blood transfusion ppt

Medicine: 41 items Pedaitric: 55

Anemia: 8 itemsBleeding: 8 itemsMalignancy: 8 itemsPolycythemia: 2 ItemsHypercoagulable: 6 itemsBlood transfusion 6 itemsStem Cell: 3 items

Anemia: 12 itemsBleeding: 12 itemsMalignancy: 12 itemsPolycythemia: 3 itemsHypercoagulable : 4 itemsBlood transfusion: 7 itemsStem Cell: 3 items

Public Health 6 items

BLOOD TRANSFUSION BLOOD TRANSFUSION AND TRANSFUSION AND TRANSFUSION REACTIONREACTION

BLOOD SELECTIONBLOOD SELECTION

Blood GroupsBlood Groups

Phenotype(blood Type)

Genotype

Antibodies present in the blood serum

AIA IA

OrIA I

Anti B

BIB IB

OrIB I

Anti A

AB IA IB -

O ii Anti A and B

Blood GroupsBlood Groups

Rh group Rh antigen Rh antibody

Rh positive None

Rh negative Anti- D

Selection of BloodSelection of BloodRed cell transfusion

◦There must be ABO and Rh D compatibility between the donor’s red cells and the recipient’s plasma. Group A individuals can receive blood

from Group A and O donors Group B individuals can receive blood

from Group B and O donors

World Health Organization: Blood Transfusion Safety

Selection of BloodSelection of BloodRed cell transfusion

◦There must be ABO and Rh D compatibility between the donor’s red cells and the recipient’s plasma. Group O individuals can receive blood

from Group O donors only Group AB individuals can receive blood

from Group AB donors, and also from Group A, B and O donors


Selection of BloodSelection of BloodPlasma and Components

containing Plasma◦In plasma transfusion, group AB

plasma can be given to a patient of any ABO group because it contains neither anti-A nor anti-B antibody Group AB plasma (no antibodies) can be

given to any ABO group patients Group O plasma (anti-A + anti-B) can be

given to Group O patients only


Selection of BloodSelection of BloodPlasma and Components containing

Plasma◦In plasma transfusion, group AB

plasma can be given to a patient of any ABO group because it contains neither anti-A nor anti-B antibody Group A plasma (anti-B) can be given to

Group O and A patients Group B plasma (anti-A) can be given to

Group O and B patients


BLOOD BLOOD TRANSFUSIONTRANSFUSION

Blood Transfusion Blood Transfusion PracticePracticeTHE DECISION to transfuse, like

any other therapeutic decision, should be

based on the risks, benefits, and

alternatives oftreatment.

PRINCIPLES OF CLINICAL PRINCIPLES OF CLINICAL TRANSFUSION PRACTICETRANSFUSION PRACTICE Transfusion is only one part of

the patient’s management. Prescribing should be based

on national guidelines on the clinical use of blood, taking individual patient needs into account.

Blood loss should be minimized to reduce the patient’s need for transfusion.

The patient with acute blood loss should receive effective resuscitation (intravenous replacement fluids, oxygen, etc.) while the need for transfusion is being assessed

Transfusion should be prescribed only when the benefits to the patient are likely to outweigh the risks.

PRINCIPLES OF CLINICAL PRINCIPLES OF CLINICAL TRANSFUSION PRACTICETRANSFUSION PRACTICE The patient’s haemoglobin

value, although important, should not be the sole deciding factor in starting transfusion. This decision should be supported by the need to relieve clinical signs and symptoms and prevent significant morbidity or mortality

The clinician should be aware of the risks of transfusion-transmissible infections in the blood products that are available for the individual patient.

The clinician should record the reason for transfusion clearly.

Blood Products Blood Products (Definition of Terms)(Definition of Terms)Blood product

Whole blood

Any therapeutic substance prepared from human blood

Unseparated blood collected into an approved container containing an anticoagulant-preservative solution

Blood Products Blood Products (Definition of Terms)(Definition of Terms)Blood

component A constituent of blood,

separated from whole blood, such as: ◦ Red cell concentrate◦ Red cell suspension◦ Plasma◦ Platelet concentrates

Plasma or platelets collected by apheresis

Cryoprecipitate, prepared from fresh frozen plasma: rich in Factor VIII and fibrinogen

Blood Products Blood Products (Definition of Terms)(Definition of Terms)Plasma

derivativeHuman plasma proteins

prepared under pharmaceutical manufacturing conditions, such as:◦ Albumin◦ Coagulation factor

concentrates◦ Immunoglobulins

RED CELL RED CELL TRANSFUSIONTRANSFUSION

WHOLE BLOODWHOLE BLOOD(450 ml whole blood donation (450 ml whole blood donation contains:)contains:)Description Up to 510 ml total volume

(volume may vary in accordance with local policies)◦ 450 ml donor blood◦ 63 ml anticoagulant-

preservative solution Hgb approximately: 12 g/ml Haematocrit: 35%–45% No functional platelets No labile coagulation factors

(V and VIII)

WHOLE BLOODWHOLE BLOOD(450 ml whole blood donation (450 ml whole blood donation contains:)contains:) Infection risk Not sterilized, so capable of

transmitting any agent present in cells or plasma which has not been detected by routine screening for transfusion-transmissible infections, including HIV-1 and HIV-2, Hepatitis B and C, other hepatitis viruses, syphilis, malaria and Chagas disease

WHOLE BLOODWHOLE BLOOD(450 ml whole blood donation (450 ml whole blood donation contains:)contains:) Indications

Contraindications

Red cell replacement in Acute Blood Loss with Hypovolaemia

Exchange transfusion Patients needing red cell

transfusions where red cell concentrates or suspensions are not available

Risk of volume overload in patients with:◦ Chronic anaemia◦ Incipient cardiac failure

Ideal component for patients who have sustained acute hemorrhage of 25% total blood volume loss◦Provides both oxygen-carrying

capacity and volume expansion.

WHOLE BLOODWHOLE BLOOD(450 ml whole blood donation (450 ml whole blood donation contains:)contains:)Administratio

nMust be ABO and RhD

compatible with the recipient

Never add medication to a unit of blood

Complete transfusion within 4 hours of commencement

Transfusion should be started within 30 minutes of removal from refrigerator

RED CELL CONCENTRATE RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-(‘Packed red cells’, ‘plasma-reduced blood’)reduced blood’)Description 150–200 ml red cells from

which most of the plasma has been removed

Hgb approximately: 20 g/100 ml (not less than 45 g per unit)

Haematocrit: 55%–75%

RED CELL CONCENTRATE RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-(‘Packed red cells’, ‘plasma-reduced blood’)reduced blood’) Infection risk

Storage

Indications

Administration

Same as whole blood

Same as whole blood

Replacement of red cells in anaemic patients

Use with crystalloid replacement fluids or colloid solution in acute blood loss

Same as whole blood

RED CELL CONCENTRATE RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-(‘Packed red cells’, ‘plasma-reduced blood’)reduced blood’)3 mL PRBC/kg will raise

◦Hb by approximately 1 gm/dl ◦Hct by approximately 3%

In normal sized adult (70 kg) 1 unit PRBC will raise the ◦Hct by 3 - 4% or 1 gm/dl

RED CELL CONCENTRATE RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-(‘Packed red cells’, ‘plasma-reduced blood’)reduced blood’)Exchange transfusion

◦Term infants -- 80-160ml/kg◦Preterm infants-- 100-200ml/kg

Routine (neonates and children)◦10-20 ml/kgDesired Hct – actual Hct x weight (kg)Desired Hb – actual Hb x weight (kg) x 3

Red Cell TransfusionRed Cell TransfusionIncreases oxygen-carrying capacity

in the anemic patient. Adequate oxygenation can be

maintained with a Hemoglobin content of 70 g/L in the normo-volemic patient without cardiac disease; ◦Co-morbid factors often necessitate

transfusion at a higher threshold

Red Cell TransfusionRed Cell TransfusionThe decision to transfuse should be

guided by the clinical situation and not by an arbitrary laboratory value.

In the critical care setting, ◦Liberal use of transfusions to maintain near-

normal levels of hemoglobin may have unexpected negative effects on survival.

In most patients requiring transfusion◦Levels of hemoglobin of 100 g/L are

sufficient to keep oxygen supply from being critically low.

Red Cell TransfusionRed Cell Transfusion(Pediatric)(Pediatric)Transfusions may be given more

stringently to children because: ◦Normal hemoglobin levels are lower

in healthy children than in adults◦Children do not have the underlying

cardiorespiratory and vascular diseases that develop with aging in adults.

Red Cell TransfusionRed Cell Transfusion(Pediatric)(Pediatric)Children should be better able to

compensate for RBC loss. ◦In the peri-operative period, for

example, it is unnecessary for most children to maintain hemoglobin levels of 80 g/L or greater, a level frequently desired for adults.

Guidelines for Pediatric Red Blood Cell Transfusions

CHILDREN AND ADOLESCENTS INFANTS WITHIN THE FIRST 4 MO OF LIFE

Acute loss of >25% at circulating blood volume

Hemoglobin of <8.0 g/dL in the perioperative period

Hemoglobin of <13.0 g/dL and severe cardiopulmonary disease

Hemoglobin of <8.0 g/dL and symptomatic chronic anemia

Hemoglobin of <8.0 g/dL and marrow failure

Hemoglobin of <13.0 g/dL and severe pulmonary disease

Hemoglobin of <10.0 g/dL and moderate pulmonary disease

Hemoglobin of <13.0 g/dL and severe cardiac disease

Hemoglobin of <10.0 g/dL and major surgery

Hemoglobin of <8.0 g/dL and symptomatic anemia

THE DECISION TO TRANSFUSE THE DECISION TO TRANSFUSE SHOULD NOT BE BASED ON THE SHOULD NOT BE BASED ON THE HAEMOGLOBIN LEVEL ALONE, HAEMOGLOBIN LEVEL ALONE, BUT ALSO ON A CAREFUL BUT ALSO ON A CAREFUL ASSESSMENT OF THE PATIENT’S ASSESSMENT OF THE PATIENT’S CLINICAL CONDITION.CLINICAL CONDITION.

PLATELET PLATELET CONCENTRATESCONCENTRATES

PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsDescription

Unit of issue

Single donor unit in a volume of 50–60 ml of plasma should contain:◦ At least 55 x 109 platelets◦ <1.2 x 109 red cells◦ <0.12 x 109 leucocytes

May be supplied as either:◦ Single donor unit: platelets

prepared from one donation◦ Pooled unit: platelets

prepared from 4 to 6 donor units ‘pooled’ into one pack to contain an adult dose of at least 240 x 109 platelets

PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonations Infection risk

Storage

Same as whole blood, but a normal adult dose involves between 4 and 6 donor exposures

Bacterial contamination affects about 1% of pooled units

Up to 72 hours at 20°C to 24°C (with agitation)

Longer storage increases the risk of bacterial proliferation and septicaemia in the recipient

PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsIndications Treatment of bleeding

due to:◦Thrombocytopenia◦Platelet function

defectsPrevention of bleeding

due to thrombocytopenia, such as in bone marrow failure

Thrombocytopenia is a risk factor for hemorrhage, and platelet transfusion reduces the incidence of bleeding. ◦The threshold for prophylactic platelet

transfusion is 10,000/L. ◦ In patients without fever or infections, a

threshold of 5000/L may be sufficient to prevent spontaneous hemorrhage.

For invasive procedures, 50,000/L platelets is the usual target level.

Guidelines for Pediatric Platelet Transfusions

CHILDREN AND ADOLESCENTS INFANTS WITHIN THE FIRST 4 MO OF LIFE

PLTs < 50 × 109/L and bleeding

PLTs < 50 × 109/L and an invasive procedure

PLTs < 20 × 109/L and marrow failure with hemorrhagic risk factors

PLTs < 10 × 109/L and marrow failure without hemorrhagic risk factors

PLTs at any count, but with PLT dysfunction plus bleeding or an invasive procedure

PLTs < 100 × 109/L and bleeding

PLTs < 50 × 109/L and an invasive procedure

PLTs < 20 × 109/L and clinically stable

PLTs < 100 × 109/L and clinically unstable

PLTs at any count, but with PLT dysfunction plus bleeding or an invasive procedure

PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsContraindicati

ons Not generally indicated for

prophylaxis of bleeding in surgical patients, unless known to have significant pre-operative platelet deficiency

Not indicated in:◦ Idiopathic autoimmune

thrombocytopenic purpura (ITP)◦ Thrombotic thrombocytopenic purpura

(TTP)◦ Untreated disseminated intravascular

coagulation (DIC)◦ Thrombocytopenia associated with

septicaemia, until treatment has commenced or in cases of hypersplenism

PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsDosage 1 unit of platelet

concentrate/10 kg body weight: in a 60 or 70 kg adult, 4–6 single donor units containing at least 240 x 109 platelets should raise the platelet count by 20–40 x 109/L

Increment will be less if there is:◦ Splenomegaly◦ Disseminated intravascular

coagulation◦ Septicaemia

TRANSFUSION OF PLATELET CONCENTRATES

Dose units: Platelet concentrate from 1 donor unit (450 ml) of whole blood contains about 60 x 109/L

Dosage Volume Platelet concentrate•Up to 15 kg 1 platelet conc. 30–50 ml* 60 x 109 /L•15–30 kg 2 platelet conc. 60–100 ml 120 x 109 /L• >30 kg 4 platelet conc. 120–400 ml 240 x 109 /L

* For small infants, the blood bank may remove part of the plasma before transfusion

PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsAdministratio

n After pooling, platelet

concentrates should be infused as soon as possible, generally within 4 hours, because of the risk of bacterial proliferation

Must not be refrigerated before infusion as this reduces platelet function

Should be infused over a period of about 30 minutes

Do not give platelet concentrates prepared from RhD positive donors to an RhD negative female with childbearing potential

PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsComplications Febrile non-haemolytic and

allergic urticarial reactions are not uncommon, especially in patients receiving multiple transfusions

The goal of platelet therapy is to control or stop the bleeding. The clinical response is more important than the platelet count.

PLATELET CONCENTRATES

FRESH FROZEN FRESH FROZEN PLASMAPLASMA

FRESH FROZEN PLASMAFRESH FROZEN PLASMADescription Pack containing the plasma

separated from one whole blood donation within 6 hours of collection and then rapidly frozen to –25°C or colder

Contains normal plasma levels of stable clotting factors, albumin and immunoglobulin fibrinogen, Antithrombin, Proteins C and S. ◦ Factor VIII level at least 70% of

normal fresh plasma level

FRESH FROZEN PLASMAFRESH FROZEN PLASMAUnit of issue

Infection risk

Usual volume of pack is 200–300 ml

Smaller volume packs may be available for children

If untreated, same as whole blood

Very low risk if treated with methylene blue/ultraviolet light inactivation

FRESH FROZEN PLASMAFRESH FROZEN PLASMAStorage At –25°C or colder for up to

1 yearBefore use, should be

thawed in the blood bank in water which is between 30°C to 37°C.

Higher temperatures will destroy clotting factors and proteins

Once thawed, should be stored in a refrigerator at +2°C to +6°C

FRESH FROZEN PLASMAFRESH FROZEN PLASMA Indications Replacement of multiple

coagulation factor deficiencies:◦ Liver disease◦ Warfarin (anticoagulant)

overdose◦ Depletion of coagulation

factors in patients receiving large volume transfusions

Disseminated intravascular coagulation (DIC)

Thrombotic thrombocytopenic purpura (TTP)

Guidelines for Pediatric Plasma Transfusions

INFANTS, CHILDREN AND ADOLESCENTSSevere clotting factor deficiency and

bleeding Severe clotting factor deficiency and

an invasive procedure Emergency reversal of warfarin

effects Dilutional coagulopathy and bleeding

Anticoagulant protein (antithrombin

III, proteins C and S) replacement Plasma exchange replacement fluid

for thrombotic thrombocytopenic purpura

FRESH FROZEN PLASMAFRESH FROZEN PLASMAPrecautions Acute allergic reactions are

not uncommon, especially with rapid infusions

Severe life-threatening anaphylactic reactions occasionally occur

Hypovolaemia alone is not an indication for use

FRESH FROZEN PLASMAFRESH FROZEN PLASMADosage

Administration

Initial dose of 15 ml/kg

Must normally be ABO compatible to avoid risk of haemolysis in recipient

No compatibility testing required

Infuse using a standard blood administration set as soon as possible after thawing

Labile coagulation factors rapidly degrade; use within 6 hours of thawing

CRYOPRECIPITATECRYOPRECIPITATE

CRYOPRECIPITATECRYOPRECIPITATEDescription Prepared from fresh frozen

plasma by collecting the precipitate formed during controlled thawing at +4°C and resuspending it in 10–20 ml plasma

Contains about half of the Factor VIII and fibrinogen in the donated whole blood: e.g. ◦ Factor VIII: 80–100 iu/ pack;◦ Fibrinogen: 150–300 mg/pack

CRYOPRECIPITATECRYOPRECIPITATE Infection risk

Storage

As for plasma, but a normal adult dose involves at least 6 donor exposures

At –25°C or colder for up to 1 year

CRYOPRECIPITATECRYOPRECIPITATE Indications As an alternative to Factor

VIII concentrate in the treatment of inherited deficiencies of:◦ von Willebrand Factor (von

Willebrand’s disease)◦ Factor VIII (haemophilia A)◦ Factor XIII

As a source of fibrinogen in acquired coagulopathies: e.g. disseminated intravascular coagulation (DIC)

CRYOPRECIPITATECRYOPRECIPITATEAdministratio

n If possible, use ABO-

compatible productNo compatibility testing

requiredAfter thawing, infuse as

soon as possible through a standard blood administration set

Must be infused within 6 hours of thawing

CRYOPRECIPITATE-CRYOPRECIPITATE-DEPLETED PLASMADEPLETED PLASMA

CRYOPRECIPITATE-DEPLETED CRYOPRECIPITATE-DEPLETED PLASMAPLASMADescription Plasma from which

approximately half the fibrinogen and Factor VIII has been removed a cryoprecipitate, butwhich contains all the other plasma constituents

Transfusion ReactionsTransfusion Reactions

Immediate effects◦ Hemolytic reactions◦ Febrile reactions◦ Allergic reaction◦ Hyperkalemia◦ Circulatory overload◦ Reactions due to

Contaminated bld

Delayed Effects Hemolytic reaction Alloimmunization Infectious

complications Hemosiderosis

Transfusion ReactionsTransfusion ReactionsManifestations of Adverse

reaction◦Fever with or without chills

most common symptom of Hemolytic transfusion reaction

◦Chills with or with out fever◦Pain at the transfusion site or in the

chest, abdomen or flanks◦Blood pressure changes

Transfusion ReactionsTransfusion ReactionsManifestations of Adverse

reaction◦Blood pressure changes

Acute Hypertension Hypotension Circulatory shock in combination with

fever, severe chills and high-cardiac-output suggest -- Sepsis or HTR

Guidelines for the recognition acute Guidelines for the recognition acute transfusion reactionstransfusion reactions

Signs◦ Localized Cutaneous

reactions Urticaria Rash

Symptoms◦ Pruritus (itching)

Possible Cause◦ Hypersensitivity

(mild)

Category 1: MILD REACTIONS

Guidelines for the recognition of Guidelines for the recognition of acute transfusion reactionsacute transfusion reactions

Signs◦ Flushing◦ Urticaria ◦ Rigors◦ Fever◦ Restlessness◦ tachycardia

Symptoms◦ Anxiety◦ Pruritus◦ Palpatations◦ Mild Dyspnea◦ Headache

Category 2: MODERATELY - SEVERE REACTIONS Possible Cause

Hypersensitivity (mod-severe)

Febrile NHAb to WBCAb to

proteins such as IgA

Contamination with pyrogens and/or bacteria

Guidelines for the recognition of Guidelines for the recognition of acute transfusion reactionsacute transfusion reactions

Signs◦ Rigors◦ Fever◦ Restlessness◦ Tachycardia (rise

of >20% in heart rate

◦ Hypotension (fall of >20% in

systolic BP)◦ Haemoglobuniri

a (red urine)◦ Unexplained

bleeding (DIC)

Symptoms◦ Anxiety◦ Chest pain◦ Pain near infusion

site◦ Respiratory

distress/ shortness of breath

◦ Loin/ back pain◦ Dyspnea◦ Headache

Category 3: LIFE-THREATENING REACTIONS Possible Cause

Acute intravascular haemolysis

Bacterial contamination and septic shock

Fluid overload Anaphylaxis Transfusion

associated acute lung injury

Hemolytic reactionsHemolytic reactions

Non-immune mediated (physical destruction)◦Overheating-use of improvised blood warmers◦Forceful transfusion-pressure cuffs◦Small bore needles(?)◦Using same line for hypotonic solutions or drugs◦Bacterial growth in blood units

Hemolytic reactionsHemolytic reactionsNon-immune mediated (physical

destruction)◦Treatment

Depends upon the severity of reaction Severe reaction, hypotension, shock and

renal dysfunction -- Intensive management

Hemoglobinuria or Hemoglobinemia -- Supportive therapy

Hemolytic reactionsHemolytic reactionsImmune mediated

◦Patient Ab reacting with donor Ag◦Wrong blood given ◦Due to rxn with ABO, Rh, Lewis, Kelly◦Severity depends upon the amount

transfused (as small as 10-15ml)


◦The most dramatic and challenging adverse event of blood transfusion.

◦There is rapid destruction of blood cells. Most commonly occurs

Whole blood Packed red cell


Can also occur in Fresh frozen plasma Platelet concentrate Other plasma derived


◦Acute Hemolytic Transfusion Reaction Immediately after or with in 24 hours of a

transfusion Incidence: 1 in 12000 to 1 in 35000 transfusion Mortality: 1 in 100000 to 1 in 600000 transfusion


◦Delayed Hemolytic Transfusion Reaction Recognized 3 to 10 days after

transfusion

Hemolytic reactionsHemolytic reactionsImmune Mediated

Signs and Symptoms of Acute Immune MediatedFeverChills and rigorsAnxiety Feeling of dreadFacial flushingOliguria

DyspneaDiarrheaHypotensionHemoglobinuriaPallorIcterus


Signs and Symptoms of Acute Immune MediatedBack painFlank pain NauseaVomitingChest painAbdominal pain

AnuriaPain on the transfusion siteDiffuse bleedingJaundice


Signs and Symptoms of Chronic Immune MediatedFeverChills and rigorsPallorDiffuse bleeding

Jaundice OliguriaAnuria

Hemolytic reactionsHemolytic reactionsStop TransfusionSeverity depends on amount (as small

as 30ml)Maintain adequate systemic arterial

blood Pressure and tissue perfusion by

hydration Normal saline solution Prevent renal failure (100ml/hr urine

output/use of diuretics)

Hemolytic reactionsHemolytic reactionsVaso-active agents (dopamine)DIC – cryoprecipitate, plateletInvestigate

◦Blood typing◦Coomb’s test

If positive identify antibody responsible◦Urine hemoglobin◦Culture of the remaining blood

Febrile Non-Hemolytic Febrile Non-Hemolytic ReactionReactionDue to anti-leukocyte Antibody

against White cell and platelet of donor

Mild reaction rule out Hemolytic Transfusion

reaction bacterial contamination

Febrile Non-Hemolytic Febrile Non-Hemolytic ReactionReaction43% - 75% of all transfusion

reaction0.5% - 1.4% on non-leukocyte

reduced red blood cell15% recurrence rate

Febrile Non-Hemolytic Febrile Non-Hemolytic ReactionReactionFeverChills with no reason

◦Temperature increase of >1C associated with transfusion and without any other explanation

Febrile Non-Hemolytic Febrile Non-Hemolytic ReactionReactionTreatment

◦Antipyretics/steroids◦Antihistamines not indicated -- not

involve histamine release◦if frequent -- washed Rbc

Allergic Transfusion Allergic Transfusion Reaction Reaction A rare complication of transfusion of

blood components or plasma derivatives

Can occur in (most common):◦ Plasma rich blood component like

Platelet concentrate◦ FFP/Cryoprecipitate

Can also occur:◦ Packed red cells

Allergic Transfusion Allergic Transfusion Reaction Reaction The risk is increased by rapid infusion,

typically when fresh frozen plasma is used as an exchange fluid in therapeutic plasma exchange.

Cytokines in the plasma may be one cause of bronchoconstriction and vasoconstriction in occasional recipients.

Allergic Transfusion Allergic Transfusion Reaction Reaction Allergic transfusion reaction

◦ Due to binding of soluble substance in donor plasma with IgE antibodies release of histamine

Allergic Transfusion Allergic Transfusion Reaction Reaction Uncomplicated allergic transfusion

reaction ◦ 45% of all transfusion Reaction

Anaphylactoid reaction ◦ 1%-3% of transfusion

Anaphylaxis ◦ 0.002%-0.005% per transfused

product

Allergic Transfusion Allergic Transfusion Reaction Reaction Allergic transfusion reaction

◦ Urticaria (diffuse or local) ◦ Discontinue temporarily but need

not be stopped◦ Stopped if with other systemic

manifestation such as hypotension, GI manifestation

◦ Anti histamines

Allergic Transfusion Allergic Transfusion Reaction Reaction Anaphylactoid

reaction ◦ Mild form of:

Fever Chills Nausea Vomiting Diarrhea And/or

Urticaria

Anaphylaxis◦ Severe form (life

threatening◦ Fever◦ Chills◦ Nausea◦ Vomiting◦ Diarrhea ◦ And/or Urticaria

Allergic Transfusion Allergic Transfusion Reaction Reaction Anaphylaxis (life threatening) May include several systems

◦ Respiratory (cough, wheezing, chest tightness)

◦ GI (vomiting, diarrheas, nausea)◦ Circulatory (arrhythmias)

Ig A deficiency

Allergic Transfusion Allergic Transfusion Reaction Reaction Treatment

◦ Stop transfusion◦ Depends upon severity

Hypotension fluids, epinephrine Bronchospasm B2 agonist,

Theophyline

Post transfusion purpura Post transfusion purpura Thrombocytopenia 5 to 21 days Patient makes an alloantibody in

response to platelet antigens in the transfused blood that for a period of time (7-48days) causes destruction of autologous antigen-negative platelets.

Sign/Symptoms: Thrombocytopenia that is frequently profound, purpura, or bleeding

Post transfusion purpura Post transfusion purpura Treatment

◦ Platelet transfusion is of very little value - should be reserved for patients with active bleeding.

◦ Therapeutic plasma exchange may be beneficial.

Transfusion related Acute Transfusion related Acute Lung Injury Lung Injury Rare Mortality: 10% Abrupt onset of non cardiogenic

pulmonary edema◦Rapid failure of pulmonary function usually presents within 1 to 4 hours of starting transfusion, with diffuse opacity on the chest X-ray.

Transfusion related Acute Transfusion related Acute Lung Injury Lung Injury Presence of antibodies in the

donor plasma reactive to recipient leukocyte antigens

Production of inflammatory mediators during storage of cellular blood components

Transfusion related Acute Transfusion related Acute Lung Injury Lung Injury Symptoms

◦ Respiratory distress◦ Fever◦ Chills◦ Increased respiratory rate◦ Cough◦ Tachycardia

Transfusion related Acute Transfusion related Acute Lung Injury Lung Injury Most resolve within 72 hours Treatment

◦ Support (O2, ventilation) ◦ Severe cases may require assisted

ventilation with high FIO2.

Circulatory overload Circulatory overload Fluid overload can result in heart

failure and pulmonary edema.May occur when:

◦ Too much fluid is transfused◦ The transfusion is too rapid ◦ Renal function is impaired.

Fluid overload is particularly likely to happen in patients with:◦ Chronic severe anaemia◦ Underlying cardiovascular disease.

Circulatory overload Circulatory overload May complicate up to 1 in 100

transfusion Symptoms

◦ Dyspnea◦ Orthopnea◦ Cough◦ Tachycardia◦ Hypertension

Infectious Infectious Bacterial /Viral

◦Can occur in: Packed red cells Plasma rich blood component (most

common)Platelet concentrateFFP/Cryoprecipitate

Bacterial InfectionsBacterial InfectionsPacked red cells

◦2.6 per 100000 transfusions Symptoms

Temperature higher than 38.5RigorsHypotensionNausea Vomiting

Dyspnea DiarrheaShockOliguriaDIC

Bacterial InfectionsBacterial InfectionsPlatelet concentrate (common)8-80 per 100000 units transfused

(random) Symptoms

◦Symptoms may begin during or shortly after transfusion or begin up to 2 weeks after transfusion: Fever, Chills, Hypotension

Viral InfectionsViral Infections Hepatitis

◦ Hepatitis A Rare 1:1million

◦ Hepatitis B 1:63000

◦ Hepatitis C◦ Hepatitis D

Viral InfectionsViral Infections Human Herpes Infection

◦ CMV◦ EBV

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blood transfusion ppt