Blood transfusion and

blood products
• Blood transfusion

• consists of the ‘safe’ transfer of blood

components from a donor to a recipient.

• Blood donor

• contribute on a voluntary basis and this is

generally preferable in terms of product
safety.
The preparation of blood
components from whole blood
The measures to
protect donors and
for donor selection
are:
Red cell antigens and blood group
antibodies
• the clinical significance of blood groups in blood
transfusion is that individuals who lack a particular
blood group antigen may produce antibodies
reacting with that antigen which may lead to a
transfusion reaction.
Cont. ….

• approximately 400 red blood cell group antigens have

been described.
• the different blood group antigens vary greatly in their
clinical significance with the ABO and Rh (formerly
Rhesus) groups being the most important.
Hazards of allogeneic blood transfusion

• Infection

• donor selection and testing of all donations are

designed to prevent transmission of diseases,
Viruses (HIV, HBV, HCV),
Bacteria (Treponema pallidum (syphilis)),
Protozoa (Plasmodium spp. (malaria))
Techniques in blood group serology

• the most important technique is based on the

agglutination of red blood cells.
• Saline agglutination is important in detecting IgM
antibodies, usually at room temperature or at
4°C (e.g. anti‐A, anti‐B).
Cont. ….

• Antiglobulin (Coombs’) test is a fundamental and

widely used test in both blood group serology and
general immunology.
• the antiglobulin test may be either direct or indirect.
Direct Antiglobulin Test (DAT)

• used for detecting antibody or complement already

on the red cell surface where sensitization has
occurred in vivo.
• the AHG reagent is added to washed red cells and
agglutination indicates a positive test.
• positive test occurs in hemolytic disease of the
newborn, autoimmune or drug‐induced immune
hemolytic anemia and hemolytic transfusion
reactions.
Indirect Antiglobulin Test (IAT)

• used to detect antibodies that have coated the red

cells in vitro.
• It is a two‐stage procedure: the
first step involves the incubation of test red cells with
serum
second step the red cells are washed and the AHG
reagent is added.
Cont. ….

• this test is used :

• as part of the routine antibody screening of
the recipient’s serum prior to transfusion
• for detecting blood group antibodies in a
pregnant woman.
The antiglobulin test for
antibody or complement on the
surface of red blood cells (RBC).
The antihuman globulin
(Coombs’) reagent may be
broad spectrum or specific for
immunoglobulin G (IgG), IgM,
IgA or complement (C3).
Cross‐matching and Pre‐transfusion
Tests
• a number of steps are taken to ensure that patients
receive compatible blood at the time of transfusion.
• From the patient
1. the ABO and Rh blood group is determined.
2. serum is screened for important antibodies by an
indirect antiglobulin test on a large panel of
antigenically‐typed group O red cells.
Cont. ….

• From the donor

an appropriate ABO and Rh unit is selected.

The Cross‐match

• techniques used in compatibility testing.

• donor cells tested against recipient serum and
agglutination detected visually or
microscopically after mixing and incubation at
the appropriate temperature.
Blood components

• blood donation is taken by an aseptic technique

into plastic bags containing an appropriate amount of
anticoagulant, usually citrate, phosphate,
dextrose (CPD).
• its total volume is about 400 ml (350 ml of blood + 49
ml of anticoagulant).
Whole blood

• one unit of blood collected in a suitable anticoagulant

solution contain:

• haematocrit 35–45%
• haemoglobin 12.0 g/dl
• non functionally effective platelets
• no labile coagulation factors
Cont. ….

storage temperature:
• 2–6°C in appropriate blood bank
refrigerator

shelf-life:

35 days (in CPDA-1)

Cont. …..

Indication:

• acute massive blood loss,

• exchange transfusion,
• non-availability of packed red cells.

risk of volume overload in patients with chronic

anemia and compromised cardiovascular function.
Packed red cells (Red cell concentrate)

• red cells from which most of plasma has been

removed

• haematocrit 55–75%
• haemoglobin 20 g/dl
• haemoglobin raises by 1 g%
or haematocrit by 3%
Cont. ….

• storage temperature:

2°–6°C and shelf-life 35 days (in CPDA)

• volume:

250 ml
Cont. ….

• indication:

replacement of red cells in anemia and in

acute/massive blood loss (along with
crystalloid or colloid)
Platelets

• obtained either from:

single donor units of whole blood by centrifugation
plateletpheresis

• platelets prepared from whole blood donation are

supplied either as a single unit or as a pooled unit.
Cont. ….

• platelets obtained from 4–6 donor whole blood units

are ‘pooled’ together in one bag.
• platelets obtained from plateletpheresis are supplied as
one pack of single donor platelets.
Cont…….

• storage:

20–24°C with constant agitation up to 72 hours.

• common indications:
• thrombocytopaenia due to decreased platelet
production and hereditary platelet function
defect.
Fresh frozen plasma

• plasma separated from whole blood within 6 hours

of collection and then rapidly frozen to –25°C or
lower
• contains all the coagulation factors
• storage:
• at –25°C or lower up to 1 year
Cont. ….

• volume:
• 200–300 ml

• indications:
• multiple coagulation factor deficiencies (liver
disease, warfarin overdose),
• disseminated intravascular coagulation
massive blood transfusion
Cryoprecipitate

• cryoprecipitate is prepared by slowly thawing 1 unit

of FFP at 4° to 6°C, plasma and a white precipitate
are obtained.
• after centrifugation, most of the supernatant plasma
is removed leaving behind sediment of cryoprecipitate
suspended in 10 to 20 ml of plasma.
Cont. ….

• the unit is then refrozen (–25°C or colder) for

storage and can be kept for 1 year at this
temperature.
• when required for transfusion, cryoprecipitate is
thawed at 30° to 37°C and then kept in the
refrigerator at 2° to 6°C till transfusion
Cont…….

• cryoprecipitate contains:
• F VIII (about 80 units)
• von Willebrand factor
• Fibrinogen
• F XIII
• Fibronectin.
Cont. ….

• if specific factor concentrates are not available,

cryoprecipitate can be used for treatment of:
F VIII deficiency,
Von Willebrand disease,
F XIII deficiency,
Hypofibrinogenaemia.
 • Blood components:
(a) plasma‐depleted red cells.
a b (b) platelets.
(c) fresh frozen plasma.

c
Blood Derivatives

• blood derivatives are manufactured by fractionation of

large pools of human plasma.
1. Human albumin solutions
2. F VIII concentrate
3. F IX concentrate
4. Prothrombin complex concentrate
5. Immunoglobulins
Autologous donation and transfusion

• anxiety over HIV and other infections has increased

the demand for auto‐transfusion.
• there are three ways of administering an autologous
transfusion:
Predeposit
blood is taken from the
potential recipient in the
weeks immediately prior to
elective surgery.
 blood is removed
Haemodilution
immediately prior to surgery
once the patient has been
anaesthetized and then
reinfused at the end of the
operation
Salvage
blood lost during the
operation is collected during
heavy blood loss and then
reinfused.
Complication of blood
transfusion
• blood transfusion is a life saving but a potentially
hazardous procedure.
• it should be considered only if there are no alternative
means (like intravenous fluids, specific treatment of
anemia) of treating the condition.
Cont.…….

• benefits of blood transfusion include:

 improvement of oxygen-carrying capacity

replacement of coagulation factors, platelets,
immunoglobulins and other proteins.
Adverse effects of transfusion are:
Complications associated with massive blood
transfusion:
• massive blood transfusion refers to the
replacement of patient’s blood loss with
transfusion of stored blood equivalent to total
blood volume within 24 hours.
Cont.…..

• storage of blood at 2 to 6°C for 48 hours is

associated with loss of platelet function and loss of
labile coagulation factors (F V and F VIII), therefore,
rapid infusion of large volumes of stored blood
will lead to dilution of platelets and coagulation
factors.
Cont…….
• Hyperkalaemia (due to release of potassium from
stored red cells).
• Hypocalcaemia (due to binding of calcium by citrate
anticoagulant).
• Hypothermia (due to rapid infusion of large quantity
of cold blood) can induce cardiac arrhythmias
• Microaggregates composed of platelets and
leucocytes form gradually in stored blood, these
microaggregates can migrate to the lungs and induce
adult respiratory distress syndrome.