Blood, Blood Products and Blood Transfusion

By;SITI AFIFAH

MARDHIYYAH

Supervisor;DR SALEHUDIN

Contents

• Definition• Functions of the blood• Blood products• Indication for transfusion• Maximum surgery blood order schedule (MSBOS)• blood transfusion: hemovigilance• Blood transfusion reaction and its management• Other complications of blood transfusion• Take home massage

Definition:

• Blood - connective tissue (fluid) consisting of plasma and cellular component.

• 8% of total BW

Functions of the blood• supplies o2 and substances absorbed from the GIT to

the tissues.• returns co2 to the lungs, and other products of body

metabolism to the kidneys.• Transport hormones produced by respective glands of

endocrine systems

Transportation

• White cells- preotection of the body againts pathogen• Platelets- limiting blood lossProtection

• Body temperature• blood pressure• pH balanceRegulation

Blood product & Blood Transfusion

• Blood product- A blood product is any component of the blood which is collected from a donor for use in a blood transfusion

• Blood transfsusion-is the process of transferring blood or blood components from one person into the circulatory system of another

WHOLE BLOOD

CELLULAR FRESH COMPONENTS PLASMA

• RED CELLS• PLATELETS• WHITE

BLOOD CELLS

FRESH FROZEN PLASMA

CRYOPERCIPITATE

CRYOSUPERNATANT

FACTOR VIIICONCENTRATE

•ALBUMIN•IMMUNOGLOBULIN•OTHER CONCENTRATES

Blood products

Blood productsWhol

e bloo

d

• Blood taken from a suitable donor using a pyrogen free anticoagulant container. The major use is used for blood component separation.

Packed red cells

• A component derived by removing part of the plasma from whole blood

Platelet

• A component derived from fresh whole blood by centrifugation which contain majority of the platelets content in theraputically effective form.

Fresh frozen plasma

• A component prepared either from fresh whole blood or from plasma collected by apheresis, frozen at an appropiate temperature to preserve the activity of labile coagulation factors.

Cryoprecipitat

e

• A component containing the cryoglobulin fraction of plasma obtained by further processing of fresh frozen plasma prepared from hard spun cell free plasma and concentrated to a final volumes required.

Cryosupernatqant

• A component prepared from plasma by removal of cryoprecipitate

Indication for transfusion of blood product

1. Packed red cells

2. Platelet

Hematological malignancies To maintain platelet > 20x 109

Massive transfusion Acute bleeding, multiple trauma

DIVC Acute DIC, aim to maintain platelet >50x109

CABG/ Ruptured AAA Reserved for post op bleeding

Immune thrombocytopaenia

Platelet function disorders If all other measures fail to control the bleeding

3. Fresh Frozen Plasma

4. Cryoprecipitate

Maximum surgery blood order schedule (MSBOS)

• Reference used to guide clinicians in ordering blood before surgery.

• The Maximum Surgical Blood Order Schedule (MSBOS) is a table of elective surgical procedures which lists the number of units of blood routinely requested, and cross-matched for them pre-operatively.

MSBOS

• For cases where blood;–Not likely to be transfused – GSH is

perfomed.– Likely to be transfused – GXM is performed.

*However when antibody screen is positive, compatible blood must be made available in all cases before surgery

Group Crossmatch• The patient's serum is

screened and tested directly for compatibility with the red cells of the units of blood to be transfused.

• Crossmatched blood will retained for 48hours in blood bank.

Group, Screen, Hold• Consist of process ABO,

Rh D grouping and antibody screen

• Serum/plasma is retained for 48 hours in the blood bank.

MSBOS ; General surgery

Abdominal – perineal resection

4

cholecystectomy GSH

Gastectomy 2

Hemicolectomy, small bowel resection

GSH

Hiatus hernia repairAbdominalTransthoracic

2GSH

Inguinal hernia repair

GSH

Laparotomy GSH

Perforated viscus 2

Mastectomy GSH

Oesophagectomy 4

Pancreatectomy 4

Portocaval shunt 4

Spelenectomy 2

Thyroidectomy, Parathyroidecomy

GSH

Varicose vein GSH

Vagotomy GSH

Whipples procedure

4

C:T Ratio

• Crossmatch : transfusion ratio• An indicator to assess the appropriateness of

cross matching of blood to the units of blood transfused

• Standard value ≤2.5

C: T ratio

• C: T ratio surgical department for the year 2013

JAN FEB MAC APR MAY JUN JUL AUG SEP OKT NOV DIS

GXM 467 497 626 341 569 550 495 538 509 315 270 547

TRANSFUSION 231 235 379 158 289 280 260 280 253 301 231 268

RATIO 2.0 2.1 1.7 2.2 2.0 2.0 1.9 1.9 2.0 1.0 1.2 2.0

Consent of blood transfusion

• Written consent• Patient should be explained regarding the benefits and

risks of blood transfusion• Explain:– Indication– Complications

• Infection• Reaction

• The patient’s consent should be obtained for the planned transfusion and recorded in the patient’s medical chart.

Hemovigilance

• Haemovigilance is a system of surveillance and alarm, from blood collection to the follow-up of the recipients.

1. Blood taking2. Giving blood

3 3

2

1

2

1

BLOOD BANK

Monitor adverse effects

VITAL SIGN SYMPTOMS• BP• PR/HR• RR• Temperature

• Fever• Chills and rigors• Pain at infusion

site/abdomen/chest• Respiratory distress• Urticaria/rashes• Nausea/vomiting

COMPLICATION OF BLOOD TRANSFUSION

• Acute – during transfusion/within 24 hours• Delayed – after 24 hours

IMMUNE MEDIATED NON-IMMUNE MEDIATED

ACUTE DELAYED ACUTE DELAYED• Hemolytic

reaction• Febrile non-

hemolytic• Urticaria• Anaphylactic

• Hemolytic Reaction

• Post Transfusion Purpura

• Graft Vs Host Disease

• Septic• Circulatory

Overload• Metabolic• Hyperkalemia• Hypocalcaemia• Metabolic

alkalosis

• Infection• Iron Overload

Management of transfusion reactionADVERSE EFFECT

STOP TRANSFUSION

Pruritus

Urticaria, Rashes

Chest pain, pain at infusion site,

respiratory distress, loin/back pain

Hypotension, hematuria, DIC

Anxiety, SOB, Palpitation, Headache

Flushing, Rigor, Fever, Tachycardia,

Restless

• Antihistamine

• If symptoms subside : resume

transfusion at slower rate

• Maintain A, B, C

• AdrenalineFurosemide/

corticosteroid/bronchodilator/

antibiotic

• Antihistamine and/or

Antipyretic

• Withold transfusion

LIFE THREATENINGMODERATEMILD

Investigations

• Blood reaction kit (immediate & post 24hr)

• 4ml in plain tube for antibody identification• 2ml in EDTA tube for FBP• >10ml urine sample- may have haemoglobin and albumin

• The remaining blood bag, containing the partially transfused blood, and all the blood bags cross-matched for the same patient at the same time of the request should be examined for the presence of free haemoglobin or discolouration before being sent to the laboratory.

• The “Report of Reaction to Blood or Plasma Transfusion” form must be completed.

• Fill up the “Transfusion Adverse Event” form in duplicate and send to the blood bank. Send also a copy of this form to the National Blood Centre.

• Other adverse transfusion reactions include:– Fluid overload– Metabolic disturbances e.G. Hyperkalaemia and

hypocalcaemia.– Hypothermia– Embolism– Iron overload– Alloimmunisation to red cell, white cell or platelet antigen.– Immunosuppression and immunomodulation– Transmission of viral infection

Transmitted Infection Incident

HIV 1 : 1,900,000

Hep A 1 : 1,000,000

Hep B 1 : 1,800,000

Hep C 1 : 1,600,000

Bacteria Infection 1 : 3,000

Take home massages

1. Blood product mainly consist of cellular component and fresh plasma.

2. The decision to transfuse depends on many factors such as haemoglobin level, anemic symptoms and risk of bleeding.

3. MSBOS used to guide clinicians in ordering blood before surgery.

4. The patient’s consent should be obtained for the planned transfusion and recorded in the patient’s medical chart.

Take home massage

4. 1 person take blood and label- confirm patient’s name and identification before label.

5. Confirm patient’s name and identification with patient’s note, compatibility label and request form before transfusion.

6. If an adverse transfusion reaction is suspected, the transfusion should be stopped immediately and must be reported.

References

1. Transfusion Practice Guidelines for Clinical and Laboratory Personnel 3rd edition March 2008. National Blood Centre, Ministry of Health Malaysia

2. Guidelines for the rational use of blood and blood products. National Blood Centre, Ministry of Health Malaysia

3. Blood Transfusion guideline (2006), National Users’ Board Sanquin Blood Supply