Blood products and

blood transfusion
Dr. Aniqa Anser
Assistant professor medicine
ANMC
• Blood is a specialized type of connective tissue in which living blood cells
are suspended in a non living fluid matrix called plasma
• Blood products are the components of the blood that are collected from a
donor for use in blood transfusion
 WHOLE BLOOD
• Whole blood = donor blood + anticoagulant
• 1 unit = 450 ml
• Rich in coagulation factors
• Stored at 1-4 C
• Shelf life is 35-42 days
• Platelets fall to < 1% in 4-48 hours, then clotting factors begin to
disappear, K level rises.
INDICATIONS OF WHOLE BLOOD:
• In case of acute blood loss with hypovolemia
• Exchange transfusion in case of severe anemia at birth and severe
hyperbilirubinemia
• Cardiac surgery
 RED CELL CONCENTRATE
• Also known as packed RBCs
• Platelets and plasma are removed
• 1 unit = 330 ml with HCT 65-75%
• Stored at 2-4 C
• Shelf life is 35 days
INDICATIONS OF PACKED RBCs:
• Anemia with clotting factor defects
• Sickle cell anemia
• Thalassemia
 PLATELET CONCENTRATE
• Platelet rich concentrate
• 1 unit = 15-20 ml
• Stored at 20-24 C
• Shelf life is 5 days
• Should be infused within 30 min
INDICATIONS OF PLATELET CONC:
• Bleeding due to thrombocytopenia
• Bleeding due to platelet dysfunction
• Drug induced haemorrhage
• Prevention of spontaneous bleeding with counts < 20,000
 FRESH FROZEN PLASMA
• Plasma collected from single donor units or by apheresis
• Frozen within 8 hours of collection
• 1 unit = 200-250 ml
• Stored at -40 to -50 C
• Shelf life is 2 years
• Contains all clotting factors, albumin and immunoglobulin
INDICATIONS OF FRESH FROZEN PLASMA:
• Single clotting factor deficiency
• Multiple clotting factors deficiencies…. DIC, Liver disease
• Warfarin overdosage
• TTP
 CRYOPRECIPITATE
• Fresh frozen plasma thawed at 4 C
• Rich in factor VIII and fibrinogen
• 1 unit = 15-20 ml
• Stored at -30 C
• Shelf life is 2 years
INDICATIONS OF CRYOPRECIPITATE:
• Hemophilia A
• Von Willebrand’s disease
• Factor VIII and fibrinogen deficiency
 BLOOD TRANSFUSION
• Transfusion of the whole blood or its components such as blood cells or
plasma from one person to another person
 Purpose of blood transfusion
• To restore the blood volume when there is sudden loss of blood
• To raise Hb level in case of severe anemia
• To treat deficiencies of plasma proteins, clotting factors or
immunoglobulins
• To provide antibodies to those persons who have low immunity
• To provide leukocyte count in case of agranulocytosis
• To replace the blood with hemolytic agents with fresh blood
 Blood grouping and cross matching
• Each person has one the following blood types:
A, B, AB, O
• Type O blood group is universal donor ( can be given to anyone but can
only receive O )
• Type AB blood group is universal recipient ( can receive any type but can
only be given to AB )
• Also, every person’s blood is either Rh positive or Rh negative
 Types of blood transfusion
• Allogenic blood transfusion ( someone else blood )
• Autogenic blood transfusion ( own blood )
• Exchange blood transfusion
 Selection of donor
• Patient should be free from diseases such as TB, cancer, jaundice or any
other transmissible disease
• Make sure that the donor has not donated the blood in last 90 days
• Physically active, between the age of 18 to 65 years
• Should be vitally stable
• Must have not been pregnant in last 6 months
• Hb level must be above 12 g/dl
• Donor should be disqualified who have history of recent dental surgery,
receipt of blood or blood components, immunization etc
• Blood should not be collected empty stomach
• After donation, donor should be asked to take rest for 1-2 hours
• Before leaving the collection center, donor’s pulse should be checked
 Collection, storage and transportation of
blood
• Donor’s blood should be collected in a sterile bag containing
anticoagulant solution ( acid citrate dextrose )
• Donor’s blood should be placed in refrigerator
• Each donor’s unit must be labelled with:
 Name of donor
 Donor’s number
 ABO blood grouping and Rh typing
 Date of drawing blood
 Date of expiry
 Results of tests of hepatitis and syphilis
• When blood is transported to distant place, use precooled insulated bags to
keep the temperature of blood below 10 C
 Administration of blood to the recepient
• Send the recipient sample for grouping and cross matching
• A request form should accompany the sample and it should contain the
following data;
 Recipient’s name
 Hospital registration number
 Bed number
 Name of the physician
 Exact amount of blood product requested
 Diagnosis of the patient
 Any previous blood transfusion and any reaction observed
• It is essential that physician writes all the orders for transfusion
• Prior to administration, a physician and nurse should verify all informations
on the report of cross match, unit’s label and pt’s identifications
• Transfusion set should be free from air
• No medications should be given through same I/V route
• Keep the patient warm and comfortable
• Patient’s vitals should be recorded before transfusion
• Allow the blood to keep at room temperature before administration
• Record any reaction and medications administered
 Complications of blood transfusion
• Acute hemolytic transfusion reactions
• Delayed hemolytic transfusion reactions
• Febrile non hemolytic reactions
• Allergic reactions
• Anaphylactic reactions
• Transmission of infectious diseases
• Non cardiogenic pulmonary edema ( TRALI )
• Circulatory overload
• Graft versus host disease
• Electrolyte imbalance
 Febrile non hemolytic transfusion
reaction
• Most common reaction
• Benign, self limiting reaction due to presence of antibodies to WBCs or platelets
antigens
• Occurs within minutes of starting transfusion
• Rise in temperature with chills
• STOP THE TRANSFUSION
• Check label and recipient identity
• Antipyretics should be given
 Acute hemolytic transfusion reaction
• Occurs when incompatible RBCs are transfused to a recipient who has
preformed antibodies
• Develops within first 5-15 min
• Hemolysis is rapid and intravascular
• Causes are;
ABO incompatibility
Rh incompatibility
 Improper storage of blood
 Storage beyond 21 days
 Warming of blood above 40 C
• Patient my have fever with chills, backache, headache, dyspnea,
hypotension, chest pain and circulatory collapse
• In severe cases, acute DIC, acute renal failure
• Death occur in 4% of acute hemolytic reactions
• STOP TRANSFUSION IMMEDIATELY
• Check recipient identity
• Inform lab to do the cross matching
• Replace I/V set and start normal saline, maintain the blood pressure
• Monitor vital signs every 15 min
• Maintain Intake output record
• Oxygen inhalation to treat dyspnoea
• Forced diuresis with mannitol may help prevent kidney injury
• Samples to assess the liver and renal functions, DIC and hemolysis
 Delayed hemolytic transfusion reactions
• Usually occur 5-10 days after transfusion
• Caused by minor red blood cell antigen discrepancies and are less severe
• Extravascular red blood cell destruction
• Persistent decrease in Hb level and low grade fever
• This reaction is missed many times
 Allergic reactions
• A type of immediate hypersensitivity reaction
• Result of hypersensitivity of the individual to the plasma proteins in the
transfused blood
• Itching, rashes, laryngeal edema and bronchospasm in severe cases.
• Treatment includes antihistamines and corticosteroids
 Anaphylactic reactions
• Rare but can be fatal
• Develops immediately after transfusion of few ml of blood
• In patients with IgA deficiency
• Dyspnoea, cyanosis, tachycardia, hypotension, anaphylactic shock
• STOP THE TRANSFUSION IMMEDIATELY
• Start the resuscitative measures
 Transfusion related lung injury
• Also known as non cardiogenic pulmonary edema
• Associated with allogenic antibodies in the donor plasma component that
binds to recipient leukocyte antigens, including HLA antigens
• Altered permeability of pulmonary capillary bed by activation of
complement, histamine mediated events which leads to fluid
accumulation, inadequate oxygenation and reduced cardiac return
• Onset of severe dyspnea and cyanosis proceeding to respiratory failure
with bilateral infiltrates on chest X-Ray
• There is no specific treatment of TRALI
• Only supportive care
• Intensive care management for respiratory failure
 Circulatory overload
• More volume of the blood transfused
• Patients with heart failure or renal impairment
• Cause: fast rate
• Leads to heart failure and pulmonary edema
• Stop the transfusion
• TREATMENT: Prop up position, Oxygen , Diuretics
 TRANSMISSION OF INFECTIOUS
DISEASES
• Viral infections (Hep B and C, HIV, CMV, Parvovirus B19 )
• Bacterial infections ( staphylococci, pseudomonas, E.Coli, Yersinia,
enterococcus, proteus )
• Protozoal infections ( malaria, leishmania, syphilis )
 Graft versus host disease
• Allogenic lymphocytes within transfused blood will engraft in some
recipients and cause alloimmune attack against tissues expressing
discrepant HLA antigens
• Patients with leukopenia and immunodeficiency are at high risk
• Fever, rash, diarrhea, hepatitis, lymphadenopathy, severe pancytopenia
• Corticosteroids can be given