BLOOD

TRANSFUSION

By Prof. F.X. Budhianto Suhadi

Definition

Blood Transfusion is a procedure in which the

blood or blood components from one person,
called a donor, is given to another, called a
recipient
Depending on the reason for the transfusion, the
person may be given whole blood or a blood
components, such as:

Red blood cells

Platelets
Blood clotting factors
Fresh frozen plasma
White blood cells

Definition (continue.)
This blood can be obtained from many sources.
Volunteer donors are carefully screened and
interviewed before they are allowed to donate
blood
Friends or family members can do a directed
donation
But, findings have shown that these donations
are nor any safer than those given by random
donors

Definition (continue.)
An autologous donation means that a
person has donated his or her own blood
to be stored for future use
This may be done prior to an elective
surgery

Who is the candidate for the procedure?

People

receive blood transfusion for

many reason.
Blood transfusions can:
Increase the bloods ability to carry oxygen
Restore the bodys blood volume
Improve immunity
Correct clotting problems

Who is the candidate for the procedure?

(continue)

A person may need a blood transfusion if he

or she has:
Lost blood and fluid volume as a result of an injury,
surgery, or burns
Anemia, or a low red blood cell count
A bleeding disorder, such as hemophilia A or
hemophilia B
An immunodeficiency disorder, a condition that
weakens the bodys ability to fight off infection

How is the procedure performed?

Most

transfusion are given in the

hospital
Sometimes they are given in outpatient
settings such as an ambulatory care
clinic, a doctors office, or even a home

How is the procedure performed?

(continue)

Unless an emergency exists, a sample of blood

will be drawn for blood typing and cross-matching
with the blood to be received
The blood type must be accurately identified
when a person is to receive whole blood or red
blood cells
The four blood types are known as A, B, AB, and
O.
Blood will also be referred to as Rh positive or Rh
negative, depending upon whether the Rh antigen
is present on the membrane of the red blood cells

How is the procedure performed?

(continue)

A careful history and physical will be

performed before the transfusion.
An intravenous (IV) will be started, usually in
the hand or arm
To lessen the chance of a reaction,
healthcare workers take several precautions
The blood is double checked by two
healthcare workers to confirm that the blood
about to be given is intended for the person
about to receive it

How is the procedure performed?

(continue)

The blood is run slowly, over 1.5 to 4 hours

The persons vital signs, such as
temperature, pulse, breathing rate, and blood
pressure, will be closely watched during the
procedure
Because an adverse reaction is most likely to
occur in the first 15 minutes, the person is
watched closely at first

How is the procedure performed?

(continue)

Signs

and symptoms of a transfusion

reaction include:
Chills
Fever
Breathing problems
Chest or back pain
Nausea
Pain at the infusion site
Hives and itching
Anything unusual or of concern

What happen right after the

procedure?
After

the procedure, the persons vital

signs will be checked and compared to
baseline measurements
Blood work, including a complete blood
count or CBC, may be drawn to assess
the persons response to the transfusion

What happen later at home?

The

healthcare provider will tell the

person which symptoms to report after
the procedure
Normal diet and most activities can be
resumed after a transfusion

What are the potential complications

after the procedure?

Transfusion reaction are usually minor, and

caused by antibodies to white blood cells still
present in the blood product
This occurs in about 1 to 2% of all transfusions
Most reactions slowly clear after the
transfusion is stopped
Rarely, blood cell destruction can occur when
the donor blood is incompatible with that of the
recipient

What are the potential complications

after the procedure? (continue)
The

person might have trouble

breathing, severe pain in the chest or
back, and blood in the urine
This condition is rare, but can be life
threatening
Other complications, such as circulatory
overload, may occur to people at risk
from previous heath problems

What are the potential complications

after the procedure? (continue)
Despite

careful donor screening and

blood testing, certain diseases can be
transmitted by blood transfusion
although the risk is very low
These diseases include:
Hepatitis C, which occur in about 1 in
10,000 transfusion
Human immunodeficiency virus, or HIV,
with a risk of 1 in 670,000 transfusions
continue.

What are the potential complications

after the procedure? (continue)
These

disease include: (continue)

Cytomegalovirus (CMV)
Bacterial infections
Malaria
Syphilis
Concerns

about the safety of donated

blood products should be discussed
with a healthcare provider

Types of Blood Donation

Allogenic Donation
2. Autologous Donation
1.

Allogenic Donation
Having

cell types that are antigenically

distinct
Transplantation biology denoting
individuals(or tissues) that are of the
same species but antigenically distinct,
as opposed to syngeneic and
xenogeneic
Called also homologous

Allogenic Donation (continue)

Syngeneic:

denoting individuals or
tissues that have identical genotypes
and thus could participate in a syngraft
Xenogeneic
Denoting individuals from different species
or tissues that have different genotypes
Called also heterogenic and heterologous

Autologous Donation

Also called autogeneic, autogenous

The practice of individuals predepositing blood
intended for transfusion into themselves prior
to procedures in which blood loss is
anticipated
Autologous blood transfusion was initiated as
a means of preventing transfusion-associated
hepatitis and became widely used after the
recognized transmission of HIV through blood
products

Autologous Donation (continue)

It is clear that in the majority of cases
that autologous blood is the safest
blood available to the patient
There are 4 methods to obtain
autologous blood:

1.
2.
3.
4.

Predeposit
Preoperative collection with hemodilution
Intraoperative salvage
Postoperative salvage

Predeposit

The most common method for obtaining

autologous blood is by predepositing blood
prior to the anticipated date of use
The phlebotomy schedule is set by the blood
bank physician in consultation with the
patients physician and should not occur more
frequently than every 72 hours (preferably 1
week between donations) with the last
donation not less than 72 hours before
anticipated use

Predeposit (continue)
Laboratory

testing of autologous blood

remains an area of transfusion medicine
that is devoid of uniform guidelines
The Food and Drug Administration (FDA)
requires that autologous blood be tested
for HIV-1 antibody and HBsAg and that
serologic testing for syphilis be performed

Predeposit (continue)
No

testing is necessary, however, if the

autologous unit is to be used in the
institution in which it is collected
Problems can arise if the site of a
patients surgery is unexpectedly
changed

Preoperative collection with

hemodilution
The intraoperative collection and reinfusion of
blood during surgical procedures has proven to
be an effective method of reducing homologous
blood requirements when used alone or in
combination with predeposited autologous blood
The only absolute contraindication to the use of
blood salvaging is contamination of the surgical
site with malignant cells or bacteria
The washing process will not remove either of
these contaminants

Intraoperative salvage

Autologous blood transfusion can involve blood

that has been collected from surgical drains
postoperatively, often referred to as shed blood
Current AABB standards mandate that blood
collected postoperatively be infused within 6
hours of the time collection was initiated
The standards also state that tissue debris and
other sterile contaminants may necessitate
special processing such as washing

Intraoperative salvage (continue)

Shed blood that is not washed contains
activated components and/or by-products of the
complement, soluble coagulation, and fibrinolytic
system that have the potential of causing harm
to the patient
Fibrin degradation product (FDPs) are potent
inhibitors of fibrin formation and platelet function
The presence of FDPs in shed blood also
indicates that the fibrinolytic system has been
activated

Intraoperative salvage (continue)

Salvaged blood is defibrinogenated

Transfusing an unwashed product will not
supply the patient with clotting factors or any
substance that could be beneficial in
maintaining balance between hemostasis and
thrombosis
On the contrary, unwashed shed blood may
contain activated products of the coagulation
system that could be deleterious to the patient

Postoperative salvage
Autologous

blood may be collected just

prior to a surgical procedure by
replacing the volume of blood collected
with an equivalent amount of sterile
intravenous solution