BLOOD TRANSFUSION AND TRANSFUSION REACTIONS DR VAISHALI JAIN

LEARNING OUTCOMES At the end of this topic, you should able to: Understand concept of Whole blood and blood components Discuss types and indications of blood transfusion Enlist tests to be performed prior to blood transfusion Understand transfusion reactions in brief

LESSON CONTENTS Whole blood and blood components What is blood transfusion? Blood transfusion- Types, Indications Pre transfusion testing Transfusion Reactions: Classification Causes Clinical features Investigations

WHOLE BLOOD AND BLOOD COMPONENTS 350ml /450 ml of blood is collected from a donor into a plastic bag containing an anticoagulant This is called 1 “unit” of whole blood Whole blood can be used as it is, or is separated into “blood components” Types of blood components:- Red blood cell concentrate (packed red blood cells) Platelet concentrate Fresh frozen plasma Cryoprecipitate The separation of blood into components means that patients can be treated with the specific fraction of blood that they lack. This reduces the chances of adverse reactions to unnecessary administration of blood constituents and ensures that more than one patient can be treated using blood from one donor.

BLOOD COMPONENTS

BLOOD TRANSFUSION Transfer of blood or blood components from one person (donor) into another person (recipient)

TYPES OF BLOOD TRANSFUSION FRESH BLOOD TRANSFUSION Blood less than 24 hours old from the time of collection AUTOLOGOUS TRANSFUSION Blood collected from a patient for re-transfusion at a later time into the same individual MASSIVE TRANSFUSION Number of units transfused in a 24 hours period exceeds the recipient’s blood volume MULTIPLE TRANSFUSION Repeated transfusion of blood over a long period of time (months or year)

INDICATIONS OF BLOOD TRANSFUSION Whole Blood: Acute blood loss Shock Exchange transfusion in neonate Packed red blood cells: Chronic severe Anemia Leukemia Thalassemia Platelets concentrate: Thrombocytopenia Bleeding due to platelet dysfunction Malignancy Major surgery

INDICATIONS (Contd.) Fresh frozen plasma: Cryoprecipitate: Liver disorders DIC Coagulation factor deficiency (V, VII) Cryoprecipitate: Hemophilia A von Willebrand’s disease Fibrinogen deficiency

PRE-TRANSFUSION TESTING ABO and Rh (D) blood grouping : Patient’s and donor’s blood sample Cross matching of blood sample: Major cross match- Pt’s serum + Donor cells Minor cross match- pt’s cells + Donor serum

BLOOD GROUPING

PRE-TRANSFUSION TESTING (contd.) Screening for Transfusion transmitted diseases (Donor Sample) HIV 1 and 2 AIDS HBsAg Hepatitis B HCV Hepatitis C Treponema pallidum Syphilis Plasmodium species Malaria

ADVERSE EFFECTS (TRANSFUSION REACTIONS) - Immune mediated Acute Onset <24 hours Delayed Onset within days/months 1. Hemolysis 2. Febrile reactions Alloimmunisation 3. Allergic Post transfusion purpura 4. Anaphylaxis Graft Vs Host disease 5. TR.Ac.lung injury Immunodilution

ADVERSE EFFECTS (TRANSFUSION REACTIONS) – Non-Immune mediated Acute Delayed 1. Bacterial contamination HIV 1 & 2 2. Circulatory overload Hepatitis B & C 3. Physical damage Syphilis 4. Chemical damage Malaria 5. Thermal damage Iron overload

CAUSES OF TRANSFUSION REACTIONS Clerical errors: Inadequate labeling Wrong blood issued Technical errors: Error in blood grouping & cross matching Incorrect interpretation of test results Others: Blood contamination during phlebotomy Blood infusion thr’ small bore needle Blood cooler to -30⁰C or warmed to > 42⁰ C Concomitant administration blood & drugs thr’ common set

CLINICAL FEATURES Fever : Ag-Ab cytokine IL-1 Fever Rigors: Cytokines Pain at infusion site: Cytokine Hypotension: Neuroendocrine response Hemoglobinuria Oliguria Anuria

LABORATORY INVESTIGATIONS Rule out Clerical errors: Identify blood sample Compare plasma color on pt’s pre & post transfusion sample - Pink: free Hb red cell destruction - Yellow: increased bilirubin Check blood color of bag & attached tubing - Purple color / clot in bag bacterial contamination - Color change hemolysis

LABORATORY INVESTIGATIONS (Contd) Repeat blood grouping on pt’s & donor sample ( Pre and post transfusion sample) Repeat cross matching Perform Direct antiglobulin test (DCT) Blood smear and culture (Donor’s blood) Others: (Post transfusion sample) Antibody screening Serum bilirubin Free hemoglobin

TRANSFUSION REACTION INVESTIGATION RECORD Patient’s particulars Blood bag details Regrouping results Re-cross matching results Red cell antibody screening results Urine investigations Microbiological results Signature of Technician in-charge

SUMMARY What is it? Types Indications Pre-transfusion testing Record Causes Clinical features Laboratory investigations BLOOD TRANSFUSION TRANSFUSION REACTIONS

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