BLOOD

TRANSFUSION
IN SURGERY
DR. NEHEMIAH LUKA (MBBS-BHUTH)

DEPARTMENT OF SURGERY,
FEDERAL MEDICAL CENTRE ABUJA
 Introduction

Classification
Epidemiology
Indications
Blood Collection and Storage
Blood Grouping and Compatibility Testing
OUTLINE Blood Transfusion
Blood Substitutes
Special Considerations

Conclusion
References
INTRODUCTION

Blood transfusion is simply the process of administering blood or blood

products into one's circulation via an intravenous route.
Blood transfusion should only be considered when the benefit out weighs the
risk.
Should only be done when necessary.
Only what is needed should be given.
Indication should be clearly stated.
Counselling and consent.
Strict asepsis and safe blood.
Doubly checked patient identifiers.
 CLASSIFICATION

Homologous (Allogenic) blood transfusion: when blood

transfusion is done with blood from another compatible
donor of the same specie

Autologous blood transfusion Autologous blood transfusion is

the collection and subsequent re-infusion of the patient's
own blood
 EPIDEMIOLOGY

Of the 118.5 million blood donations collected globally, 40% of these are collected in
high-income countries, home to 16% of the world’s population.
In low-income countries, up to 54 % of blood transfusions are given to children under 5
years of age; whereas in high-income countries, the most frequently transfused patient
group is over 60 years of age, accounting for up to 76% of all transfusions.

Deaths prevented per annum

 MA
INDICATIONS JO
PRO R O
INDICATIO Blo
od
CE
DU
PER
RES
ATI
VE
NS
SEVERE BLOOD LOSS (Ab
Ca
dom
rdi
loss
ino
is in
e vita
Trauma, Pathological lesions ova p erin ble
oth scu eal
ers lar and
)
sur
ger
ies
V E am
E R A T I ong
R O P l
M AJ O eri ne a
U R E S m in op
O C ED (A b d o t he r s)
PR t ab le ong o
i ne vi ie s a m
lo s s is sur ge r
Blood io va sc u la r
C a rd Severe burns
a nd
Haemolysis despite adequate fluid
and protein replacement
 INDICATIONS
INDICATIO
A NE MIA PATIENT IN A
CHRONIC HEMORRHAGIC STATE
WIT NS
URG EN T
H
SURG ICAL To arrest hemorrhage or as
IC A T IO N prophylaxis prior to surgery in
IND t r a t i o n o f
e a dm in i s patients with Thrombocytopenia,
e - o p er a t iv i en t
Slo w p r is in su f f i c
h er e tim e Hemophilia or Liver disease.
ke d c e lls w m i a is
p ac a py or a n e
m en t t he r
la ce
for rep er a py ( A p l a s t i c
ns iv e t o t h
unr e sp o MAJOR OPERA
TIVE
Anemia) PROCEDURES
Blood loss is ine
POSTOPERATIVELY vitable
(Abdominoperi
neal and
Patients becoming severely Cardiovascular
anemic surgeries amon
others) g
ARAICO PHARMACEUTICAL | VACCINES
 BLOOD DONATION CRITERIA
No major surgery in past 6 months No blood
Age 18-65 years transfusion or organ transplant in past 12
Not in high risk group months
No blood donation in past 6 months No No tattoo or skin piercing in last 12 months
pregnancy within last 12 months, No needle stick injury or acupuncture in last
not lactating 12month
No dental procedure in last 72 hours Not vaccinated in last 4 weeks
No history of HIV infection, HBV, syphilis
 BLOOD DONATION CRITERIA
Not on cytotoxics,
hypoglycaemic agents, or
Hb 12.5g/dl or more (F),
teratogenic drugs Medical
13.5g/dl or more (M)
history: no HTN, DM, cardiac
Seronegative for HIV I & II,
renal or liver disease, cancer,
HBsAg, HCV, VDRL antibodies,
bleeding disorder, SCD
No MPs
Clinically stable
Negative for anti-CMV
-Weight >51kg
antibodies in some case
Normal BP, Pulse, chest and
abdominal findings
 BLOOD
COMPONENTS
RBC Products
Whole Blood Platelet Concentrates Fresh Frozen Plasm
Packed RBC: Patients
Sudden haemorrhage with chronic anaemia Contains all
Thrombocytopenia
with loss of up to 20% Elderly
Consumptive coaglophaty components of
of blood volume Small children coagulation and
Aplastic anaemia.
EBT Patients prone to fluid fibrinolytic system
Lack of appropriate overload & cardiac
blood component failure

Washed RBC,
FEDERAL MEDICAL CENTRE ABUJA
 BLOOD
COMPONENTS Others

Albumin
Fresh Frozen
Granulocyte concentrates
Plasma
Concentrates Coagulation
Cryoprecipit
Contains all ate factor
Severe
components concentrates
neutropenia
of Haemophilia Immunoglobu
<0.5 x 109/L
coagulation VonWillibran lins
• Focal
and d's disease Anti thrombin
bacterial
fibrinolytic III
infection
system concentrate
unresponsive
Protein
to antibiotics
concentrates
STORAGE
Standard blood bag: 450 +/- 45mls blood + 60mls of
anticoagulant preservative Stored at 2-6°C

Anticoagulants include
Heparin: 24 hours Acid-Citrate-Dextrose (ACD): 21 days
Citrate-Phosphate-Dextrose (CPD): 28 days
Citrate-Phosphate-Dextrose-Adenine (CPDA): 35 days
EFFECTS OF STORAGE
RBC: 1% cell population are lost per day of storage Viability decreases as
ATP and 2,3-DPG levels fall
Increased affinity of Hb to O₂ and decreased O₂ release at tissue level
Leucocytes and platelets: Not viable after 24 hours of storage
K: plasma levels increase at rate of 1 mmol/day
Na: concentration increases because of the sodium citrate in the CPD
anticoagulant
Ca: no ionized calcium, it displaces sodium in the anticoagulant
Clotting factors: Activity falls after 24hrs (lost after 7days)
BLOOD GROUPING
There are >30 major blood group system > The most important
blood group are the ABO and Rh or ▸ ABO system base on present of
antigen A B ▸ Rh is base on presence of antigen D (Rh factor) ›
Other; Kell, duffy, MNS, lewis, kidda etc
COMPATIBILITY TESTING
▸Cross matching is done to detect the rare Ags present on the
recipient RBCs such as Kell, duffy
Plasma protein Ag capable of causing reaction can be detected
 BLOOD
TRANSFUSION
Check blood bag for damage, expiry date,
discoloration of the blood
Pre transfusion vital signs
IV line must be secured and patent before
opening the bag
Warming with blood warmer when necessary
Administration must commence within 30mins
of leaving the blood bank
Monitoring is crucial esp. In 1st 30min.
Determine volume to be transfused
Use blood giving set, or infusion
pump
Symptoms of adverse effects usually
occur during transfusion of the first
100mls, Thus start at 20-30 d/m (2-
3mls/min), then increase to 60-
80d/m after 1 hour In children and
elderly 40d/m
 COMPLICATIONS

IMMEDIATE DELAYED REACTIONS

REACTIONS
1. Febrile non-haemolytic reaction 2.
Allergic and anaphylactic reaction 3.
Haemolytic reaction
4. Bacterial contamination
5. Circulatory overload
6. Cardiac arrest
7. Air embolism
8. Non-cardiogenic pulmonary oedema
1. Thrombophlebitis
2. Delayed haemolytic reaction
3. Post-transfusion Thrombocytopaenic
purpura
4. Transmission of diseases
5.Iron overload (Transfusion haemosiderosis)
6. Immunosuppression
7. Post-transfusion graft-versus-host disease
 BLOOD
SUBSTITUTES
PLASMA SUBSTITUTES
Plasma substitutes include Crystalloids:
NS, RL
Colloids: Dextrans - Dextran 70, 40, 110,
Gelatins - haemacel, gelofuscine
Stable plasma protein solution Albumin
Hydroxyethyl starch preparations:
Hetestarch, Pentastarch
RED CELL SUBSTITUTES
Diaspirin cross linked Hb: PLATELET
similar 02 transport and SUBSTITUTES
exchange properties as whole Pegylated
blood Recombinant Human
Perfluorocarbons: dissolve 02 Megakaryocyte
and release to tissues by Growth and
diffusion Encapsulated Hb Development Factor
Stroma free Hb: high 02 (PEG-rHuMGDF)
affinity, nephrotoxic
Recombinant DNA derived Hb
MASSIVE BLOOD TRANSFUSION
The replacement by transfusion of blood equivalent to or greater than a patient's
total blood volume within a 24 hour period or Replacement of more than half of
the patient's blood volume in 1 hour.

INDICATIONS: Haemorrhagic shock from Trauma eg #s, splenic rupture, Ruptured

aortic aneurysm, Massive GI haemorrhage, Liver transplant.

COMPLICATIONS: Technical & clerical errors, Circulatory overload, Hypothermia,

Hyperkalaemia, Hypocalcaemia (citrate toxicity), Acidosis, ARDS, DIC.
 BLOOD SALVAGE
1. Intra operative shed blood from a wound or body cavity during surgery is
collected and subsequently re-infused into the same patient aseptically.

septic Anticoagulant filtration; 4-6 layers of gauze or special filters Shelf life
4hrs at room temperature or 24hrs at 4°

Haemonetic cell savers can be used. Contraindicated in tumour surgery,

contamination Complication;- Bleeding

2. Postoperative blood salvage Blood shed after surgery can be collected and
re-infused to patient
 CONCLUSION
Quality-assured screening of all donated blood for transfusion-
transmissible infections, Rational use of blood and blood products
to reduce unnecessary transfusions and minimize the risks
associated with transfusion, the use of alternatives to transfusion
where possible, and safe and good clinical transfusion practices,
including patient blood management is advised.
 REFERENCES
Badoe E. A; Principles and Practice of Surgery, 4th
edition
Drew p. & charles R. J; In Oxford handbook of
clinical haematology, 2nd edition
Courtney M. T; Sabiston Textbook of surgery 6th
edition.
 Phone Number
+2348101182415

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Email Address
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