BLOOD TRANSFUSION PR

INTRODUCTION
The Process of blood Transfusion Is defined as receiving blood pro

Intravenously. This is usually done as a life saving manoeuvre to re

Products lost through sever bleeding, during surgery when sever b

the blood count in an anemic patients. One's blood transfusion inv

red blood cells, white blood cells, plasma, clotting factors and plat
BLOOD GROUPS AND CROSS-M
Red blood cells have many different antigens on their cell surface tw
practice the ABO and the rhesus systems.
❖ the ABO system: these are strongly antigenic and associated with n
the serum.
❖ it consist of 3 allelic genes A,B and O. the A and B contains specific
provoke a reaction if a mix happens while the O group has no antige
antibodies
BLOOD GROUPS AND CROSS
❖ Rhesus system:
• the rhesus D antigen is strongly antigenic and present in the majori
• antibodies to the "D" antigen unlike the ABO system are not natural
sensitised by the transfusion of RH+ red blood cells or may be acqu
baby by a RH- mother.

•
 SAFE TRANSFUSION ME
❖ Positive patient identification.
Positive patient identification at all stages of the transfusion process is esse
are:
• Last name, first name, date of birth, unique identification number.
• Whenever possible ask patients to state their full name and date of birth
identify themselves (paediatric, unconscious, confused or language barri
from a parent or carer at the bedside. This must exactly match the inform
equivalent).
• All paperwork relating to the patient must include, and be identical in eve
identifiers on the identity band.
❖ Patient information and consent for transfusion
Where possible, patients (and for children, those with parental responsibility
and alternatives to transfusion explained to them in a timely and understand
patient information, such as national patient information leaflets, should be u
❖ Blood groups and blood group antibodies
❖ Screening for infectious agents
At each donation, the following mandatory tests are performed:
• Hepatitis B – HBsAg
• Human immunodeficiency virus – anti-HIV 1 and 2 and HIV nAT (nucleic acid
• Hepatitis C – anti-HCV and HCV nAT
• Human T-cell lymphotropic virus – anti-HTLV I and II
• Syphilis – syphilis antibodies.
Some donations are tested for cytomegalovirus (CMV) antibodies to provide CM
patients with certain types of impaired immunity .
Additional tests, performed in special circumstances, include:
• Malarial antibodies
• West nile Virus antibodies
• Trypanosoma cruzi antibodies.
❖ Requests for transfusion
Must include:
• Minimum patient identifiers and gender
•Diagnosis, any significant co-morbidities and reason for transfusion
•Component required, volume/number of units and special requirements
•Time and location of transfusion
• Name and contact number of requester.
❖ Administration to patient
• The final check must be conducted next to the patient by a trained and co
professional who also administers the component.
• All patients being transfused must be positively identified.
• Minimum patient identifiers on the patient’s identity band must exactly
match those on blood component label.
• All components must be given through a blood administration set (170–20
• Transfusion should be completed within 4 hours of leaving controlled tem
❖ Monitoring the patient
Patients should be under regular visual observation and, for every unit transf
should include:
• Pre-transfusion pulse (P), blood pressure (BP), temperature (T) and respira
• P, BP and T 15 minutes after start of transfusion – if significant change, chec
• If there are any symptoms or signs of a possible reaction – monitor and reco
appropriate action.
• Post-transfusion P, BP and T – not more than 60 minutes after transfusion c
• Inpatients observed over next 24 hours and outpatients advised to report lat
to clinical advice).
❖ Completion of transfusion episode
• If further units are prescribed, repeat the administration/identity check with e
• If no further units are prescribed, remove the blood administration set and e
documentation is completed.
MASSIVE TRANSFUSION
The replacement of a large volume of blood in response to massive

Criteria of massive hemorrhage

• loss of more than 1 blood volume within 24 hours

• loss of 50% of the total blood volume within 3-4 hours
• bleeding rate of more than 150 mL/minute
• bleeding that leads to significant hypotension (SBP < 90 mmHg) a
minute).
MASSIVE TRANSFUSION
Criteria of massive transfusion

Complete replacement of a patient's blood volume (∼ 10 units of RB

Replacement of ≥ 50% of a patient's blood volume (∼ 5 units of RBC

Blood loss replacement at a rate of > 150 mL/minute

Transfusion of ≥ 3 units of pRBCs within 1 hour

RISKS
❖ Massive transfusion-associated complications:
• Acidosis
• Hypothermia
• Coagulopathy
• Electrolyte imbalances
• Citrate toxicity
• Transfusion-related lung injury
• Transfusion-associated circulatory overload

Judicious use of blood products to avoid over-transfusion is the bes

transfusion-associated complications!
MASSIVE TRANSFUSION PROTO
• Goal: prevent the risks of massive transfusion
• Clinical application: trauma, major surgery, obstetric complicatio

• Initial approaches : prior to laboratory results.

A. Fixed ratio approach : Transfusion of RBCs, FFP, and platelets at
B. Whole blood approach: Used as an alternative to the fixed ratio ap

• Targeted transfusion regimen : consider once laboratory results

hemostatic control is achieved.

• Requires frequent laboratory monitoring (e.g., every 1–2 hours)

• Thresholds and dosing vary by local protocols
MASSIVE TRANSFUSION PROTOC
 MASSIVE TRANSFUSION PROTOCO
Activate the MTP, following local hospital guidance.



Start monitoring, including continuous telemetry. 



Place 2 large-bore peripheral IV cannula . 



Obtain routine baseline massive transfusion studies, including CBC,
ionized calcium, BMP, and blood gases.



Consider using point-of-care thromboelastography if available.



Start transfusing blood through blood-warming equipment.



Regularly reassess the patient to assess for signs of fluid overload an


Repeat massive transfusion studies, including arterial blood gases, a
EMERGENCY TRANS
• Emergency-release blood components can be issued from the
minutes but are associated with an increased risk of hemolytic
reactions.

• Unknown recipient blood type: Give universal donor blood prod

products that could potentially be safely transfused to any reci
of their ABO blood type, including blood type O negative packe
type AB plasma, and blood type AB platelets)

• Known recipient ABO type and Rhesus status: Give type-specifi

products.

• emergency transfusion can occur prior to pretransfusion testing

uncrossmatched products.
 BLOOD PRODUCT SELEC
• Unknown recipient blood type

◦ pRBCs: Uncrossmatched blood type O (universal RBC donor) pR

possible)
◦ FFP: Blood type AB (universal plasma donor) FFP
◦ Platelets: Ideally use blood type AB platelets (preferably Rh(D)-ne
blood type may be used.

• Known recipient blood type

◦ pRBCs: Uncrossmatched ABO and RhD-compatible pRBCs

◦ FFP: ABO-compatible FFP
◦ Platelets
▪ ABO-compatible platelets are preferred but platelets of any bloo
▪ Rh(D)-negative platelets are preferred for Rh(D)-negative recipie
COMPLICATION OF BLOOD TR
Complications from a single transfusion
Complications from a single transfusion include:
• incompatibility haemolytic transfusion reaction
• febrile transfusion reaction
• allergic reaction
• infection
– bacterial infection (usually due to faulty storage) hepatitis
– HIV
– malaria
• air embolism
• thrombophlebitis
• transfusion-related acute lung injury (usually from FFP).
 COMPLICATION FROM MASSIVE TRA
Complications from massive transfusion include:
• coagulopathy
• hypocalcaemia
• hyperkalaemia
• hypokalaemia
• hypothermia.
In addition, patients who receive repeated transfusions over long pe
with thalassaemia) may develop iron overload. (Each transfused uni
approximately 250 mg of elemental iron.)
 Reaction cause Clinical signs

1.d
imm
2.N
Pro
Hemolytic reaction: Chills , fever, headache ,backache, 3.m
incompatibility between client’s dyspnea ,chest pain ,tachycardia, 4.m
s blood and donor’s blood hypotension out
5.s
bag
clie
lab
Reaction cause Clinical signs

1.s
dep
Flushing, itching, urticaria,
Allergic reaction (mild ) 2.N
bronchial wheezing
3.a
ord

1.s
2.k
sal
3.n
Dyspnea, chest pain ,circulatory
Allergic reaction (sever) imm
collapse, cardiac arrest
4.m
CP
5.a
oxy
 Reaction cause Clinical signs

1.d
imm
Fever , chills, warm and flushed
Febrile reaction 2.g
skin , headache,anxiety, muscle
3.n
pain
4.k
sal
 Reaction cause Clinical signs

1.
2.
no
Sepsis:contaminated blood High fever ,chills,vomiting,diarrhea, 3.
transfusion hypotension 4. A
5.
the
6.
tub
 Reaction cause Clinical signs

1.
Circulatory overload : fee
Cough, dyspnea, crackles (rales),
Blood administered faster than 2. S
distended neck veins, tachycardia,
The circulation can accommodate 3.
hypertension
4.
as
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