Blood Transfusion

Dr. Mahmoud Al-Balas, MBBS

Higher Specialty Certificate of General Surgery JUST

Jordanian Board of General Surgery
E.C.F.M.G. Certificate
MRCS Ireland
 Blood Products

Cellular Components
Red cell concentrate
Platelet concentrate
Granulocyte Concentrate

Plasma Components
FFP
Cryoprecipitate

Plasma Derivatives
Albumin
Immunoglobulin
Coagulation Factors
 Blood Volume

Premature 100 ml/kg

Full term 85 ml/kg
Infant 72 ml/kg
Children 76 ml/kg
Adults 80 ml/kg
 Whole Blood

Whole Blood = Donor Blood + Anticoagulant

1 unit = 450 ml
Anticoagulant = 63 ml
No functional platelets
No labile anticoagulants
Used for component preparation
Hct = 45%
Stored at 2-6 C
Shelf life = 35 days
 Whole Blood

Indications for transfusion

Hypovolemic Blood loss
CABG
Exchange transfusion (e.g. anemia, Hyperbilirubinemia)
Massive transfusion

Dosage of transfusion = 20 ml/kg

1 unit increase Hb 1 g/dl

 Whole Blood

Transfusion Considerations Adverse effects

Hemolytic
ABO compatible
Febrile
Cross match compatible Allergic, Anaphylactic
Start transfusion slowly Infectious
Sepsis
Fluid overload
TRALI
TA-GVHD
 Red Cell Concentrate

Packed red cells

Platelets and plasma are removed
1 unit = 200-250 ml
Hct= 65-75%
Shelf life 35 days
Storage 2-4 C
Leucoreduced Red Blood Cells

Indications
Symptomatic anemia
Repeated transfusions
Prevent febrile non hemolytic anemia

Characteristics
WBC < 5* 108/L
HCT = 50-60%
Volume = 350 ml
Shelf life = 42 days
Stored at 2-6 C
 Washed RBC

RBC washed with 1-2L of N.S.

RBS 20% reduced
WBC 90% reduced
Platelet 90 reduced
Prevent febrile non hemolytic reactions
Transfuse within 6 hours
Antibodies and plasma components are removed
 Washed RBS

Indications

Multitransfused patients with febrile reactions

Urticarial reactions
Anaphylactic reactions
IgA deficiency with IgA antibodies
Paroxysmal nocturnal hemoglobinurea
 Platelet Concentrates

Random donor platelets Single donor platelets

(RDP) (SDP)
From unit of Whole blood From Single donor
1 unit = 50*109 platelets 1 unit = 300*109 platelets
Volume = 50 cc = 6 RDP
Volume = 200-350 cc
 Platelet Concentrates

Storage = 20-24 C
Shelf life = 5 days
Should be AB compatible

Contraindications
TTP
HIT
 Granulocytes
Granulocyte Concentrates
Prepared by apheresis
1 unit = 1*109 granulocytes
Volume 200-300 ml
Dose = 1 or more / day
Buffy Coat
Layer between RBC and
plasma
1 unit = 1-2 *109 granulocytes
Volume 50 ml
Dose = 10/ day
Shelf life 1 day
Storage 22-24 C
Should be irradiated, ABO
and Rh specific
 Irradiated Blood Products

Inactivate T-Lymphocytes
Prevent GVHD
Shelf life 28 days

Indications
Bone marrow/ stem cell transplant
Intrauterine transfusion
 Blood warming

Not indicated for routine transfusion

Indicated for:
Rapid infusion through CVP lines
Presence of cold agglutinins
Exchange transfusion in neonates

Warming increase RBC metabolism and bacterial

growth
 FFP

Contain all coagulation factors and plasma protiens

Indications
Massive transfusion
TTP, DIC
Warfarin overdose
Clotting factor or factors deficiency
 FFP

Dosage = 12-15 ml/kg

1 unit = 200-250 cc
Must be ABO compatible
Storage = < - 30 C
 CRYO

1 unit contain
Factor 8, 13
vWF
Fibrinogen

1 unit = 15 cc
Storage = (- 30 C)
 Stored Plasma

Anticoagulant factors containing preservative

solution
Contain stable clotting factors
NO labile clotting factors
Volume 200-250 cc
Shelf life 1 year
 Adverse Effects of
Blood Transfusion

Causes

Incorrect blood component transfusion

Errors in Collection, Storage, blood administration
Lab. Errors
Compatibility testing errors

Acute Vs. Delayed

 Acute Transfusion Reactions

Immunologic Non Immunologic

Marked fever with shock

Hemolytic transfusion
Atypical reaction with hypotension
reaction
CHF
Febrile non-hemolytic Air embolism
reaction Hypocalcaemia
Allergic Hypothermia
Anaphylactic Hypo-/Hyperkalemia
TRALI thrombophlebitis
Delayed Transfusion Reactions

Immunologic
Non Immunologic

Alloimmunization to
Iron overload
RBC, WBC, Platelets,
Proteins and HLA Transfusion transmitted
diseases
Hemolytic reactions
Post-transfusion
purpura
THANK YOU