1. BLOOD TRANSFUSION
Begashaw M (MD)

2. Definition
is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream

3. Indications
In acute hemorrhage is based on: • volume lost >2000 • rate of bleeding • hemodynamic status

4. Indications In Chronic blood loss: -Healthy, younger individuals
HCT<21%
-Cardio respiratory compromised patients
HCT < 25-33%
If severe ,even <40%

5. Perioperative red blood cell transfusion criteria

6. Component therapy specific factor deficiencies
-factor VIII concentrates -classic hemophilia

7. ABO blood group system -Blood group O is the universal donor
-Blood group AB is the universal recipient

9. Cross matching o Blood grouping -ABO and Rhesus antigens
o Antibody screening
Detects atypical red cell antibodies in recipients serum
o Crossmatching
Tests donor red cells against patients serum

10. Blood products Whole blood Packed red cells Granulocyte concentrates
Platelet concentrates
fresh frozen plasma
Plasma protein fraction
Human albumin 25%
Cryoprecipitate
Clotting factors - Factor VIII / IX

11. Blood Components

12. Component therapy Factor VIII for classic hemophilia
Platelet transfusion for patients with bone marrow suppression

13. preparation FRESH UNIT WHOLE BLOOD+CPDA THAW AT 4 degree celcius
PRBCs 80% HCT STORED AT 1-6 degree celcius
PLASMA AND 70% OF PLTS
PLT PELLET and CLOTTING FACTORS EXCEPT FACTOR III
PLASMA STORED AT to-30 DEGREE CELCIUS
THAW AT 4 degree celcius
CRYOPRECIPITATE
PROTEINS

14. Whole blood
is collected in citrate phosphate dextrose- adenine solution (CPDA-)
450 ml of whole blood and approximately 60ml of anticoagulant preservative
within 24 hours-freshwhole blood
shelf life of 35 days
one unit of whole blood raises the recipient’s hematocrit by 3%

15. Whole blood

16. Packed RBC
are remains after plasma has been separated from whole blood
One unit raises the recipient’s hematocrit by 3%
warmed to a temperature not exceeding 37 c before transfusion
Shelf life is 35 days

17. Packed RBC

18. Platelet concentrate Platelets are separated from one unit of blood
may be stored for 3-7 days
One unit of platelet concentrate contains about 5.5×1010 platelets and increases the platelet count by 5000/ml
For a patient with platelet count below 25,000/mm3, 6-8 units are usually given
Platelet concentrate must be administered through a special platelet filter

19. Fresh frozen plasma
_is anti-coagulated plasma separated from a person’s blood and frozen within 6 hours _stored up to 1 year _contains all clotting factors _provides proteins for volume expansion

20. Cryoprecipitate
_is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 degree centigrade
_white precipitate
_shelf life of about 1 year
_contains factor VIII, fibrinogen and factor XIII
_treatment:
-classic hemophilia
-DIC

21. FRESH FROZEN PLASMA

22. Cryoprecipitate

24. Protein
Albumin - for oncotic support and plasma expansion - disadvantage-rapid excretion & expense Plasma protein fraction -Similar to albumin but contains additional protein molecules

25. Complications of Blood Transfusion

26. Complications Hemolytic transfusion reactions
Non-hemolytic transfusion reaction

27. Hemolytic transfusion reactions
Intravascular hemolytic transfusion reactions
life threatening reactions
due to incompatibility of the ABO system
are very rare occurring in 1 out of 15, ,000 transfusions

28. Pathophysiology
all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuria and renal failure
activate the complement system with subsequent release of vasoacative amines causing hypotension
Complement activation -intravascular thrombosis, DIC & hemorrhage

29. Clinical features Patient feels unwell and agitated
back pain and pain at infusion site
shortness of breath, rigors
hypotension, oliguria and bleeding from venepuncture sites
Urinalysis will show haemoglobinuria

30. Management Discontinue transfusion immediately and remove giving set
Check unit of blood against patients identity
Give intravenous crystalloid
Transfer to ICU
Take blood for CBC, haemoglobin, clotting, repeat grouping
Monitor urine output

31. Non-hemolytic transfusion reaction
Febrile reaction:
- in 0.5% -1%
- is usually treated with antipyretic drugs
Allergic reaction:
in 2-3%
manifests by urticaria and rashes
Antihistamins, steroids or epinephrine

32. Transmission of disease-include:
Hepatitis
HIV
Malaria
Epstein- bar virus, cytomegalovirus
Brucellosis

33. Other complications
• Citrate toxicity • Acidosis • Hyperkalemia