An adult human has about 46 liters of blood circulating

in the body. Among other things, blood transports oxygen

to various parts of the body.
Blood consists of several types of cells floating around in

a fluid called plasma.

Blood in History
China, 1000 BC
The soul was contained in the blood.
Egyptians bathed in blood for their health.
Pliny and Celsus describe Romans drinking the blood of
fallen gladiators to gain strength and vitality and to cure epilepsy.
Taurobolium, the practice of bathing in blood as it cascaded
from a sacrificial bull, was practiced by the Romans.

Animal to Human Transfusion

Early lamb blood transfusion

 A blood transfusion is the infusion of whole blood or a

blood component such as plasma, red blood cells, or

platelets into the patients venous circulation.

You may need it if you loose too much bood, such:

Injury or major surgery.
An illness that causes bleeding, such as a bleeding
ulcer.
An illness that destroys blood cells, such as hemolytic
anemia or thrombocytopenia.

PURPOSE OFBLOOD

 Cross matching is the process of dermining

compatibility between blood specimens

WHAT IS BLOOD GROUP ?

Bloood group is an inherited trait,is
determined by the type of antigens
and antibodies present in the blood

BLOOD TYPES
A - B - AB - O

BLOOD GROUP

ANTIGEN

antigen

AB

A+B

antigens

antigen

Negative

RH
Positive

WHAT IS ANTIGENS ?
An antigens is a substance that
causing the formation of antibodies
WHAT IS ANTIBODYS ?
Antibodies is a protein substance
develop in the body in response to
the presence of an antigen that has
entered the body

Life Saving &

Life Threatening Process

 Hemolytic transfusion reaction

Febrile non hemolytic transfusion reaction

Alergic reaction
Allo immunization
Graft versus host response
Infection
Bacteria
Volume overload

Iron toxicity
Acute transfusion-related acute lung injury (TRALI)

 Malaria

Chagas disease
West nile virus
Variant Creutzfeldt-Jakob disease

 Hep B

1: 140,000
Hep C
1: 225,000
Hep A
1: 1,000,000
HIV
1: 1,500,000
HTLV
1: 650,000
Bacterial
1: 1,000,000
Malaria
1: 1,000,000
Syphylis
1: 1,000,000

 Mistransfusion rate
1 : 14.000 US
1 : 28.000 UK

Half in the clinical arena and 30 % in the laboratory

 Transfusion of mis-matched ABO cells

1: 35,000
ABO incompatible death rate
1:600,000
Transfusion of red cells to wrong patient
1: 17,000
Transfusion of pre-deposited blood to wrong

patient
1:20,000

 The only true indication for red cell transfusions is a

need to rapidly increase the delivery of oxygen to the

tissues

 Hb > 10 Gr % rarely require transfusion

Hb < 7 Gr% frequently require blood transfusion

NIH Consensus Conference. JAMA 1988; 260:2700 - 2706

 Hgb > 10 gr% rarely indicated

Less than < 6 g/dl almost always indicated

6 10 g/dl based on patient risk

Anesth 1996;84: 732 - 747

 Platelet Transfusion Indication

Bone marrow failure

Autoimmune thrombocytopenia
Alloimmune thrombocytopenia
Abnormalities of platelet function
Dilutional thrombocytopenia
Cardiopulmonary bypass surgery

Contraindications to platelet transfusions

thromboticthrombocytopenic purpura
haemolytic uraemic syndrome
heparin-induced thrombocytopenia

 Granulocyte Transfusion Indication

Bone marrow failure caused by disease or myelotoxic treatment
Abnormal neutrophil function and persistent infection

 To increase the level of clotting factor

It is abnormal signs and

symptoms that will occur during
or after transfusion and effects
the patiens health

Acute Reaction

Allergic

Causes
Sensitivity to
plasma
protein or
donor
antibody,
which reacts
with
recipient
antigen

Clinical
Mainifestations

Management

Flushing
STOP TRANSFUSION
itching ,rash
IMMEDIATELY
urticaria, hives
asthmatic
KEEP VEIN OPEN WITH NS
wheezing
laryngeal
Notify doctor , infection
edema
control, blood bank
anaphylaxis
Give antihistamine as
directed.
Send blood samples and blood
bags to blood bank. Collect
urine samples for testing.

Prevention
ASSESSMENT
Before transfusion ask the patient
About past reaction
Have emergency drugs ( Bed Side)

Acute Reaction

Causes

Clinical

Management

Mainifestations

hypersensitivity to
donor white blood
cells , platelets, or
plasma protein

Febrile
non hemolytic

Flushing
sudden
chills
and fever
headache
anixiety

STOP TRANSFUSION
IMMEDIATELY
KEEP VEIN
OPEN with NS
Notify doctor , infection
control, blood bank
Give antipyretics as
directed.
Check temperature every
1/2hrs.or as indicated
send blood samples and
blood bags to blood
bank
Collect urine samples for
testing.

Prevention
ASSESSMENT

Give antipyretic before

transfusion as directed
Leukocyte poor blood
products may not be
recommended for future
transfusion

Acute
Reaction

Septic
reactions

Causes

Clinical

Management

Mainifestations

Transfusion of
blood or blood
components
contaminated with
bacteria

STOP TRANSFUSIOM
rapid onset of IMMEDIATEL
chils
High fever
KEEP VEIN OPEN
Vomiting ,
with NS
diarrhea
Notify doctor , infection
Marked
control, blood bank
hypotension
give antipyretics as
directed.
check temperature every
1/2hrs.or as indicated
obtain cultures of
patients blood
return blood bags &
blood set to blood bank.
treat septicemia as
directed ( IV fluids.
Antibiotics...

Prevention
Do

not permit blood to stand at

room temperature longer than
necessary.
Warm temperatures promote bacterial
growth.
Inspect blood for gas bubbles,
clotting or abnormal color.

Acute
Reaction

Circulatory
overload

Causes

Clinical

Management

Mainifestations

Fluid
administreted at a
rate or volume
greater than the
circulatory system
can accommodate .
Increased blood in
pulmonary vessels
and decreased lung
compliance.

rise in venous
pressure
distended neck
veins.
Dyspnea
Cough
Crackles at base
of lunges

STOP TRANSFUSIOM
IMMEDIATEL
KEEP VEIN OPEN
with NS
Notify doctor ,
infection control, blood
bank
place patient upright
with feet in dependent
posision.
administer prescribed
diuretic, oxygen,
morphine , and
aminophylline.

Prevention
concentrated blood products
should be given whenever
positive.
transfuse at a rate within the
circulatory reserve of the
patient.
monitor central venous
pressure of patient with heart
disease.

Acute Reaction

Hemolytic
reaction

Causes
Infusion of incompatible
blood product.
Antibodies in
RECIPIENTS
plasma
DONORS RBCs

Incompatible
PLASMA
OR

Antibodies in DONOR
plasma
RECIPIENTS RBCs

Incompatible
RBCs

Clinical
Mainifestations
chills, fever
lower back pain
feeling of head fullness,
flushing
oppressive feeling
Tachycardia,tachypnea
hypotension,vascular
collapes
hemoglobinurea,hemog
lobinemia
bleeding
acute renal failure

 MANAGEMENT

PREVENTION

STOP TRANSFUSION

Verify patient identification from

sample collection to product
infusion.
Begin infusion slowly and
observe closely for 30 min

KEEP VEIN OPEN with 0.9% saline.

Notify doctor , infection control,
blood bank
Treat shock if present
Draw testing samples, collect
urine samples.
Maintain blood pressure with IV
colloid solutions.
Administer prescribed diuretic,to
maintain blood flow, glomerular
filtration, and renal blood flow.
Monitor urin output.
Patient may require dialysis if
renal failure occur

DELAYED
REACTION

Delayed
hemolytic
reaction

Causes

Clinical

Management

Mainifestations
The destruction of
transfused flood cells
by antibody not
detect

Fever
Mild jaundice
Decreased
hematocrit

Generaly no acute
treatment is required, but
hemolysis may be enough
to cause shock and renal
falure

PREVENTION
The crossmatch blood sample should be drawn
within 3 days of blood transfusion. antibody
Formation may occur within 90 days of
transfusion

DELAYED
REACTION

Iron
overlood

Causes

Clinical

Management

Mainifestations
Deposition of iron in
the heart, endocrine
organs,liver,spleen,skin
and other major organs
as a result of multiple,
long tearm transfusion
.

Diabetes
Decreased thyroid
function
Heart failure and
other symptoms
related to major
organ failure

NO PREVENTION

Treat symptomatically
deferoximine which
removes accumulated iron
through the kidneys. I.VI.M-S.C

DELAYED
REACTION

CLINICAL
CAUSES

Elevated liver enzymes

Anorexia, malaise
Nausea and vomiting
Fever
Dark urine
Jaundice

Hepatitis B

Hepatitis C

AIDS

MAINIFESTATIONS

INFECTED
BLOOD
PRODUCT
S

Elevated liver
enzymes
Chronic liver disease
and cirrhosis may
develop

MANAGEMENT
Treat symptomatically
as instructed by
doctors

Treat symptomatically
as instructed by
doctors

Night sweats
As instructed by
Unexplained weight loos doctors
Diarrhea
Etc

DELAYED
REACTION

Syphilis

Malaria

CLINICAL
CAUSES

INFECTED
BLOOD
PRODUCTS
INFECTED
BLOOD
PRODUCTS

MAINIFESTATIONS

MANAGEMENT

Generalized rash
Penicillin therapy
Regional
lymphadenopathy
Presence of chancre
Fever
Fatigue
Hepatomegaly
Splenomegaly

Rest and supportive

management

PREVENTION OF DELAYED REACTION

Proper blood screening

In case of malaria donor should be asked if he has
cold,flu or foreign travel

GENERAL
CONCIDERATIONS
TO
PREVENT BLOOD
TRANSFUSION
REACTION

DONORS
Blood donors must be selected with care.
Donors should be healthy & free of diseases.
Donors should be examined carefully at the
time of donation.
Blood donated from people who have allergies
or those with a history of a chronic diseases,
such as tuberculosis, certain types of cancer,
and hemophilia, is usually not used.

For precaution some blood banks dont

accept blood from a donor who has
been recently immunized because of a
possible allergic reaction

Individuals may give blood only if their

blood count, temperature, pulse,
respiration, blood pressure, and weight
are within normal range

LABORATORY
Blood screening for
infectious diseases.
Proper storage (4 C)
Antibody screening
Blood compatibility -RH
To protect the donor from
possible risks of donation
and protect the patient
from the risk of transfusion

PATIENT
Previous allergic reaction
Consent
Name and phone number of a
contact person in case of emergency

DOCTOR
The physicians order should specify
Blood component, volume, and
rate of transfusion

NURSE
Only trained and qualified nurses are
allowed to perform the
blood transfusion steps

NURSE
Sending blood sample for cross
matching with CLEAR and CORRECT
Patient name, file number, room number,
age, sex, department, bed number,
date,time,nurse name and signature

NURSE
BEFORE receiving blood
Doctor order
Consent
Patient assessment
Premedicate the PT.30min. before
transfusion for TABs & before transfusion is
initiated for IV