Blood transfusion &

Blood components

Presented by
P . Adithya
A . Pravalika
Overview
• what is a blood transfusion
• Purpose
• Indications
• Blood products
• Nursing implications
• Administering a blood transfusion ( skill)
Definition
• Blood transfusion is the transfusion of the whole blood or
its components such as blood cells or plasma from one
person to another person
• Reaches patients blood vessels & enters the circulatory
system
Functions of blood
• Blood carries the following to the body tissues
• Nourishment
• Electrolytes
• Hormones
• Vitamins
• Antibodies
• Heat
• Oxygen
• Blood carries the following away from the body tissues
• Waste matter
• Carbon dioxide
Purpose
• Restore blood volume
• Replace clotting factors
• Improve oxygen carrying capacity
• Restore blood elements that are depleted
• Prevent complications
• To raise Hb lvl
• To provide antibodies
Blood products
• Components of blood which are collected from a donor for
use in blood transfusion.
• Transfusion products include
• Whole blood
• Fractionated blood components
• Packed red blood cells
• Platelet transfusion
• Fresh frozen plasma
• Cryoprecipitate
• Plasma derivatives
Packed red blood cells
• Contents include RBCs , preservative, typically citrate based
• Unit volume: ∼200–350 mL
• Effect
• ↑ Hb and oxygen-carrying capacity of the blood, Leading
to improved organ perfusion and tissue oxygenation
• 1 unit of pRBCs increases Hb value by ∼ 1 g/dL.
• Intravascular volume expansion roughly equivalent to
unit volume

• Indications for RBC transfusion are not determined solely

by Hb value, but rather by an assessment of the clinical
circumstances and the patient's overall condition.
Common indications of pRBC
• Hemorrhagic shock or ongoing rapid blood loss
• Exchange transfusion: e.g., in severe sickle cell disease or
methemoglobinemia
• Severe anemia (even if asymptomatic)
• Hb ≤ 7 g/dL even if no additional factors are present
• Hb ≤ 8 g/dL with pre exisiting cardiovascular disease or
if the patient is due to undergo cardiac or orthopedic
surgery
• Moderate anemia, in any of the following situations:
• Symptoms of anemia [26]
• Increased risk of complications, e.g., acute onset ,
significant comorbidities, older age
• Signs of hypoxia
• Planned surgery
Fresh Frozen Plasma
• Content
• Plasma, including all coagulation factors and plasma
proteins
• All cellular components are removed from the
transfusion product.
• Unit volume: ∼200–300 mL
• Effect
• Correction of both isolated and multiple coagulation
factor deficiencies
• Intravascular volume expansion roughly equivalent to
unit volume
• Contains no RBCs
• 1 unit of FFP = increases lvl of any clotting factor by 2-3%
• Compatibility requirements:
• ABO compatibility must be considered.
• Transfused plasma must be ABO compatible, as it may
contain anti-A and/or anti-B antibodies. Blood type
AB (universal plasma donor) FFP may be used for
emergency transfusions if the recipient's blood type is
unknown, as it does not contain anti-A or anti-B
antibodies.
• Rh(D) matching: not required ;
• the risk of Rh(D) sensitization from FFP is extremely
low, as plasma components do not contain RBCs.
• Indications

• Management of coagulopathy in patients with multiple

clotting factor deficiencies (e.g., due to liver cirrhosis, DIC)
• Prevention of dilutional coagulopathy in massive transfusion
• Plasma exchange transfusion, e.g., in TTP
• Management of some coagulation factor deficiencies if no
specific concentrate for treatment exists
• Alternative therapy for:
• Management of plasma protein deficiencies if
recombinant products are unavailable
• Immediate reversal of warfarin in patients with life-
threatening bleeding or intracranial hemorrhage if 4-
factor PCC is unavailable ( 4-factor PCC is preferred over
FFP for the immediate reversal of vitamin K antagonists.)
Pretransfusion testing
• Goal: Ensure compatibility between recipient and donor
blood products and avoid hemolytic transfusion reactions.

• Methods: A variety of test strategies that mostly rely on

hemagglutination (i.e., clumping of erythrocytes) induced
by antibodies binding to RBC antigens

• Standard testing requirements: vary by blood

product and institutional policy

• RBC: Blood typing, RBC antibody screen, and

crossmatching are typically required.

• FFP: Blood typing is typically required.

Typing & Screen
Crossmatching
 Type Blood type O Blood type A Blood type B Blood type AB

Prevalence ∼ 45% ∼ 40% ∼ 10% ∼ 5%

Antigens on RBCs No antigens A antigen B antigen A and B antigens

Anti-A and anti-B

Antibodies in plasma Anti-B antibodies Anti-A antibodies No antibodies
antibodies

AB, A, B, O
Can receive RBCs
O A, O B, O (universal RBC
from
recipients)
O, A, B, AB
Can donate RBCs to (universal RBC A, AB B, AB AB
donors)
O, A, B, AB
Can receive FFP
(universal FFP A, AB B, AB AB
from
recipients)
AB, A, B, O
Can donate FFP to O A, O B, O (universal FFP
donors)
Platelets
• Contents
• Platelets suspended in plasma or platelet additive solution
• Typically provided as either of the following: [35]
• Single donor apheresis platelets (SDAP) unit: derived
from 1 unit of whole blood from a single donor
• Random donor pooled platelets (RDP) pack: derived
from 4–6 units of whole blood from various donors

• Effect
• 1 unit of apheresis platelets or 1 pack of pooled platelets
increases the platelet count by 20–60,000/mm3.
• Intravascular volume expansion roughly equivalent to
unit/pack volume
Compatibility requirements
• Compatible donor platelets may not be available due to
limited supply. The risks of incompatible platelet
transfusion are lower than those of incompatible pRBCs.
• ABO compatibility: preferred but not required for routine
transfusions
• Rh(D) matching: Rh(D)-negative platelets are preferred
in Rh(D)-negative recipients to prevent
alloimmunization. ( ex. Rh(D)-negative women of child-
bearing age )
• Consider donor plasma compatibility when transfusing
multiple units.
Indications

• Treatment of active bleeding in patients with any of the

following:
• Platelets < 50,000/mm3
• Platelets < 100,000/mm3 and brain injury or multiple
trauma
• Qualitative platelet disorders (e.g., Bernard-Soulier
syndrome)
• Massive hemorrhage as part of balanced resuscitation

• Prevention of bleeding in any of the following situations:

• Severe thrombocytopenia (platelets < 10,000/mm3 )
secondary to active treatment-induced
myelosuppression E.g., from radiation or chemotherapy.
• Patients with thrombocytopenia who are due to undergo
invasive procedures
• Elective central venous catheter placement or bone
marrow aspirate in patients with platelets <
20,000/mm3
• Neurosurgery in patients with platelets < 100,000/mm3
• Other invasive procedures in patients with platelets <
50,000/mm3 E.g., diagnostic lumbar puncture,
percutaneous liver biopsy, major (nonneuraxial) surgery

• Childbirth, if maternal platelets are < 50,000/mm3

• Note:
• Do not use platelet transfusions to treat severe
thrombocytopenia due to ITP, TTP, HUS, or HIT unless
there is major bleeding.
Whole blood
• Not commonly used except for extreme cases of. Acute
hemorrhage
• Replaces blood volume and all blood products

Autologous Red blood cells

• Used for blood replacement following planned elective
surgery
• Must be donated 4-5 weeks prior to surgery
Cryoprecipitate
• Content:
• clotting factors (fibrinogen, factor VIII, factor XIII), vWF,
and fibronectin
• Cryoprecipitate is obtained by centrifuging thawed FFP at
cool temperatures.

• Effect: 1 unit of cryoprecipitate per 7–10 kg of the patient's

body weight increases serum fibrinogen by ∼ 50–75 mg/dL.

• Compatibility requirements
• ABO compatibility: preferred but not required
• Rh(D) matching: not required
• Indications
• Bleeding associated with fibrinogen deficiency (e.g., due
to DIC, liver disease): typically performed if serum
fibrinogen is < 100–150 mg/dL
• Alternative therapy for deficiencies in clotting factors,
including vWF, factor VIII, and factor XIII; Used when
first-line single-factor preparations are not available
• Treatment of uremic bleeding syndrome ; Typically used
in combination with other interventions (e.g.,
desmopressin)
Plasma Derivatives
Prothrombin complex concentrate
• Content
• Vitamin K-dependent clotting factors: factors II, VII, IX,
and X . 4-factor PCC contains all four factors, while 3-factor
PCC contains little to no factor VII.
• Anticoagulants: protein C, protein S, antithrombin, and/or
heparin
• Indications
• Vitamin K antagonist-associated major bleeding: 4-factor
PCC is given with IV vitamin K
• Treatment and prevention of bleeding in patients with rare
clotting factor deficiencies if specific factor preparations are
not available
• Consider for the reversal of DOACs in life-threatening
bleeding.
 Single-factor concentrates
• Content:
• specific clotting factors that have
been pooled from multiple donors
• Indications:
• specific clotting factor deficiencies
(e.g., factor VIII and factor IX are
used for the treatment of
hemophilia A and hemophilia B) if
recombinant factors are not
available .( Recombinant factors
are preferred if available, as they
are associated with a lower risk of
viral transmission than single-
factor concentrates.)
Antithrombin III
• Content:
• antithrombin III, which is synthesized in the liver and
inhibits coagulation factors IXa, Xa, XIa, and XIIa, and
thrombin
• Indications
• Patients with hereditary antithrombin III deficiency to
optimize thrombosis prophylaxis with heparin
• Patients on cardiopulmonary bypass who are
experiencing heparin resistance
• DIC, in select cases
• Effect: increases the effects of heparin
Albumin & plasma Protein
fraction
• Blood volume expander
• Provides plasma protein
General Instructions For Giving
Blood Transfusion
• Donor must be free of diseases
• No history of any disease
• They have not donated blood within the previous 90 days
• They should be physically healthy and should be between 18
and 65 years
• Donor must have a normal temperature ,pulse and blood
pressure
• There hemoglobin level must be above 12 grams per 100ml
• The donors are disqualified who have a history of recent
dental surgery or major surgery, receipt of bloodor
blood components, immunizations or vaccinations,use
of narcotics
• Before the blood transfusion ABO grouping and Rh
typing with recipient blood should be done
• Blood should not be collected to the empty stomach
• A second withdrawal of blood should not be made until
the blood volume and constituent have written to
normal that is usually after 3 months
Collection, Storage, And
Transportation Of Blood
• Collection of blood from the donor is done in the
laboratory.The donors blood collected into a sterile container
containing anticoagulant solution.The anticoagulant used is
acid citrate dextrose or citrate phosphate dextrose
• All the articles used for collection of blood should be sterile
and pyrogen free
• The donor blood immediately after it is withdrawn should be
placed in the refrigerator.
• Usually it is stored in temperature of 1 to 6 degree centigrade
• The transportation of blood in the hospital should be done within
30 minutes after it is taken from the place of storage
• Freezing and heating of blood will destroy the blood cells
Regarding Administration Of
Blood To Recepient
• When sending the recipient blood sample for grouping and
cross matching it must be carefully labelled at the bedside
of recipient
• It is essential that the physician writes all orders for typing
cross matching and administration of whole blood and
blood products
• Whole blood and blood products should be administered
through an appropriate sterile pyrogen free transfusions set
containing a filter which will remove clots and larger
aggregates of leukocytes and platelets
• Care is to be taken to prevent introduction of air into
apparatus
• No medication like antibiotics, vitamins, calcium should
be added to the unit of blood or administered through
the same intravenous system as they may cause damage
to red cells
• If IV infusion is to be given immediately before during
or after the blood transfusion always use saline to
prevent haemolysis of blood in the tubing.
• Prior to administration of blood the patient's vital signs
should be recorded correctly on the record to provide a
baseline for further observation
• Adjust the rate of flow to 5 to 10 ml per minute during
the first 30 minutes of transfusion to detect any
complication as early as possible
• Give the blood at a slower rate if patient is elderly or
suffering from heart disease and lung disease and
anaemia
• Whole blood and packed cells administered cold. No
attempt is made to heat the blood. However blood may
be allowed to stand at room temperature for 30 to 45
minutes before it is administered
• The procedure involved in administration of blood is
the same as that of administration of IV infusion
• Watch the patient carefully for the onset of any
complications
• Any reaction developed in the patient should be
reported to the physician immediately
Procedure
• Explain the procedure to patient. Selected site basilic
and cephalic veins, saphenous
• Wash hands. Remove the bottle seal from top clean the
top with spirit swab holding the bottle upright inside
the drip set and air went into the bottle
• Close the clamp and hang the bottle on the IV stand
about 18 to 25 high
• Open the clamp and flush the blood through the tubing
and needle into the kidney tray until ait is removed
• Clamp the tubing again applied protective cap over the
needle
• Prepare few strips of adhesive tapes
• Apply a tourniquet firmly proximal to the site
• Encourage the patient to clinch and unclench the fist
rapidly
• Clean the area with spirit swab
• Insert the needle into the vein at 15 to 30 degree angle
and once it enters the vein make it parallel with the skin
and follow the course of vein
• When the backflow of blood occurs into the needle and
tubing insert the needle further up into the vein
• Release the tourniquet and open the clamp to let the
blood run
• Secure the needle and tubing by adhesive strips
Complications Of Blood
Transfusion
• Blood transfusion reaction is a systemic response by the
body to blood incompatible with that of recipient
• It is mainly caused due to
• ABO incompatibility
• Allergic reaction to WBC platelets or plasma protein
components of transfused blood
• Potassium or citrate preservative in the blood
Types of blood transfusion
reactions
• Acute reactions
• Acute immunological reactions
Acute hemolytic transfusion reactions
Allergic reactions
Febrile non hemolytic transfusion reactions
Transfusion related acute lung injury
• Acute Non immunological reactions
Volume control
Citrate toxicity
Hypothermia
Bacterial contamination
• Delayed reactions
• Delayed immunological reactions
• Delayed hemolytic transfusion reaction
• Post transfusion purpura
Acute hemolytic transfusion
reaction
• During the first 5 to 15 minutes
• In the hemolytic transfusion reaction circulating RBC
are ruptured with the release of hemoglobin
• Clinical features
• Onset of fever
• Chills, headache ,dyspnoea ,cyanosis ,chest pain
• Nausea and vomiting
Management
• Discontinue the transfusion immediately
• Inform the laboratory to do cross matching and
grouping of blood
• Maintain IV infusion with 5% glucose or saline using the
new IV set
• Large quantities of fluid is given to promote diuresis and
counteract shock
• Oxygen inhalation is given to leave dyspnea
Pyogenic reactions
• It develops immediately or within 6 hours of infusion
• IT results from organic substances from the tubings
• Causes
• Improper preparation of donor site
• Not following proper aseptic technique
• Improper refrigeration
Allergic reaction
• Develops any time or within one hour of blood
transfusion
• Allergic reactions are due to sensitivity of individual to
plasma protein in the transfused blood
• Characterized by itching, rashes, laryngeal edema and
bronchial asthma
• Treatment includes injection of antihistamines and
corticosteroids
TRALI
• Clinical syndrome similar to ARDS
• Occurs 1 to 6 hours after receiving plasma containing
blood products
• Treatment including respiratory support