Crossmatch & Transfusion Procedure Hospital

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1. TRANSFUSSION AND CROSSMATCH

2. The first successful transfusion of human blood was performed in 1818 by a British obstetrician, Dr James Blundell, who drew blood from the patient’s husband and, to prevent the blood from coagulating ex vivo, infused it directly into the patient BLOOD TRANSFUSION Blood transfusion begins with collecting whole blood from a donor using a preservative-anticoagulant combination (typically citrate phosphate dextrose or citrate phosphate dextrose adenine-1). The blood is then tested for transfusion-transmitted diseases, separated into its specific components, and then transfused as clinically indicated. Zomorrodi A, Picciola EA, Hotwagner DT. Determining the Need for Blood Transfusion. [Updated 2023 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564300/

3. storing blood and blood components at appropriate temperatures and conditions; developing appropriate procedures for further processing of the blood and blood components prior to transfusion – for example, pooling, washing and irradiation, where applicable; appropriate pre-transfusion testing of patients and cross-matching to ensure compatibility of the blood component to be transfused maintaining appropriate records to ensure that blood components can be traced to their recipients and from recipients back to their donors; documenting and investigating nonconformities and deviations related to the handling of blood and blood components; quarantining of blood and blood components that are under investigation by the blood establishments/banks and hospitals; reporting adverse events and reactions that are related to the quality of blood components to the blood establishments/banks; investigating, evaluating and documenting all adverse transfusion reactions; ensuring the appropriate use of blood and blood components by clinicians THE BLOOD TRANSFUSION SYSTEM World Health Organizatiom

4. COMPLICATIONS OF BLOOD TRANSFUSION Bates, I., & Owusu-Ofori, S. (2009). Blood Transfusion. Manson's Tropical Diseases , 229–234. https://doi.org/10.1016/B978-1-4160-4470-3.50018-5

5. BLOOD TYPE AND CROSS MATCH To avoid a transfusion reaction, donated blood must be compatible with the blood of the patient who is receiving the transfusion. The donated RBCs must lack the same ABO and Rh D antigens that the patient's RBCs lack Before transfusion Blood type Cross match the recipient's blood type is determined, their ABO type and Rh D status may still be incompatible because it contains other antigens that are not routinely typed but may still cause a problem if the recipient's serum contains antibodies that will target them to ensure that the donor RBCs actually do match against the recipient's serum Dean L. Blood Groups and Red Cell Antigens [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2005. Chapter 3, Blood transfusions and the immune system. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2265/

6. CROSS MATCH To perform a cross match, a small amount of the recipient's serum is mixed with a small amount of the donor RBCs Dean L. Blood Groups and Red Cell Antigens [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2005. Chapter 3, Blood transfusions and the immune system. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2265/ If the proposed transfusion is incompatible, the donor RBCs are agglutinated by antibodies in the recipient's serum .

7. RED BLOOD CELLS Packed red blood cells (RBCs) are prepared from whole blood by removing approximately 250 mL of plasma. One unit of packed RBCs should increase levels of hemoglobin by 1 g per dL (10 g per L) and hematocrit by 3 percent. Indication : Acute sickle cell crisis (for stroke prevention) Acute blood loss of greater than 1500 mL or 30% of blood volume Patients with symptomatic anemia if they cannot function without treating the anemia When a patient has a hemoglobin level less than or equal to 10 g per dL and hematocrit level less than or equal to 30 % Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011 Mar 15;83(6):719-24. PMID: 21404983. A single unit of packed red blood cells is roughly 350 mL and contains about 250 mg of iron

8. RED BLOOD CELLS Storage: designated temperature controlled refrigerator 4 ±2 oC Shelf life: 35 days Dose: 4ml/kg (equivalent to 1 unit per 70kg adult) typically raises Hb concentration by about 10g/l All red cell units should be transfused within 4 hours of removal from designated temperature controlled storage Guidelines for blood transfusion : Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011 Mar 15;83(6):719-24. PMID: 21404983.

9. Post-operative patients In haemodynamically stable post-operative surgical patients, the trigger for transfusion is Hb ≤ 8 g/dl or presence of symptoms of inadequate oxygen delivery (chest pain of cardiac origin, orthostatic hypotension or tachycardia unresponsive to fluid resuscitation, or congestive heart failure). QoE : High; SoR : Strong Patients with neurotrauma or neurological diseases In patients with traumatic brain injury, the target Hb should be 7-9 g/dl; and in those with additional evidence of cerebral ischaemia the target Hb should be >9 g/dl. QoE : Low; SoR : Weak In patients with subarachnoid haemorrhage the target Hb should be 8-10 g/dl. QoE : Low; SoR : Weak In patients with an acute ischaemic stroke the Hb should be maintained above 9 g/dl. QoE : Low; SoR : Weak Yaddanapudi , S., & Yaddanapudi , L. (2014). Indications for blood and blood product transfusion. Indian journal of anaesthesia , 58 (5), 538–542. https://doi.org/10.4103/0019-5049.144648

10. Patients in the intensive care unit In critically ill normovolaemic patients transfusion is considered at a Hb level of ≤7 mg/dl with a target of 7-9 g/dl, unless specific co-morbidities or acute illness-related factors modify clinical decision-making. QoE : Moderate to High; SoR : Strong During the early resuscitative phase of severe sepsis if there is evidence of inadequate oxygen delivery to the tissues (central venous oxygen saturation <70%, mixed venous oxygen saturation <65% or lactate concentration >4 mmol/L), blood transfusion is considered to achieve a target Hb of 9-10 g/dl. QoE : Low; SoR : Weak In the later phases of severe sepsis, the guidelines are similar to those for other critically ill patients with target Hb of 7-9 g/dl. QoE : Low; SoR : Weak Blood transfusion should not be used to assist weaning from mechanical ventilation if the Hb is >7 g/dl. QoE : Very low; SoR : Weak Yaddanapudi , S., & Yaddanapudi , L. (2014). Indications for blood and blood product transfusion. Indian journal of anaesthesia , 58 (5), 538–542. https://doi.org/10.4103/0019-5049.144648

11. Patients with cardiac disease In haemodynamically stable patients with cardiovascular disease transfusion is considered for Hb ≤ 8 g/dl, or the presence of symptoms of inadequate oxygen delivery. QoE : Moderate; SoR : Weak In critically ill patients with stable angina, Hb should be maintained >7 g/dl. Transfusion to a Hb of >10 g/dl has uncertain benefit. QoE : Moderate; SoR : Weak In patients suffering from acute coronary syndrome, the Hb should be maintained at >8-9 g/dl. Restrictive transfusion strategy (trigger Hb: 7-8 g/dl) is recommended for patients with coronary artery disease. QoE : Low; SoR : Weak Yaddanapudi , S., & Yaddanapudi , L. (2014). Indications for blood and blood product transfusion. Indian journal of anaesthesia , 58 (5), 538–542. https://doi.org/10.4103/0019-5049.144648

12. PLASMA Plasma contains all of the coagulation factors . Fresh frozen plasma infusion can be used for reversal of anticoagulant effects . Thawed plasma has lower levels of factors V and VIII and is not indicated in patients with consumption coagulopathy (diffuse intravascular coagulation) Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011 Mar 15;83(6):719-24. PMID: 21404983.

13. PLATELET indicated to prevent hemorrhage in patients with thrombocytopenia or platelet function defects Contraindications to platelet transfusion include thrombotic thrombocytopenic purpura and heparin-induced thrombocytopenia. One unit of apheresis platelets should increase the platelet count in adults by 30 to 60 × per μL (30 to 60 × per L).   Spontaneous bleeding through intact endothelium does not occur unless the platelet count is no greater than 5 × per μL (5 × per L)   Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011 Mar 15;83(6):719-24. PMID: 21404983.

14. PLATELET In Neonates, transfusing 5 to 10 mL per kg of platelets should increase the platelet count by 50 to 100 × per μL (50 to 100 × per L).   Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011 Mar 15;83(6):719-24. PMID: 21404983.

15. PLATELET Storage: temperature controlled 22 ± 2 °C – with continuous gentle agitation Platelets must not be refrigerated Shelf life: 5 days (In certain controlled circumstances 7 day platelets may be supplied) Platelet concentrates should not be transfused through administration sets which have already been used to administer other blood components The infusion should be commenced as soon as possible after the component arrives in the clinical area

16. CRYOPRECIPITATE Cryoprecipitate is prepared by thawing fresh frozen plasma and collecting the precipitate Cryoprecipitate contains high concentrations of factor VIII and fibrinogen Each unit will raise the fibrinogen level by 5 to 10 mg per dL (0.15 to 0.29 μmol per L), with the goal of maintaining a fibrinogen level of at least 100 mg per dL (2.94 μmol per L) The usual dose in adults is 10 units of pooled cryoprecipitate. Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011 Mar 15;83(6):719-24. PMID: 21404983.

17. WHOLE BLOOD There has been increasing interest in using low titer group O whole blood (LTOWB) in military and civilian trauma, and there is evidence to show that it saves lives. LTOWB provides all of the components of blood (RBCs, platelets, and plasma with fibrinogen) and provides a balanced resuscitation addressing oxygen needs and coagulopathy in a single bag of blood. The transfusion of up to 4 units of whole blood has been shown to be safe. Zomorrodi A, Picciola EA, Hotwagner DT. Determining the Need for Blood Transfusion. [Updated 2023 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564300/ The whole blood has a critical titer of anti-A and anti-B of less than 50 to 200

18. Platelet Transfusion In Thrombocytopenic Patients for Phacoemulsifications Thrombocytopenia is a common risk factor for surgery. In phacoemulsification cataract surgery, it can cause serious periocular or intraocular hemorrhage, and leads to severe complications. L ee , Tsung—Han. Et al. 2014. The use of platelet transfusion in thrombocytopenic patients for phacoemulsification. Taiwan Journal of Ophtalmology . Vol.04. No.1. Pp 52-55 In order to better control the intraoperative bleeding, platelet transfusion in patients with thrombocytopenia is commonly carried out in some major operations The normal platelet count range is around 150,000–400,000/ μL , and the threshold of 20,000/ μL for prophylactic transfusion is widely accepted to prevent spontaneous bleeding . For patients undergoing invasive procedures, an optimal platelet count of >50,000/ μL has also been suggested .

19. Platelet Transfusion In Thrombosytopenic Patients for Phacoemulsifications L ee , Tsung—Han. Et al. 2014. The use of platelet transfusion in thrombocytopenic patients for phacoemulsification. Taiwan Journal of Ophtalmology . Vol.04. No.1. Pp 52-55 60 years old man with refractory cytopenia with multilineage dysplasia who had undergone phacoemulsification for his right eye. The platelet level is 5000/µL, 12-unit platelet transfusion was administered 2 hours prior to the surgery. The surgery was performed smoothly without any complication After the operation, his postoperative Day-1 follow-up revealed a favorable wound condition in his right eye with minimal subconjunctival hemorrhage, but without periorbital ecchymosis, hyphema , or even choroid hemorrhage Preoperative Postoperative day 1 CASE 1

20. Platelet Transfusion In Thrombosytopenic Patients for Phacoemulsifications L ee , Tsung—Han. Et al. 2014. The use of platelet transfusion in thrombocytopenic patients for phacoemulsification. Taiwan Journal of Ophtalmology . Vol.04. No.1. Pp 52-55 70 years old female with steroid refractory severe idiopathic thrombocytopenic purpura who had undergone splenectomy. Her platelet level was 6000 / µ, then 12-unit platelet transfusion 2 hours prior to the operation was given. On postoperative Day 1, mild subconjunctival hemorrhage of her right eye was observed when the wound dressing was changed Then at her 1-month follow-up clinic, the subconjunctival hemorrhage in her right eye regressed, and the BCVA of her right eye improved from 0.07 to 1.0. There was no bleeding-associated adverse event reported or found on ocular examination Preoperative Postoperative day 1*** CASE 2 Preoperative 1-month postoperative

21. Transfusion in Sickle Cell Retinopathy Surgery Proliferative sickle retinopathy is characterized by the development of peripheral retinal neovascularization, vitreous hemorrhage, and tractional or combined tractional-rhegmatogenous retinal detachment Chen, R. W., Flynn, H. W., Jr, Lee, W. H., Parke, D. W., 3rd, Isom, R. F., Davis, J. L., & Smiddy, W. E. (2014). Vitreoretinal management and surgical outcomes in proliferative sickle retinopathy: a case series. American journal of ophthalmology , 157 (4), 870–875.e1. https://doi.org/10.1016/j.ajo.2013.12.019 The earliest surgical series for proliferative sickle retinopathy was published prior to the era of vitrectomy and reported a high rate of anterior segment ischemia, prompting some surgeon to recommend preoperative exchange transfusion and avoidance of an encircling scleral buckle Proliferative sickle retinopathy remains a challenging ocular condition, and anterior segment ischemia is a possibility even with modern surgical techniques and in the absence of scleral buckling or muscle detachment