Terms used

Blood Components

Red cells, Platelets and Plasma separated from

whole blood.

Blood product

Any therapeutic product made from blood or

plasma
They are_

1.Plasma reduced blood (Packed cells)

2.Washed Red cells

3.Plasma protein fraction (HPPF)

Purified preparations of plasma proteins those are made

in industrial-scale processes from vary large pools
of donor plasma. eg. Albumin, Immunoglobulin,
Coagulation factor concentrate.
 4.Fresh frozen plasma (FFP)

 5.Cryoprecipitate (VIII rich)

 6.Factor VIII concentrate

 7.Factor II, VII, IX and X concentrate

 8.Factor XI concentrate

 9.Fibrinogen

 10.Platelet concentrate
(Platelet Rich Plasma - PRP)
Indications for transfusion of Whole blood and Blood
Products

Whole Blood

• As replacement for haemorrhages.

• For expected blood loss during operations.

• For volume loss, such as deep burn.

Blood Products

• Packed Cells for anaemia such as

• Haemolytic anaemia,
• Aplastic anaemia etc.

• Platelet rich plasma for

• Thrombocytopenia,
• ITP etc.

• Cryoprecipitate for coagulation factor deficiencies

especially Factor VIII
(Haemophilia).
 Specific factor concentrate for clotting factor
deficiency diseases,
such as factor VIII and IX concentrates.

 Low salt Albumin for hypoproteinaemia,

Chronic liver diseases.

 Gamma globulins for passive immunizations,

such as Tatanus (ATG).
 Complications of Blood
Transfusion
 Immune complications

1. ABO incompatibility

(Acute haemolytic Transfusion
Reaction)
 Symptoms occur soon after starting
transfusion

 Patient feels
– unwell and agitated,
– back pain,
– pain at transfusion site,
– shortness of breath,
– rigors,
– hypotension,
– oliguria,
And tends to develop bleeding from
venepuncture sites.
 Ifunrinalysis done - haemoglobinuria.
(anaesthetised –
persistent hypotension and unexplained oozing)

 Symptoms and signs are the same as

those
in Bacterial Transfusion Reaction,
so the managements are the same
 Management

 Discontinue immediately and change the

transfusion set and
 keep IV line.
 Check the particulars

 IV line open with Crystalloid

 ICU care if necessary

 Blood sample for
 FBC (full blood count),
U & E

 Plasma Hb,

 Clotting Time,

 blood culture &

 repeat grouping.

 Broad spectrum Antibiotics

 Monitor urine output & ECG

 2. Rhesus incompatibility

Possible haemolytic reaction as

well as paediatric problems which are
better prevented.
3. Delayed haemolytic transfusion reaction

Due to atypical antibodies - previous transfusion,

delayed up to 5-10 days.
Clinical features are minimal,
Jaundice,
Progressive anaemia,
Fever,
Arthralgia,
Myalgia.

Management

-LFT, clotting and red cell antibodies screen.

-Replacement using washed RBCs or
phenotyped RBCs.
4. Non-haemolytic febrile transfusion
reaction
Due to pyrogens and leucocytes (Anti-leucocyte antibodies).

Usually appears 30 min. after transfusion,

Patient feels well but

is shivering,
Temperature may soar <38.5C,
BP usually normal
 Management

Stop transfusion and assess the

patient,

 Restart at lower rate

 Antipyretics

Hydrocortisone should not be

routinely used.
5. Hypersensitivity reaction to plasma
components
(Anaphylactic reation)

Soon after the start of transfusion, there appear

1. Circulatory collapse &

2. Bronchospasm.
 Management

 Discontinue transfudion and remove blood set

(Continue IV line)

 Maintain airway & O2

 Adrenaline, Anti-histamine, Bronchodilator

(salbutamol)

 Further transfusion carefully planned.

B. Transmission of infection

Bacteria
Signs and Symptoms –
the same as in acute haemolytic transfusion reactions.

Management –
Also the same.

Virus
Transmission of HIV, Hepatitis B and C and Cytomegalovirus
are prevented by donor screening.

Protozoa
Transmission of Malarial parasite is common and prevented
by donor screening with history of malaria.
C. Others

•Immunosuppression
(in case of colorectal tumour operation,
peri-operative blood transfusion may cause early recurrence)

•circulatory over load

(Prevented by using packed RBCs instead of whole blood)
leading to cardiac failure
 Iron overload

 graft versus host reaction

 transfusion associated lung injury

 air embolism

 thrombophlebitis
Massive blood transfusion

Replacement of patient's own blood volume

(adult patient =10-12 units) with (usually) stored blood,
within 24 hr.
Rapid transfusion has more chance of complications
of transfusion plus_
 1. Cardiac Abnormalities
(due to hyperkalaemia,
low temperature of
transfused blood and
high acidity)

 2. Metabolic acidosis
(due to low pH of stored blood)

 3. Failure of haemostasis
(Stored blood
has very little clotting factors and
DIC is commoner in this case)
 4. ARDS

 5. Hypothermia

 6. Hypocalcaemia
(Citrate Intoxication)

 7. Haemolytic jaundice

 8. Hyper-amoeniasaemia.