BT19P77-STEM CELLS AND REGENERATIVE MEDICINE

BLOOD TRANSFUSION UNIT-4

AND ROLE OF STEM

CELLS

by AKASH M
BLOOD TRANSFUSION
What is a blood transfusion?
A blood transfusion is a procedure that restores blood to the body.A healthcare
professional will pass blood through a rubber tube into a vein using a needle or thin tube.

Blood transfusions work to replace blood that is lost due to injury, surgery, or to treat
medical conditions. The type of blood transfusion given depends on the reason for
requiring one.

According to the American Red Cross, there are four common types of blood transfusions:

● Red blood cell transfusions: A person may receive a red blood cell transfusion if they
have experienced blood loss, if they have anemia (such as iron deficiency anemia), or
if they have a blood disorder.
 ● Platelet transfusions: A platelet transfusion can help those who have lower platelet
counts, such as from chemotherapy or a platelet disorder.
● Plasma transfusions: Plasma contains proteins important for health. A person may
receive a plasma transfusion if they have experienced severe burns, infections, or
liver failure.
● Whole blood transfusion: A person may receive a whole blood transfusion if they
have experienced a severe traumatic hemorrhage and require red blood cells, white
blood cells, and platelets.

Before a blood transfusion, a healthcare professional will remove the white blood cells
from the blood. This is because they can carry viruses.
That said, they may transfuse white blood cells called granulocytes to help a person recover
from an infection that has not responded to antibiotics. Healthcare professionals can collect
granulocytes using a process called apheresis.
It is important that a healthcare professional uses the correct blood type during a
blood transfusion. Otherwise, the body might reject the new blood, which can have
severe consequences.
There are four types of blood:

● A
● B
● AB
● O
Each blood type can be positive or negative.Blood type O is compatible
with all other blood types. People with blood type O are universal donors.If
someone is in a critical condition and bleeding heavily, a doctor may use
Why are blood transfusions necessary?
Blood transfusions are necessary when the body lacks enough blood to function properly. For example, a person
may need a blood transfusion if they have sustained a severe injury or if they have lost blood during surgery.

Some people need blood transfusions for certain conditions and disorders, including:

● Anemia: This occurs when a person’s blood does not have enough red blood cells. It can develop for a
number of reasons, such as if a person does not have enough iron in their body. This is known as iron
deficiency anemia.
● Hemophilia: This is a bleeding disorder wherein the blood is unable to clot properly.
● Cancer: This occurs when cells in the body divide and spread to the surrounding tissues.
● Sickle cell disease: This is a group of red blood cell disorders that change the shape of red blood cells.
● Kidney disease: This occurs when the kidneys are damaged.
● Liver disease: This occurs when the liver stops functioning properly.
What to expect

Most blood transfusions take place in a hospital or at a clinic. However, visiting nurses may be able to
perform blood transfusions at home. Before this, a doctor will need to perform a blood test to determine a
person’s blood type.

During a blood transfusion, a healthcare professional will place a small needle into the vein, usually in
the arm or hand. The blood then moves from a bag, through a rubber tube, and into the person’s vein
through the needle.

They will carefully monitor vital signs throughout the procedure. It can take up to 4 hours

Trusted Source to complete a blood transfusion.

Aftercare
Recovery time may depend on the reason for the blood transfusion. However, a person can be
discharged less than 24 hours after the procedure.

A person may feel an ache in the hand or arm after a transfusion. There may also be some bruising at the
site.

There may be a very small risk of a delayed reaction to the transfusion. Although this does not typically
cause problems, a person should consult a doctor if they feel unwell and have unexpected symptoms,
such as nausea, swelling, jaundice, or an itchy rash.

It is important to let a doctor know about any symptoms that might signal a reaction, such as nausea or
difficulty breathing.
Risks and complications
Blood transfusions are very safe.Strict procedures exist to ensure that the testing, handling, and storage of
donated blood is as safe as possible.However, it is possible for a person’s body to react to the new blood.
Such reactions can be either mild or severe.Some reactions occur immediately, while others can take
several days to appear. Examples include:

Allergies

Allergic reactions are common. In fact, according to the Centers for Disease Control and Prevention (CDC),
allergic reactions make up over 50%of reported reactions to blood transfusions.Antihistamine medications
can help treat allergic reactions.

Trusted Source
Fever

A person may experience a fever following a blood transfusion.Although this is not serious, if they also
experience chest pain or nausea, they should let a doctor know as soon as possible.

Hemolytic reaction

This can occur when the blood types are not compatible, causing the immune system to attack the new blood
cells.This is a serious reaction, but it is very rare.Symptoms may include:

● lower back pain

● chest pain
● dark urine
● nausea
● fever
Transmission of infections

In very rare cases, donated blood can contain bacteria, viruses, or parasites that may cause infections such as
HIV or hepatitis B or C.

However, according to the CDC, experts test every blood donation for these contaminants. It is therefore very
rare for a person to contract an infection from a blood transfusion.

In fact, according to the American Red Cross, the chance of a person contracting hepatitis B is 1 in 300,000,
and the likelihood of contracting hepatitis C is 1 in 1.5 million.

The chances of getting HIV from a blood transfusion in the United States is less than 1 in 1 million
 BLOOD TRANSFUSION AND HSCT
(TRANSFUSION SUPPORT OF HSCT)
Transfusion support for hematopoietic stem cell transplantation (HSCT) is an essential part of supportive care,
and compatible blood should be transfused into recipients.

As leukocyte antigen (HLA) matching is considered first and as the blood group does not impede HSCT, major,
minor, bidirectional, and RhD incompatibilities occur that might hinder transfusion and cause adverse events.
Leukocyte reduction in blood products is frequently used, and irradiation should be performed for blood
products, except for plasma.

To mitigate incompatibility and adverse events, local transfusion guidelines, hospital transfusion committees,
and patient management should be considered.

Hematopoietic stem cell transplantation (HSCT) is a curative therapy for these patients and requires human
leukocyte antigen (HLA) matching, which is a major barrier to donor selection. Rigorous matching is associated
with favorable outcomes.

ABO and Rh matching statuses are not considered before HSCT, but crossing the ABO and Rh barrier has
caused complications after HSCT and difficulties in selecting optimal transfusion products.
● Patients undergoing HSCT often have complex transfusion needs.
● ABO and Rh incompatibility between the donor and recipient can occur.
● Patients with hematologic malignancies may have alloantibodies that make it difficult to find compatible
blood products.
● Patients undergoing HSCT may be at increased risk for transfusion-related complications.
These ABO blood group antigens are not a prerequisite for T cell sensitization for the production of antibodies
and are poor inducers of T cell-specific response. ABO antibodies are mostly IgM or IgG, which are formed by
extrafollicular B-1 cells, whereas antipeptide antibodies are formed by follicular B-2 cells .

The ABO blood group is important in solid organ transplantation and can cause hyperacute rejection via pre
existing isoagglutinin (anti-A and/or anti-B). The importance of ABO blood group matching status is less critical
in HSCT than in organ transplantation, such as the kidney or liver. However, ABO-incompatible HSCT can
cause some transfusion-related issues.

A minor RhD mismatch can be defined as a negative donor with a RhD-positive recipient. A major RhD
mismatch can be defined as RhD-positive donors with RhD-negative recipients. Several studies showed that
alloimmunization of RhD or anti-D production occurred in 9% of minor RhD mismatch HSCT, whereas 1%
occurred in major RhD mismatch HSCT RhD blood group mismatch.

For RhD-positive recipients and RhD-negative donors, RhD-positive blood can be transfused until RhD antigens
are weakened. For RhD-negative recipients and RhD-positive donors, RhD-negative blood should be selected
until the RhD antigen appears to some degree, and then RhD-positive blood should be selected. In the case of
platelets, anti-RhD should be administered before RhD-incompatible transfusion.
 Recipient antigen

Donor antigen

D negative with anti-D D negative without anti-D D positive

D negative with anti-D Identical Identical Minor incompatibility

D negative without anti-D Identical Identical Minor mismatch

D positive Major incompatibility Major mismatch Identical

Because HLA molecules are immunogenic factors, the HLA locus should be matched to overcome the
histocompatibility barrier. As HLA matching status is the main criterion for donor selection and HLA genes are
inherited independently from the ABO gene, 40–50% of HSCT procedures are performed across the ABO blood
group

The estimation of the effect of HLA mismatch is complicated by the diversity of HLA alleles and the occurrence
of a mismatch from different loci with different allele combinations. These variables were simplified and yielded
averaged results for many variables.

The advantages and disadvantages of peripheral blood HSCT include rapid engraftment compared to bone
marrow transplantation and the incidence of chronic graft versus host disease (GVHD) has increased compared
to bone marrow transplantation, respectively. For cord blood transplantation, rapid collection and administration
of grafts are possible with lower infections and GVHD and less stringent HLA matching criteria, whereas
engraftment has been delayed, and graft rejection and relapse have increased

Transfusion support is a critical supportive method for the patient before (Phase I), during (Phase II), and after
(Phase III) HSCT [3, 10]. The general principle of transfusion is to transfuse cells or plasma that exactly matches
the donor and recipient. However, these circumstances are usually unmet for patients undergoing HSCT.
Therefore, additional principles are required to ensure a safe transfusion.
If exact matching is unavailable, transfusion should be performed on the recipient using a product expressing
fewer antigens and antibodies. For example, packed red blood cells (PRC) with blood group O can be transfused
into recipients with an AB blood group. As antibodies are an important factor for transfusion with abundant
plasma components, platelets, fresh frozen plasma, or cryoprecipitate with blood group AB can be transfused to
a recipient. Determination of ABO and Rh typing is important for transfusion. Cell typing and serum typing
results should be considered when determining blood groups [3-6].