TRANSFUSION

MEDICINE

BY

DR. C .C . OKAN Y
Consultant Physician/Haematologist
LUTH
 PR INC IPL ES OF BLOOD
TRANS FUS ION

- B.T. should only be given when the

potential benefits clearly outweigh the
risks.
- Patients for elective surgery should
have their anaemias corrected by
appropriate means before surgery.
- Moderate anaemia is not a contra-
indication for surgery especially when
the surgery is likely to correct the
cause of the anaemia
- Habit of “topping up” to be
condemned.
- Hb concentration alone is not
enough indicator for need of B.T.
 BLOOD COMPONENTS
• O2 Carrying Components
- Red Cell concentrate
- Leucocyte – poor blood
- Frozen – thawed red cells
• Platelet Products
- Platelet rich plasma (PRP)
- Platelet concentrate
 PLASMA DERIVATIVES
• Plasma Products
- Fresh frozen plasma
- Cryoprecipitate
- Stored plasma (X, IX, XII, VII)
• Coagulation factor concentrates
- factor VIII
- factor IX
• Oncotic Agents
- Albumin
• Immune Serum Globulin
- Immune serum globulin(IgG)
- Hepatitis B immune globulin
- Varicella – zoster immune globulin
- Rh immune Globulin
- Tetanus Immune globulin
- Rabies
- Rubella
- Hepatitis A.
INDICATIONS FOR TRANSFUSION
OF RED CELLS
• Anaemia produced by recurrent
haemorrhage
• Pre-op transfusion
• Anaemia discovered late in
pregnancy
• Chronic anaemia in conditions like
leukaemia, aplastic anaemia
malignancies, CRF etc.
 COMPATIBILITY TESTING
• Defined as invitro demonstration of
serological compatibility between the
prospective recipient’s (patient’s) serum
and donor’s red cells.
• Types of cross matching
- saline at room temperature
- saline at 37oC
- Albumin at 37oC
- Indirect Coomb’s test
- with enzyme Papain
 SELE CTI ON OF BLO OD FO R
TR AN SFUSI ON AC CORD ING TO
PAT IENT S AB O G ROUP

Patient Group Blood for transfusion

Blood group when 1st
Blood groups1st choice choice is not available
0 0 -
A A 0
A with anti – A1 A2 0
B B 0
AB AB A or B
(exceptionally 0)
 Complications of blood transfusion
• Febrile reactions
• Allergic reactions
• Circulatory overload
immediate
• Haemolytic reaction delayed
• Infected blood
• Transfusion of diseases
- Viruses, HBV, HCV, HIV, CMV
- Malaria
- syphilis
- Chagas disease (Trypanosoma cruzi)
- Other rare transfusion-transmissible infections
e.g. human parvovirus B19, brucellosis, Epstein-
Barr virus, toxoplasmosis, infectious
mononucloeosis.
 Complications of blood transfusion
(contd)

• Thrombophlebitis
• Air embolism
• Haemosiderosis
• Complication of massive BT
- Cardiac Arrythmias (excessive citrate, low pH,
cold blood, hyperkalaemia
- bleeding (excess citrate, thrombocytopenia)
 CATEGORIES OF ACUTE TRANSFUSION
REACTIONS

• Category 1: Mild Reactions

Signs symptoms possible
cause
Localised cutaneous Pruritus
Hypersensitvity
Reactions (itching) (mild)
- Urticaria
- Rash
 CATEGORIES OF ACUTE TRANSFUSION
REACTIONS (CONTD)
• Category 2: Moderately Severe Reactions
Signs symptoms Possible cause
* Flushing * Anxiety * Hypersensitivity
* Urtricaria * Pruritus (moderate-severe)
* Rigors * Palpitations * Febrile non-
haemolytic
* Fever * Mild dyspnoea transfusion reactions:
* Restlessness * Headache - Antibodies to WBC,
platetlets,
* Tachycardia Antibodies to
proteins, including IgA
- Pyrogens and/or bacteria
 CATEGORIES OF ACUTE TRANSFUSION
REACTIONS (CONTD)
CATEGORY 3: Life Threatening Reactions
Signs symptoms Possible cause
* Rigor * Anxiety * Acute intravascular
* Fever * Chest pain haemolysis
* Restlessness * Dyspnoea * Bacterial
* Hypotension * Loin/back pain
contamination and
* Tachycardia * Headache septic
shock
* Haemoglobinuria * Fluid overload
* Unexplained bleeding * Anaphylaxis
(DIC)
 De layed haemo lytic tra nsfu sion
reactio ns
• Sign appears 5-10 days after transfusion
• Fever
• Anaemia
• Jaundice
• Occasionally haemoglobinuria.
• Post-transfusion purpura
7. A rare but potentially fatal complication or transfusion
of red cells or platelet concentrates, caused by
antibodies directed against platelet-specific antigens
in the recipient
8. Most commonly seen in female patients.
Signs and symptoms
• Signs of bleeding
• Acute, severe thrombocytopenia 5-10 days after
transfusion defined as a platelet count of less than
100 x 20 x 109/L.
 MANAGEMENT OF TRANSFUSION
REACTIONS
Category 1: Mild Reactions
2. Slow the transfusion
3. Administer antihistamine IM (e.g.
chlorpheniramine 0.1 mg/kg or equivalent)
Category 2: Moderately Severe Reaction
• Stop the transfusion, replace the infusion set
and keep IV line open with normal saline.
• Send blood unit with infusion set, freshly
collected urine and new blood sample (1 clotted
and 1 anticoagulated) from vein opposite
infusion site with appropriate request form to
blood bank for laboratory investigations.
 MANAGEMENT OF TRANSFUSION
REACTIONS (CONTD)
1. Administer antihistamine IM (e.g.
chlorpheniramine 0.1mg/kg or equivalent) and
oral or rectal antipyretic (e.g. paracetamol 10
mg/kg: 500mg – 1 g in adults). Avoid aspirin in
thrombocytopenic patients.
2. Give IV corticosteroids and bronchodilators if
there are anaphylactoid features (e.g.
broncospasam, stridor).
 MANAGEMENT OF TRANSFUSION
REACTIONS (CONTD)
Category 3: Life-Threatening Reactions
2. Stop the transfusion. Replace the infusion
set and keep IV line open with normal saline
3. Infuse normal saline (initially 20-30ml/kg) to
maintain systolic BP. If hypotensive, give
over 5 minutes and elevate patient’s legs.
4. Maintain airway and give high flow oxygen
by mask.
5. Give adrenaline (as 1:1000 solution)
0.01mg/kg body weight by low intramuscular
injection.
 MANAGEMENT OF TRANSFUSION
REACTIONS (CONTD)
• Give IV corticosteriods and bronchodilators
if there is anaphylactoid features (e.g.
broncospasm, stridor).
• Give diuretic: e.g. frusemide 1 mg/kg IV or
equivalent.
• Send blood unit with infusion set, fresh urine
sample and new blood samples (1 clotted and
1 anticoagulated) from vein opposite infusion
site.
 COMPLICATIONS OF MASSIVE BLOOD
TRANSFUSION
• Massive transfusion is the replacement of blood loss
equivalent to or greater than the patient’s total blood
volume in less than 24 hours.
• 70 ml /kg in adults.
• 80-90 ml/kg in children or infants.

Complications
• Cardiac abnormalities
For the prevention of cardiac complications calcium
gluconate (2ml of 10% solution to be given per a unit of
blood).
• Acidosis
To prevent this fresh blood should be given as much as
possible.
 COMPLICATIONS OF MASSIVE
BLOOD TRANSFUSION (CONTD)
• Haemostatic failure
• Shock lung syndrome (ARDS) The
pathogenesis of ARDS is unclear, but direct
damage to alveolar lining cells, local DIC,
microvascular fluid leakage and emoblisation
by microaggregates from stored blood all
contribute.
• Jaundice
 OTHER TYPES OF BLOOD TRANSFUSION
1. Exchange blood transfusion
Indications
- Haemolytic Disease of the New Born
- Sickle Cell Anaemia
- Pre-operative
- Severe sequestration crisis
- Severe crisis around labour puerperium
- CNS infarction
- Acute Priapism
- Acute chest syndrome
- Treatment of fulminant Hepatitis or coma
- Drug poisoning
- D.I.C in infants
 OTHER TYPES OF BLOOD TRANSFUSION
(CONTD)

Autologous Blood Transfusion

Advantages
Types
• Salvage autologous B.T
• Peri-operative haemodilution
• Pre-deposit autologous B.T
 PLASMA SUBSTITUTES
• These are colloid and crystalloid solns used for
maintaining the circulation volume following acute
haemorrhage, shock, burns and septicaemias.
Plasma substitutes have no 02 carrying capacity
and also lack haemostatic properties.
Crystalloids – no oncotic activity
Colloids – temporary oncotic activity (short half life)
• Plasma substitutes are used in emergency to “buy
time” necessary for provision of compatible blood
and appropriate blood product.
 Advantages and Disadvantages
Soln Advantage Disadvantage
Crystalloids Readily available Lack of oncotic
Easy storage pressure in plasma
Easy administration
Non-immunogenic
Non-toxic
Do not inhibit synthesis
of albumin

Colloids Readily available short halflife in circulation

Easy storage mildly immunogenic
Easy to administer may interfer with
haemostasis
Do no transient disease may interfer with grouping
and cross-matching
Provides oncotic pressure may delay replenishment
Cheap of albumin.
 COLLOIDS
- Dextrans
Polysaccharide fragment (mol wt 40-15,000) stored at room temp shelf life
3-5yrs
Side effects
- hypotension due to release of vasoactive substances
- Circulatory overload
- Rarely anaphylactoid reaction
- Renal failure (plugging or capillaries by polysaccharide pigments)
- Bleeding
- Hydroxyethyl starch (derived from a waxy starch mol wt 450,000)
Side effects are rare circulatory overload
Renal failure
Mild bleeding tendency
- Gelatin (Haemacel)
Side effects – release of vasoactive substances especially if administered
rapidly.
CRYSTA LLOID S
Normal saline (Na+ Cl-)
Ringer’s soln (Na+, K+ Ca++, Cl-)
Hartman’s Soln (Na+, K+, Ca++, HCO -)
Artificial blood (synthetic O2 carrying Agents)
Synthetic O2 carrying agents are still experimental
Two classes exist Perfluorochemicals
Chemically modified haemoglobin
The perfluorochemicals are fluorinated hydrocarbons.
They readily dissolve oxygen, but are poorly
soluble in plasma. One of these compounds “
fluorosol – DA” has been studied in animals and is
currently being studied in humans.
Side effects: hypotension and DIC, leucopenia,
thrombocytopenia, toxic to macrophages.
Free haemaglobin has a very short life. It can be
chemically modified to increase its intravascular
survival and make it more effective in carrying
oxygen.
THANKS FOR
LISTENING