General surgery

BLOOD TRANSFUSION
ASSIST. PROF. Dr. LUTFI GHULAM AWAZLI
Consultant General Surgery and Cosmetic Laser Surgery

University of Baghdad
College of Dentistry
20123 - 2024
‫ج ِميعًا{المائدة ‪}32 :‬‬ ‫َو َم ْن أ َ ْحيَاهَا فَ َكأَنَّ َما أ َ ْحيَا النَّ َ‬
‫اس َ‬
 WHAT IS BLOOD TRANSFUSION?
Definition:
Blood transfusion is the transfer of blood (or blood components)
from one person (donor) into another person (Recipient / Patient),
which is given through intravenous line (IV) with appropriate blood
grouping and cross matching by medical staff.

Donor Recipient
 WHAT IS BLOOD?
Definition:
Blood is a specialized body fluid in the circulatory system that
transports oxygen (O2) and nutrients to the tissue cells and carries
carbon dioxide (CO2) and other waste products ( Urea, Uric acid,
Nitrogen, ) away from the cells.

Blood

Nutrients
O2
Vitamins
CO2

Tissue cells
 Functions of the blood:
1) Transports oxygen, nutrients (glucose, salts, vitamins and proteins) and
hormones to the tissue cells.
2) Carries away carbon dioxide and other waste products from the cells.
3) Forming blood clots to prevent excess blood loss (stop bleeding).
4) Carries cells (WBC) and antibodies that fight infection (immune system).
5) Regulates pH, temperature, water content of cells.

WBC
 Blood Components = Blood Elements = Blood fractions:
 Whole blood can be divided (fractionated ) into various main components,
these include:
 Plasma
 Red blood cells (RBC)
 White blood cells (WBC)
 Platelets

 Because certain components are more appropriate and more useful than the
whole blood transfusion for certain clinical conditions.
 2
1

4
 Blood Components = Blood fractions for transfusion
Whole blood

White Blood Cells

Plasma
RBC

Platelets

C) Fibrinogen
A) Cryoprecipitate B) Human albumin 4.5 per cent.
 Blood Components for transfusion

 Whole blood:
 Whole blood Includes (i.e. Plasma, RBCs, Platelets , WBCs)
 The total volume of blood in single unit is approximately 450 - 500 ml.
 Whole blood must be stored in special blood bank refrigerator controlled at
low temperature at ( 4 °C ± 2 °C ) until they are needed.
 Whole blood have a shelf life about six weeks (42 days) from the date of
collection.

 Indication of whole blood transfusion:

 Traumatic severe bleeding
 Non-Traumatic (Pathological) severe
bleeding.
 Packed Red Blood Cells ( Concentrated RBCs):
 Packed RBCs can be obtained by centrifugation of whole blood at 2000-3000
r/m for 15-20 minutes.( by letting the blood sediment and removing the plasma).
 Each single unit of concentrated RBCs is about 200 - 300 ml.
 Packed RBCs must be stored in special blood bank refrigerator controlled at
low temperature at ( 4 °C ± 2 °C ) until they are needed.
 Packed RBCs have a shelf life about six weeks (42 days) from the date of
collection.

 Indication of Packed Red Blood transfusion:

 Chronic anemia
 Elderly
 Small children
 Patients with cardiac failure.
 Platelets Concentration:
 Platelet concentrate is prepared by centrifugation of platelet rich plasma at
1200—1500 r/m for 15- 20 minutes.
 Each single unit of platelet concentrate is about 45 – 50 ml.
 Platelets are stored on a special refrigerator at room temperature (20 - 24 °C)
and have a shelf-life of only 5 days.

 Indication of Platelets transfusion:

 Thrombocytopenia (very low Platelets)
 Platelet dysfunction.
 Patients on anti-platelet therapy such as
aspirin, or clopidogrel who are actively
bleeding and undergoing major surgery may
require almost continuous infusion of platelets
during the course of the procedure.
 Fresh-frozen plasma ( FFP):

 Plasma removed from fresh blood obtained within 4 hours is rapidly frozen
by immersing in a solid carbon dioxide and ethyl alcohol mixture.
 Each single unit of Fresh-frozen plasma is about 200 - 300 ml.
 This is stored at (- 40 to - 50 ° C ) with a 2-year shelf-life and is a good
source of all the coagulation factors.

 Indication of Fresh-frozen plasma transfusion:

It is the treatment of choice in patient with
coagulation factors deficiencies such as:
 Hemophilia
 Christmas disease
 Liver failure
 Vitamin K deficiency.
 Plasma may be further fractionated in various ways.

A. Cryoprecipitate:

 When fresh frozen plasma is allowed to thaw at (4 °C) a white glutinous

precipitate will form. If the supernatant plasma is removed, the precipitate
remains.
 Each single unit of Cryoprecipitate is about 15 - 20 ml.
 The precipitate is stored at (- 40 °C) with a 2-year shelf-life.
 Cryoprecipitate is a very rich source of:
 Factor VIII
 Fibrinogen

 Indication of Cryoprecipitate transfusion:

 Hemophilia A (Factor VIII deficiency)
 Hypofibrinogenaemia
B. Human albumin 4.5 per cent.
 Repeated fractionation of plasma by organic liquids followed by heat
treatment results in Human albumin 4.5 per cent, which is rich in protein.
 Each single vial of human albumin is about 100 ml.
 This may be stored at 4 °C for several months in liquid form.

 Indication of Human albumin 4.5 per cent:

It is suitable for replacement of protein, for
example:
 Hypoalbuminemia
 Following severe burns more than 50%.
C. Fibrinogen:

 Fibrinogen is prepared by organic liquid fractionation of plasma and stored

in the dried form.
 Each single vial of human fibrinogen is about 1 gm.
 The shelf-life in dry state is about 60 months when stored between 2 - 6 °C

 Indication of Fibrinogen transfusion:

When reconstituted with distilled water, it is
used in patients with severe depletion of
fibrinogen:
 Congenital afibrinogenaemia
 Acquired Hypofibrinogenaemia as
Disseminated intravascular coagulopathy.
 Clinical indications for transfusion of blood and blood
components in general:
1. Severe blood loss following traumatic injury (Bullet injury, Car accident).
2. Severe blood loss due to pathological lesions (i.e. Bleeding peptic ulcer).
3. Preoperative, where surgery is indicated urgently in anemic patient, (Hb < 10
g /dl).
4. Intraoperative, During major operative procedures where large amount of
blood loss is inevitable, (i.e. GIT, Hepatic or cardiovascular surgery).
5. Postoperative, in a patient who become severely anemic after surgery.
6. Following severe burns where, despite initial fluid and protein replacement,
there may be associated haemolysis.
7. To arrest hemorrhage (or as a prophylactic measure prior to surgery), in a
patient with coagulation factors deficiencies such as hemophilia ,
thrombocytopenia, or liver disease.
 Blood Donation:
 What are the criteria for a person who can donate
blood? Who can donate blood?
 Any healthy adult, both male and female, can donate blood.
(i.e. No Chronic diseases as heart failure, renal failure, hepatic
failure, Cancer, AIDS, Viral Hepatitis, uncontrolled DM or HT,
Genetic diseases, Hemophilia, ……. etc.)
 Age group of 18 to 65 years.
 Weight must be > 45 kg.
 Hb must be > 12.5 g/dl
 How much blood can the adult donate?

 Men can donate blood safely once in every three months while
women can donate every four months.
This is because men generally have higher iron levels than
. women.

 During a regular donation, the adult will give around 450ml of

whole blood. This is about 9% of the average adult's blood
volume. The body replaces this volume within 24 to 48 hours,
and replenishes red blood cells in 10 to 12 weeks
 Blood Donation:
 Blood Donation:
 Blood Donation:
 Blood Donation:

 Blood screen :
After collection of blood from the donor , the staff carefully test and
screen all donated blood for:
 Infectious agents, such as viruses (HBV, HCV, AIDS), bacteria,
Parasites… etc
 Blood grouping:
 ABO grouping : A, B, AB, or O
 Rh type : Rh +ve or Rh -ve

 NOTE: To prepare blood for a transfusion, some blood banks remove

white blood cells ( WBC). This process is called ( white cell or
leukocyte reduction). Some people are allergic to white blood cells in
donated blood. Removing these cells makes allergic reactions less
likely.
 Blood storage
 All blood for transfusion must be stored in special medical sealed sterile
plastic bags in special blood bank refrigerators controlled at low
temperature at ( 4 °C ± 2 °C ) until they are needed.
Q) Why is blood stored at 4 ⁰C degree (between +2 to
+6 ⁰C degree?

A)
1. Storage of red cells at + 4 °C ( between +2 to +6 ⁰ C ) decreases the
enzyme activity of the cells, so the metabolic rate will decrease and this
enables blood to be stored for longer periods.
2. At Lower temperature < + 2 °C can cause freezing injury to the red
cells leading to haemolysis (ice crystals damage the cell membrane of the
cells). If haemolysed blood is transfused to a patient, it can cause fatal
consequences.
3. At higher temperatures > +6 °C , the enzyme activity will increase,
RBCs consume more glucose for their metabolism, so lactate production
will increase, leading to a lowering of ph (acidosis).
At higher temperatures > +6 °C can lead to overgrowth of bacteria
which may have entered the blood bags during collections or component
preparation.
 Blood grouping and Cross-matching
Human Red Blood Cells (RBCs) have on the cell surface many different
antigens. For practical purposes, there are two groups of antigens which are of
major importance in surgical practice:

1) Antigens of the ABO blood groups:

These are strongly antigenic and are associated with naturally occurring
antibodies in the serum. Individuals show four different ABO cell groups.

AB

O
2) Antigens of the Rhesus blood groups:
 The antigen of major importance in this group is Rh (D), which is strongly
antigenic and is present naturally in approximately 85 % of the population,
called (Rh +ve ).
 Antibodies to the D antigen are not naturally present in the serum of the
remaining 15% of individuals, called (Rh -ve ).
 Sometimes Rh +ve may be stimulated in Rh –ve patient by the transfusion of
Rh-positive red cells or they may be acquired during delivery of a Rh +ve
baby.
 Acquired antibodies are capable of crossing the placenta during pregnancy
and, if present in a Rh(D)-negative mother, they may cause severe haemolytic
anaemia and even death (hydrops fetalis) in a Rh(D)-positive fetus in utero.
  ABO and Rhesus grouping:
RBC = Antigen
Serum = antibody

NOTE: Blood group (O - ve) is the Universal donor type as it contains no

antigens to provoke a reaction.
Conversely, group (AB +ve ) are ‘Universal recipients’ and can receive any
ABO blood type as they have no circulating antibodies.
 Blood Incompatibility:
If the recipient’s serum antibodies are incompatible with the donor’s RBC
antigen

Incompatible transfusion reaction will result

Agglutination and haemolysis of the donated RBC

In severe cases leading to acute renal tubular necrosis and renal failure.

For this reason, therefore, it is essential that all transfusion should be preceded by:
 ABO and rhesus grouping of the recipient’s serum and donor’s RBCs so that
only ABO and Rh (D) compatible blood is given.

Direct blood grouping and cross-matching require full laboratory procedures

. and take 1 hour.
  Complications of blood transfusion:
Complications from blood transfusion can be categorized as those arising from a
single blood transfusion and those related to massive repeated blood transfusion

 Complications from a single blood transfusion include:

 Incompatibility hemolytic transfusion reaction.

 Febrile transfusion reaction.
 Allergic reaction.
 Infection:
 Bacterial infection (usually as a result of faulty storage);
 Viral infection : Hepatitis ( HBV, HCV, AIDS)
 Parasitic infection: Malaria.
 Air embolism.
 Thrombophlebitis.
 Transfusion-related acute lung injury (usually from FFP).
 Possible complications of a massive repeated blood transfusion
include:
1) Complications from a single blood transfusion
PLUSE ( + )

2)
 Coagulopathy;
 Hypocalcaemia;
 Hyperkalaemia;
 Hypokalaemia;
 Hypothermia.
 Metabolic alkalosis
 Hemochromatosis : Patients who receive repeated transfusions over
long periods of time (e.g. Patients with thalassaemia) may develop iron
overload ( Hemochromatosis ). (Each transfused unit of red blood cells
contains approximately 250 mg of elemental iron.)
 What is Massive blood transfusion?

 Transfusing 10 units (10 x 500 ml = 5000 ml= 5 L) of blood in a 24 hours.

 or 5 units (5 x 500 ml = 2.5 L) of blood in 4 hours.

THE END