1. BLOOD TRANSFUSION
Blood transfusion is generally the process of receiving blood or blood products into one's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets.

2. History of Transfusions
Blood transfused in humans since mid-1600’s
1828 – First successful transfusion
1900 – Landsteiner described ABO groups
1916 – First use of blood storage
1939 – Levine described the Rh factor

4. INDICATION OF BLOOD TRANSFUSION
1- To replace blood lost during surgery or loss of blood due to bleeding in case of injury or any disease cause bleeding such as bleeding DU.
To restore oxygen carrying capacity of blood
To provide plasma factor to prevent or treat bleeding
If patient cannot make blood in blood disease

5. All donated blood should also be tested for the ABO blood group system and Rh blood group system to ensure that the patient is receiving compatible blood.

7. Before a recipient receives a transfusion,
The first step before a transfusion is given is to type and screen the recipient's blood.
compatibility testing between donor and recipient blood must be done..
The sample is then screened for any alloantibodies that may react with donor blood.
It takes about 45 minutes to complete (depending on the method used).
the history of the patient to see if they have previously identified antibodies and any other serological anomalies.
- The blood bank scientist also checks for special requirements of the patient (e.g. need for washed, irradiated or CMV negative blood)

9. Donar must be free of the disease and especially HIV, Hepatitis B, Hepatitis C, Treponema pallidum (syphilis) and, where relevant, other infections that pose a risk to the safety of the blood supply, such as Trypanosoma cruzi (Chagas disease) and Plasmodium species (malaria

10. Component of blood
Denoting blood is usually subjected to processing after it is collected to make it possible to use in specific patient.
Collected blood is separated in to blood components by centrifugation
1- RBC
2- Plasma ; FFP fresh frozen plasma, Cryoprecipitate
3-platlets
4-albumin protein
5-clotting factor concentrate
6-immunoglobins (antibody)
7- others Anti-D, Growth Factors, Colloid volume expanders
Apheresis may also used to collect blood components

11. 1-Whole Blood Storage Indications 4° for up to 35 days
Use filter as platelets and coagulation factors will not be active after 3-5 days
Donor and recipient must be ABO identical
Indications
Massive Blood Loss/Trauma/Exchange Transfusion

13. 2-RBC Concentrate Storage 4° for up to 42 days, can be frozen
Recipient must not have antibodies to donor RBC’s (note: patients can develop antibodies over time)
Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl)
Usually transfuse over 2-4 hours (slower for chronic anemia
Indications
i e anemia, hypoxia, shock due to bleeding etc.

14. RBC Transfusions Preparations
Type
Typing of RBC’s for ABO and Rh are determined for both donor and recipient
Screen
Screen RBC’s for atypical antibodies
Approx 1-2% of patients have antibodies
Crossmatch
Donor cells and recipient serum are mixed and evaluated for agglutination

15. RBC Transfusions Administration
Dose
Usual dose of 10 cc/kg infused over 2-4 hours
Maximum dose cc/kg can be given to hemodynamically stable patient
Procedure
May need Premedication (Tylenol and/or Benadryl) (to ovoid allergy)
Filter use—routinely leukodepleted
Monitoring, clinical status
Do NOT mix with medications
Complications
Rapid infusion may result in Pulmonary edema
Transfusion Reaction

17. 3-Platelets Storage Indications Up to 5 days at 20-24°
Contain Leukocytes and cytokines
1 unit/10 kg of body weight increases Plt count by 50,000
- Donor and Recipient must be ABO identical
Indications
Thrombocytopenia, Plt <15,000
Bleeding and Plt <50,000
Invasive procedure and Plt <50,000

18. Platelet Transfusions Preparations
ABO antigens are present on platelets
ABO compatible platelets are ideal
This is not limiting if Platelets indicated and type specific not available
Rh antigens are not present on platelets
Note: a few RBC’s in Platelet unit may sensitize the Rh- patient

19. Platelet Transfusions Administration
Dose
May be given as single units or as apheresis units
Usual dose is approx 4 units/m2—in children using 1-2 apheresis units is ideal
1 apheresis unit contains 6-8 Plt units (packs) from a single donor
Procedure
Should be administered over minutes
Filter use
Premedicate if hx of Transfusion Reaction
Complications—Transfusion Reaction

20. 4 - Plasma and FFP (fresh frozen plasma)
Contents—Coagulation Factors (1 unit/ml)
Storage
FFP--12 months at –18 degrees or colder
Plasma should be recipient RBC ABO compatible
In children, should also be Rh compatible
Account for time to thaw
- Usual dose is 20 cc/kg to raise coagulation factors approx. 20%
Indications
Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease, exchange transfusion, massive transfusion

21. 5-Cryoprecipitate Description Storage Indication
Precipitate formed/collected when FFP is thawed at 4°
Storage
After collection, refrozen and stored up to 1 year at -18°
ABO compatible preferred (but not limiting)
- Usual dose is 1 unit/5-10 kg of recipient body weight
Indication
Fibrinogen deficiency or dysfibrinogenemia
vonWillebrands Disease
Factor VIII or XIII deficiency
DIC (not used alone)

22. 6 - Granulocyte Transfusions
Prepared at the time for immediate transfusion (no storage available)
Indications – severe neutropenia associated with infection that has failed antibiotic therapy, and recovery of BM is expected
Donor is given G-CSF (granulocyte- colony stimulating factor)and steroids or Hetastarch (volum expander)
Complications
Severe allergic reactions
Can irradiate granulocytes for GVHD prevention

23. Transfusion Complications
Acute Transfusion Reactions (ATR’s)
Chronic Transfusion Reactions
Transfusion related infections

24. Acute Transfusion Reactions
Hemolytic Reactions (AHTR)
Febrile Reactions (FNHTR)
Allergic Reactions
TRALI
Coagulopathy with Massive transfusions
Bacteremia

25. 1 - Acute Hemolytic Transfusion Reactions (AHTR)
Occurs when incompatible RBC’s are transfused into a recipient who has pre-formed antibodies (usually ABO or Rh)
Antibodies activate the complement system, causing intravascular hemolysis
Symptoms occur within minutes of starting the transfusion
This hemolytic reaction can occur with as little as 1-2 cc of RBC’s
Labeling error is most common problem
1 in 25,000
Can be fatal

26. Symptoms of AHTR High fever/chills Hypotension Back/abdominal pain
Oliguria
Dyspnea
Dark urine
Pallor

27. What to do? If an AHTR occurs
STOP TRANSFUSION
ABC’s
Maintain IV access and run IVF (NS or LR)
Monitor and maintain BP/pulse
Give diuretic
Obtain blood and urine for transfusion reaction workup
Send remaining blood back to Blood Bank

28. Labs found with AHTR Hemoglobinemia Hemoglobinuria
Positive (DAT) direct agglutination test
Hyperbilirubinemia

29. Monitoring in AHTR Monitor patient clinical status and vital signs
Monitor renal status (BUN, creatinine)
Monitor coagulation status (DIC panel– PT/PTT, fibrinogen, D-dimer/FDP, Plt, Antithrombin-III)
Monitor for signs of hemolysis (LDH, bili, haptoglobin)

30. 2- Febrile Nonhemolytic Transfusion Reactions (FNHTR)
Definition--Rise in patient temperature >1°C (associated with transfusion without other fever precipitating factors)
Occurs with approx 1% of PRBC transfusions and approx 20% of Plt transfusions
FNHTR caused by alloantibodies directed against HLA antigens
Need to evaluate for AHTR and infection
1 in 200

31. What to do? If an FNHTR occurs
STOP TRANSFUSION
Use of Antipyretics—responds to Tylenol
Use of Corticosteroids for severe reactions
Use of Narcotics for shaking chills
Future considerations
May prevent reaction with leukocyte filter
Use single donor platelets
Use fresh platelets
Washed RBC’s or platelets

32. 3 - Allergic Nonhemolytic Transfusion Reactions
Etiology
May be due to plasma proteins or blood preservative/anticoagulant
Best characterized with IgA given to an IgA deficient patients with anti-IgA antibodies
Presents with urticaria and wheezing
Treatment
Mild reactions—Can be continued after Benadryl
Severe reactions—Must STOP transfusion and may require steroids or epinephrine
1 in 1,000
Prevention—Premedication (Antihistamines)

33. 4-Transfusion Related Acute Lung Injury TRALI
Clinical syndrome similar to ARDS
Occurs 1-6 hours after receiving plasma-containing blood products
Caused by WBC antibodies present in donor blood that result in pulmonary leukostasis
Treatment is supportive
High mortality

34. 5- Massive Transfusions
Coagulopathy may occur after transfusion of massive amounts of blood (trauma/surgery)
Coagulopathy is caused by failure to replace plasma
See electrolyte abnormalities
Due to citrate binding of Calcium
Also due to breakdown of stored RBC’s

35. 6-Bacterial Contamination
More common and more severe with platelet transfusion (platelets are stored at room temperature)
Organisms
Platelets—Gram (+) organisms, ie Staph/Strep
RBC’s—Yersinia, enterobacter
Risk increases as blood products age (use fresh products for immunocompromised)

36. 7-Chronic Transfusion Reactions
Alloimmunization
Transfusion Associated Graft Verses Host Disease (GVHD)
Iron Overload
Transfusion Transmitted Infection

37. transfusion Associated Infections
Hepatitis C
Hepatitis B
HIV
CMV
CMV can be diminished by leukoreduction, which is indicated for immunocompromised patients