‫‪Blood transfusion‬‬

‫مت تفريغ كالم الدكتور سعد‬

‫العزاوي على احملاضرة باللون‬
‫األخضر‬

‫كل الشكر للطالبة ‪ :‬أبرار‬

‫الصرايرة على جمهودها‬
: DEFINITION

The process of transfering blood or

blood products from one
person to the circulatory system of
another

Excluding from this definition the

autotransfusion and the artificial hemoglobin
( biological , chemical )
 Introduction
An average-sized man has about 12 pints of blood in his body, an .1
average-sized woman has about 9 pints
Blood constitute .2

:Blood has many different functions.3

a.transporting oxygen and nutrients to the lungs and tissues
.b.forming blood clots to prevent excess blood loss
c.carrying cells and antibodies that fight infection
d.bringing waste products to the kidneys and liver, which filter and clean
the blood
e.regulating body temperature
 History of blood transfusion

. the first successful blood transfusion was in 1813

The first fully-documented human blood transfusion was - 1667
administered by Dr. Jean-Baptiste Denys .He transfused the
. blood of a sheep into a 15-year old boy

James Blundell, a British obstetrician performed the first - 1818

. successful transfusion of human Blood to a patient

it was possible to store blood for few days by using anti- – 1910
coagulant
The first non-direct transfusion was performed on March 27 1914
by the Belgian doctor Albert Hustin, who used sodium citrate as an
anticoagulant
The discovery that blood could be seperated in to red blood cells – 1940
and plasma and refrigerated
Further extending the shelf life of stored blood was an - 1979
anticoagulant preservative, CPDA-1
What is the main concern in blood
? transfusion

Safety

Availability
 Safety
there is no blood safe 100%
The advent of second and third generation tests and the *
implementation of Nucleic Acid Testing in the early 00's has
. reduced some risks

,In united states as of 2006

the risk of acquiring hepatitis B via blood transfusion is -

, about 1 in 250,000 units transfused
the risk of acquiring HIV or hepatitis C via a blood -
transfusion is estimated at 1 per 2 million units transfused
Every year, nearly five million Americans need blood *
transfusions. 43,000 pints (or units) of donated blood are
,used each day in the United States
 Cont.Safety

Transmission of new infectious agents either not

previously present in the country, or not considered
: .significant earlier e.g
,West Nile virus -
”Chagas' disease”American trypanosomiasis -
,bacterial sepsis -
,parvovirus -
”babesiosis”malaria like protozoal infection -
 Problem of blood transfusion
: concern the safety
1- infections
2- immunomodulation :after giving a patient
blood we may have over stimulation or
depression to the immune system ( up and down
regulation), which increase the risk of
autoimmune diseases in case of upregulation and
the risk of infections in case of downregulation .
 Safe blood

 :Blood for transfusion is considered safe when it is

 
 Donated by a carefully selected, healthy donor.1
 
Free from infections that could be harmful to the recipient.2

Processed by reliable methods of testing, component .3

production, storage and transportation

.Transfused only upon need for the patient’s health.4

A complex phenomenon termed :
transfusion-related immunomodulation , TRIM
It involve both downregulated cellular immunity and *
upregulated, inappropriate inflammatory responses ,
the result of infusion into the recipient of large amounts of
 . foreign antigens in both soluble and cell-associated forms
TRIM-associated effects include an increased rate of cancer *
, recurrence and of post-operative bacterial infection
,reduce the recurrence rate of Crohn disease
enhances the survival of renal allografts
 Indication for blood transfusion

? Who is in need for blood

? Is any one who lost blood need to be transfused

Adequate tissue perfusion can be attained

by maintaining normovolemia
 The arterial pressure at the capillary end is
30mmHg , and the venous pressure 15mmHg
and the oncotic pressure in the capillary
. 25mmHg
So the blood pressure at the arterial end is higher
than the oncotic pressure allowing movement
, of the fluid out of the capillary
And the pressure at the venous end is lower than
that of the oncotic so the blood return back to
the capillary again
• So to have adequate tissue perfusion the
arterial pressure must be 30mmHg by having a
normal systemic blood pressure (120/80) .
• So if I have normovolemia , normal systemic
blood pressure , I am going to have a normal
arterial end capillary pressure and normal
transportation of oxygen regardless ( not 100%
) the percentage of Hb .
Class IV Class 111 Class 11 Class 1
2000> 1500-2000 750-1500 Up to 750 Blood loss,ml

40%> 30-40% 30% -15 Up to 15% Blood loss,

.%b.vol
140> 120> 100> 100< Pulse rate

decreased decreased normal normal Blood

pressure
Confused,leth Anxious, Mildly anxious normal CNS.,mental
argic confused state
Crystaloid Crystaloid & crystaloid crystaloid Fluid
&blood blood replacement
 In patient looking pale sweaty with
hypotension after trauma with no visible
: source of bleeding , we should look for

abdomen ( hemoperitoneum) -1
chest ( hemothorax ) -2
long bones and pelvis -3
 The recomendations for B. transfusion
: American Association of Blood Banks say that
In most hemodynamically stable hospitalized adults,transfused red
blood cells can be withheld until lower thresholds
7 g/dL* for hemodynamically stable adults, and 8 g/dL for
patients with preexisting cardiovascular disease or those
undergoing surgery
The minimum level of hb that need to be given blood *
The American Society of Anesthesiologists recommendations
: on transfusion which based on hemoglobin concentration are
a.Hemoglobin > 10 g/dL : transfusion is rarely indicated
: b.Hemoglobin 6-10 g/dL
indications for transfusion should be based on the patient's risk
of inadequate oxygenation from ongoing bleeding ( rapidity of
blood loss)
.c.Hemoglobin < 6 g/dL : transfusion is almost always indicated
The level of hb which is incomputable with life
in acute blood loss is 6g .
And in chronic blood loss is 3g
 Clinical indications for blood
transfusion
1. Following Traumatic Incidents
concealed haemorrage”blunt trauma”
open trauma”stab,bullets
2. Haemorrage from Pathological Lesions
i.e. bleeding d.u. Bleeding typhoid ulcer.
3. During Major Operative procedures
4. Post operative severe anaemia
5. Pre operative anaemia
6. Following sever Burn-i.e. Deep burn
7. Patients with haemorragic diseases, prophylaxis or to
arrest bleeding
8. Septicaemia.
Why chronic septicemia causing sever
? anemia
: Due to
hemolysis of the RBCs due to sepsis -1
depression of the bone marrow -2
nutritional causes in ICU patients -3
The steps in Blood transfusion

Donation :selection of donors .1

Screening and blood processing .2
storage .3
giving the blood .4
Watching for a possible complications .5
 : The Donation
1. Blood is colected in sterile bag contains 75 ml of anti- caogulant
sol. “CPD” with closed sterile unit
2. The donor lying on acouch 425ml of blood collected
3.During collection the blood constantly mixed

4.Donors are eligible to donate no sooner than 56 days after their

previous donation. this interval vary depending upon how
rapidly the person's body is able to replenish its red blood cells
 Donor selection
donors are asked if they have ever had heart, lung, or blood .1
diseases. irregular heartbeat, disease of the blood vessels in
, the brain, heart failure
People who have undergone recent surgery are permitted to .2
donate blood when they have resumed full activity. However,
if a transfusion was given at the time of surgery, donation is
.not allowed for one year
Women who are pregnant are not permitted to donate blood .3
during pregnancy and for six weeks after the pregnancy
. ends
The minimum age for blood donation is 16 years, .4
depending upon the state., In most cases, there is no upper
, age limit for donation
Individuals weighing less than 50 kg are not permitted to donate .5
blood. The less a donor weighs, the greater the likelihood of
having a reaction, such as dizziness and fainting
 Apheresis donation
A donor gives only RBC. platelets, WBC. rather than whole *
.blood

A whole blood is drawn from the donor, and a machine *

separates the blood into its components selectively and
.returns the rest of the blood to the donor

erythrocytapheresis -
,plateletpheresis -
Leukapheresis -
 Blood screening for infection
all donated blood in the United States is screened
2005-for the following infectious agents ,As of mid

HIV-2 and HIV-1 -

)HTLV-1 and HTLV-2( Human T-lymphotropic virus -
Hepatitis C -
Hepatitis B-
West Nile virus-
Treponema pallidum-
: Processing of blood

Component separation .1

,Leukoreduction .2

.Irradiation .3
:Blood components separation.1
: Packed Red Blood Cells.1
: Indications
a. Chronic anaemia
b. Elderly patient
c. Small children
d. Patients need large amount of blood

2. Platlet concentrates: stored at room temp.for 5 days

3.White Blood Cells: Transfused within 24 hours after collection
4. Cryoprecipitate: plasma protien ,rich in certain clotting factors

5.Fresh frozen plasma : frozen within hours after donation,contains

albumin globulin,fibrinogen ,clotting protiens

6. Plasma Derivitives :
a. factor viii concentrate
b. factor Ix cncentrate
c.albumin
d.Imuno globulin
e. Fibrinogen
: Processing of blood.2

: Leukoreduction .1
the removal of white blood cells from the blood product
. by filtration

:Leukoreduced blood is appropriate for

a. Chronically transfused patients

b. Patients with previous febrile nonhemolytic
transfusion reactions
c. CMV seronegative at-risk patients for whom
seronegative components are not available
Irradiation of blood products.3

Gamma irradiation ( to kill the lymphocyte) to

cellular blood products
to prevent Transfusion Associated Graft-Versus Host
Disease (TA-GVHD)
 Blood storage
1. Blood for Transfusion must be stored in special Bl. Bank
Refrigirator controled at 4c +-2c

2. CPD blood should be used within 3 weeks

3.Packed red cells stored at 4c

4. Fresh frozen plasma stored at -20c

5.Platelets are stored at 20-240C on a platelet agitator for a

period of 5 days from collection
6.Clotting factor concentrates are stored in blood bank
between 2 & 80C
 Giving the blood
1. Selection & preparation of the site ( good
caliber vein >> cephalic and basilic veins )

2. Careful checking of the donor blood :Name,

ward,Hosp.no. B.gp

3. Giving a detailed Written Instruction: rate of

flow,watching for possible complications.

4. Warming the blood by Temp. Regulated blood

warming unit. cold blood can cause cardiac
arrest .( thermostat at the 37 c with warm
water ) >> important in massive transfusion .

5. Filtering the blood: the use of Micro filter

forplatelets aggr.& leucocyte membranes.

Blood must be commenced within 30.6

minutes of arrival on ward
Maximum transfusion time is 4 hours
more than 4 hours .. more prone to (
)infection
 ABO group incompatability
We must observe the patient during the first 15 minutes of
transfusion
* It is a transfusion reaction resulting in agglutination &
haemolysis of RBC with systemic disturbances due to
inaccurate ABO group matching

The Clinical Features:

1. Rash
2. Tachycardia
3. Hypotension, Shock
4. Tachypnoe
5. Rise of Temp.+ Rigor
6. Pain in the loins
7. Pain along infusion vein
8. Oligurea, Hemoglobinuria, Renal failure
 Complications of Blood
Transfusion
1. transfusion reaction
a. ABO group incompatability
b. simple pyrexial reaction
c. allergic reactions
d. sensitization to leucocytes & platelets

2. infection :
Hepatitis B,C, HIV ,Malaria ,Syphlis,other bacterial infections
3.congestive cardiac failure ( extremes of age )
4. air embolism
5.Iron over load ( in massive transfusion )
6. transfusion-related acute lung injury
7.Transfusion associated graft versus host
disease
( the lymphocyte ingrafted causing lymphocyte
related diseases >> lymphoma , leukemia and
Hodgkin disease )

8. Microchimerism
the genetic line of the blood cells may cause change in
the genetic line of the cells in the recipient body
9.thrombophlebitis
 Treatment of blood incompatability

Stop transfusion immediately as soon as reaction is .1

suspected
Continue IV infusion with normal saline.2
Check the name, type and crossmatch.3
Obtain urine specimen for free hemoglobin .4
” “Hemoglobinuria
 AUTO TRANSFUSION
.

1. pre deposit autologous transfusion

2. acute isotonic dilution This process dilutes your own blood so
you lose less concentrated blood during surgery.
This technique has been widely used in cardiothoracic surgery.

3. blood salvage
blood is collected and processed for reinfusion
a. peri operative
Blood lost from surgical site may be saved
b. Post operative: wound drains
 Massive transfusion
Defined as:
the replacement by transfusion of more than 50 percent of a
patient's blood volume in 12 to 24 hours, may be associated with
a number of hemostatic and metabolic complications

The most frequent indication:

1.Hemorrahgic shock secondry to trauma,
2. ruptured aortic aneurysm,
3. massive GI hemorrhage
4.liver transplantation
: Complications of massive transfusion

:I.acute metabolic complications

a.Volume overload
:b. Hypothermia
:c. CitrateToxicity
The citrate bind to calcium causing hypocalcemia
:d. Hyperkalemia
The hypothermia stop the Na k pump action , so the intracellular k go out of the
. cell to the serum through the plasma membrane

:II.Coagulation Abnormalities
Dilutional thrombocytopenia is the major cause of >
microvascular bleeding
Coagulation factor deficiency by consumptive >
coagulopathy