonin
resulting in leukocyte emboli
aggregating in the lung
Transfusion-Associated TACO is an iatrogenic (physician- Dyspnea, coughing, orthopnea, chest
Circulatory overload
caused) transfusion reaction
discomfort, headache, restlessness,
(TACO)
Transfusion of a unit at too fast at
tachycardia, systolic hypertension,
a rate
abnormal electrocardiogram results
Hypercalemia leads to congestive Transfusion
should
be
stopped
heart failure and pulmonary
immediately slowest possible rate
edema
must be used
IV line should be maintained, patient
may be placed in a sitting position
ECG and chest X-ray assess cardiac and
pulmonary status
Central nervous pressure and vital
signs should be monitored
Bacterial Contamination Low frequency, rapid onset and Appear rapidly during transfusion or
Reaction
will lead to death
within about 30 minutes after
Most are caused by Yersenia

transfusion

Reaction
is
termed
as
WARM
enterolitica (CDC)
Commonly caused by endotoxin
characterized by dryness and flushing

produced by bacteria growing in


of the skin

Fever,
hypotension,
shaking,
chills,
cold temperatures (psycrophilic)

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Page 12

If sign and symptoms occur during transfusion, the


transfusion should be discontinued and not
restarted
Leukocyte-reduced blood complement should be
used
Adequate respiratory and hemodynamic supportive
treatment

Oxygen therapy and intravenous diuretics should be


used
Therapeutic phlebotomy can be used:
*more rapid fluid reduction is necessary
- transfusion rates should be 100 ml/hour or less are
appropriate (200ml/hour)
- Donor units should be split into aliquots
to
permits transfusion for longer period
- washed/frozen RBC should be used to reduce
plasma oncotic load

Broad spectrum antibody should be administered in


IV
Therapy for shock, steroids (dopamine), fluid
support, respiratory ventilation and maintenance
of renal function may be indicated
Visual observation of RBC units for color change
(brown/purple discoloration), visible clots or

*Pseudomonas
Escherichia coli
enterolitica

and

species,
Yersenia

muscle pain, vomiting, abdominal


cramps,
bloody
diarrhea,
hemoglobinuria, shock, renal failure
and DIC
Transfusion
must
be
stopped
immediately
IV line should be open
nonspecific,
common
are
facial
numbness,
chills,
generated
numbness, muscle twitching, cardiac
arrhythmias,
nausea,
vomiting,
perioral tingling, altered respirations

and anxiety
laboratory test for electrolyte levels: Cs,
blood pH, glucose, U/A, hemoglobin,
hematocrit, platelet, CL, PT and PTT

Heterogenous
of
transfusion
reaction may include:
*physical RBC damage
*depletion
and
dilution
of
coagulation factors and platelets
*hypothermia,
citrate-toxicity,
hypokalemia and air embolism

can
result
in
intravascular
hemolysis
factor VII decline in activity
Delayed Nonhemolytic Transfusion Reaction
Alloimmunization
Result from prior exposure to Maybe mild, slight fever and falling
donor blood components
hemoglobin and hematocrit levels
Adverse effect of blood transfusion Severe platelet refractoriness with
Lymphocyte memory is involved,
bleeding
production of IgM and IgG Antibody screening
If HLA antibodies are suspected,
antibodies
Secondary exposure, production of
lymphocyte
panels
and
large amounts IgG rising in the
lymphocytotoxic antibody procedures
1st 2 days after reexposure to the
are performed on patients serum
Thorough patient history of past
antigen
Antibody produced attaches to the
transfusion,
transplantation
and
antigenic surface and may
pregnancies are important
interact with the complement
system or RES or MPS (monocyte
phagocytic system)
Post Transfusion Purpura Rare
complication
of
blood Occur about 1-2 weeks after transfusion
transfusion, usually involving Thrombocytopenia can be severe <10,

000/mm3
platelet concentrates
Characterized by a rapid onset of Hematuria, melena, vaginal bleeding
have been reported
thrombocytopenia as result of
anamnestic
production
of Platelets transfusion for severe cases
Platelet count and coagulation support
platelets alloantibody
US usually occurs in multiparous Patients sera should be tested for
platelet-specific
antibodies,
HLA
females
antibodies
and
lymphocytotoxic
7-14 days lag time between
antibodies
transfusion
and
onset
of
thrombocytopenia
Physically/Chemically
Induced Transfusion
Reaction

BLOODBANK

Page 13

hemolysis
Infusion of blood components with 4 hours
Adherence to policies and procedures regarding
blood component collection, storage, handling and
preparation

Hypothermia, placing the patient in a warm blanket,


blood warmers should used
Supportive care to
any cardiac arrhythmias or
electrolyte imbalance
Heparin might be indicated for DIC
Citrate toxicity, administration of Ca-rich product
(milk, antacid with Ca gluconate)

3rd generation bedside leukocyte filters, delay if not


prevention of anti-leukocyte antibody production
Matching of donor and patient RBC phenotypes to
avoid sensitization

Corticosteroids,
exchange
transfusion
and
plasmapheresis
IV immunoglobulin therapy
Through patient history of prior transfusion and any
adverse reaction

Platelet alloantibody attaches to


the platelet surface permitting
extravascular destruction by the
RES in the liver and spleen
Patients platelets are destroyed
enhancing thrombocytopenia
Transfusion-Associated Complication of blood component
Graft Versus Host Disease
therapy
or
bone
marrow

transplantation (rare)
Death is usually caused by
infection
or
hemorrhage
secondary to bone marrow
aplasia

RISK GROUPS:

Iron Overload

BLOODBANK

Appear
about
3-30
days
post Corticosteroid,
cyclosporine,
methotrexate,
transfusion up until 2 months
azathioprine and anti-thymocyte globulin
Pancytopenia, fever, elevated liver Irradiated blood components
enzymes, copious watery diarrhea,
skin errythmia desquamation
Tissue biopsies, lab test for liver
function
Observation for infection or coagulation
abnormalities should be monitored
Patients experiencing lymphopenia
HLA typing to confirm the presence of
or bone marrow suppression
donors cells in the patients circulation
Fetus
receiving
exchange
transfusion
Individuals
with
congenital
immunodeficiency syndromes
Patient with certain hematologic
and oncologic disorders
Patient
receiving
blood
components from blood relatives
Caused by proliferation of T-cell
lymphocytes from donors blood
responding to major and minor
histocompatibility antigens in the
patient
Patient
with
cell
immediate
immunodeficiency are at risk of
not
being
able
to
reject
transfused lymphocyte
Patient
who
have
an
HLA
haploidentical type donor (1st
degree relatives)
Long term complication of packed Muscles weakness, fatigue, weight loss, Removal of accumulated tissue in iron stores
RBC transfusion
mild jaundice, anemia, mild diabetes Subcutaneous infusion of desferrioxamine (ironKnown
as
Transfusion
chelating agent)
and cardiac arrhythmias
Assessment of storage iron level
Hemosiderosis
Each unit of RBC has about 225
(ferritin) and other iron studies should
mg iron
performed
Patients chronically dependent on Tissue strains for iron in tissue biopsies
RBC transfusion support

Page 14

Congenital hemolytic anemias


Aplastic anemia and chronic renal
failure, end stage organ damage
Accumulated
iron
affect
the
function of heart, liver and
endocrine glands leading to
hemosiderosis, the interference
of mitochondrial function by
excess iron accumulation
Immunosuppression
Generalized nonspecific effect that No specific sign and symptom, no No specific therapy regimen is available
Transfusion reaction investigation
diminishes the activity of the
specific work up defined
recipients immune system after
blood transfusion
Wide
range
of
effects
on
transfusion recipient (for further
research)
No specific mechanisms have been
definitely proved
Several theories such as rapid
uptake of blood component
cellular matter into RES or MPS
The transfusion history may give clues as
Transfusion Service Manual
to the possible cause of the reaction. The
Transfusion Reaction Investigation
Detection, reporting and evaluation
following questions related to transfusion
SOPs
& medical information:
Necessary for:
Specimen requirements
Clerical and technical check procedures
1. How many ml of RBCs or component
1. Diagnosis
Return of bag, solutions, filter set and
were transfused?
2. Selection of appropriate therapy
intact tubing
3. Transfusion management
Immediate and extended investigation
4. Prevention
of
future
transfusion
procedures
reaction
Test procedures and record policies
2. How fast and for how long was the unit
Interpretation,
reporting
and
THE ABSENCE OF EVIDENCE IS NOT
transfused?
notification procedures
EVIDENCE
OF
THE
ABSENCE
OF
3. Were RBCs given cold or warmed?
4. Was the transfusion given under
TRANSFUSION REACTION
pressure, and what needle size was
Investigation should include the ff.:
used?
5. How was it given? Was a filter used,
1. Diagnosis
and if so, what type? What other
2. Medical
history
of
pregnancies,
solutions were given?
transplant and previous transfusion
6. Were any drugs given at the time of
Nursing Manual
3. Current medications
transfusion?
4. Clinical sign and symptom of the
Recognition and response SOPs
reaction
SOP for Transfusion Reactions:
S/S description
Stop the transfusion instructions

BLOODBANK

Page 15

Patient care responsibilities


Notification
to
physician
transfusion service

and

Depending
on
the
Preliminary
Investigation results, more specimen may
be required:

1. A clotted blood specimen drawn 5-7


hours
after
transfusion
for
unconjugated
indirect
bilirubin
determination
2. The first voided post-transfusion urine
collection
3. Other specimens collected at various
times that are considered appropriate
to the transfusion reaction investigation

1. Clerical Checks (mislabeling & misidentification)


a) Patient and specimen identification
b) Blood unit inspection
c) Relisting filter and solution examination
d) Label and record checks
2. Visual Inspection
a) Observe the serum of the patient pre and
3.
post transfusion reaction blood specimen
b) Color of pre and post transfusion recipient
4.
serum/plasma for hemolysis
5. DAT: Performed on Post Transfusion Specimen
6. Additional Typing
a) ABO/Rh typing
b) Compatibility Testing
c) Antibody and Alloantibody identification
d) Bilirubin
e) Hemoglobin and Hematocrit
f) Urine test
g)
h)
i)
j)
k)
l)

m)

BLOODBANK

Page 16

Immediate Laboratory Investigation


Laboratory Investigation outline for
HTR
Immediate laboratory Investigation: