Blood transfusion

Presenter :Balamurugan E
Moderator : Ms. Poonam joshi
Blood
 Blood is a connective tissue composed of a
liquid matrix called plasma that dissolves
and suspends various cells and cell
fragments


 Functions
Transportation
Regulation
Protection

Physical characteristics
Denser ,more viscous than water
Temp-38 C
pH- 7.35-7.45
20%ECF
8% total body mass
5-6l for males
4-5l for females
Composition of blood
Substances in blood plasma
Constituents Description

Water (91.5%) Acts as solvent and

suspending medium for
Plasma proteins (7.0%) exerts colloidof blood
components
Albumins pressure,transportation of
Other solutes
Globulins Cations
steroids sodium, potassium,
and hormones,
Electrolytes
Fibrinogens calcium,
formationmagnesium
of
Nutrients Amino
Anions acids, glucose,fatty
chloride,
immunoglobulins bicarbonates
acids and glycerol, vitamins
Gases Oxygen , carbon dioxide ,
and minerals
nitrogen
Regulatory substances and Enzymes and hormones
waste Urea, uric acid
creatinine,ammonia etc
Formed elements
Red blood cells
Erythrocytes
Biconcave in shape
7.5 microns in diameter
4.5 – 5.5 million /mm3
PCV/ Hematocrit
◦ 38-46 for females
◦ 40-54 for males

 Functions of RBC
◦ To transport oxygen
◦ To transport CO2
◦ To maintain Ph of bld
Formation –bone marrow
Destruction -spleen
Average life span – 120 days

WHITE BLOOD CELLS
Platelets
Thrombocytes
Discshaped
Function
Form platelet plug in hemostasis
Blood grouping
Blood is categorized into various groups
based on these isoantigens.


Within the blood group there may be

many blood types

>24 Types bld groups, >100 isoantigens

Imp-ABO & Rh bld groups
Lewis, Kell, Duffy are other blood
group systems


 Based on the presence of Rh antigen
Rh factor present on surface of RBC
◦ Rh factor positive: D antigen is present
◦ Rh factor negative: D antigen is not present
Plasma does not contain anti-Rh
antibodies

 Rare blood group Bombay blood group


Histroy
1667-bld of sheep was transfused into a
boy
1678-found that animal to human
transfusion would not work
1888-Blundell performed the first
successful transfusion



Definition
It is the l/V administration of whole bld or
components such as plasma ,packed
RBC or platelets.
 OR
It is the transfer of blood or blood
components from one individual (donor)
to another (recipient).

 Blood from
◦ Blood banks
◦ Indian red cross society
Recipient – the person who receives the
bld
Donor – the person giving the blood

Purpose
To increase the circulating bld volume
To increase the number of RBCs & to
maintain Hb levels
To provide selected cellular components

BASIC REQUIREMENTS FOR
DONATION
Be in generally good health and feeling well.
Be at least 17 years of age; upper age 60 .
Weigh at least 110 pounds (45 kg).
◦ Weight for 350 ml <60 kg, for 450 ml >60
kg (for males)
◦ Only 350 ml is taken for females

Pulse: 80 to 100 beats/min and regular.
Temperature: Should not exceed 99.5 (37.5c).




Blood Pressure: acceptable range is
160/90 to 110/60.
 Skin: the venipuncture site should be free
of any lesion or scar of needle pricks
No multiple organ or renal disorders
Not addicted to any drugs
No history of malignancy or systemic
disease

Don’t donate if
A history of viral hepatitis
A h/o BT within 6 months
A h/o untreated syphilis or malaria
A h/o drug abuse
High risk groups
A skin infection

A h/o recent asthma, allergy
Pregnancy within 6 months
A h/o tooth extraction /oral Sx
Recent immunization
A h/o of recent tattoo
Cancer


 DONATION FREQUENCY
Whole Blood donors may donate every
3months.



Donation process
 Before donation
get a good night's sleep
eat a well-balanced meal
drink extra caffeine-free fluids before
donating
not take aspirin within 36 hours before
donation


Post-donation care
 Eat and Drink something before leaving

 Drink more liquids than usual in next 4 hours

 Avoid consuming alcohol until you have eating something

 Don't smoke for next 30 minutes

 Resume all normal activities if no symptoms occur

 Remove bandage next day

 Do not lift the heavy weights for next 24 hours

 Do not do any hard physical work for next 24 hours

Types of donations
Based on donation
Volunteer whole blood donation
Directed donation
Autologous blood donation



Complications Of
Donation


1) Needle injuries included

hematoma
pain
paresthesia
2) Vasovagal reactions included

discomfort
Syncope
3)Seizures

4)Anginal chest pain


Types of blood transfusion
Types:


◦ Homologous transfusion
 Voluntary
Directed transfusion


◦ Autologous transfusion



Autologous Blood transfusion
Autologous Blood transfusion is the
collection and re-infusion of the patient's
own blood or blood components. Also
called self-donation.


Can be made every 3 days

At or above Hb > 12 g/dl
Patient placed on oral iron supplements




 The advantages of this technique are the
avoidance
◦ HIV
◦ Hepatitis
◦ The alleviation of potentially deadly
transfusion reactions.

C/I – those with
◦ Bacteremia
◦ Leukemia
◦ Anemia


1.Preoperative autologous blood donation,
transfusion and storage
2.Intraoperative hemodilution
3.Intraoperative Blood salvage
4.Postoperative Blood salvage
5.Autologous self stored Blood (Blood
banking)


  Preoperative autologous Blood donation, transfusion
and storage (PABD)
◦ Units of blood are drawn
◦ 3 to 5 weeks before an elective surgical procedure
◦ Stored for transfusion at the time of the surgery.

 Intraoperative hemodilution:
◦ Blood is collected at the start of surgery
◦ The fluid volume lost is replaced with appropriate
IV solutions
◦ Finally stored blood is reinfused after surgery.


Intra-operative hemodilution
 Intraoperative Blood
salvage:
◦ Blood is salvaged
from the surgical
area during the
operation for re-
infusion during or
after the surgical
procedure.



Postoperative Blood salvage:
◦ Blood is collected after the surgical
procedure is complete by drainage of the
operative area and re-infused.
Autologous self stored Blood (Blood
banking):
◦ One’s own Blood is preserved in a frozen
state
◦ Can be used by that person or his/ her
designee at a later time.



Blood matching
Two aspects
Grouping
Cross matching


Screening
SCREEN FOR,
The drug and cosmetic acts /rule of India
2002(3rd amendment)
Mandatory screen for 5 transmissible
infections


Viruses
◦ HIV,Hep B,C,CMV
PARACITES
◦ Malaria,syphilis ,lyme disease

Processing of blood prior to
transfusion
Component separation:
◦ RBCs, plasma and platelets are separated
into different containers and stored in
appropriate conditions so that their use can
be adapted to the patient's specific needs
◦ Prepared by centrifugation
Storage
◦ Plasma -18 to -40°C
◦ RBCs 2 to 8°C
◦ Platelets in continuous shaking platform at
room temperature (2 to 24°C)


 Blood preservation


 Following preservatives used:

◦ ACD (acid citrate dextrose)
◦ CPD (citrate phosphate dextrose)
◦ CPDA (citrate phosphate dextrose adenine)



  Leukoreduction, or the removal of stray white blood
cells from the blood product by filtration.
◦ Less likely to cause alloimmunization
◦ Less likely to cause febrile transfusion reactions
◦ Appropriate for
Chronically transfused patients
Potential transplant recipients
Patients with previous febrile non-hemolytic
transfusion reactions



Types of blood products
ØWhole blood
ØPacked red blood cells
ØPlatelet concentrates
ØFresh frozen plasma
ØCryoprecipitate
ØPlasma derivatives
ØPlasma protein fraction
ØHuman serum albumin
ØCoagulation factor concentrates

Type of blood
Whole blood transfusion
Contains RBC and plasma
components (400 ml/bag)
Packed RBC
form(150-200 ml/bag); 80% RBC & Hb<9 gm/dl
20% plasma
Indication
 Acute massive blood
loss( >15% of blood volume in
adults, >10% of blood volume
in children)
 To increase the oxygen carrying
capacity of the blood
Thalessemia, Aplastic anemia,
Cardiovascular or renal failure
GI bleed
Blood loss > 15% of blood volume
(adults) and 10% (children)
Systolic pressure <100 mm Hg,
heart rate >100/min with active
bleeding.
Type of blood Indication
Platelet concentrate Platelet count <20,000/ul (non-
50-70 ml/bagplasma
Fresh frozen surgical)
 Replace deficient coagulation
Composition – 91% h2o, 7% Active bleeding and platelet count
factor
proteins & 2% carbohydrates <50,000/ul
 Prothrombin time> 1 and half
180-200ml/bag. platelet
timescount <50,000/ul and
the control
surgery
 Acitivated prothrombin
Consumption
time>>55 coagulopathy
secs
Massive
 blood
Massive transfusion
blood transfusion
Type of blood Indication
Plasma protein fraction Serum albumin<3gm/dl
Human serum albumin
Available as 5%/100 ml Liver transplant

To restore intravascular
volume

To treat shock, burns, hypo-

proteinemia.

To increase the colloidal

osmotic pressure of the blood
Type of blood Indication
Cryoprecipitate Hemophilia A
 80-120 units of factor Replacement of factor
VIII, VIII
 250 mg fibrinogen & Factor XIII deficiency
 20-30% of factor XIII
Blood transfusion reaction
Transfusion reaction is a problem that
occurs after a patient receives blood .

Febrile non-hemolytic transfusion
reaction
Caused by antibodies to donor WBCs
They occur between 1 and 6 hours of
transfusions
s/s
fever, chills, and malaise, dyspnea.
Rx
Antipyretics
Prevention
Reduce the amount of WBC count

Hemolytic transfusion reactions
Result of antibodies in the recipient's
plasma directed against antigens on the
donor's erythrocytes.
s/s
Fever ,Chills ,Flushing ,Nausea ,Burning
at the intravenous (IV) line site ,Chest
tightness, Restlessness ,Apprehension
 Joint pain ,Back pain


Rx
Stop the transfusion
Bld &urine specimen for analysis
Maintain bld volume


Anaphylactic reaction
Due to a sensitivity reaction to plasma
proteins
S/S
Chills
Abdominal cramps
Dyspnea
Vomiting
Diarrhea
Tachycardia
Flushing
Urticaria
In more severe cases, wheezing, laryngeal
edema, and hypotension

GVH (Graft versus host)disease
S/S
Fever
Abdominal pain
Nausea
Vomiting
Diarrhea, often copious
Anorexia

Massive transfusion complications
S/S
Volume overload
Hypothermia
Hyperkalemia
Hypocalcemia

OTHERS
Transfusion related acute lung injury
(TRALI)
Bacterial Contamination


Equipments
Sterile tray containing a 5cc/10 cc syringe.
IV cannula
Spirit swabs
sterile gloves
Blood transfusion sterile set with a line
filter
Leukoplast
Arm board
Spirit
Blood bag


Tourniquet
Normal saline
IV stand
Mackintosh
Kidney-tray, bandages
Torch light
Some type of anti-allergic drugs
Resuscitation articles


Procedure
Assessment
üCritical part in the procedure
üCheck for the physician’s order.
üObtain informed consent
üAssess the veni-puncture site for the signs of
infection, infiltration
üDetermine the gauze of the IV cannula
üDetermine the patency and functioning of
the IV cannula



 Planning
üWash hands
üGather the necessary equipments
üObtain the blood product from the bank and
ensure that transfusion is started within 30
min of removal from refrigerated storage in
blood bank.
üIn case of massive transfusion, warm the
blood before the transfusion to prevent
temperature drop
üCheck and verify the blood to be transfused
üGet it checked with second RN
üObserve for signs of puncture, gas bubbles,
colour and consistency
üEnsure the use of only normal saline with
blood products.



Implementation
üEnsure informed consent, check the blood
bag with the patient’s identification data
üExplain the procedure
üWash hands and assemble the articles by the
bed-side
üMake pt. warm and comfortable
üObtain baseline vitals and record
üPrime infusion line with saline
üBegin transfusion slowly, initially at the rate
of 2ml/min for first 15min.
üDuring this period observe for any
reactions,check vitals every 5 min.


 ◦ After 15 min regulate the rate of flow.
◦ In case of any transfusion reaction:
üStop the transfusion and start IV normal
saline
üCheck the vitals, be with the patient.
üNotify the physician and blood bank.
üGet ready with resuscitation articles.
üAdminister anti-allergic if required.
üSend back the blood and the used set to
the blood bank with the physician’s
note.

 üSee that the patient is comfortable.
üObserve aseptic techniques
üCheck the rate of infusion often
üAssess for phlebitis or infiltration at the IV
site
üRecord the time, date, amount, group , rate
of flow and reactions if any.
üClamp the set before it finishes and start
normal saline infusion.
üTo discontinue transfusion-clamp and
withdraw the needle while applying
pressure with the spirit swab.
üDiscard the blood bag and set after cutting in
the yellow bag.
üRemove gloves and wash hands.

Evaluation
üVital signs and compare it with the baseline
measurement
üComfort of the patient
üAny transfusion reaction
Documentation
üThe type and amount of blood product,
blood bag number, time of starting and
completing, the name of those who
checked and verified.
üVitals
üFlow rate
üPertinent patient response
ü
Points to remember
Blood should be at room temp. 30-40 mts.
Observe aseptic technique.
Check often to see the blood is running at
correct rates.
No bag should be hanged > 4 hrs.
Observe the swelling around the needle.
Never add any medication to bld/bld
products


Evaluation
What are contraindication of
blood donation?
What are the types of blood
products available?
What has to be done if a patient
develops symptoms of
haemolytic reaction?
