Blood Transfusion PDF

BLOOD TRANSFUSION Prof.U.Murali. Learning Objectives • List the types of blood groups. • Identify the donor criteria & method of collection & storage of blood for transfusion. • Explain the indications & complications of blood transfusion. • Write about Massive & Autologous blood *Image via Bing...

BLOOD TRANSFUSION Prof.U.Murali. Learning Objectives • List the types of blood groups. • Identify the donor criteria & method of collection & storage of blood for transfusion. • Explain the indications & complications of blood transfusion. • Write about Massive & Autologous blood *Image via Bing transfusion. • Enumerate blood substitutes. BLOOD GROUPS Types of blood groups • There are more than 20 genetically determined blood group systems known today. • The AB0 and Rhesus (Rh) systems are the most important ones used for blood transfusions. ABO blood grouping system • There are 4 different kinds of blood types: • A, B, AB & O (null). Blood Types • Each person has one of the following blood types: A, B, AB, or O. • “O” can be given to anyone but can only receive O, so called as Universal Donor. • “AB” can receive any type but can only be given to AB, so called as Universal Recipients. • Also, every person's blood is either Rh-positive (or) Rh-negative. The Rhesus (Rh) System • Well, there's another antigen to be considered always - the Rh (D) antigen. • Some of us have it, some of us don't have. • If it is present, then blood is Rh D positive, if not it's Rh D negative. • So, for example, some people in group A will have it, and will therefore be classed as A + (or A positive). • While the ones that don't, are A - (or A negative). • And so it goes for groups B, AB and O. Blood Donor Criteria • Age – 17 – 65 ( New up to 60 ) • Weight - > 45 kg • Hb - > 13 M / > 12 F • Fit without serious diseases – HIV / Hepatitis & Malaria • A person can donate blood every 90 days (3 months). Collection & Storage • Bag – 75ml CPD • Stored – Special Ref. - 4⁰ C. [+/- 2⁰C] • Shelf Life of CPD Blood - 3 weeks • R.B.C’s - 3 weeks • W.B.C – Rapidly Destroyed • Platelets – Reduced in 24 hours • Clot. Factors – Labile – Levels fall B T - INDICATIONS / COMPLICATIONS Overview – Blood Transfusion • It is a procedure in which a patient receives a blood product through an intravenous line. • It is the introduction of blood components into the venous circulation. • Process of transferring bloodbased products from one person into the circulatory system of another. Indications • Acute blood loss – Due to Trauma. • Chronic Anemia. • Major Operative procedures. • As a prophylactic measure to Surgery. • Severe Burns / In Septicemia. • Blood Disorders. Transfusion Trigger • This is the threshold at which blood transfusion is indicated. • The decision to transfuse any patient for a given indication must balance the risks of not transfusing. • RBC transfusion is no longer indicated when Hb < 10g / dl. Transfuse Criteria - < 6g/dl - Benefit from transfusion - 6 - 8g/dl - Unlikely to benefit – absence of bleeding - > 8g/dl - Not indicated COMPLICATIONS IMMEDIATE Immunological Non- Immunological - Febrile / non hemolytic - Congestive Cardiac Failure - Allergic / Anaphylaxis - Haemolytic TR - TRALI - Infection - Air Embolism - Thrombophlebitis - TACO IMMUNOLOGICAL Febrile Non Hemolytic Transfusion Reaction • Defined to be a rise in temperature of 1⁰C [or] more (>=38⁰ C), within few hours of transfusion with chills & rigors. • Due to cytokines in the blood itself and/or pyrogens in the transfusion apparatus. Allergic / Urticarial Transfusion Reaction • Most common usually due to allergies to specific proteins in the donor’s plasma. • Mild – Treatment – Steroids & Antihistamines. • For severe (anaphylaxis), unit is discarded. New washed RBC’s and platelets are used. Acute Hemolytic Reaction • Transfusion of an incompatible blood component. { ABO incompatibility } • A disaster, almost always preventable. • Most often due to ABO mismatch due to a clerical error (i.e., the wrong blood and / or the wrong recipient). • Intravascular destruction – ARF & DIC. Acute Hemolytic Reaction • Features - fever, hypotension, NV, tachycardia, dyspnea, chest or back pain, flushing & anxiety. • Post-op site: diffuse bleeding. • Treatment - Fluids, diuresis and transfusion support for bleeding. Transfusion Related Acute Lung Injury [ TRALI ] • Due to donor plasma containing an antibody, usually against the patient's HLA (or) leukocyte specific antigens. • The donor antibodies cause these neutrophils to release toxic products and thus produce ARDS. • Features - Dyspnea, hypotension and fever typically begin 30 minutes to 6 hours after transfusion. • Chest x-ray shows diffuse non-specific infiltrates , “white out”. NON - IMMUNOLOGICAL Infections [TTI / TTD] Transfusion Associated Cardiac Overload [ TACO ] • 1% of Transfusions are complicated by TACO. • Features – Dyspnea, hypertension, crepitations & low O2 saturation. • Risk of volume overload / respiratory distress especially in small / elderly patient. • Largely avoidable by careful attention to fluid balance. COMPLICATIONS DELAYED Immunological Non- Immunological - Delayed hemolytic TR - Iron Overload - Post – T Purpura - TRIM - TR-GVHD - TTD Delayed Hemolytic Transfusion Reaction • Previously sensitized to an antigen through transfusion (or) pregnancy. • Can result in symptomatic (or) asymptomatic hemolysis several days (2-10 days) after a subsequent transfusion. • These patients present with flu-like symptoms, recurrent anemia and jaundice. Transfusion-associated graft-versus-host disease (TA-GVHD) • Donor T- cells attack host tissues. • Symptoms occur within 1-4 weeks. • Rare but always fatal. • Features – Pancytopenia / Rash / Liver dysfunction. Skin manifestation of GVHD Generalized swelling, erythroderma and bullous formation • Difficult to treat. Massive Blood Transfusion • Replacement (Or) Transfusion of blood = pt’s blood volume within 24 hours [ In normal adult – 10 units (or) 5 - 6 L ] [OR] • Single transfusion > 2500ml continuously. MBT - Complications • Coagulopathy • Hyperkalemia / Hypocalcaemia • Citrate toxicity • Hypothermia • Infections • Incompatibility & Transfusion reactions • ARDS / DIC / CCF Autologous Blood Transfusion • Collection / infusion of client’s own blood. • Can be collected weekly as long as client’s H (>11g) & H (>30%) are within safe range. • Up to 3 weeks before surgery. • Hct - 45%. • Stored at 2 - 6 ˚C. • Shelf life - 35 days. Autologous Blood Transfusion • Preoperative Donation: A patient can donate once weekly for three weeks before operation; the patient is put on iron and recombinant human erythropoietin. • Acute Normovolaemic Haemodilution: In the anesthetic room under anesthesia, three to four units of blood are withdrawn and replaced with crystalloid (or) colloid. The whole blood is reinfused at the end of the operation. • Perioperative Blood Salvage: At the time of surgery lost blood is collected in a cell-saver that washes and collects red blood cells, which are then reinfused during (or) after the operation. BLOOD SUBSTITUTES Blood Substitutes • They are an attractive alternative to the costly process of donating, checking, storing and administering blood, especially given the immunogenic and potential infectious complications associated with transfusion. BLOOD SUBSTITUTES Biomimetic Substitutes Abiotic Substitutes - Hemoglobin based - Perfluorocarbon based - Mimic – O2 carrying capacity of blood - Synthetic O2 carriers BLOOD SUBSTITUTES Artificial Blood Red Cell Substitutes Plasma Substitutes - Perfluorocarbon - Human albumin 4.5% - Stroma-free hemoglobin - Dextran - Chelates - Gelatin - Hydroxyethyl starch To Summarize • Types of blood groups. • Donor criteria / Collection & Storage methods. • Various Indications for blood transfusion. • Complications of blood transfusion & their management. • Massive & Autologous blood transfusion. • Types of Blood substitutes. World Blood Donor Day-June 14th References Question Time • List the blood donor criteria & blood substitutes for blood transfusion. • Categorize the blood cells and their storage capacity. • Enumerate 5 indications for blood transfusion. • Differentiate transfusion trigger from transfusion criteria. • Write the immediate complications of blood transfusion. • Abbreviate: TRALI / CPD / TACO / CCF / TA-GVHD • Name 5 infections that can occur during blood transfusion. • Define massive transfusion and mentions its 5 complications. After blood transfusion, the febrile nonhaemolytic transfusion reaction occurs due to • a) Pyrogens. • b) Allergic reaction. • c) Antibody reaction. • d) Technical error. After blood transfusion, the febrile nonhaemolytic transfusion reaction occurs due to • a) Pyrogens. • b) Allergic reaction. • c) Antibody reaction. • d) Technical error. One of the following is a complication of massive transfusion – • a) Hyperthermia. • b) Hyperkalemia. • c) Hypermagnesemia. • d) Hypercalcemia. One of the following is a complication of massive transfusion – • a) Hyperthermia. • b) Hyperkalemia. • c) Hypermagnesemia. • d) Hypercalcemia. The acceptable haemoglobin level for perioperative red blood cell transfusion is - • a) < 6. • b) 6 – 8. • c) < 8. • d) < 10. The acceptable haemoglobin level for perioperative red blood cell transfusion is - • a) < 6. • b) 6 – 8. • c) < 8. • d) < 10. One of the following is not a part of donor criteria for blood transfusion – • a) Age between 18 – 60 years. • b) No operation within 6 months of donation. • c) Interval of > 6 months from last donation. • d) Should weigh above 45 kg. One of the following is not a part of donor criteria for blood transfusion – • a) Age between 18 – 60 years. • b) No operation within 6 months of donation. • c) Interval of > 6 months from last donation. • d) Should weigh above 45 kg. One of the following is not a blood substitute – • a) Dextran. • b) Gelatin. • c) Human albumin. • d) Fibrinogen. One of the following is not a blood substitute – • a) Dextran. • b) Gelatin. • c) Human albumin. • d) Fibrinogen. THANKS