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Blood Request To Transfusion - Practical Aspects Presented by – Dr. Rajesh Kucheria Medical Director, Arpan Chain Of Blood Banks BLOOD TRANSFUSION PROCESS.

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Presentation on theme: "Blood Request To Transfusion - Practical Aspects Presented by – Dr. Rajesh Kucheria Medical Director, Arpan Chain Of Blood Banks BLOOD TRANSFUSION PROCESS."— Presentation transcript:

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2 Blood Request To Transfusion - Practical Aspects Presented by – Dr. Rajesh Kucheria Medical Director, Arpan Chain Of Blood Banks BLOOD TRANSFUSION PROCESS START TO END Blood Request Patient’s Sample Collection Blood Grouping Crossmatching & Compatibility Storage of Blood / Components Pre - administration Precautions Administration Of Blood / Components Monitoring Of Patient During Administration Adverse Transfusion Reactions Management Of Adverse Reactions

3 ARPAN’S QUALITY POLICY Arpan is committed to deliver highest level of quality standard in its products and services. We believe that this can be achieved only with continuous improvements, global bench marking & ceaseless effort to learn. We aim to set new standards for quality in our region & become a role model for all those who want to contribute in this sphere of public health.

4 PREFACE Emerging from Arpan’s vision, this document is a very specific effort towards bringing entire chain of professionals working in blood transfusion cycle to a common understanding of the complex process. Starting with the point in the hospital where it is decided to opt for blood transfusion to the logical conclusion of patients acceptance of this emergency drug, every step is discussed with detailed medical understanding as well as administrative check points. The purpose is to ensure that there is no error whatsoever at any point in this lifesaving mechanism. We are sure, clinicians, paramedical staff, blood banking staff and administrative professional touching this process would find this document very useful and pragmatic for their day to day work and will make entire cycle error free and thus safest. We would be more than happy to receive your feedback / suggestions on this on - Arpan Family -

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6 INDEX 1.Blood request ……………………………………………………………………….. 1 To 6 Requisition form filling Blood sample collection NAT test Guidelines for use of blood components Plasma by apheresis (PL-A) 2.Blood groups, Crossmatching & Compatibility……………………… 7 To 32 ABO & Rh blood group systems Crossmatching ABO crossmatching ABO compatibility for Whole blood, PCV, Plasma & Platelets Rh compatibility Compatibility & selection of unit for neonatal transfusion 3.Storage of blood & blood components…………………………………. 33 To 34 In blood bank In hospital 4.Administration of blood & blood components……………………… 35 To 38 Pre-administration precautions Administration Monitoring of patient during administration 5.Adverse transfusion reactions & their management…………… 39 To 44 Infectious adverse transfusion reactions Non infectious adverse transfusion reactions Management of adverse transfusion reactions Leuco-depletion

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8 BLOOD REQUEST

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10 Patient information 1. Always write patient’s full name as multiple requests come to blood bank from many hospitals & there are chances of two requests of same name & surname from two different hospitals. 2. Compulsory write patient’s blood group on form. If any discrepancy is noted in blood group written on requisition form and blood group detected in blood bank on patient’s sample, it can be resolved & right blood can be issued to the patient. 1. Always write date & time of requirement of blood / component unit, so that unit can be reserved, if it is going to be available meanwhile. Product requirement 1. Always write treating doctor’s name & mobile no. on requisition form, so that in case of any problem or doubt, it can be resolved by talking with him. 2. Always give hospital seal on requisition form. It is legally compulsory & possible malpractices can be avoided. Hospital information REQUISITION FORM FILLING 1

11 BLOOD SAMPLE COLLECTION Patient’s Sample Label Sticker Always remove needle & then pour blood in sample bulb Never send sample in syringe Always label sample bulb properly with patient’s full name & hospital name 2 Patient’s Full Name First Middle Surname Hospital

12 NAT TEST NAT testing lab is established at Arpan Blood Bank, Nashik. It is 2 nd Stand alone blood bank in the country to start NAT testing facility. NAT tested blood will be available at all centres of Arpan blood bank across State. NAT – Nucleic Acid Amplification test used to detect HIV, HBV & HCV infection. It is most advanced technology used Worldwide. In this test, viral RNA is captured, amplified & detected. As it detects genetic material, detection is accurate & very early than conventional methods (ELISA & Cheminileuscence). Pilot Study – The first Indian study for NAT testing shows that 1 in 1,528 blood units are found to be positive for any of the Three viruses which were seronegative by ELISA technology. A pilot study at AIIMS among 5,818 donors shows that 1 in 1,164 blood units were found to be positive for any of the three viruses which were seronegative by ELISA technology. window period reduction There is no reported case of either of three infections after transfusion of NAT tested blood. Cost- As NAT test is done in addition to routine ELISA test, extra cost is added for NAT tested unit. But the cost is negligible considering the physical, mental trauma & economic loss for treatment of these diseases. 3 InfectionWindow period (When tested by ELISA technology using best 4 th generation kits) Window period (When tested by NAT technology) HIV 20.3 days5.6 days HBV 53.3 days24.6 days HCV 58.3 days4.9 days

13 GUIDELINES FOR USE OF BLOOD COMPONENTS -Recipient is exposed to many donors. -Risk of alloimmunization and so platelet refractoriness -Chances of transfusion reaction are more as leucoreduction is not always possible. -Recipient is exposed to single donor. -Leucoreduced platelets are obtained so risk of transfusion reaction and platelet refractoriness is reduced. Increases Platelet count by 5,000- 8,000/ml per unit Increases Platelet count by 50, ,000/ml per unit To Increase Platelet Count -More chances of transfusion reactions due to plasma proteins. -It is like unnecessary multidrug therapy. -Least chances of transfusion reactions as total plasma is removed. -Viability of RBCs is better. -Platelets and Plasma can be utilised for another patient. Hb by 1 g% HCT by 3% Hb by 1 g% HCT by 3% 2. Whole Blood (WB) 1.Packed Red Cells In Additive Solution (PCV) To Increase HB% PreferenceReasonsDesired EffectOptions Transfusion Indication 2. Random Donor Platelets (RDP) 1.Single Donor Platelets (SDP) As per volume of PCV - If you want to replace blood loss more than two liters quickly. - If you want to replace blood loss less than two liters. To Replace Blood Loss 2. Whole Blood 1. PCV 4 As per volume of WB

14 To Give Clotting Factors - Fresh Frozen Plasma can be given when all clotting factors are required. - It also supplies Albumin. - If we want to supply factor VIII (AHF), VWF or Factor XIII, Cryoprecipitate should be preferred over FFP as volume is reduced & so chances of transfusion reactions. -Raises all clotting factors (I to XIII) -Supplies Albumin -Raises Factor VIII, VWF and Factor XIII & Fibrinogen 1. Fresh Frozen Plasma (FFP) 2. Cryoprecipitate (CRYO) As per individual PCV & FFP or CRYO As per individual PCV & RDP or SDP Fresh Blood is not an option because all labile clotting factors get destroyed at C within 6 hrs. And it usually takes more than 6 hrs from collection to issue. Hence fresh blood will not supply clotting factors. 2. Fresh Blood 1. PCV + FFP /CRYO To Increase HB% And Clotting Factors Fresh blood is not an option because blood needs to be preserved at C, till testing is done and 80-90% platelets become non viable at C. Hence this blood will not supply viable platelets. You will only get RBCs & Plasma from Fresh Blood. 2. Fresh Blood 1. PCV + RDP / SDP To Increase HB% And Platelet Count Only increase in HB% as per Whole Blood PreferenceReasonsDesired EffectOptions Transfusion Indication GUIDELINES FOR USE OF BLOOD COMPONENTS 5

15 PLASMA BY APHERESIS (PL-A) In western India, Arpan blood bank, Nashik is the only blood bank to have Plasma Apheresis facility. As platelets are collected by apheresis, 500ml plasma can also be collected by apheresis. The unit of 500 ml plasma collected by apheresis is called PL-A. Advantages of plasma by Apheresis (PL-A). 1.As plasma is collected & frozen within 2 hours, the quality of product is much superior & the yield of clotting factors is much high than routine FFP. 2.The desired effect of 4 FFP unit is achieved by single unit of PL-A. So the risk of exposure to four different donors & therefore TTI is significantly reduced. 3.The same donor can donate another unit of PL-A after 15 days. 6

16 BLOOD GROUPS, CROSSMATCHING&COMPATIBILITY

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18 BLOOD GROUPS 1.ABO blood grouping system ABO Blood GroupAntigens on RBCsAntibodies in plasma O-A & B AAB BBA ABA & B- 2.Rh blood grouping system Rh Blood GroupAntigens on RBCsAntibodies in plasma Rh PositiveD- Rh Negative-- ABO antibodies are naturally occurring i.e. opposite antibody (to antigen on RBCs) appears in plasma naturally within few months after birth. In contrast Rh antibodies are not naturally occurring. They are immune antibodies. They develop against antigenic stimulus i.e. when Rh positive RBCs enter in circulation of Rh negative person. 7

19 CROSSMATCHING Blood unit (Donor) Sample Donor RBCs (Antigen) Donor plasma (Antibody) Patient sample Patient’s plasma (Antibody) Patient’s RBCs (Antigen) Major crossmatch Minor crossmatch D D P P If Major crossmatch is incompatible, then donor cells (which are less in volume) will react with antibodies in patient’s plasma (which is large in volume) & will get destructed completely to cause serious hemolytic reaction. So it is called Major. If Minor crossmatch is incompatible, then donor’s plasma (which is less in volume) will get diluted in patient’s plasma (which is large in volume) and there are less chances of reaction between antibodies in donor’s plasma with antigens on patients cells & so least chance of hemolytic reaction. So it is called Minor. 8

20 COMPATIBILITY Agglutination reactionIncompatible No agglutination reactionCompatible Results : Major MinorCompatibility Compatible groups Optional groups ( Can be given in emergency, when compatible group is not available.) Incompatible groups (Can not be transfused) Interpretation : The unit is called compatible if it is compatible for both blood grouping systems i.e. 1.ABO blood group system 2.Rh blood group system 9

21 ABO Crossmatch of ‘O’ blood group patient with all blood groups No agglutination reaction (X-compatible) D P D P Patient Sample Antibodies A & B AntigenMajorMinor Bl. Unit Sample Antigen - Antibodies A & B Blood Group O O - D P D P Agglutination reaction (X-incompatible) No agglutination reaction (X-compatible) Patient Sample Antibodies A & B AntigenMajorMinor Bl. Unit Sample Antigen B Antibody A Blood Group B O - D P D P Agglutination reaction (X-incompatible) No agglutination reaction (X-compatible) Patient Sample Antibodies A & B AntigenMajorMinor Bl. Unit Sample Antigen A Antibody B Blood Group A O - D P D P Agglutination reaction (X-incompatible) No agglutination reaction (X-compatible) Patient Sample Antibodies A & B AntigenMajorMinor Bl. Unit Sample Antigens A & B Antibodies - Blood Group AB O - 10

22 ABO Compatibility table of ‘O’ blood group patient O Major MajorMinor Bag’s Blood Group Patient’s Blood Group O A B AB 11

23 ABO Crossmatch of ‘A’ blood group patient with all blood groups ABO Crossmatch of ‘A’ blood group patient with all blood groups D P D P No agglutination reaction (X-compatible) Agglutination reaction (X-incompatible) Patient Sample Antibody B Antigen AMajorMinor Bl. Unit Sample Antigen - Antibodies A & B Blood Group O A D P D P Agglutination reaction (X-incompatible) Patient Sample Antibody B Antigen AMajorMinor Bl. Unit Sample Antigen B Antibody A Blood Group B A D P D P No agglutination reaction (X-compatible) Patient Sample Antibody B Antigen AMajorMinor Bl. Unit Sample Antigen A Antibody B Blood Group A A D P D P Agglutination reaction (X-incompatible) No agglutination reaction (X-compatible) Patient Sample Antibody B Antigen AMajorMinor Bl. Unit Sample Antigens A & B Antibodies - Blood Group AB A 12

24 ABO Compatibility table of ‘A’ blood group patient A Major Major Minor Minor Bag’s Blood Group Patient’s Blood Group O AB A B 13

25 ABO Crossmatch of ‘B’ blood group patient with all blood groups D P D P No agglutination reaction (X-compatible) Agglutination reaction (X-incompatible) Patient Sample Antibody A Antigen BMajorMinor Bl. Unit Sample Antigen - Antibodies A & B Blood Group O B D P D P No agglutination reaction (X-compatible) Patient Sample Antibody A Antigen BMajorMinor Bl. Unit Sample Antigen B Antibody A Blood Group B B D P D P Agglutination reaction (X-incompatible) Patient Sample Antibody A Antigen BMajorMinor Bl. Unit Sample Antigen A Antibody B Blood Group A B D P D P Agglutination reaction (X-incompatible) No agglutination reaction (X-compatible) Patient Sample Antibody A Antigen BMajorMinor Bl. Unit Sample Antigens A & B Antibodies - Blood Group AB B 14

26 ABO Compatibility table of ‘B’ blood group patient B Major Major Minor Minor Bag’s Blood Group Patient’s Blood GroupO AB A B 15

27 ABO Crossmatch of ‘AB’ blood group patient with all blood groups D P D P No agglutination reaction (X-compatible) Agglutination reaction (X-incompatible) Patient Sample Antibody - Antigens A & BMajorMinor Bl. Unit Sample Antigen - Antibodies A & B Blood Group O AB D P D P No agglutination reaction (X-compatible) Agglutination reaction (X-incompatible) Patient Sample Antibody - Antigens A & B MajorMinor Bl. Unit Sample Antigen A Antibody B Blood Group A AB D P D P No agglutination reaction (X-compatible) Agglutination reaction (X-incompatible) Patient Sample Antibody - Antigens A & BMajorMinor Bl. Unit Sample Antigen B Antibody A Blood Group B AB D P D P No agglutination reaction (X-compatible) Patient Sample Antibody - Antigens A & BMajorMinor Bl. Unit Sample Antigens A & B Antibody - Blood Group AB 16

28 ABO Compatibility table of ‘AB’ blood group patient Major Major Minor Minor Bag’s Blood Group Patient’s Blood GroupO AB AB A B AB 17

29 O A BAB Major Minor Major Minor Major Minor Major Minor WHOLE BLOOD ABO CROSSMATCH TABLE Patient’s Blood Group Bag’s Blood Group O A B AB 18

30 WHOLE BLOOD ABO COMPATIBILITY TABLE Patient’s GroupCompatible GroupOptional Group OO- AAO BBO AB A, B, O 19

31 Blood unit (Donor) sample Patient sample Donor RBCs Patient’s plasma Major crossmatch Patient’s RBCs Minor crossmatch Not Applicable As total plasma is removed from blood unit while preparing PCV, minor crossmatch is not applicable for PCV transfusion. PCV (WITH ADDITIVE SOL) ABO CROSSMATCH 20

32 O A B AB MajorMinor Major Minor Major Minor Major Minor PCV (WITH ADDITIVE SOL) ABO CROSSMATCH TABLE NA Patient’s GroupCompatible GroupOptional Group OO AA,O BB,O ABAB,A,B,O PCV (WITH ADDITIVE SOL) ABO COMPATIBILITY TABLE Patient’s Blood Group Bag’s Blood Group O A B AB 21

33 PLASMA(FFP) ABO CROSSMATCH Donor plasma Blood unit (Donor) sample Patient sample Patient’s plasma Major crossmatch Patient’s RBCs Minor crossmatch Not Applicable After separating RBCs from blood unit plasma is prepared, so major crossmatch is not applicable for plasma transfusion. 22

34 O A B AB MajorMinor Major Minor Major Minor Major Minor NA Patient’s GroupCompatible GroupOptional Group OO,AB,A,B- AA,ABB,O BB,ABA,O AB A,B,O PLASMA (FFP) ABO CROSSMATCH TABLE PALASMA (FFP) ABO CROSSMATCH Patient’s Blood Group Bag’s Blood Group O A B AB 23

35 PLATELET COMPATIBILITY ABO antigens are not usually expressed on platelets. They are expressed on platelets in only 7% population, in which they are expressed weakly and on some platelets. So platelet cross matching is not applicable for platelet transfusion. Platelet can be transfused across group safely i.e. any group platelets can be given to any group patients. 24

36 O A B AB MajorMinor Major Minor Major Minor Major Minor Patient’s GroupCompatible GroupOptional Group OO,AB,A,B- AA,AB,B,O- BB,AB,A,O- ABAB,A,B,O- PLATELET ABO COMPATIBILITY (AS PER PREFERENCES) PLATELET ABO COMPATIBILITY TABLE NA Patient’s Blood Group Bag’s Blood Group O A B AB 25

37 Whole Blood ABO Compatibility Patient’s GroupCompatible GroupOptional Group OO- AAO BBO AB A, B, O PCV (with Additive sol.) ABO Compatibility Patient’s GroupCompatible GroupOptional Group OO- AA,O- BB,O- ABAB,A,B,O- So it is always better to give ‘O’ group PCV with 0 (zero)% risk rather than ‘O’ group whole blood when same group is not available in blood bank. COMPARISON OF WHOLE BLOOD Vs PCV COMPATIBILITY 26

38 Patient’s GroupCompatible GroupOptional Group OO,AB,A,B- AA,ABB,O BB,ABA,O AB A,B,O Plasma ABO Compatibility Patient’s GroupCompatible GroupOptional Group OO,AB,A,B- AA,AB,B,O- BB,AB,A,O- ABAB,A,B,O- Platelet ABO Compatibility COMPARISON OF PLASMA Vs PLATELET ABO COMPATIBILITY 27

39 Rh COMPATIBILITY ‘Rh positive’ patient can receive ‘Rh positive’ as well as ‘Rh negative’ blood or blood components. 'Rh negative' person should receive ‘Rh negative’ whole blood and PCV. For plasma & platelet transfusion, when ‘Rh negative’ units are not available, ‘Rh positive’ units can be transfused weighing the need of transfusion and risk of Rh alloimmunisation. While transfusing ‘Rh positive’ unit to ‘Rh negative’ woman with child bearing potential, Rh Ig prophylaxis should be given. For cryoprecipitate transfusion Rh compatibility is not applicable. 28

40 COMPATIBILITY & SELECTION OF UNIT FOR NEONATAL TRANSFUSION Neonate: Patient under the age of 4 months are neonates for blood transfusion purpose. Blood Request: Write compulsory ‘whether you suspect HDN or not’ on requisition form. Blood Samples: Send blood samples of both – 1.Baby 2.Mother Compatibility Testing: 1.First direct coomb’s test (DCT) on baby’s RBCs & indirect commb’s test (ICT) on maternal plasma are performed to r/o HDN. TestResults DCT on baby’s RBCs –+–+– ICT on maternal plasma –++–– Clinically suspected case of HDN –±±±+ Interpretation: No e/o HDN e/o HDN 29

41 Neonate’s GroupCompatible GroupOptional Group OO- AAO BBO AB A, B, O 2.If there is no e/o HDN: Select unit of same ABO & Rh blood group as that of neonate. ABO COMPATIBILITY, IF NO E/O HDN NOTE: If mother’s group is same as that of baby, additional major crossmatch with maternal plasma should be done. 3.If there is e/o HDN: Use ABO & Rh compatible unit to both baby’s & mother’s sample. Group is compatible, if MajorMinor With baby’s sample With mother’s sample NA Group is optional, if MajorMinor With baby’s sample With mother’s sample NA 30

42 O,A,BAB OBB OBB O-A OB O-B OA OAA -OB -OA A O O O Mother’s ABO group -O O OA AB O- B O- A Optional GroupCompatible Group Neonate’s ABO Group ABO COMPATIBILITY, IF E/O HDN NOTE: If mother’s group is ‘AB’, then baby’s group can not be ‘O’ and if mother’s group is ‘O’, then baby’s group can not be ‘AB’ 31

43 Rh compatibility if e/o HDN: If there is e/o HDN, unit should be Rh compatible to both baby’s & mother’s group i.e. if either of two is Rh negative, then select Rh negative unit. General rules of neonatal transfusion: 1.Don’t use PCV with SAGM solution (additive solution) for neonatal transfusion, as it contains mannitol. Neonatal transfusion is the only contraindication for using PCV with SAGM solution. 2.If you are transfusing blood of optional group (whether there is e/o HDN or not), use semi-PCV (i.e. whole blood from which plasma is removed partially) with low anti-A or anti-B titre. 3.Use fresh blood (<48hrs old preferably) for neonatal transfusion. It should not be more than 5 days old to avoid risk of hyperkalemia. 4.For plasma & platelet transfusion, same group unit as that of baby, should be used. If there is e/o HDN & mother is Rh negative, use unit of Rh negative group. 32

44 STORAGE OF BLOOD & BLOOD COMPONENTS

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46 ProductTempShelf life WB2 0 – 6 0 c35 Days PCV (with Additive Sol) c42 Days FFP, CRYO<-30 0 c1 Year RDPC, SDPC20 0 – 24 0 c5 Days In Blood Bank Platelets should be kept continuously agitating till issued to patient. 33

47 STORAGE OF BLOOD & BLOOD COMPONENTS In Hospital ProductTempShelf life WB c24 Hrs. PCV (with SAGM) c24 Hrs. FFP, CRYO2 0 – 6 0 c12 Hrs. RDPC, SDPCRoom Temp. - Platelets should be kept continuously agitating till transfused to patient. Ideally blood/component units should not be stored in hospital as temp. of the hospital refrigerator is not controlled. Ask the patient’s relatives to bring blood unit from blood bank just before transfusion. 34

48 ADMINISTRATION OF BLOOD & BLOOD COMPONENTS

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50 PRE-ADMINISTRATION PRECAUTIONS Check unit for – Leakage/damage Clot S/o hemolysis S/o contamination 35 Testing Label (On blood unit) Cross-match Label (On blood unit) Issue Report (Sent by Blood Bank) Case Paper Blood bag No. Blood Group of patient Patient’s Name Check For Expiry Date Blood Group of bag

51 ADMINISTRATION BT Set – Use BT set for transfusion of all blood products i.e. WB, PCV, FFP, RDPC, SDPC, & Cryoprecipitate. Change BT set every 12 hrs., if patient is requiring ongoing transfusion. Warming – Warming of blood unit is not needed. Infusion of 2-4 units of refrigerated blood over several hours causes no harm. Warming is needed in following conditions – Infants receiving exchange transfusion. Patients receiving rapid transfusion through central venous line. Patients receiving rapid & massive transfusions. Patients with cold – antibodies. (If warming is needed, unit should not be warmed above 37 0 c. Excessive warming may cause hemolysis in unit & can lead to serious transfusion reaction). Don’t add any medication to unit. You can add only normal saline or 5% albumin to dilute. 36

52 TIME LIMITS FOR TRANSFUSION TIME LIMITS FOR TRANSFUSION WB / PCV – Within 3-4 hours. ( If room temp. is c. At higher room temp., there should be shorter out of refrigerator time). FFP – Within mins. Cryo – Within 5-10 mins. Platelets – Within mins. (RDPC & SDPCs) 37

53 MONITORING OF PATIENT DURING TRANSFUSION - WHEN - Before starting transfusion As soon as transfusion started At 15 mins Every hour On completion 4 hrs. after completion - FOR - General appearance Pulse, B.P., Temp. Respiratory rate Signs of adverse reactions –Fever –Chills –Rash –Back pain –Respiratory distress –s/o anaphylaxis 38

54 ADVERSE TRANSFUSION REACTIONS & THEIR MANAGEMENT

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56 INFECTIOUS ADVERSE TRANSFUSION REACTIONS ReactionPresentationCauseHow to avoid - Risk of transmission of HIV, HBV & HCV through transfusion can be reduced to nearly zero %, by using NAT tested blood. - By using advanced fully automated systems for testing, technical & interpretational errors can be minimized. 1. During window period, HIV, HBV & HCV infections can not be detected. The test results in blood bank are negative. 2. Technical & interpretational errors HIV, HBV, HCV, Malarial parasite, T.pallidum (causative agent of syphilis) are the organisms which can get transmitted through transfusion. Presentation will be as per infection transmitted. Transfusion transmitted infections 39 Transfusion associated sepsis Fever, chills hypotension, septic shock, DIC Bacterial contamination due to technical errors - Take aseptic precautions during blood collection, product preparation & at the time of transfusion.

57 NON INFECTIOUS ADVERSE TRANSFUSION REACTIONS ReactionPresentationCauseHow to avoid - Use PCV instead of WB - Use cryoprecipitate instead of FFP, when indicated Antibody to donor plasma proteins Urticaria, pruritis, flushing, rashes Allergic reactions (Very common) Leukocytes - Accumulated cytokines - Antibody to donor leukocytes Fever, chills/rigors, headache, vomiting Non hemolytic febrile transfusion reactions (NHFTR) (Very common) - Antibody to donor plasma proteins - Accumulated cytokines Urticaria, hypotension, bronchospasm, respiratory distress, local edema Anaphylaxis Respiratory failure, hypotension, fever, bilateral pulmonary edema, hypoxemia Transfusion associated acute lung injury (TRALI) - Antibodies to donor leukocytes - Use leuco-depleted components - Use leuco depleted components - Leukocytes - Allomunisation, HLA antigens No rise in platelet count on platelet therapy Platelet refractoriness 40

58 ReactionPresentationCauseHow to avoid - Avoid warming - Don’t add any medications to blood unit -Demand blood from Blood bank at the time of transfusion (Don’t store blood units in hospital) Physical or chemical destruction of RBCs (heating, freezing, adding drugs to blood unit) Chills, fever, hypotension, hemoglobinuria, hemoglobinemia Hemolytic transfusion reaction (Non immune hemolysis) - Avoid use of fresh blood (<48 hr old) from blood related donors - Irradiate blood unit before transfusion in immunocompromised patients Donor lymphocytes engraft in recipient & mount attack on host tissue Erythroderma, maculopapcular rash, Nausea, vomiting, diarrhea, Jaundice, fever, pancytopenia Graft Vs host disease (Delayed reaction) -Volume overload Dyspnea, orthopnea, cough, tachycardia, hypertension Circulatory overload - Avoid sample collection errors - Write blood group on requisition form - Pre administration check details - Use of advanced gel technology for crossmatching Mismatched blood transfusion Chills, fever, hypotension, back pain, pain along infusion vein, oozing from IV sites, hemoglobinuria, renal failure with oliguria Hemolytic transfusion reaction (Immune hemolysis) NON INFECTIOUS ADVERSE TRANSFUSION REACTIONS 41

59 MANAGEMENT OF ADVERSE TRANSFUSION REACTIONS ReactionPresentationTreatment -Slow the transfusion -Give IM antihistaminic -If no improvement or worsening then treat as moderately severe reaction Urticaria, Rashes, Itching Mild reactions -Stop transfusion, replace set & keep IV line open with NS. -Notify the treating doctor -Administer IM antihistaminic, oral antipyretic -Give IV steroid & bronchodilator if indicated - If improved, can restart transfusion slowly with new blood unit -Send blood unit with BT set, post transfusion blood sample collected from vein opposite to infusion site & post transfusion urine sample to blood bank along with reaction report - If worsen, treat as severe reaction Fever, Rigors/chills, Tachycardia, Urticaria, Flushing, Restlessness, Headache, Mild dyspnea Moderately severe reactions 42

60 ReactionPresentationTreatment 1. Stop transfusion, replace set & keep IV line open with NS. 2. Infuse NS to maintain BP. 3. Maintain airway & give high flow O Give adrenaline in severe allergic reactions. 5. Give IV steroids & bronchodilators if indicated. 6. Give diuretics to maintain urine output. 7. If e/o DIC, give platelets along with cryoprecipitate or FFP. 8. If bacteremia is suspected, send blood culture & start broad spectrum antibiotics. 9. If renal failure is suspected, maintain fluid balance accurately. 10. Send blood unit with BT set & post transfusion blood & urine sample to blood bank along with reaction report. Fever with rigors, Headache, Dyspnea, Chest pain, Back pain, Pain at infusion site, Respiratory distress, Restlessness, Hypotension (>20%), Tachycardia (>20%), Hemoglobinuria, Unexplained bleeding Severe reaction MANAGEMENT OF ADVERSE TRANSFUSION REACTIONS 43

61 LEUCO-DEPLETION 1.By removing buffy coat at the time of separation 2.By filtration using leukocyte filters a.After collection & before component separation using in-line leukocyte filter bags b.At the time of transfusion using leukocyte filters 44

62 ABOUT ARPAN Arpan Blood Bank is Not-for-profit organization run by a Charitable Trust. We have been serving this domain of public health for last 15 years on 24X7 basis. We run 08 blood banks across Maharashtra State. MISSION Arpan Blood Bank is working with single minded focus of creating a role model at national level by becoming the best blood bank of the country by year By this way, we would have inspired enough souls to spread this great work and wipe out all exploitations in this critical domain of public health.

63 ARPAN - MAJOR MILESTONES 1996: Established first blood bank at Nashik. 2000: Introduced Apheresis Technology first time in North Maharashtra. 2002: Formed State level Association of blood banks operating on Not-for-Profit principle. 2003: Replication of successfully build model at other locations in Maharashtra state started. 2009: Developed in-house ERP to ensure Quality. 2010: Only 3 rd large sized Blood Bank to get NABH Accreditation to raise Quality Standard further. 2011: Established NAT laboratory at Nashik to raise safety of blood transfusion.

64 An Independent Thalassemia Care Center Cord Blood Bank Leuco - Depletion Facility In Blood Bank Irradiation Facility In Blood Bank Certification Course For Transfusion Medicine DNB Course For Transfusion Medicine ARPAN – FUTURE INITIATIVES ARPAN – FUTURE INITIATIVES

65 ARPAN Chain of blood banks

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