Presentation is loading. Please wait.

Presentation is loading. Please wait.

Blood Transfusion Teoman SOYSAL Prof. MD.

Similar presentations

Presentation on theme: "Blood Transfusion Teoman SOYSAL Prof. MD."— Presentation transcript:

1 Blood Transfusion Teoman SOYSAL Prof. MD

2 Blood Donation Healty adult donors
450 ml +/- 10% per whole blood donation Male: 5/year, Female : 4/year > 8 weeks between two donations

3 Apheresis: Platelets Plasma White cells (or subsets) Red cells The procedure can be done for treatment or transfusion purposes.

4 Blood Preservation Whole blood or red cells
1-Liquid phase storage : 1-6º C 63 ml anticoagulant-preservation liquid/unit duration of preservation ACD: 3 weeks CPD: 3 weeks CPD-A1: 35 days RBC concentrate with SAG-Mannitol : 7 weeks 2- Frozen storage of red cells -80 to º C , with glycerol etc: Years

5 Blood Preservation Effects of storage Red cells: ATP, 2-3 DPG,
osmotic fragility and oxygen affinity Plasma : Hb, K, NH3 : pH: Platelets: Lost in 2 days Coagulation factors: Eg: FV: adequate levels for about 5 days FVIII: Below 80% of original level after 1-2 days FXI: Less than 20% of original level after 7 days

6 Blood Preservation Platelets: Plasma : Use fresh or freeze
liquid phase : 1 - 5 days, room temp., avoid light exposure kept on special agitator Plasma : Use fresh or freeze frozen at -18 º C within 8 hrs of collection

7 Blood components & products
Cell containing components Red cells: Whole blood( fresh or not) Red cells: packed red blood cells washed red blood cells frozen red blood cells leukocyte – reduced red blood cells Platelets: Random donor platelets Apheresis platelets ( single donor platelets) Granulocytes or mononuclear cells Peripheral blood progenitor cells

8 Blood components & products
Plasma and products Plasma : fresh / fresh-frozen plasma Cryopresipitate Coagulation factor concentrates Immunglobulin preperations Albumin others

9 White cell reduction White blood cell filtered or,
Washed red cells or, Frozen red cells are white cell reduced red blood cell components.

10 Deciding blood transfusion;
Severity of symptoms Cause of anemia Rapidity of anemia or symptoms Co-morbidities and the age of the patient Can we treat the anemia without transfusion? And Is there enough time to wait for the response of such a treatment ?

11 This is not a guide to be used in every patient
Hemoglobin >10 g/dL : Tx rarely needed Hemoglobin < 6-7 g/dL: Tx mostly necessary Hemoglobin : 6-10 g/dL: Dependable

12 Important: Symptoms related to anemia may differ from one patient to another for a given Hb level; The trigger for red cell transfusion may differ from one patient to another!!!!!

13 Indications for transfusion of blood or its components
Whole blood: Acute massive bleeding 1 unit increases Hb: 1g/dl, Hct: 3% Fresh whole blood: Massively bleeding patient/shock Exchange transfusion, open heart surg, severe renal or hepatic failure, Red blood cells: (To increase the oxygen carrying capacity in case of symptomatic anemia not treatable by other means or due to urgency of symptoms) Symptomatic anemia (May be due to different causes), post-bleeding hypovolemia

14 Indications for transfusion of blood or its components
White cells reduced RBC’s: < 5x106 WBC’s per unit White cell filters (before storage or before transfusion) An indication for RBC transfusion + To prevent reactions caused by WBC antibodies Febrile non-hemolytic transfusion reactions To prevent alloimmunization To prevent CMV transmission

15 Indications for transfusion of blood or its components
Washed RBC’s: An indication for RBC transfusion + Any need to prevent the recipient allo-immunisation to WBC’s , plasma antigens or any contraindication to infuse complement PNH IgA deficiency Prevention of anaphylaxis Washed units must be transfused no later than 24 hours Frozen RBC’s: Autologous transfusion: rare blood groups, Catastrophy etc Washed before infusion !!

16 Indications for transfusion of blood or its components
Blood Irradiation To prevent transfusion related GVHD in; Congenital immune deficient states Bone marrow or stem cell transplantation Some cases of hematologic malignancies Hodgkin’s disease Purin analogue or anti-CD52 treatment Intra-uterin transfusion New borne exchange transfusion Transfusions between relatives first or second degree HLA matched platelets

17 Some of the indications for platelet transfusions
Decreased platelet production because of bone marrow failure or infiltration :bleeding or risk of bleeding Leukemia MDS Myelofibrosis Malignant tm infiltration Myelosupression Aplastic anemia Functional platelet disease and bleeding or risk of bleeding Dilutional thrombocytopenia (after massive transfusion) Cardiac by-pass surgery Increased platelet destruction or consumption DIC Drug induced sepsis ITP

18 Indications for transfusion of blood or its components
Platelets: Thrombocytopenia due to decreased platelet production Platelet count/mm Bleeding /surgery Indication for plt transfusion > , No No < Yes Yes No No (if there is bleeding/fever/DIC/plt dysfunction) Yes < Yes or No Yes

19 Some special conditions about platelet transfusion
Disease status may change the transfusion effectiveness: DIC Hypersplenism Sepsis Allo-immunisation Cotraindicated in Thrombotic Thrombocytopenic Purpura: Used only in high risk bleeding Not effective/useful in Immune Practical issues ABO matched platelets have a longer in-vivo life span after transfusion Use Rh- platelets for Rh- recipients (to prevent Rh immunisations) or use anti-Rh(D) Ig if Rh+ component used in such recipients

20 Types of platelet concentrates
Random donor plt concentrate (single unit) 5,5 x 1010 plts /mm3 plt increase after transfusion Pooled plt concentrate (eg:6 random units) Apheresis plts >3x1011 plts /mm3 increase after transfusion WBC reduction of platelets is indicated in the same situations like red cells.

21 Indications for transfusion of blood or its components/products
Fresh frozen plasma ( contains all coag. Factors) Congenital or acquired coag.Factor deficiency (bleeding or surgery) Oral anticoagulant overdose Plasma exchange (eg:TTP) After massive transfusion 10-20 ml/kg : to increase deficient factor level about 20-30% from baseline

22 Indications for transfusion of blood or its components/products
Cryoprecipitate Includes FVIII, vWF, FXIII, fibrinogen and fibronectin units of FVIII, ≥150 mg fibrinogen and % of FXIII that is in one unit of plasma Can be used for the purpose of replacing the deficient state of these factors in case of bleeding or surgery

23 Practical Issues Is there a need for transfusion? Which product should be used? Number of units? Re-check the blood types of the patient and donör and be sure about the cross match Read label, ID, inspect the product Is irradiaton necesssary? Temperature? Filters? Flow rate ? (start 5 ml/min-15 minutes , the rest ml/hr) Drugs ?

24 Transfusion Reactions
Immunologic reactions Non-immune reactions or Acute reactions Late reactions

25 Hemolytic reactions Reasons: Mismatched transfusion
Transfusion of hemolysed blood During storage or warming etc May be acute or late

26 Acute hemolytic reaction
Frequency up to 1/25.000 1/ Tx mortal 40% symptomatic ABO mismatch IgM antibodies (anti-A or anti-B) ,complement binding and intravascular hemolysis Early onset ( first ml’s),seldom after 1-2 hrs pain at the infusion site, flushing, chest or back pain,dyspnea,vomiting, fever-chills, hypotension and tachicardia,bleeding, hemoglobinuria Complications: Acute Renal Failure, shock,DIC

27 Acute hemolytic reaction
Stop transfusion, Take measures to keep normal BP and urine output: hydration/diuretics, Re-check groups, re-cross, take blood cultures, Follow signs of hemolytic anemia, antiglobulin tests,renal function and DIC tests, Treat accordingly (eg: dialysis/ICU etc)

28 Delayed hemolytic reaction
1/2500-1/6000 Onset: 3-21 days after transfusion Reason: Rh, Kidd etc mismatches Previous alloimmunization and anamnestic response Coombs + ( do not confuse with OIHA) Jaundice or absence of the expected increase in red cell values. Frequently undetected Treatment : none

29 Febrile reactions 0,5- 3% of all transfusions
Cause: Antibodies against white cell/plt/plasma antigens Fever-chills, increased pulse rate during or after transfusion Antipyretics/antihistamines Stop transfusion if there is doupt about hemolysis Prophylaxis: White cell reduction

30 Allergic reactions Cause:Antibodies against donor plasma proteins
Pruritus,urticaria,edema,anaphylaxis,bronchospasm IgA deficient patients are under the greatest risk Treat according to the type of reaction For IgA deficient patients: use washed or frozen red cells instead of regular red cells or whole blood.

31 Pulmonary hypersensitivity reaction/TRALI
1/5000 frequency Cause : Leukocyte incompatibility and agglutination of white cells inside the pulmonary vascular area leading to complement activation and endothelial damage- pulmonary edema. Fever-chills,tachycardia,chest pain, hemoptysis, BP fall within 4 hrs of transfusion Respiratory support may be necessary

32 Transfusion Related Graft- versus -Host Disease
Cause: Immune deficient recipient transfused with viable lymphocytes which are engrafted and start allo-reaction against mismatched HLA and other antigens of the recipient. High fatality with skin,liver and gut symptoms, pancytopenia and infections Prophylaxis: Blood irradiation Treatment: immunosupressive drugs Mortality high



35 Circulatory overload Old aged or premature/ new borne or patients with cardiopulmonary compromise are under risk. Clinics: Acute heart failure Treatment: As acute myocardial failure Prophylaxis: Slow infusion rate, low volume of transfusion

36 Bacterial Contamination
Bacterial contamination may cause a reaction with symptoms resembling Acute Hemolytic Reaction without LAB findings of hemolysis. May be fatal: Mortality: Plt constr: 1/ – 1/65.000 Red cells: <1/ Stop transfusion, take cultures, treat with IV fluids and antibiotics , take support measures and follow against shock, renal failure,DIC

37 Air embolism May cause acute respiratory and circulatory failure
Clump the tubing Change the posture of the patient: Left side / Trandelenburg (left side ,head- down, legs upside) Swan -Ganz catheter

38 Massive transfusion may cause:
Patients with bone marrow failure , transfused chronically are under the risk of transfusion hemosiderosis. Massive transfusion may cause: Citrate toxicity: Hypocalcemia Hyperkalemia Bleeding ( due to thrombocytopenia and /or factor deficiency)

39 Transfusion transmitted pathogens
Hepatitis ( C,B,A ,D etc ) HIV HTLV CMV E-Barr HHV Creutzfeldt-Jakob or variant CJD (therotical) Parvovirus Malaria Lyme ? (not enough evidence) Chagas Babesiosis Sy Toxoplasmosis West Nil virus

Download ppt "Blood Transfusion Teoman SOYSAL Prof. MD."

Similar presentations

Ads by Google