1. BLOOD TRANSFUSION AND TRANSFUSION REACTIONS
DR VAISHALI JAIN

2. 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

3. 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

4. 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.

6. BLOOD COMPONENTS

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

10. 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)

11. 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

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

13. 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

14. BLOOD GROUPING

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

16. 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

17. 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

18. 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

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

21. 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

22. 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

23. 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

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

25. THANK YOU…