Blood transfusion

Blood transfusion

Dr.Ayad Abbas Slman

Types

a)Preoperative autologus donation(PAD): (2-6) units of blood taken from the patient over a period of days or weeks before surgery with concurrent iron treatment. b)Intraoperative autologus donation(IAD):many devices are used to collect blood from wound and filter it for retransfusion

c)Acute normovolaemic haemodilution: At start of surgery 1-2 bints of blood drawn and replaced by fluid and retransfuse at the end of operation

RBC antigens (Ag) are of 2 types: 1.Ag with naturally occurring Ab: theses are A & B and their presence or absence give rise to ABO groups.

A
B
AB
O
Ag on RBC
A
B
A and B
Non
Ab in serum
Anti B
Anti A
Non
Anti A and anti B
compatable
A ,AB
B,AB
AB
A,B ,AB,O
percent
40
11
4
45


Crossmatuing
Major: test if there is reaction between recipient serum against donor cellsMinor: test if there is reaction between recipient cells against donor serum and now replaced by Ab screen on donor blood so emergent case we can transfuse:1)Type specific parcially crossmatched blood (last 5 min.)2) Type specific uncrossmatched blood3)O –ve blood

Anticoagulants needed for preservation of blood

1.C.P.D ( Citrate,phosphate, Dextrose) Shelf life of RBC in such solution 21 days. 2.C.P.D.A (Citrate, Phosphate, Dextrose, Adenine) Shelf life of RBC in such solution 35 days. 3.Heparin: shelf life of RBC is 4 hrs.

Indication of Blood Transfusion

1.Severe blood loss: trauma, GIT bleeding.2.Following severe burn → RBC haemolysis.3.During major surgery that associated with severe blood loss.4.Anemic patient (severe).5.Thrombocytopenia.6.Bleeding due to clotting factor deficiency or dysfunction e.g. haemophilia and liver disease.

Forms of blood may be obtained for blood transfusion

1.Whole blood stores in CPD or CPDA or heparin.These forms are stored in 4○C.◊ Blood preserved with heparin used in open heart surgery:● not diluted by ACD or CPDA volume● given within 4 days

2.Fersh whole blood stored in ACD or CPDA.Used within 24 hrs for: ● Thrombocytopenia● Exchange transfusion of newborn

3.Concentarted RBC (plasma reduced blood).Stored temperature: 4○ , expiry:12 hrsIndication:● severe anemia● patient with severe heart failure● very young or very old patient

4.Fresh frozen plasma

● storage temperature: (-20)-(-30) ○C● separated immediately from RBC● It is 225 ml ● could be stored for several monthsIndication:● Haemophilia or any isolated factor deficiency● Massive blood transfusion(deficiency of facter 5 and 8


5.Platelet concentrate:50-70 ml● storage temperature -20○ ● expiry: given within 12 hrsIndication: thrombocytopenia or functional platelets disorder

6.Cryoprecipitate :

it is white,cold,and insoluble precipitate results from thawing of unit of fresh frozen plasma It is 10 ml contains80-145U facter 8,250mg fibrinogen,andVonwillbrand fact. Indication:1) haemophilia (factor IIX deficiency). 2) fibrinogen deficiency 3)Facter 7 deficiency 4) Vonwillbrand disease

Massive Blood Transfusion

Transfusion of half of blood volume within 1 hr (i.e. for adult ~ 5 bint = 2.5 L). (or) Transfusion of an amount equals to or more than one blood volume within 24 hr

5.Metabolic acidosis (early) followed by alkalosis when citrate metabolized to HCO3. 6.Fluid overload 7. thrombosis and air embolism 8.High O2 affinity blood (tissue hypoxia) 9.Infection

Complication of Blood Transfusion

2.Non-immunological● Coagulopathy● Metabolic acidosis Fluid overload● Hyper K+ Hypo Ca+2● Thrombosis Air embolism● Hypothermia● High O2 affinity Hb● Infection: HIV, hepatitis, CMV, malaria and syphilis

1.Immunological: Ag-Ab reaction 

Haemolytic reaction a.Immediate intravascular due toABO incompatibility Symptoms: Fever, chill, chest pain, hypotension,tachycardia, nausea, vomiting, dyspnea, respiratory failure, haemorrhage.

Treatment:

● Take samples of recipient and donor blood for analysis● i.v. fluid & O2­● Adrenalin 0.5-1 ml of 1:1000 every 3-5 min. as required and may followed by infusion● Antihistamine e.g. chlorphenamin 10-20 mg● hydrocortisone 100-500 mg i.v.● NaHCO3 may be required according to blood gas analysis

Treat renal vascular ischemia by: 1)crystalloid 2)diuretic e.g frusemide 20 mg 3)low dose dopamine 2-5Microgram/kg/min



b.Delayed extravascular : ● Occur due to reaction to minor blood group other than ABO.● Occur 7-10 days Symptoms:Fever, anemia and jaundiceTreatment:Conserative treatment