Basics of

Transfusion
Therapy
 Blood fractions:
 Packed RBCS
 Plasma
 Platelet
RBC Transfusion: Indications

 Acute Blood Loss

 Symptomatic Anemia
 Exchange (SS, Co)
 Major surgery
 septicaemia
Pre-Transfusion Testing
 BLOOD TYPING:
 ABO, D Antigens only

 CROSSMATCH
 Major: Patient Serum vs. Donor Cells
RBC Transfusion Volume
 Usual: Up to 15cc/Kg in 3-4 hours

 Unusual: Acute Hemorrhage:

replace ongoing losses
Fresh Frozen Plasma

 200-250 ml of plasma containing all

clotting factors, Protein C & S.
 Compatibility Important
Indications: FFP
 Replacement of Coagulation Factors
 Abnormal Bleeding with coagulopathy
 Multiple factor deficiency:
 Liver disease
 DIC
 Dilutional
 Isolated factor deficiency-no concentrate
 Factor XI, XIII
Guidelines: FFP Use
 Usual dosing: Adult 10ml/Kg
Peds 10-15ml/Kg
Transfused Platelets/Survival

 Dose: child 1 unit/5-6 kg

adult 1 unit/8-10 kg
 Lifespan: 7-10 Days Native
2-3 Days Transfused
 Factors shortening Lifespan:
 Fever,Sepsis
 HLA, Platelet Specific Abs
 DIC
Hemolytic Transfusion Reactions

 Acute HTR 1/25,000

 Fatal Acute HTR 1-4/1,000,000

 Delayed HTR 1/5-10,000

Symptoms and Signs of Acute
Hemolytic Reactions
 Severe Back Pain
 Substernal Tightness, Dyspnea
 Hypotension / Circulatory collapse
 Vomiting, diarrhea
 Icterus
 Hemoglobinuria
 Renal shutdown
 Diffuse Oozing from wounds/punctures
Response to Suspected Hemolytic
Reaction
 Stop Transfusion
 Hydrate
 Specimens to Blood Bank
Cause of Acute HTR
 ABO incompatibility
Nonhemolytic Transfusion Reactions

 Metabolic/ Physical
 Immunoglobulin Associated  Citrate Toxicity
 Urticaria/Fever  Hypothermia
 Ig E  Circulatory Overload
 ALI
 Platelet Associated
 Post transfusion Purpura
 Neonatal Thrombocytopenia
Risk of Transfusion-
Transmitted Infection
HIV
Hepatitis C
Hepatitis B
Bacteria
Malaria, T Cruzi, Babesia, Yersinia,
Syphilis, Lyme
Prevention of Post Transfusion
Infection
 Don’t Transfuse
 Minimize Transfusion
 Limited Donors (dedicated units)
 Autologous Transfusions
 Erythropoetin
 Donor Screening: HIV Ab, HIV NAT, HCV Ab,
HCV NAT, HBV Ag, Ab, HBc Ab, VDRL, West
Nile NAT, HTLVI/II Ab, CMV Ab, Bacterial
Culture (Platelets)