blood transfusion

Dr. Moamar Mortada

Blood TransfusionBlood Transfusion

• History

• Type of Transfusion

• Indication

• Transfusion Reactions

• Autologous transfusion

• Component Transfusion


History and SignificanceHistory and Significance

Lower Lower (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

Is there any suitable

Blood Substitutes

World war IIWorld war II

Successful blood transfusion is relatively recent

• Crossmatching

• Anticoagulation

• Plastic storage container


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


• 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)

--Volume Expander

Dextran• Most widely used• Low/Middle M.W. (40,000-70,000)• Massive transfusion could impair coagulation• Occasional ALLERGIC reaction

Hydroxyethyl Starch Formulation (HES)• More stable• Containing essential electrolytes• No allergic reaction

Plasma SubstitutesPlasma Substitutes

Indication：

Acute massive blood loss;

Anaemia and hypoalbuminemia;

Overwhelming Infection;

Dysfunction of Coagulation;


Technique of Transfusion:

Approach Route:

Peripheral Vein, Center Vein

Filtration before Transfusion：

Velocity of Transfusion：5-10ml/min


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：


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 ：


Urticaria

Abdominal cramps

Dyspnea

Vomiting

Diarrhea

Anaphylactic 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


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：


Double Check name,type and crossmatch

Operate carefully and routinely

Temperature Monitor

Prevention：


Massive transfusion complications:

Volume Overload

Congestive Heart Failure

Tachycardia

Tachypnea

Cyanopathy


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：


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 ：


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 ：：

blood transfusion

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