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THE PROCESS OF RECEIVING BLOOD/BLOOD PRODUCTS INTO ONE’S CIRCULATION INTRAVENOUSLY

• History

• Type of Transfusion

• Indication

• Transfusion Reactions

• Autologous transfusion

• Component Transfusion

Blood TransfusionBlood Transfusion

History and SignificanceHistory and Significance

LOWERLOWER (1665)

First blood transfusionFirst blood transfusion

Philip (1825)

FIRST HUMAN BLOOD TRANSFUSIONFIRST HUMAN BLOOD TRANSFUSION

Landsteiner (1900)

Discovery of ABO typeDiscovery of ABO type

How to store blood longer?

World war IWorld war I

1920-19491ST TO 2ND WORLD WAR1920 DR.EDWIN JOHN &DR.CHARLES

DREWREVOLUTIONISED STORAGE

&DISTRIBUTION OF BLOOD1922DR.PERCY LANE OLIVER

BLOOD DONOR SERVICE (VOLUNTEERS ON 24HRS CALL)

1930 DR.SERGIE YUDINE –CADAVERIC BLOOD TO HUMANS

1935-ANAESTESIOLOGISTS-STORED CITRATED BLOOD

1936 DR.DURAN JORDO- BARCELONA BLOOD TRANSFUSION SERVICE

1937 DR.BERNARD FANTUSCOINED THE TERM BLOOD BANKCOOK COUNTY HOSPITAL IN CHICAGO,IL

1940 DR.CHARLES DREW –PLASMA STORAGEVIABLE SUBSTITUTE FOR BLOOD

1957 DR.GIBSON STORED FOR 28 DAYS –ACD&SOD. DEHYDRO PHOSPHATE

ESTABLISHED IN

SCHOOL OF TROPICAL MEDICINE, KOLKATTA

BY SIR. UPENDRANATH BRAHMACHARI CHAIRMAN OF BENGAL RED CROSS

SOCIETY

Anti coagulationRefrigeration1st anti coagulant used sodium citrateOSWARD HOPE ROBARTSON

IST blood bankFranceWorld war 1

1939 – KARL LANDSTEINER –Rh blood group system

W.B.MURPHY 1st used plastic bag to store blood

Is there any suitable

Blood Substitutes

WORLD WAR IIWORLD WAR II

A-B-O SYSTEM

Rh SYSTEM

Successful blood transfusion is relatively recent

• Crossmatching

• Anticoagulation

• Plastic storage container

Blood TransfusionBlood Transfusion

ENHANCEMENT OF OXYGEN CARRYING CAPACITY OF BLOOD

RESTORATION OF BLOOD VOLUMEMAINTAIN HOMEOSTASISTO SUPPLY

PLATELETSCOAGULATION FACTORSFRESH BLOODFFP/APPROPRIATE COMPONENTS

20% LOSS -- NO NEED

20 TO 30% -- PLASMA SUBSTITUTION

>30% LOSS -- BLOOD TRANSFUSION

W– WHETHER REQUIRED

H –HOW MUCH REQUIRED

A –ACTUAL COMPONENT REQUIRED

T –TIME OF DURATION &ADMINISTRATION

Type of Transfusion： Whole Blood；

Blood Component；

RBC PLT FFP Leukocyte concentrate

Plasma Substitutes；Use of whole blood is considered to be a waste of

resources

Blood TransfusionBlood Transfusion

R.B.C MIXED WASHED WITH SALINEONE PORTION MIXED WITH ANTI A –

SERUM WHICH CONTAINS ANTI A-ANTIBODY

ONE PORTION MIXED WITH ANTI B-SERUM WHICH CONTAINS ANTI B- ANTI BODY

DEPENDING ON AGGLUTINATION BLOOD GROUP IS DETERMINED

R.B.C TYPE

ANTI-A ANTI-B

O _ +

A + _

B _ +

AB

+ +

CROSS MATCHING

DONOR’S R.B.C + RECIPIENTS SERUM+ COOMB’S REAGENT

FIT DONORSCREENED DONORCOMMERCIALLY AVAILABLE PLASTIC BAGSDONOR ON A COUCH ,RELAXED,B.P CUFF

APPLIED TO UPPER ARM70MM HG/9.3K PA -80/10.615G NEEDLEMEDIAN CUBITAL VEIN410 ML OF BLOOD BAG CONTAINING 75ML OF CPD (CITRATE ,

POTASSIUM,DEXTROSE)

PROFESSIONALSVOLUNTEERSRELATIVESAUTODONORS

ELECTIVEEMERGENCY

MOBILE DONORS

ANAEMIACERTAIN

MEDICATIONSMALARIAPREGNANCYREC EXPOSURE TO

HEPATITISRECENT TATTOOTRANSFUSION

PREVIOUS 12 MONTHS

AIDSBLEEDING

DISORDERSCANCER(NOT

TREATABLE) HEPATITIS

SEVERE ASTHMASEVERE HEART

DISEASE

PERMANENT

SPECIAL REF. 4DEGREES CENTI.+/_2DEG.CEN

HIGHER TEMP –MORE THAN 2HRS –INFECTION

SHELF LIFE OF CPD BLOOD -3WKSW.B.C RAPIDLY DESTOYED IN STORED

BLOODPLATELETS AT4DEG CEN.AFEW AFTER 24

HRSSEPARATED PLT GOOD SURVIVAL EVEN

AFTER 72HRSCLOT. FACTORS 8&5 LABILE

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CENTRIFUGE

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REFRIGERATED CENTRIFUGE

TRAUMAHAEMORRHAGE FROM PATHOLOGICAL LESIONSMAJOR OPERATIVE PROCEDURESSEVERE BURNSPOST OPERATIVELYPREOPERATIVELY

CH.ANAEMIAAPLASTIC ANAEMIA

AS APROPHYLACTIC MEASURE PRIOR TO SURGERY IN HAEMORRHAGIC STATESTHROMBOCYTOPENIAHAEMOPHILIALIVER DISEASE

BLOOD COMPONENTS AND THEIR

TRANSFUSION

Symptomatic anemia (providing

oxygen-carrying capacity)

Transfusion trigger

(HCT<30% ; HB<10g/dl)

1 Unit increases 3% HCT or 1g/dl

Shelf life =42 d (1-6 )℃

Red Blood CellsRed Blood Cells

THROMBOCYTOPENIA

(< 50,000)

PLATELET

DYSFUNCTION

EACH UNIT INCREASE

5,000 PLTS AFTER 1 H

PlateletsPlatelets

PROFOUNDLY GRANULOCYTOPENIA (<500)

SERIOUS INFECTION NOT RESPONSIVE TO

ANTIBIOTIC THERAPY

GranulocytesGranulocytes

COAGULATION FACTOR DEFICIENCIES

1 ML INCREASES 1% CLOTTING FACTORS

BEING USED AS SOON AS POSSIBLE

ALBUMIN, HETASTARCH, CRYSTALLIODS ARE EQUALLY EFFECTIVE VOLUME EXPANDER BUT SAFER THAN FFP

AFTER USE OF 5 U OF RBCS, MATCHING 2 U OF FFP

Fresh Frozen Plasma (FFP)Fresh Frozen Plasma (FFP)

DEXTRAN MOST WIDELY USED LOW/MIDDLE M.W. (40,000-70,000) MASSIVE TRANSFUSION COULD IMPAIR

COAGULATION OCCASIONAL ALLERGIC REACTIONHYDROXYETHYL STARCH FORMULATION

(HES) MORE STABLE CONTAINING ESSENTIAL ELECTROLYTES NO ALLERGIC REACTION

Plasma SubstitutesPlasma Substitutes

Technique of Transfusion:

Approach Route:

Peripheral Vein, Center Vein

Filtration before Transfusion：

Velocity of Transfusion：5-10ml/min

BLOOD TRANSFUSIONBLOOD TRANSFUSION

Double Check: Name, Type and Crossmatch

Storage Time: Citrate Phoshate Detrose

Acidic Citrate Detrose

21D, 35D

Pre-heat： No any other Medication： Observation during / after Transfusion：

Attention：

BLOOD TRANSFUSIONBLOOD TRANSFUSION

Incidence ： 2%

Chills, Fever 39-40.C

Headache, Sweatiness

Nausea, Vomiting, Flushing

15min-1hr

Febrile Reactions ：

Transfusion ReactionsTransfusion Reactions

Immuno-reaction ：

Endo-toxins：

Contamination or Hemolysis：

Analyze possible reasons：

Stop Transfusion ：

General Support：

Treatment：

Febrile Reactions ：

TRANSFUSION REACTIONSTRANSFUSION REACTIONS

Urticaria

Abdominal cramps

Dyspnea

Vomiting

Diarrhea

Anaphylactic reactions：

TRANSFUSION REACTIONSTRANSFUSION REACTIONS

Immuno-reaction ： IgE

Hereditary Immunoglobulin ： IgA

Reason：

Administer antihistamines

Administer epinephrine, diphenhydramine,

and corticosteroids：

Support airway and circulation as necessary：

Treatment：

ANAPHYLACTIC REACTIONS：

Burning at the intravenous (IV) line site

Fever, Chills, Dyspnea

Shock

Cardiovascular Collapse

Hemoglobinuria, Hemoglobinemia

Renal Failure

DIC

Hemolytic transfusion reactions

Transfusion ReactionsTransfusion Reactions

ABO incompatibility

Rh Incompatibility

Non-immune Hemolysis

Immune Hemolysis

Reasons：

Hemolytic Transfusion Reactions

Stop Transfusion as soon as reaction is suspected

Check the name, type and crossmatch

Urine Exam

Renal Protection

(Aggressive Fluid Resuscitation, Furosemide)

DIC Monitor

Treatment：

Hemolytic Transfusion Reactions

Double Check name,type and crossmatch

Operate carefully and routinely

Temperature Monitor

Prevention：

Hemolytic Transfusion Reactions

IT IS DEFINED AS TRANSFUSION OR INFUSION OF WHOLE BLOOD EQUAL TO OR EXCEEDING THE PERSONS BLOOD VOLUME WITH IN 24 HRS PERIOD

MEDICAL EMERGENCIES

MAJOR SURGERY

EXCHANGE TRANSFUSION

PHYSICALHYPOTHERMIA

CHEMICALHYPOCALCEMIAACIDOSISHYPOKALEMIA WITH MET.ACIDOSIS

PHYSIOLOGICALOXYGEN DIS. CURVE TO LEFTDEPLETION OF LABILE COAG. FACTORSDILUTIONAL THROMBOCYTOPENIA

Massive transfusion complications:

Volume Overload

Congestive Heart Failure

Tachycardia

Tachypnea

Cyanopathy

Transfusion ReactionsTransfusion Reactions

Volume Overload

Heart Functional Failure

Lung Functional Failure

Reasons：

Stop Transfusion

Heart Functional Support

Diuresis (Furosemide)

Treatment：

Massive Transfusion Complications:

Contamination:

Fever

Shock

DIC

Bacterial Contamination

Reasons：

Transfusion ReactionsTransfusion Reactions

Stop Transfusion

Bacterial Exam and Culture

Antibiotics

Treatment：

Double Check

Operate carefully

Prevention：

Contamination:

Hepatitis B, Hepatitis C

HIV

Cytomegalovirus (CMV)

Syphilis

Malaria

Acquired diseases ：

Transfusion ReactionsTransfusion Reactions

No risk of infectious disease transmission

No transfusion reactions

No compatibility testing

Reduced demand on blood bank stores

An immediate source of autologous blood

AUTOTRANSFUSIONAUTOTRANSFUSION ：：

Red Blood Cells

Packed RBC

White Blood Cells

Pooled Platelets

Blood Cell：

Component TransfusionComponent Transfusion ：：

• Saving blood source

• Less likely carrier of transmitted diseases

• Shortage of quality blood

• Greater shelf life than whole blood

• Helping to make blood safer by filtration

• Infusing regardless of ABO type in some blood

products

giving only essential/desired blood component

Component TransfusionComponent Transfusion ：：

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