Transfusion

Types, Indications and

Dr- Hor chantha

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 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

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 Transfusion Overview
• Integral part of medical treatment
• Most often used in Hematology/Oncology, but
other specialties as well (surgery, ICU, etc)
• Objectives
– Blood components
– Blood group.
– Indications for transfusion
– Complications

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 Blood Groups
O A B AB

Antigen on red None A B A&B

Antibody in Anti A&B Anti-B Anti-A None

% in UK 47 42 8 3

Rhesus antigen +ve (D) and -ve (d), antibody anti-D (there
is no anti-d) 4
 Blood Components
• Whole blood is separated by differential
centrifugation
– Red Blood Cells (RBC’s)
– Platelets
– Plasma
• Cryoprecipitate
• Others
• Others include Plasma proteins, Coagulation
Factors, albumin, Anti-D, Growth Factors, Colloid
volume expanders
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Blood Components

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 Differential Centrifugation
First Centrifugation

Closed System

Whole Blood Satellite Bag Satellite Bag

Platelet-rich
RBC’s Plasma 7
Differential Centrifugation
Second Centrifugation

RBC’s Platelet-rich
Plasma
Second

Platelet Plasma
RBC’s Concentrate 8
 Whole Blood
• Storage
– 4° for up to 35 days
• Indications
– Massive Blood Loss/Trauma/Exchange Transfusion
• Considerations
– Use filter as platelets and coagulation factors will
not be active after 3-5 days
– Donor and recipient must be ABO identical

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 RBC Concentrate
• Storage
– 4° for up to 42 days, can be frozen
• Indications
– Many indications—ie anemia, hypoxia, etc.
• Considerations
– 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
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 Platelets
• Storage
– Up to 5 days at 20-24°
• Indications
– Thrombocytopenia, Plt <15,000
– Bleeding and Plt <50,000
– Invasive procedure and Plt <50,000
• Considerations
– Contain Leukocytes and cytokines
– 1 unit/10 kg of body weight increases Plt count by 50,000
– Donor and Recipient must be ABO identical

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 Plasma and FFP
(Fresh frozen plasma)
• Contents—Coagulation Factors (1 unit/ml)
• Storage
– FFP--12 months at –18 degrees or colder
• Indications
– Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease,
exchange transfusion, massive transfusion
• Considerations
– 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%

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

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 Autologous blood
• Autologous blood is blood donated by a patient before his
operation.
• Advantage. Autologous blood is beneficial because of the
risk of blood-borne disease in donor blood. It also is an
advantage for a patient with a very rare blood type to
donate his own blood.
• Preparation. A patient can donate several units of blood
over a period of several weeks. However, blood becomes
outdated after approximately 45 days. If a large amount
of blood is needed, it can be frozen.

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 Indications for transfusion.
It has been shown that a hemoglobin of 7 grams is adequate in
most patients to deliver oxygen to the tissues if the circulating
volume is normal.
• During the consideration to transfuse, the following points should
always be kept in mind:
– Age of patient.
– Degree of anemia.
– Intravascular volume.
• Indications for the transfusion of red blood cells
• Promote oxygen delivery in patients who are actively bleeding.
• Treat symptomatic anemia unresponsive to conservative
treatment.
• The medical necessity of treatment cannot be delayed.

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 Leukocyte Reduction Filters
• Used for prevention of transfusion reactions
• Filter used with RBC’s, Platelets, FFP, Cryoprecipitate
• Other plasma proteins (albumin, colloid expanders,
factors, etc.) do not need filters—NEVER use filters
with stem cell/bone marrow infusions
• May reduce RBC’s by 5-10%
• Does not prevent Graft Verses Host Disease (GVHD)

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 RBC Transfusions
Preparations
• Type
– Typing of RBC’s for ABO and Rh are determined for
both donor and recipient
• Crossmatch
– Donor cells and recipient serum are mixed and
evaluated for agglutination
• Dose
– Usual dose of 10 cc/kg infused over 2-4 hours
– Maximum dose 15-20 cc/kg can be given to
hemodynamically stable patient
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 RBC Transfusions
Administration
• Procedure
– May need Premedication (Tylenol and/or Benadryl)
– Filter use—routinely leukodepleted
– Monitoring—VS q 15 minutes, clinical status
– Do NOT mix with medications
• Complications
– Rapid infusion may result in Pulmonary edema
– Transfusion Reaction

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 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

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 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 20-40 minutes
– Filter use
– Premedicate if hx of Transfusion Reaction
• Complications—Transfusion Reaction
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 Transfusion Complications
1. Immediate reactions
a. Allergic or febrile reactions.
Itching, hives, flushing, fever, bronchospasm,
The treatment for this type of reaction is administration of
antihistamines and antipyretics.
b. Agglutination or hemolytic reactions occur very early during the
transfusion.
• Pain occurs in the vein that is receiving the transfusion as well as
in the chest, flank, and extremities. Fever, chills, oliguria,
hemoglobinuria, and jaundice also occur.
• An agglutination or hemolytic reaction may be difficult to
diagnose during an operation. The reaction may only manifest by
diffuse bleeding.
• Treatment is to stop the transfusion

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 Transfusion Complications
2. Physiologic reactions.
a-Hyperkalemia Cells damaged during storage may lyse when infused
and release their intracellular potassium..
b-Hypocalcemia occurs because of the excess citrate in the unit of
blood being transfused. The citrate binds with the calcium in the
plasma and effectively removes calcium from the circulation..
c-Hypothermia.
Banked blood is stored at approximately 5°C. Transfusion of large
amounts of banked blood can lower the patient's body
temperature.
d. Hypervolemia can easily occur from blood transfusion in patients
being treated for chronic anemia, because these patients tend to
have an increased intravascular volume.
e. Coagulopathy. When massive transfusions are being administered
for resuscitation, it is possible to dilute the coagulation factors in
the plasma to a level where a coagulopathy occurs.
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 Transfusion Complications
3. Delayed reactions
• Hemolysis can occur days after a transfusion. It
most likely is caused by previously formed
antibodies that were not at levels high enough to be
detected during crossmatching.
• Infections: hepatitis B and C, cytomegalovirus
(CMV), and HIV. In addition to these viral diseases,
bacterial and parasitic diseases can be transferred,
and bacterial contamination of blood can occur
during donation or storage.
• The use of volunteer donor pools reduces the risk.
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 Transfusion Complications
4-Immunological Complications
A-Haemolytic disease of the newborn Rhesus -ve mothers with
Rhesus +ve babies
-At every delivery or miscarriage that requires surgery there is
transfer of fetal red blood cells into the maternal circulation
-Rh +ve babies will result in Rh -ve mothers developing anti-D
-This causes no problems with the first pregnancy, but at any
subsequent pregnancy with a Rh +ve baby, anti-D crosses the
placenta and haemolyses the fetus’s blood resulting in severe
anaemia and possibly death (hydrops fetalis)
• all Rh-ve mothers with Rh+ve babies should receive anti-D within
72 hours of delivery also after amniocentesis, abdominal trauma,
antepartum haemorrhage, ectopic pregnancy, all therapeutic
abortions, spontaneous abortions if there is surgical intervention,
spontaneous abortions after 12 weeks, threatened abortions after
12 weeks.

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 Transfusion Complications
4-Immunological Complications
B-Reactions to incompatible blood transfusions
-Are severe only if the patient has the appropriate
antibody - usually against an antigen on red blood
cells (many are transfused), occasionally against a
plasma protein.
-Naturally occurring antibodies (no previous
exposure) eg. Anti-A, anti-B.
-Immune antibodies after pregnancy or
transfusion eg. Anti-D

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Reference:
1-Bruce E.Jarrell, national medical serie s for independent
study, surgery 3rd edition.
2-Robert E Condon ,manual of surgical therapeutics, Ninth
edition

QCM
1-Why we need transfuse isogroups and isorhesus?
2-Could we transfuse isogroup and diferrence rhesus?
3-Before transfusion,why we need to do Cross matching?
4-Indication for blood transfusion?
5-Complication of blood transfusion?

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