Revelation 1: 5,7

“To Him who loves us and

has freed us from our sins
by His blood,,… Look, He is
coming with the clouds,
and “every eye will see
Him, even those who
pierced Him..”
 BLOOD CELLS

√
√
Liquid
portion

√
√

√
√ $
Blood cells settle themselves according to their volume.
Some of the important groups:
$
Pathology associated with the null phenotype of the RBC antigen

Ranadhir Mitra, Nitasha Mishra, and Girija Prasad Rath

 ES !
D TYP
LOO
R B
JO
MA Blood is segregated
according to their
“TYPE”.
 DI
ST
RI
BU
TIO
N

% % % %

% % % %
 JAPAN
S IN
USTOM
YPE C
OD T
B LO
A common
superstition in Japan
is that blood type is
an indicator of a
person's personality

?
 IV E?
HT TO G
I G n
R
th e o m?
Who od to w h
t e b lo
can do na

RIGHT TO R
Who the ECEIVE?
n can rec
eived blo
od from
whom ?
 Inc
om
pat
blo ible
od!
!

CROSS
MATCH
ING
 d
bloo
s
type

die rs
sol

Rh antigen positive Rh antigen negative

$
>precaution against cross-contamination & diseases
like hepatitis, HIV etc.
>recommend waiting = 6 to 12 months to allow the
tattoo’s design to properly heal.
 BLO
OD
CO
MP
ON
EN
TS

PACKED RED BLOOD CELLS WHOLE BLOOD

PLASMA PLATELET
CONCENTRATE
 blood t
ransfu
RE sion
ACTIO
cy ! NS
Acute (<24 hours)
ge n
e r
E ?m
Ho w (2 )
wh
y? Delayed (>24hours) 3-4 weeks after transfusion
 Acute (<24 hours)

Nau
se a &
vom
iting
 Acute (<24 hours)

e din g
t ro l la ble ble
uncon
o p e n i a :
cy t s)
P la te le t
(R B C,
 Acute (<24 hours)
Hypotension
(A drop of at least 10
mmHg in systolic or
diastolic arterial BP-
during transfusion)

tachycardia,
cardiac arrhythmia
Acute (<24 hours)

loss of consciousness,
shock,
or cardiac arrest.
 Delayed Reactions (>24hours)
commonly occurs about 4-8 days
after blood transfusion,
= may develop 3-4 weeks after transfusion

renal failure
falling liver
hematocrit dysfunction
 FACTORS LEADING TO TRANSFUSION REACTIONS

BLOOD BANK PATIENT

DONOR’s FACTORs PATIENT’s FACTORs 

IATROGENIC ERRORs 
$
 IATROGENIC (Hospital)ERRORs 

•Attending Physician’s Factors :

= transfusion-related volume overload $
 IATROGENIC (Hospital)ERRORs 

Laboratory Ward- Nursing Dept

Assistants
= mislabeling = wrong blood = wrong patient

= mishandling = mishandling = mishandling

= improper storage = improper container = delayed

temperature transfusion

= Bacterial = Bacterial = Bacterial

contamination: contamination: contamination:
Collection & Unclean wrong thawing &
processing hands/container unsterile instruments
PATHOLOGY & CLINICIAN
= HAND IN HAND
•Blood recipient & designated blood unit =
properly identified before transfusion
 •Consult a Blood Bank physician if there
is an urgent need for transfusion.

TRANSFUSION REACTION LOGBOOK

Time Number of Type of Nurse Corrective / Laboratory

Blood Blood Type Blood Bag Unit Patient's Attending Nurse Witness of Immediate
Date Transfusion Patient's Name Blood Units Clinical Diagnosis Transfusion Responsible for Preventive Investigative Comments
Component of Unit (Bag) No. Blood Type Physician Reaction Action
Started Transfused Reaction Transfusion Action Action

                                 

                                 
 Time Blood Type
Date Transfusio Blood of Unit Blood Bag Patient's
n Started Component (Bag) Unit No. Name

           

Nurse
Patient's Number of Clinical Type of Attending Responsible
Blood Blood Units Diagnosis Transfusion Physician for
Type Transfused Reaction Transfusion

           

Nurse Immediate Corrective / Laboratory

Witness of Preventive Investigative Comments
Reaction Action Action Action
         
 BLOOD TRANSFUSION ALGORITHM

REVIEW “TRANSFUSION ORDER (by Physician)”

CHECK & RECORD PATIENT’S BASELINE VITAL SIGNS & SYMPTOMS:

(Temperature, Blood Pressure, HR/RR);
Presence of Pre-transfusion Skin Rashes or Itchiness;

DON’T GET BLOOD REQUEST FOR RELEASE of Ordered Blood Component

(Postpone) if Patient (Compatible Patient’s Blood Type) From Blood Bank.
is Febrile = to be RELEASED by not less than 2 Med Techs

RECHECK RELEASED BLOOD UNIT

PHYSICIAN
(Exact Serial No. COMPATIBLE with Patient’s Blood;
TREATS FEVER.
Yellow color of plasma; No leakage nor clumps)
= to be done by not less than 2 NURSES

Select APPROPRIATE IV TUBING (BLOOD FILTERS for ALL blood components)

& INITIATE TRANSFUSION WITHIN 30MINUTES from time blood unit was
released.
 TRANSFUSION REACTIONS ALGORITHM

SERIOUS REACTIONS MINOR REACTIONS

• Hypotension/shock • Nausea/vomiting
• Rigors • Hemoglobinuria • Allergic reaction? Febrile reaction?
• Dyspnea/SOB • Back/chest pain Hives/rashes ONLY • ≥38°C or 1ºC rise
• Tachycardia / • Bleeding/pain at covering ≤25% body • Onset > 15 min
arrhythmias IV site (no other symptoms) into transfusion. w/
• Flushing, Hives/rashes: ≥25% body no other symptoms
• ≥39°C OR a rise of≥ 1.5ºC over baseline

= STOP TRANSFUSION; KEEP IV LINE OPEN WITH 0.9% SALINE

= NOTIFY PHYSICIAN
= CHECK VITAL SIGNS Q15min
= REVIEW FOR CLERICAL DISCREPANCY
= NOTIFY & RETURN BLOOD W/ TUBINGS TO BLOOD BANK
= FILL UP TRANSFUSION REACTION FORMS, LOGBOOK (kept for 5 years)

PHYSICIAN WILL DETERMINE IF TRANSFUSION

SHOULD CONTINUE OR NOT…
 TRANSFUSION REACTIONS INVESTIGATION ALGORITHM (w/in 24Hr)

RE-CHECK FOR PROPER LABELING

POST-TRANSFUSION BLOOD [compare with Pre-Transfusion Blood]

(Best from 1hr- 7thhr post-reaction)

CENTRIFUGE, CHECK PLASMA DIRECT CBC INDIRECT Perform ABO/ Rh

FOR HEMOLYSIS / ICTERUS ANTIGLOBULIN ANTIGLOBULIN typing on PRE AND
TEST (DAT) TEST (IDAT) POST-
TRANSFUSION
EXTRACT 2nd POST-TRANSFUSION SPECIMENS; & ON
BLOOD Confirm that Hemolysis is DONOR’S BLOOD
If IDAT(+), perform
not due to Poor collection
ANTIBODY
technique.
IDENTIFICATION

Leucopenia, or If different,
Post –transfusion blood = If DAT(+) Neutropenia , or Antibody
Antibody search if
(+) hemolysis Thrombocytopenia identified, another
mediated
Pre-transfusion blood = patient
hemolysis=
(-) hemolysis INCOMPATIBLE may be at
RED CELLS Donor’s risk; notify
TRANSFUSED Antibodies Do phenotyping of blood
against: transfused unit(s) supplier
INTRAVASCULAR for corresponding
(HLA), (HPA),
HEMOLYSIS antigen
or (HNA)
 TRANSFUSION REACTIONS INVESTIGATION ALGORITHM (w/in 24Hr)

DONOR’S BLOOD PATIENT’S

URINE

Visually inspect for If febrile = Perform an Check for

hemolysis, clots or do Culture & ANTI HUMAN hemoglobinuria
discoloration sensitivity GLOBULIN & bilirubinuria
(AHG)
crossmatch
inject 10-20ml of with
culture broth into pre and post-
Tubing (+) Both Tubing &
the unit(s) transfusion ACUTE
hemolysis, Donor Donor unit (+)
specimens HEMOLYTIC
unit (-) hemolysis hemolysis
TRANSFUSION
REACTIONS
• agitate unit(s)
and withdraw COMPARE
broth PRE & POST
FAULTY INFUSION Due to:
DEVICE
1) physically
hemolysed Unit; Gram or Acridine use broth for
orange stain inoculation of
2) addition of a cultures
solution to the
unit that had
caused red cell IDENTIFY
destruction ORGANISM