Blood transfusion

This PPT is basically based on the topic - Blood transfusion in Bailey & Love and mainly very useful for Final MBBS students.during their course as well as their in clinical practice.

1. BLOOD TRANSFUSIONS Dr. Murali . U. M.S; M.B.A. Prof. of Surgery D.Y.Patil Medical College Mauritius.

2. Objectives Blood Groups Indications Donor Criteria & Collection of Blood Complications Massive Transfusion Blood Substitutes 2 *Image via Bing

3. Overview 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 blood-based products from one person into the circulatory system of another.

4. BLOOD GROUPS 4

5. 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. 5

6. ABO blood grouping system T here are four different kinds of blood types: A, B, AB or O (null). 6

7. 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. 7

8. The ABO blood groups The table shows the four ABO phenotypes ("blood groups") present in the human population and the genotypes that give rise to them. 9 Blood Group Antigens on RBCs Antibodies in Serum Genotypes A A Anti-B AA or  AO B B Anti-A BB or  BO AB A and B Neither AB O Neither Anti-A and anti-B OO

9. The Rhesus ( Rh ) System Well, there's another antigen to be considered always - the Rh antigen . Some of us have it, some of us don't have. If it is present, then blood is RhD positive, if not it's RhD 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. 10

10. According to above blood grouping systems, you can belong to either of following 8 blood groups: 11

11. History Of Blood Transfusion 1492 – Pope Innocent VIII 1628 – William Harvey 1665 – Richard Lower 1667 – Jean – Baptiste Denis 1670 – France 1829 – James Blundell 1900 – Karl Landsteiner 1914 – Albert Hustin 1926 – British Red Cross 1939 – Rhesus system

12. India’s First Blood Bank School of Tropical Medicine, Kolkatta By SIR. UPENDRANATH BRAHMACHARI Chairman of Bengal Red Cross Society.

13. CROSS MATCHING DONOR’S R.B.C + RECIPIENTS SERUM + COOMB’S REAGENT

14. Blood Donor Criteria Age – 17 – 65 ( New upto 60 ) Wt - > 45 kg Hb - > 13 M / > 12 F Fit without serious diseases – HIV / Hepatitis & Malaria A person can donate blood every 90 days (3 months).

15. Collection & Storage Bag – 75ml CPD Stored – Special Ref. - 4Deg C. +/-2Deg C Shelf Life of CPD Blood - 3 wks R.B.C’s - 3 wks W.B.C – Rapidly Destroyed Platelets – Reduced in 24 hrs Clot. Factors – Labile – Levels fall

16. Blood Donation 475ml Blood + 63ml Anticoagulant Post – Transfusion Purpura Red cells + Optimal Additive solution SAGM Expiry date = 35 days One unit of blood raises the haemoglobin concentration by approximately 1g/100 ml

17. Indications Acute blood loss – Due to Trauma. Chronic Anemia. Major Operative procedures As a Prophylactic measure to Surgery Severe Burns Blood Dyscariasis

18. Transfusion Trigger The decision to transfuse any patient for a given indication must balance the risks of not transfusing . RBC transfusion not indicated when Hb >10g/dl Transfuse Criteria - < 6g/dl - Benefit from Transfusion - 6 - 8g/dl - Unlikely to benefit – absence of bleeding - > 8g/d l - Not indicated

19. IMMEDIATE COMPLICATIONS Immunological Febrile / n on haemolytic Allergic / Anaphylaxis Haemolytic TR TRALI Non- Immunological - Congestive Cardiac Failure Infection Air Embolism Thrombophlebitis TACO

20. Febrile Non Haemolytic Transfusion Reaction Defined to be a rise in temperature of 1 °C or more and >=38 °C, within few hours of transfusion with Chills & Rigors. Due to cytokines in the blood itself and/or pyrogens in the transfusion apparatus.

21. Allergic / Urticarial Transfusion Reaction Most common usually due to allergies to specific proteins in the donor’s plasma. Mild – Trt – Steroids & Antihistamines. For severe (anaphylaxis ), unit is discarded. New washed RBC’s and platelets are used.

22. Acute Haemolytic 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

23. Acute Haemolytic Reaction Features - fever , hypotension, NV, tachycardia, dyspnea, chest or back pain, flushing & anxiety Post-op site: diffuse bleeding Trt - Fluids , diuresis and transfusion support for bleeding

24. 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”

25. Infections Bacterial infection – Due to faulty storage. Serum hepatitis. HIV Infection Malaria transmission Viral – EBV / CMV Syphilis / Yersinia

26. Transfusion Associated Cardiac Overload [ TACO ] 1% of Transfusions are Complicated by TACO. Features – Dyspnoea , hypertension, crepitations & low O2 Sat. Risk of volume overload / respiratory distress especially in small / elderly pt. Largely avoidable by careful attention to fluid balance.

27. Delayed Complications Delayed Haemolytic TR Post – Transfusion Purpura Transfusion related graft versus host disease { TGVH } Immunosuppression Iron overload – Multi transfused recipients

28. Delayed Haemolytic Transfusion Reaction Previously sensitized to an antigen through transfusion or pregnancy. C an result in symptomatic or asymptomatic hemolysis several days (2-10 days) after a subsequent transfusion. These present with flu-like symptoms, recurrent anemia and jaundice.

29. 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. Difficult to treat. Skin manifestation of GVHD Generalized swelling, erythroderma and bullous formation

30. 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

31. MBT - Complications Coagulopathy Hyperkalemia / Hypocalcaemia Citrate toxicity Hypothermia Infections Incompatibility & Transfusion reactions ARDS / DIC

32. Blood Substitutes DEXTRAN Most Widely Used Polysaccharides - ↑ Plasma volume Leuconostoc Mesenteroides Bacteria Low Mol.Wt (40,000 mol.wt ) High Mol.Wt (70,000 ) Massive Transfusion – Impair Coag . 33

33. Blood Substitutes Human Albumin – 4.5% Plasma fractionation – Albumin Extract No risk - Hepatitis Can be used daily Expensive 34

34. Blood Substitutes Gelatin Haemaccel - Plasma Expander 30% Remains - Intravascular Hydroxethystarch Contains – Starch / NaOH / Ethylene Oxide Lasts – 6 hrs 35

35. M C Q – TIME

36. 1 . Which of the following is not a delayed complication of blood transfusion ? A TRALI B TG-VH C Post – transfusion purpura D Iron overload

37. 2 . Which of the following is not a complication of massive blood transfusions ? A Coagulopathy B Hypercalcemia C Hyperkalemia D Hypothermia.

38. 3 . The first successful documented human transfusion was done by - ? A Karl Landsteiner B James Blundell C Richard Lower D Jean – Baptiste Denis

39. 4 . Shelf life of CPD Blood is - A 7 days B 14 days C 21 days D 28 days

40. 5 . One of the following is not a Blood substitute - A Hydroxystarch B Haemaccel C Human albumin D LMW – Dextran

41. Observing / Monitoring the Patient During a Blood / Blood Component Transfusion is part of safe transfusion Rigors Haemoglobinuria Tachycardia Hyper / Hypotension Pyrexia Nausea / vomiting Breathlessness / coughing Restlessness Agitation Confusion Chest, abdominal, muscle, bone or loin pain Flushing Urticaria - Itchy rash Headache Collapse Generally feeling unwell

42. blood and blood transfusions 43

43. PRE-TRANSFUSION RESPONSIBILITIES Assess laboratory values Verify the medical prescription. Assess the client’s vital signs, urine output, skin color and history of transfusion reactions . Obtain venous access. Use a central catheter or at least a 20-gauge needle, if possible . blood and blood transfusions 44

44. Obtain blood products from a blood bank; transfuse immediately. With another registered nurse, verify the patient by name and number, check blood compatibility and note expiration time. Administer the blood product using the appropriate filtered tubing. blood and blood transfusions 45

45. Remain with the patient during the first 15-30 minutes of the infusion. Infuse the blood product at the prescribed rate. Monitor vital signs. blood and blood transfusions 46

46. World Blood Donor Day-June 14th

47. THANKS