BLOOD TRANSFUSION

BY

Dr. HASSAN TAHA

ANESTHESIA SPECIALIST

OBJECTIVES

History of blood transfusion

Purposes for blood transfusion

Function and properties of blood

Time of blood transfusion

Blood component

Properties and indication of transfusion for every one

Complications and management of blood transfusion

HISTORYHISTORY

The science of blood transfusion dates to the first decade of the 19th century, with the discovery of distinct blood types leading to the practice of mixing some blood from the donor and the receiver before the transfusion.

First blood transfusion was done by LOWER in 1665 from dog to dog

In 1901 Sir Austrian Karl Landsteiner discovered blood groups.

He was awarded nobel prize for this discovery in 1930.

BLOOD TRANSFUSION

It is a procedure in which a patient receives a blood product

through an intravenous line.

It is the introduction of blood components into the venous

circulation.

Process of transferring blood-based products from one

person into the circulatory system of another.

PURPOSES

To replace blood lost during surgery or a serious injury.

To restore oxygen-carrying capacity of the blood.

To provide plasma factors to prevent or treat bleeding.

Done if patient’s body is not capable of making blood

properly because of an illness or acute los of blood.

FUNCTION AND PROPERTIES OF BLOOD

A vehicular organ that perfuses all other organs

Blood and interstitial fluid deliver nutrients to cells and

remove wastes

Haemostatic governors are carried to and from

appropriate sites

Blood resembles an average 8% of body weight

FUNCTION OF BLOOD

• TRANSPORT:

suspended cells include RBCs that carry O2 , One

RBCs can carry 1 billion O2 molecule

Platelets that contributes to the haemostatic process ,

Chemicals dissolved in plasma (nutrients, waste,

hormones, etc)

metabolic heat for disposal

ONE cubic ml of blood contain 400.000 platelets

FUNCTION OF BLOOD

• REGULATION:

plasma contains pH buffers

plasma water absorbs heat

plasma solutes maintain osmolality

FUNCTION OF BLOOD

• PROTECTION:

plasma precursor proteins form blood clot when

stimulated

suspended WBCs attack bacteria and viruses ( body’s

defense )

plasma contains antibodies and opsonins for immunity

BEFOR TRANSFUSION WE MUST DETERMINE- W.H.A.T- FOR ANY PROCEDURE

Blood transfusions can be grouped into two main types

depending on their source:

Homologous transfusions, or transfusions using the

stored blood of others.

Autologous transfusions, or transfusions using one's own

stored blood.

BLOOD TRANSFUSIONBLOOD TRANSFUSION 

When Hb concentration falls below “acceptable” values When Hb concentration falls below “acceptable” values

and SaO2 is adequate, SVO2 or oxygen extraction ratio and SaO2 is adequate, SVO2 or oxygen extraction ratio

may be useful in predicting adequate tissue oxygenationmay be useful in predicting adequate tissue oxygenation

20% loss – no need20% loss – no need

20%-30% loss - plasma substitution20%-30% loss - plasma substitution

>30% - Blood transfusion >30% - Blood transfusion

WHENE BLOOD TRANSFUTIONWHENE BLOOD TRANSFUTION ( ( INDICATIONINDICATION))

.

FRESH WHOLE BLOODFRESH WHOLE BLOOD

Blood that has been drawn recently (within 24 hours) but Blood that has been drawn recently (within 24 hours) but

NOT separated into its components.NOT separated into its components.

Contains red blood cells, plasma, clotting cascade factors, Contains red blood cells, plasma, clotting cascade factors,

and plateletsand platelets

Anticoagulant (CPDA-1)-63mlAnticoagulant (CPDA-1)-63ml

Hct 35-45% . 1 Unit- 450mlHct 35-45% . 1 Unit- 450ml

Contents of fresh bloodfresh bloodo RBC’s RBC’s o WBC’sWBC’so Platelets Platelets o PlasmaPlasmao Clotting factorsClotting factors

If refrigerated within 8 hours of collection, store up to 5 days, If refrigerated within 8 hours of collection, store up to 5 days, the product only has RBCs and plasma as platelets become the product only has RBCs and plasma as platelets become non-viable at 4oC non-viable at 4oC Indications Acute loss of whole bloodAcute loss of whole blood Massive transfusionMassive transfusion Cardiovascular bypass surgeryCardiovascular bypass surgery

1. PACKED RED BLOOD CELL ( PRBCs )PACKED RED BLOOD CELL ( PRBCs )

(PRBCs) 1 unit contain (250 ml and Hct.70%)

Healthy, normovolemic individual, tissue oxygenation is

maintained and anemia tolerated at Hct as low as 18-25% (Hb

6gm%).

RBC transfusion is rarely indicated when Hb > 10 g/dl and is

almost always indicated when Hb < 6 g/dl.

Fastest way to increase the oxygen-delivering capacity of the blood. Fastest way to increase the oxygen-delivering capacity of the blood.

A unit of whole blood or packed red cells will raise the hematocrite A unit of whole blood or packed red cells will raise the hematocrite

by 3% and the hemoglobin by 1 gm/dlby 3% and the hemoglobin by 1 gm/dl

RBCs made and destroyed by a rate of 2-3 million per second .

D5W lyses RBC’s.

ONE cubic ml of blood contain 5 million of RBCsONE cubic ml of blood contain 5 million of RBCs

We have approximately 25-30 trillion RBCs in our blood at any

given time

Each RBCs has 250 million hemoglobin molecule

Every hemoglobin molecule can hold 4O2 molecule so one

RBCs can carry 1 billion O2 molecule

One cubic milliliter of blood has only 5.000-10.000 white

WBCs

Contents

RBC’s

20% Plasma

Indications

Replace O2 carrying capacity

with less volume

Severe anemia, slow blood loss, CHF

2. FFP ( initial therapeutic dose : 10-15 ml/kg )( initial therapeutic dose : 10-15 ml/kg )

4-5 units of FFP- in deterioration of normal hemostasis4-5 units of FFP- in deterioration of normal hemostasis

Stored at -30 C Stored at -30 C (shelf life of 12 months) . Thawed rapidly at 37 C. shelf life of 12 months) . Thawed rapidly at 37 C.

ONE unit increase coagulation factors 2-3 %ONE unit increase coagulation factors 2-3 %

Infused intravenously through a standard blood set with on-line Infused intravenously through a standard blood set with on-line

filterfilter

ABO group must be compatibleABO group must be compatible

Infusion of 1 unit should be complete within 4 hr of thawingInfusion of 1 unit should be complete within 4 hr of thawing

ContentsContentsClotting factors Clotting factors Fibrinogen Fibrinogen Prothrombin Prothrombin Albumin & GlobulinsAlbumin & Globulins

indicationindication

Isolated factor deficienciesIsolated factor deficiencies

Reverse warfarin therapyReverse warfarin therapy

Correction of coagulopathy associated with liver diseaseCorrection of coagulopathy associated with liver disease

Used in patients who are received massive blood Used in patients who are received massive blood

transfusion with microvascular bleeding transfusion with microvascular bleeding

Antithrombin III deficiencyAntithrombin III deficiency

TTP ( Thrombotic thrombocytopenic purpura )TTP ( Thrombotic thrombocytopenic purpura )

# # Do not use for volumeDo not use for volume

3. platelets

1 unit (50-70 ml, stored at +20 to +24c for 5 days) 1 unit (50-70 ml, stored at +20 to +24c for 5 days)

indicationindication

thrombocytopenia or dysfunction platelets in thrombocytopenia or dysfunction platelets in

the presence bleeding the presence bleeding

prophylactic : plt. counts below 10,000 to 20,000prophylactic : plt. counts below 10,000 to 20,000

prophylacticprophylactic preoperative : plt. counts below preoperative : plt. counts below 50,000 50,000

Microvascular bleeding in surgical patient Microvascular bleeding in surgical patient

with platelets < 50,000 with platelets < 50,000

Neuro/ ocular surgery > 75,000Neuro/ ocular surgery > 75,000

4. Cryoprecipitate 4. Cryoprecipitate Concentrate of factor VIII, von Willebrand’s factor and fibrinogenConcentrate of factor VIII, von Willebrand’s factor and fibrinogen

20 ml containing 150-300 mg of fibrinogen and 80-120 IU of factor VIII20 ml containing 150-300 mg of fibrinogen and 80-120 IU of factor VIII

Stored at -30 C (shelf life 12 month)Stored at -30 C (shelf life 12 month)

Also thawed at 37 CAlso thawed at 37 C

1U/ 10kg 1U/ 10kg fibrinogen 50 mg/dL (usually a 6- pack) fibrinogen 50 mg/dL (usually a 6- pack)

Transfusion should be complete within 4 hourTransfusion should be complete within 4 hour

indicationsindications Hemophilia AHemophilia A

Factor XIII deficiencyFactor XIII deficiency

Hypofibrinogenemia (congenital or acquired)Hypofibrinogenemia (congenital or acquired)

Microvascular bleeding (fibrinogen < 80-100mg/dL)Microvascular bleeding (fibrinogen < 80-100mg/dL)

Bleeding patients with vWDBleeding patients with vWD

Complication of Blood Transfusion

A. Immediate reactions

– Febrile reactionFebrile reaction– Allergic reactionsAllergic reactions– Hemolytic transfusion reactionHemolytic transfusion reaction– Circulatory over loadCirculatory over load– Air embolismAir embolism– Potassium toxicityPotassium toxicity– Citrate toxicityCitrate toxicity– Reaction due to infected blood Reaction due to infected blood

B-Delayed transfusion reactions

ThrombophlebitisThrombophlebitisinfectioninfection

-- AIDS (HIV) Hepatitis (HBV, HCV) AIDS (HIV) Hepatitis (HBV, HCV)

-- Syphilis (Treponema pallidum / Spirochetes) Syphilis (Treponema pallidum / Spirochetes)

-- Malaria , C.M.V & other Malaria , C.M.V & otherImmunological sensitization or alloimmunizationImmunological sensitization or alloimmunizationPost transfusion purpuraPost transfusion purpurahemolytic transfusion reactions (HTR)hemolytic transfusion reactions (HTR)Complication of massive transfusion Complication of massive transfusion

Hemolytic transfusion reactions (HTR)

• Incompatibility between donors and recipient

99% of causes is human error and preventable by•

Adequate knowledge of blood groupsAdequate knowledge of blood groups

Careful attention to all details of the techniquesCareful attention to all details of the techniques

- blood group incompatibility- blood group incompatibility

- outdated and infected blood - outdated and infected blood

- Haemolysed blood - Haemolysed blood

- Incorrect anticoagulant- Incorrect anticoagulant

Chills & rigorsChills & rigors

Chest painChest pain

Back painBack pain

Nausea, vomitingNausea, vomiting

Flushing, sweatingFlushing, sweating

Pain at infusion sitePain at infusion site

Abdominal discomfortAbdominal discomfort

Anxiety & RestlessnessAnxiety & Restlessness

Symptoms of hemolytic transfusion reactions Symptoms of hemolytic transfusion reactions

SignsSigns

Fever with rigorsFever with rigors

TachycardiaTachycardia

DyspnoeaDyspnoea

TachypnoeaTachypnoea

PallorPallor

HypotensionHypotension

HemoglobinuriaHemoglobinuria

Anuria / OliguriaAnuria / Oliguria

CyanosisCyanosis

Shock & DICShock & DIC

Unexplained bleeding Unexplained bleeding

Under anesthesia and sedationUnder anesthesia and sedation

Bleeding from wound / needle sitesBleeding from wound / needle sites

Persistent hypotensionPersistent hypotension

Tachycardia, hyperthermiaTachycardia, hyperthermia

Lab evidenceLab evidence

direct antiglobulin test ( DAT ) positivedirect antiglobulin test ( DAT ) positive

Indirect bilirubin increased Indirect bilirubin increased

HemoglobinemiaHemoglobinemia

HemoglobinuriaHemoglobinuria

ManagementManagement

Stop transfusion immediatelyStop transfusion immediately

Maintain IV access with crystalloid Maintain IV access with crystalloid

Maintain BP, pulseMaintain BP, pulse

Ventilation & oxygenationVentilation & oxygenation

IV diuretics - mannitol IVIV diuretics - mannitol IV

frusemide IV bolusfrusemide IV bolus

Send blood samples to blood bank-5ml of plain blood & Send blood samples to blood bank-5ml of plain blood &

2ml of EDTA blood2ml of EDTA blood

CBC and blood pictureCBC and blood picture

Urine sample for hemoglobinuriaUrine sample for hemoglobinuria

If intravascular hemolysis is confirmedIf intravascular hemolysis is confirmed

Monitor renal statusMonitor renal status

Monitor coagulation statusMonitor coagulation status

If Hb is markedly reduced ,compatible red cell transfusion If Hb is markedly reduced ,compatible red cell transfusion

may be required to combat hypoxemia.may be required to combat hypoxemia.

Treat DIC if it occursTreat DIC if it occurs

Don’ts for Blood TransfusionDon’ts for Blood Transfusion

Don’t use blood without mandatory screening test.Don’t use blood without mandatory screening test. Don’t delay initiation of blood transfusion.Don’t delay initiation of blood transfusion. Don’t warm blood without proper monitoring.Don’t warm blood without proper monitoring. Don’t transfuse 1 unit over more than 4 hours.Don’t transfuse 1 unit over more than 4 hours. Don’t use 1 transfusion set for >4 hours or >2 units of Don’t use 1 transfusion set for >4 hours or >2 units of

blood.blood. Don’t leave patients unmonitored.Don’t leave patients unmonitored. Don’t add any medication to blood bags.Don’t add any medication to blood bags. Don’t forget to return unused blood to the blood bank for Don’t forget to return unused blood to the blood bank for

safe disposal.safe disposal. Don’t store platelets in a refrigerator.Don’t store platelets in a refrigerator.