TRANSFUSION OF

BLOOD & BLOOD

PRODUCTS
 FRESH BLOOD COMPONENTS
 WHOLE BLOOD
 RED BLOOD CELL IN ADDITIVE
SOLUTION
 PLATELETS
 FRESH FROZEN PLASMA (FFP)
 CRYOPRECIPITATE
 PLASMA FRACTION
 HUMAN ALBUMIN
 PROTHROMBIN COMPLEX
CONCENTRATES
 IMMUNOGLOBULIN PREPARATION
(90% Ig G)
 RED CELL SEROLOGY
 ABO ANTIGENS
 RHESUS ANTIGENS (Rh)
 OTHER RED CELL ANTIGENS
• Kell antigens
• Duffy antigens
• Kidd antigens
 PRETRANFUSION TESTING
 TYPE AND SCREEN
 CROSS- MATCHING
 EMERGENCY REQUIREMENTS FOR
BLOOD
 ORDERING BLOOD IN AN
EMERGENCY
 Immediately take samples for cross-matching
 Inform the blood bank of the emergency,the
volume of blood required,and where blood is
to be delivered
 One individual should take responsibility for
all communications with the blood bank, and
should ensure that it is clear who will be
responsible for the blood delivery
 In cases of exsanguinations use emergency
group O Rh(D)-negetive blood.
 Do not ask for cross-matched blood in an
emergency
 BLOOD ADMINISTRATION
 Before administrating blood 2 staff members
(one of whom must be a doctor or trained
staff nurse) must check
• the patient’s full identity
• the blood pack,compatability label and report form
• the blood pack for signs of haemolysis or leakage
from the pack.
 Any discrepancies means that the blood must
not be transfused and that the laboratory
must be informed
 TRANSFUSION ERRORS
 Almost all deaths from transfusion reaction
are due to ABO incompatility
 Errors in patient identification at the time of
blood sampling or administration are the
major cause
 When taking the initial blood sample
• check the patient’s identity verbally and on the
wrist identification band
• label the sample fully before leaving the bedside
• make sure that the blood request form is clearly
and accurately completed.
 ADVERSE EFFECTS OF
TRANSFUSION
 ACUTE HAEMOLYTIC REACTIONS
 DELAYED HAEMOLYTIC REACTIONS
 FEBRILE NON-HAEMOLYTIC REACTION
 ALLOIMMUNIZATION
 ALLERGIC REACTIONS
 CARDIAC FAILURE
 GRAFT-VERSUS-HOST REACTION
 TRANSFUSION- ASSOCIATED LUNG INJURY
 IMMUNE MODULATION
 TRANSFUSION-TRANSMITTED INFECTIONS
 BACTERIAL INFECTIONS
 AUTOLOGOUS TRANSFUSION
 PREOPERATIVE DONATION
 ISOVOLAEMIC HAEMODILUTION
 CELL SALVAGE
TRANSFUSION REQUIREMENTS IN
SPECIAL SURGICAL SETTINGS
 MASSIVE TRANSFUSION
 THROMBOCYTOPENIA
 COAGULATION FACTOR DEFICIENCY
 HYPOCALACAEMIA
 HYPERKALEMIA & HYPOKALAMIA
 HYPOTHERMIA
 ADULT RESPIARATORY DISTRESS
SYNDROME (ARDS)
 MASSIVE BLOOD
TRANSFUSION
 This is defined as the transfusion of the equivalent
of the the circulating blood volume within a 24hour
period (in practice 10-20 units in an adult)
 Common identifications for massive blood
transfusion are major trauma, gastrointestinal
bleeding and obstetrics complications.
 Major problems associated with massive blood
transfusion include
• underlying coagulopathy
• thrombocytopenia
• lack of coagulation factor 5 & 8
• hyperkalaemia
• hypothermia
 METHODS TO REDUCE THE NEED
FOR BLOOD TRANSFUSION
 ACUTE VOLUME REPLACEMENT
 HYDROXYETHYL STARCH (HES)
 DEXRAN 70
 DEXTRAN40
 UREA-BRIDGED GELATIN
(HAEMACCEL
 MECHANISM FOR REDUCED
BLOOD USE IN SURGERY
 PREOPERATIVE
 * Surgery elective – Correct the Haemoglobin level.
 Stop drugs that interfere Haemostasis
 INTRAOPERATIVE
• Posture
• Use of Vasoconstrictors
• Use of tourniquets
• Use of anti-fibrinolytic drugs eg Aprotinin
• Using Fibrin Sealant
 POST OPERATIVELY
• Blood can be salvaged from drains into collection devices that permit reinfusion
• Decision to transfuse post operatively should depend
 * Age of the patient
 * Ability to tolerate lower levels of anaemia
 * Rate & amount of continuing blood loss
TRANSFUSION OF
BLOOD &BLOOD
PRODUCTS
Clinical Scenarios
 A 65 year old man has undergone a
left nephrectomy 3 days ago. He
required 3 units of packed cells intra-
operatively. He looks pale and is
dyspnoeic but his vital signs and
urinary output are satisfactory. You
check his FBP. Hb is 7 PCV 0.28.

 What would you do?

 A 34 year old man presents in the
resuscitation room of the A/E department.
He is anxious, short of breath, sweating
and his BP is 80 systolic, Pulse 120. There
is a stab wound on the right side of the
chest. A chest drain was inserted by the
SHO and 1000mls of blood drained
immediately.

 What would you do with respect to his

fluid
 A 57 year old man needs a left
hemicolectomy for carcinoma. He
declares himself to be a
Jehovah’s witness and refuses a
blood transfusion under any
circumstances.

 What will you do?