BLOOD TRANSFUSION

DR. SAIMA MINHAS

A S S O C I AT E P R O F E S S O R , PAT H O L O G Y
D O W U N I V E R I T Y O F H E A LT H S C I E N C E S

BDS
 LECTURE OBJECTIVES

• At the end of the lecture, student should learn about:

• aim of blood transfusion
• products prepared from a whole blood unit
• infectious diseases tested on blood products
• steps in a transfusion
• blood transfusion reactions, and their
pathogenesis
 AIM OF BLOOD TRANSFUSION

• To replenish depleted blood component of

recipient
packed RBC
platelets
fresh frozen plasma
others
Safe Transfusions
 BLOOD PRODUCTS ROUTINELY PREPARED
FROM A WHOLE BLOOD UNIT

• Packed RBCs
• Platelets
• Fresh Frozden
Plasma
• Cryoprecipitate
 TRANSFUSION TRANSMISSIBLE
INFECTION

• Hepatitis B, and C

• Human Immunodeficiency virus

• Syphilis

• Malaria
STEPS OF A SUCCESSFUL TRANSFUSION

• blood order
• donor recruitment
• history & questionnaire; CBC; tests for infectious
diseases
• preparation & storage of blood products
• transfusion of blood products
• hemovigilence
 BLOOD PRODUCT STAORAGE

Product Storage Period Storage Temperature

packed RBC 35 days 1-6 C

platelets 05 days 20-24 C

fresh frozen plasma 12 months -18 C

 HEMOVIGILANCE

Systematic surveillance of adverse reactions related

to transfusion with the aim of improving transfusion
safety
COMPLICATIONS OF
TRANSFUSION
COMPLICATIONS OF TRANSFUSION
Febrile Non-hemolytic Transfusion Reaction
S/S
Fever and chills, may have mild dyspnea
Occurs within 6 hours of transfusion (packed cells,
platelets)
Pathogenesis
Antibodies in recipient to donor WBCs cause cytokine
release
Chances of reaction increase with duration of storage of
blood product
Prevention by limiting
donor product WBC
quantity; by using
FILTERS

Managed by
antipyretics
 ALLERGIC REACTIONS

• Urticarial Reactions

Relatively common and mild

Due to an allergen in blood product

IgE mediated response in recipient

Managed by antihistamine
Anaphylactic Reactions

Uncommon, may be fatal

Occurs in patients with IgA defiency, having anti-

IgA anbodies
HEMOLYTIC
REACTIONS
1. Acute
2. Chronic
 1. ACUTE HEMOLYTIC TRANSFUSION
REACTION

Due to error in patient identification

Rapid onset and fatal

Preformed (IgM) antibodies of ABO system in patient
Antibodies fix complement, causing hemolysis

S/S

Fever, chills, flank pain, DIC, shock, hemoglobinuria,

acute renal failure, death
Complement-mediated intravascular hemolysis
Labs
Anemia
Lactate Dehydrogenase
Direct Coombs test positive
Low Haptoglobin
2. DELAYED HEMOLYTIC TRANSFUSION
REACTION

Induced antibodies (IgG) in the recipient against

donor RBC antigens
Patient develop antibodies through prior
transfusions or pregnancy

• Labs
Direct Coombs test positive
Low Haptoglobin, raised Lactate
Dehydrogenase
Icteric Sample
 TRANSFUSION-RELATED ACUTE LUNG
INJURY
Severe and fatal
Activation of neutrophils in the lung vessels
Common in patients with lung disease
Two - hit pathogenesis:

1.increased expression of adhesion molecules,

trap neutrophils in lung vessels

2.Anti neutrophil antibodies in blood products

activate neutrophils
Diffuse Alveolar Damage
Antibodies commonly in FFP and platelets from
multiparous female donors
S/S
• Sudden-onset respiratory failure
• Diffuse bilateral pulmonary infiltrates
• Fever, hypotension, hypoxemia
Management is supportive
 INFECTIOUS COMPLICATIONS

Can be bacterial, viral and parasitic (malaria)

Bacteria transmit through skin flora at the time

of blood draw from donor

Virus present in donors who is infected but virus

is undetectable (WINDOW PERIOD)

Bacterial contamination common in
platelet units as these are stored at
room temperature

S/S
Fever, chills, hypotension
 QUESTIONS?
R O B B I N S PAT H O L O G Y, 2 0 2 0