BLOOD TRANSFUSION

BY – Dr. Manish Kumar Singh

Asst. Professor
Dept. of Shalya tantra
INTRODUCTION
Blood
• Blood is a red vascular connective tissue
• Blood contribute in 6-10% of body weight
• Blood pH -7.35 to 7.45
• Blood transports vital requirement and waste products of
the body.
• Blood consist of two types of components

Blood cells Plasma

 Blood

Blood Cells Plasma

RBC WBC Platelets

Or Or Or
Erythrocytes Leucocytes Thrombocytes
ERYTHROCYTE(RBC)

• They are bi-concave non-nucleated disc like cells.

• Edge contain haemoglobin, which transports
respiratory gases, i.e oxygen and carbon dioxide.
• The Shape favors flexibility for absorbing and
releasing gases quickly.
• Size- 7.2 micron
• Total count
 Males- 5 to 5.5 millions/cubic mm of blood
 Females- 4 to 4.5 millions/cubic mm of blood
Leucocyte(WBC)

• These are colourless, nucleated cells.

• Count-4,000 to 10,000 WBC/ cubic mm of blood
• Classification- on presence of granules in their
cytoplasm
 Granulocyte
 Agranulocyte
Continuation…..

Neutrophil

Granular Eosinophil

Basophil
WBC

Lymphocyte
Agranular
Monocytes
Platelets or Thrombocytes

• Smallest of all blood cells.

• Shape-Spindle shape with diameter 2 to 3 micron
• Help in Clotting of blood
• Short life span upto few hours
• Count- 1.5 to 4 lakhs / cubic mm
Plasma
Functions of Blood

1. Deliver O2, nutrients to all body cells

2. Transport waste products from cells for
elimination
3. Transport hormones
4. Maintain body temp (distribute heat)
5. Maintain pH (carry buffers)
6. Maintain fluid volume
7. Prevent blood loss (clotting)
8. Prevent infection (WBCs, antibodies)
Blood Group

• 4 main groups- A, B, AB and O.

• Surface of an individuals red blood contains a
number of proteins known as antigen that are
unique for each person.
• Among antigens, A, B and Rh are most
important to determine the blood group.
• Antigens promotes agglutination or clumping
of blood cells, hence called as agglutinogens.
 Rhesus(Rh) factor
• It is an inherited antigen in human blood.
• Blood that contains Rh factor is known as Rh-positive and vice-
versa.
• If Rh positive blood is injected into Rh negative, may cause
severe serious reaction with clumping and haemolysis of blood
cells.
 BLOOD TRANSFUSION

HISTORY -
• 1492 - Pope Innocent VIII suffers a stroke and receives blood
transfusion from three 10-year-old boys.
• 1665 Richard Lower in Oxford conducts the first successful
canine transfusions
• 1667 - Jean-Baptiste Denis reports successful sheep–human
transfusions .
• 1678 -Animal–human transfusions are banned in France
because of the poor results .
• 1818 -James Blundell performs the first successful documented
human transfusion in a woman suffering post-partum
haemorrhage. She received blood from her husband and
survived.
Cont……

• 1901 - Karl Landsteiner discovers the ABO

system.
• 1914 -The Belgian physician Albert Hustin
performed the first non-direct transfusion, using
sodium citrate as an anticoagulant .
• 1926 The British Red Cross instituted the first
blood transfusion service in the world.
• 1939 The Rhesus system was identified and
recognized as the major cause of transfusion
reactions .
 DEFINITION

• A blood transfusion is the infusion of whole blood or

blood components such as plasma, red blood cell or
platelets into the patients venous circulation.
• Before transfusion it must be check that blood of the
donor is compatible with the patient.
• The process of determine the compatibility between
blood specimen is called as crossmatching.
• Cross matching is the final step in the pre tranfusion.
CROSSMATCHING
DONOR SELECTION

• The person from whom blood is collected for

transfusion is called as donor and the patient who
is going to receive is called as “recipient”.
• For men once in three month and for women once
in four month can donate .
• Criteria for blood donor
• Age – between 18-65 years
• Hemoglobin – not less than 12.5g/dl
• B.P. and temperature should be normal range.
• Body weight not less than 45 kg.
Conti…….

• Past one yr. not treated for rabies, jaundice and

hepatitis.
• Past three month s- donated blood or treated for 
malaria.
• Past on month – had any immunization.
• Past 48 hour – taken any antibiotic
• Past 24 hour – taken alcohol or beverages.
• Past 7 hour – taken aspirin
• Present – suffering from cold cough and flue.
BLOOD COLLECTION

• Phlebotomy is a practice of drawing blood.

• Donor blood collection should be polite and
friendly.
• Blood collection is done in sterile closed plastic
collection bag.
• The labels on every bag containing full
information regarding donor and blood. 
• Care of donor  - 30 min observation + necessary
instruction to be done.
• The blood is stored in refrigerators at 4c to 6c.
 COLLECTION OF BLOOD
• The donor is made to sit or lie down
comfortably. Ensure that the information on
the label matches with the donor's
information.

SELECTION OF VEIN:
• Select a large, firm vein, preferably in the
antecubital fossa, from an area free from skin
lesions or scars.
• Apply a tourniquet or blood pressure cuff
inflated to 40-60 mm Hg, to make the vein
more prominent.
• Ask the donor to open and close the hand a
few times.
• Once the vein is selected, release the
pressure device or tourniquet before the skin
site is prepared.

VENEPUNCTURE:
• Disinfect the site of puncture with spirit swab
• A 16 guage needle is introduced into the vein
at 30 degree angle. The needle is connected
to a plastic tube which is attached to a
plastic bag forming a closed sterile unit.
• Ask the donor to open and close the fist slowly
every 10–12 seconds during collection.
• Remove the tourniquet when the blood flow is
established or after 2 minutes, whichever comes
first.

MONITORING:
• Closely monitor the donor for sweating, pallor or
giddness and the site of injection for swelling, etc
• About every 30 seconds during the donation, mix
the collected blood gently with the anticoagulant,
either manually or by continuous mechanical
mixing.
AFTER BLOOD DONATION:
• Transfer the blood unit to a proper storage
container.
• Ensure that collected blood samples are
stored and delivered to the laboratory with
completed documentation, at the
recommended temperature, and in a leak-
proof, closed container.
• Each unit of blood is tested for evidence
of hepatitis-b, hepatitis-c, human
immuno deficiency virus I & II and syphilis. 
• The blood is then processed into sub-
components. These are:
 Whole blood 
 Packed cell volume
 Fresh frozen plasma 
 Platelets
 Cryoprecipitate
ANTI-COAGULANT SOLUTIONS
1) Acid Citrate Dextrose (ACD)
2) Citrate Phosphate Dextrose (CPD) 
3) Citrate Phosphate Dextrose Adenine (CPDA-1)

• 15 ml of ACD, 14ml of CPD or CPDA is used for

preserving 100ml of blood.

PURPOSE: 
To prevent coagulation.
To preserve the storage life of blood
BLOOD COLD CHAIN-STORAGE
AND TRANSPORTATION OF
BLOOD
• The ‘Blood cold Chain’ is the systematic process for
safe storage & transportation of  blood & blood
components so that they are kept at the correct
temperature at all times from blood collection from a
donor to administration of blood to a patient  in need
of transfusion. 

• Blood bank refrigerators ,Plasma freezers, platelet

agitator and incubators, blood transport boxes are the
blood cold equipments used for storage of blood and
it's components.
 WHOLE BLOOD
• It is the unseparated blood containing
an anticoagulant – preservative solution. 
• One unit of whole blood contains- 
 450 ml of donor blood. 
 50 ml of anticoagulant-preservative solution. 
 Hemoglobin approx.12g/ml & haematocrit
35%- 45%. 
 No functional platelets
• Stored between +2 and +6 degrees
centigrade in a blood bank refrigerator. 
• Transfusion should be started within 30
minutes of removal from the refrigerator and
completed within 4 hours of commencement
because changes in the composition may
occur due to red cell metabolism.
PACKED RED CELLS

• Packed red cells are cells that are spun down

and concentrated. 
• One unit of packed red cells is approx. 330 ml
and has a haematocrit of 50-70%. 
•  They are stored in a SAG-M (saline-adenine-
glucose-mannitol) solution to increase their
shelf life to 5 weeks 
• It is stored at a temperature of 2-6 degrees
centigrade.
FRESH FROZEN PLASMA(FFP)

• The plasma is separated from a unit of blood

within 6-8 hrs of donation and rapidly frozen
• Fresh frozen plasma is rich in coagulation
factors. 
• It is separated from whole blood and stored at
-40 to -50 degrees centigrade.
• It has a shelf life of 2 years. 
• It is the first line therapy in the treatment of
coagulopathic haemorrhage
 CRYOPRECIPITATE
• Cryoprecipitate is a supernatant precipitate of
fresh frozen plasma and is rich in factor VIII
and fibrinogen.
• It is stored at -30 degrees centigrade with a
2 years shelf life. 
• Indicated in low fibrinogen states (<1g/l) or in
cases of factor VIII deficiency (hemophilia-a),
von will brand's disease and as a source of
fibrinogen in disseminated intravascular
coagulation. 
• Must be infused within 6 hours.
PLATELETS

• Platelet are prepared by manual as well as

automated methods and then stored at 22
degree C -24 degree C in platelet agitator
cum incubator to maintain platelet function.
• Platelets should never be REFRIGERATED
and should be transfused as soon as
possible. 
STORAGE OF BLOOD IN
DIFFERENT PRESERVATIVES

PRESERVATIVE SHELF LIFE

ACD( Acid citrate dextrose) 21 days

CPD(Citrate phosphate dextrose) 28 days

CPDA( CPD+ Adenine) 35 days

SAGM( Saline Adenine Glucose

35 days
Mannitol)
TYPES OF BLOOD
TRANSFUSION

1) ALLOGENEIC 
• Tranfusion of blood taken from a donor to a
recipient.
2) AUTOLOGOUS
• Re-infusion of blood or blood products
taken from the same patient.
 TYPES OF BLOOD
TRANSFUSION
PACKED CELL PLATELET PLASMA
TRANSFUSION TRANSFUSION TRANSFUSION
• Chronic Anaemia • Platelet function • Deficience of
• Acute sickle cell defect Coagulation factors
crisis • Thromobocytopenia • Vitamin K deficiency
• Acute blood loss • Correction of • Disseminated
• Cardiac Failure coagulopathy Intravascular
• Intra-operative Coagulation(DIC)
Haemorrhage •  Thrombotic
• Leukemia thrombocytopenic
purpura 
• Heparin-induced
thrombocytopenia
TRANSFUSION OF BLOOD

• Blood to be transfused should be identified

and checked against the recipient’s name
and group. 
• The drip is set up under asepsic condition
using 17 gauge or larger needle.
• The rate should initially be 20-30 drops/min
i.e.2-3 ml/min. 
• It is increased after half an hour to 60-80
drops/min
• If there is blood loss, the rate of infusion
should be rapid, squeezing the bag containing
the blood if necessary.
• In the elderly and very young, the rate should
be slow-about 40 drops or less /min.
• The patients general condition, pulse and BP
should be monitored throughout.
 COMPLICATIONS OF BLOOD
TRANSFUSION
1) TRANSFUSION REACTIONS:
Causes-
A. Incompatibility:
CLINICAL FEATURES TREATMENT
• Rigor and Fever • The transfusion should be
• Headache immediately stopped.
• Nausea • Fresh sample of blood and
• Vomiting urine are sent to laboratory
• Tingling sensation in the along with the rejected blood to
extremities compare.
• Dyspnoea • Diuretics, Antihistamine,
• Appearance of Jaundice Hydrocortisone, Haemodialysis
• Urine output gradually etc may be needed
diminshed
 B) Pyrexial Reactions: C) Allergic Reactions:

-Fever -Tachycardia
-Chills -Urticarial Rash
- Rigor -Fever
-Dyspnoea
-Restlessness
-Acute anaphylactic shock
-Headache 
-Increased pulse rate
-Nausea
-Vomiting

2) TRANSMISSION OF DISEASES:
• Hepititis A or B
• AIDS
• Bacterial Infection
• Malaria
• Syphilis
• Immunosuppression
COMPLICATIONS OF BLOOD
TRANSFUSION
 A. IMMEDIATE B. DELAYED
REACTIONS REACTIONS
• 1. Febrile non- • 1.Thrombophlebitis 
haemolytic reaction • 2. Delayed
• 2.Allergic reaction haemolytic reaction 
• 3. Haemolytic • 3. Post-transfusional
reaction thrombocytopaenic
• 4. Bacterial purpura
contamination
• 5. circulation overload
• 6 Cardiac arrest
• 7.Air embolism
OTHER
COMPLICATIONS:

 Circulatory overload 
 Hyperkalemia 
 Hypocalcemia  
 Haemosiderosis
 Infiltration and Hematoma 
 Thrombophlebitis
 Pulmonary embolism
CONCLUSION

• Blood transfusions can be a life-saving

measure.
• The likelihood of contracting infections from a
blood transfusion is very low (varies with the
infectious agent from 1 in 350,000 to 1 in 1
million), but can occur.
THANK YOU!