SEMINAR ON

Blood Transfusion
Dr. kiran kumar
2nd MDS Gitam Dental college and Hospital

Blood Groups
Carl landsteiner-1909- first gave the classification 19 Blood group systems & Over 200 antigens were identified

Cross matching and compatability

Other important blood groups

Rh grouping: D antigen.

Bombay blood group.

Components of blood that can be transfused

WHOLE BLOOD CELLULAR PLASMA

RBCS

WBCS

PLATELETS

FFP

CRYO

PPF

packed

frozen

washed

Commonly used Components:

RBC
Platelet FFP

cryopresipitate

Selection of Components
Most patients require only one particular component Better patient management is achieved by giving only the desired and/or essential component. Blood products have a greater shelf life Blood filtration and other techniques makes Blood safer Blood products can often be infused regardless of ABO Blood group

Use of whole Blood is a waste of resources

Apheresis
Process of removing a specific component of the Blood such as platelets, and returning the remaining components to the donor.

Allows more of one particular part of the blood to be collected than could be separated from a unit of whole blood

blood donation:
300-400ml of whole blood is collected + 63ml of citrate phosphate dextrose is added

storage period is 21days at a temperature of -2 to 6c. As 2-3diphospho glycerate increases - release of oxygen reduced.

Principle of blood transfusion

The transfer of blood or blood components from one person (the donor) into the bloodstream of another person (the recipient).

WHO recommendations for screening tests in blood donations

HIV 1&2 HEPATITIS B& C MALARIA SYPHILIS CHAGAS DISEASE

Regular voluntary blood donation.

 Rigth IV selection:
The size of the IV catheter is important. Too small = hemolysis = wasted infusion Need at least a 20G but preferably an 18G.

Recommended rate of transfusion intially for the first 15 min it should be 10 drops/min later 40 drops/min

Check for vital signs

check for temp,B.P,heart rate. A temperature 100 or higher should be reported even if it is pre-existing. If a transfusion reaction occursthis will be important for careful assessment of the situation

INDICATIONS FOR BLOOD TRANSFUSION:

ACUTE BLOOD LOSS (SURGERY, TRAUMA OR BLEEDING)

15 - 30 percent - should be treated with crystalloids or colloids,

not RBCs, in young, healthy patients-<700ml hematocrit value- >40.

30 - 40 percent -- requires rapid volume replacement,

and RBC transfusion is probably necessary 800-1500ml of blood. hematocrit value-30-40

>40 percent -- is life-threatening and volume replacement,

including RBC transfusion, is required. >2000ml of blood. hematocrit value-<30.

INDICATIONS FOR BLOOD TRANSFUSION:

Hemoglobin concentration:
Hemoglobin > 10 g/dL -- transfusion is rarely indicated.

Hemoglobin 7-10 g/dL -- indications for transfusion should be based on the patient's risk of inadequate oxygenation from ongoing bleeding and/or high-risk factors . Hemoglobin < 7 g/dL -- transfusion is almost always indicated. TRANSFUSION THRESHOLD LEVEL 7g/dl

7/30 rule

INDICATIONS FOR BLOOD TRANSFUSION:

peri-operative transfusion- if Hb 7g/dl if significant blood loss is expected

SPECIAL SITUATIONS: Severe Thalassemia Or Other Congenital Anemia. Sickle Cell Disease Burn Patients .

RBC Transfusion
Packed RBC:
Stored under refrigeration for 42 days May be frozen for up to 10 years. One unit contains approx 180ml of red cells Does not provide platelets or coagulation factors All RBC transfusions must be ABO/Rh compatible

INDICATIONS:
Hemoglobin levels less than 7/8g/dl or hemocrit level less than 30-40%.

1 unit of packed RBC increases Hct by 5%.

Platelet Transfusion
Colour - cloudy and yellowish Red blood cell compatibility is generally not necessary

INDICATIONS: Purpura.
Aplastic anemia. Chemotherapy induced leukemia. Disseminated intra vascular coagulation(DIC). Thrombocytopenia.

Whole Blood platelet concentrate

Apheresis Platelets Leukoreduced single donor

17,600

105,600

Pt.`s with more than 50,000- not required Pt.`s with less than 20,000- required if C/F are seen.

Plate let pack contains:

3-510 platelets - 10 times more than normal 1 unit of whole blood

FFP
Fresh frozen plasma (FFP) is the plasma from a unit of whole Blood and frozen at or below -18 c within 8 hours Kept in a frozen state for one year Qty : 225 ml Must be ABO compatible with the recipients red cells Rh need not be considered. Control bleeding due to low levels of clotting factors

INDICATIONS:
Clotting deficiencies. Reversal of warfarin effect. Antithrombin 111 deficiencies.

Cryoprecipitate
Indications: Acute hemorrhagic episodes of hemophilia Burns- b/o high opsonin conc. Septicemia.

1 unit of cryoprecipitate contains -100 units of factor VIII.

Adverse effects of transfusion

Acute
Allergic Anaphylaxis Hemolytic Metabolic Transfusion related lung injury Circulatory overload Non-hemolytic febrile transfusion reactions Haemostatic: dilution of clotting factors and thrombocytopenia Septic shock (bacterially infected units)

Acute Haemolytic Reaction: -caused by transfusion of ABO incompatible blood

SYPTOMS:
Chills , fever Facial flushing Hypotension Chest pain Dyspnea Generalized bleeding Renal failure DIC

Hemoglobinemia Shock Hemoglobinuria Nausea Vomitting Back pain Pain along infusion vein

Acute Haemolytic Reaction:

MANAGEMENT:
FIRSTStop the transfusion Keep the line open with the 0.9% NS Stay with the client. Monitor Vital signs. Record and Collect urine specimen Return blood, bag, tubing, labels, transfusion record to the blood bank

MANAGEMENT: Anti histaminic drugs Analgesics Corticosteroids IV fluids for renal clearance.

COMPLICATIONS:
Acute kidney failure Anemia Lung dysfunction Shock.

 Late
Delayed haemolytic transfusion reactions. Sensitization/Alloimmunization. Immune suppression. Graft-vs-Host disease. Transfusion iron overload (haemosiderosis)

Transfusion Alternatives
Acute Volume Repalcement (volume expanders)
Dextran/ Gelatin/HES-Hydroxy ethyl starch)

Autologous transfusion
Preoperative autologous blood donation (PABD) Cell salvage : Intraoperative blood salvage, Postoperative blood salvage

Acute normovolemic hemodilution (ANH)

JEHOVAH`S WITNESSES:

Reservation of blood

direct relation donor

Conclusion
Avoid unnecessary transfusions Transfusion of a single unit is often unnecessary

Booking system for blood

Use appropriate component rather than whole blood

Cooperation is the Key to Success!!!

REFERENCES:

Text book of General Medicine-Davidson Physiology- Sembulingam. Pharmacology- satoskar. Hand book of transfusion medicine-Mc clelland. Practice guidelines to blood transfusion-American red cross. Screening donated blood for transfusion-transmissible infections: recommendations- WHO recommendations