BLOOD TRANSFUSION

DR. SHAIMAA ALARABY

SPECIALIST OF GENERAL SURGERY
 Background
• The transfusion of blood and blood products
has become common place since the first
successful transfusion in 1818.
• The aim is to restore the circulating volume in
order to improve tissue perfusion and to
maintain an adequate blood oxygen carrying
capacity.
• It can be either autologus or allogenic blood
transfusion.
 Types Of Blood Transfusion
1. Allogenic : receiving blood of another person.
2. Autologus: transfusion of patient own blood
which was collected previously.
A. Autologous (acute) normovolemic
hemodilution.
B. Preoperative autologous donation.
C. Intraoperative autotransfusion/cell salvage.
 ABO System
• ABO grouping is a test performed to determine an
individual's blood type.
• It is based on the premise that individuals have
antigens on their red blood cells (RBCs) that
correspond to the 4 main blood groups: A, B, O, or AB.
• Individuals have antibodies (isohemagglutinins) in
their plasma that are directed against blood group
antigens that their RBCs lack . These antibodies
(isohemagglutinins) form early in life.
• ABO antigens are expressed on RBCs, platelets, and
endothelial cells and are present in body fluids.
 Rhesus System

• After the ABO system, the Rh blood group system is

regarded as the second most important blood group
system.
• It consists of over 50 red cell antigens.
• There are 5 main Rh red cell antigens D, C, c, E, and e
that involve most clinically significant transfusion
complications.
• One gene, RHD, encodes for the D antigen. Individuals
with the D antigen present on their red blood cells are
labeled as "Rh (D)–positive." Those who do not have
the D antigen are labeled as "Rh (D)–negative."
 Typing and Cross-Matching

• In selecting blood for transfusion, serologic compatibility is

established routinely for the recipients' and donors' A, B, O,
and Rh groups.
• Cross-matching between the donors' red blood cells and
the recipients' sera (the major cross-match) is performed.
• As a rule, Rh-negative recipients should be transfused only
with Rh-negative blood.
• Rh-positive blood should not be transfused to Rh-negative
females who are capable of child-bearing. Administration of
hyperimmune anti-Rh globulin to Rh-negative women
shortly before or after childbirth largely eliminates Rh
disease in subsequent offspring.
 Blood and blood products
• Blood is collected from donors who have been
previously screened to avoid harm for both
donor and recipient.
• Up to 450 mL of blood is drawn, a maximum
of three times each year.
• Each unit is tested for evidence of hepatitis B,
hepatitis C, HIV-1, HIV-2 and syphilis.
• The ABO and rhesus D blood group is
determined.
 Whole blood

• Whole blood is now rarely available in civilian practice as it is an

inefficient use of the limited resource.
• However, whole blood transfusion has significant advantages over
packed cells as it is rich with coagulation factors.
• The shelf life has been extended to 40 ± 5 days.
• At least 70% of the transfused RBCs remain in the circulation for 24
hours after transfusion and are viable.
• 1. Banked blood is a poor source of platelets because they lose
their ability to survive transfusion after 24 hours of storage.
• Among the clotting factors, all but factor V and VIII are stable in
banked blood.
• Within 21 days of storage, the pH decreases from 7.00 to 6.68, and
the lactic acid level increases from 20 to 150 mg/dL.
• The potassium concentration rises steadily to 32 mEq/dL.
 Whole blood
• 2. Fresh Whole Blood
• This refers to blood that is administered
within 24 hours of its donation and is rarely
indicated.
• Because of the time required for testing for
infectious disease, it must be administered
untested.
• Fresh whole blood is a poor source of
platelets and factor VIII.
 Packed red cells

• Packed Essentially, it provides oxygen-carrying

capacity.
• It is the product of choice for most clinical situations.
• Each unit is approximately 330 mL and has a
haematocrit of 50–70 per cent.
• Packed cells are stored in a SAG-M solution (saline–
adenine–glucose–mannitol) to increase shelf life to 5
weeks at 2–6°C.
• Older storage regimens included storage in CPD –
citrate–phosphate–dextrose solutions which have a
shelf life of 2–3 weeks.
 Fresh-frozen plasma

• Fresh-frozen plasma (FFP) is rich in coagulation

factors and is removed from fresh blood and
stored at −40 to −50°C with a two-year shelf life.
• It is the first-line therapy in the treatment of
coagulopathic haemorrhage.
• Rhesus D-positive FFP may be given to a rhesus
D-negative woman although it is possible for
seroconversion to occur with large volumes due
to the presence of red cell fragments, and rhesus
D immunization should be considered.
 Platelets

• Platelets are supplied as a pooled platelet concentrate and contain

about 250 × 109/L.
• Platelets are stored on a special agitator at 20–24°C and have a
shelf life of only 5 days.
• Platelet transfusions are given to patients with thrombocytopenia
or with platelet dysfunction who are bleeding or undergoing
surgery (50,000 to 100,000/L. ).
• One unit of platelet concentrate has a volume of approximately 50
mL.
• Platelet preparations can transmit infectious diseases and account
for allergic reactions similar to those caused by blood transfusion.
• prophylactic platelet transfusions are given when platelets count is
10,000/L in non bleeders.
 Cryoprecipitate

• Cryoprecipitate is a supernatant precipitate of

FFP and is rich in factor VIII and fibrinogen.
• It is stored at −30°C with a two year shelf life.
• It is given in low fibrinogen states or factor VIII
deficiency.
 Indications Of Blood Transfusion
• 1. Improvement in Oxygen-Carrying Capacity.
• 2. Volume Replacement.
• 3. Replacement of Clotting Factors
 Massive Blood Transfusion

• It implies a single transfusion greater than

2500 mL or 5000 mL transfused over a period
of 24 hours.
• Hypovolemic shock secondary to hemorrhage
is the most frequent indication for massive
blood transfusion.
 Complications from a single
transfusion
1. Incompatibility haemolytic transfusion reaction
2. Febrile transfusion reaction.
3. Allergic reaction.
4. Infection:
– bacterial infection (usually due to faulty storage)
– hepatitis
– HIV
– malaria
5. Air embolism.
6. Thrombophlebitis.
7. Transfusion-related acute lung injury (usually from FFP).
 Complications from massive
transfusion
1. Coagulopathy.
2. Hypocalcaemia (citrate intoxication).
3. Hyperkalaemia.
4. Hypothermia.
5. Circulatory overload.
6. Acidosis.
7. Same as single transfusion.
 Repeated Blood Transfusion
• The human body has no active mechanism for the
excretion of iron.
• 1-2 mg/d of iron absorbed from the small intestine and
is balanced by the iron lost through sloughing of
intestinal mucosa and skin, as well as in the urine and
bile.
• A unit of blood contains a 250 mg of iron. In patients
who are transfusion dependent the excess iron
accumulates in various tissues, causes haemosidrohsis.
• Iron chelation therapy is used to prevent the
accumulation of iron to harmful levels.
 As doctors we do not
study to pass exams we
study for the day when
we are the only thing
between the patient
and the grave