Professional Documents
Culture Documents
A A Anti B 45
B B Anti A 8
AB A&B - 4
O - Anti A Anti B 43
43
Blood Group: Rh System
• Described in 1940 by Landsteiner &
Wenier
• Rh –ve: lacking D antigen
• Rh +ve ( 80-85%): D present,
• Antibodies rarely occur naturally,
clinically significant antibody occur
after exposure to Rh antigen
• A delayed transfusion reaction may occur
Sources of blood
• Allogeneic / Homologous-donor
• Autologous- collection & reinfusion of Blood
to the same Pt.
Preperation of Blood Products
• Whole Blood is first separated PRBCs and Platelet
rich plasma (PRP) by slow centrifugation.
• PRP then centrifuged in high speed to yield one unit
of Platelets and one unit of FFP
• Cryoprecipitate is produced by thawing FFP to
precipitate the plasma proteins, which are then
separated by centrifugation
Preparation……..
• Platelets also collected by apheresis technology, that
is collection of multiple units from a single donor.
• Plasma also be collected by apheresis.
• Plasma derivatives such as albumin, intravenous
immunoglobulin, antithrombin 3 and coagulation
factor concentrates are prepared from very large
pools(20,000 donors per pool)
Whole blood enters the centrifuge on the
left and separates into layers so that
selected components can be drawn off on
the right
Storage & Preservation of Blood
• Donor blood is screened for Hb, Blood typed,
screen for Ab and tested for HBV, HCV, syphilis,
HIV1&2, CMV, HTLV1&2
• Preservative anticoagulant solution is added
• CPDA (citrate, phosphate, dextrose, adenine)
– lifespan = 35 days
– stored to 1-6OC( inhibits bacteria, slows RBC
glycolysis, preserves 2,3 DPG)
Storage Contd.
• Citrate: acts as anticoagulant
• Phosphate: acts as buffer
• Dextrose: as energy source for red cell
• Adenine: to increase the red cell survival ,
which re synthesize the ATP
• Shelf life 35 days in CPDA and 42 days in AS- 1
(Adsol) or AS –3 (Nutrice) ADSOLE contains : Adenine, glucose,
mannitol and sodium chloride, NUTRICE contains : Glucose, adenine ,
citrate, phosphate and sodium chloride
Storage……
• During storage a series of biochemical
reaction is going on:
- Decrease PH : From 7.55 to 6.73
- The storage temp (1-6’ C) stimulate Na K
pump : Na 169 to 153, K 4.2 to 17.2 meq/Lit
- Osmotic fragility of RBC increased, Lysis of RBC
, Increase in HB % 0.5 to 46 mg/dl
Blood Products
Whole Blood
• each unit = 450 ml with Hct 40%
• Stored at 4’C
• no functioning platelets after 2-3days
• decrease 2,3 DPG by two weeks
• Normal albumin and clotting factors except V
and VIII
• Risk of transmission of pathogen
• Use: active bleeding, blood loss > than 25%
Blood product
Packed red cells
• Volume =250 ml , hemetocrit 70%
• 1 unit of pcv raised hemoglobin by 1.5-
2g%
• Use-when volume replacement is not
necessary like in chronic anemic pt
• No functioning platelets
Blood Products (contd)
• Deglycerolized RBC/frozen RBC
– Stored in the frozen state in a hypertonic
glycerol solution for up to 10 yrs
– Indicated for prolong storage of rare red
cells
-expensive but the chance of reaction &
diseases transmission is less
- Glycerol must be separated from RBC
before transfusion
Blood Products (contd)
• Washed red blood cells
– Patients who had previous severe allergic
reactions(severe urticarial or anaphylactic
reaction)
• Leukocyte reduced RBC
– Indicated for patients with the h/o previous
febrile transfusion reactions
– Reduce alloimmunization, transfuse transmitted
infection.
– Probably more used in future.
Blood Products
Platelets concentrates
• Volume-50 ml
• Only blood products which are stored at room
temp
• 1 unit of platelets increases the count by
5000-10000
• Transfused platelets survive only for 2-7 days
• ABO compatible platelet should be used
• Uses-thrombocytopenia(< 20,000/cu mm, For
surgery <50,000/cu mm)
Blood products
fresh frozen plasma
• Volume-225 ml
• Prepared from single donation , centrifuging whole
blood and the supernatant is frozen
• Contains all plasma proteins, factor V and VIII
• Risk of transmission of infection and anaphylaxis,
Sensitization to foreign Proteins.
• Each unit of FFP increases the level of each
clotting factor by 2-3%
Blood Products
FFP (contd)
Use-
• Urgent Reversal of warfarin therapy.
• Correction of multiple coagulation factor
deficiency ( DIC)
• Correction of microvascular bleeding in
Massive blood transfusion.
• Anti thrombin III deficiency
• Treatment of immunodeficiency
• Treatment of thrombotic thrombocytopenic
perpura
Blood Products
Cryoprecipitate
• Volume-10 ml , Prepared from FFP by slow
thawing,
• High in factor Vlll, fibrinogen, Von
willebrand’s factor,and Factor XIII,
fibronectin
• Use-DIC,VW disease, hemophilia A
(factor Vlll deficiency)
Hypofibrinogenemea
Prothrombin Complex
• Complexes of II, VII ,IX and X
• Two commercial preparation now available:
Konyne and Proplex
• Used in treatment
- factor IX deficiency that is Hemophilia B
(Christmas disease)
- Hypoprothrombinemic bleeding disorder
• Limited use because of risk of Hepatitis
Blood Products (contd)
. Human serum albumin
• Immunoglobulin product
-Fraction of plasma as 90% IgG
– No risk of infection
– Use: Immune deficiency states
• Granulocyte concentrate
– Prepared by continuous flow or intermittent flow
leukopharesis
– Dificult to obtain , so only used in higher center
– Uses- severely leukopenic (<500mm3) patients with
evidence of septicemia & fever
Things to consider before transfusion
• Checked by two individuals
• Identification with patients name and bag
number
• Blood grouping and X match
• Date of collection and expiry
• Inspected for bacterial contamination such as
discoloration, bubbles, or any suspended
particles and clots inside the bag
Things to consider before transfusion
(contd)
• Warming up to 37’ C
– Rapid transfusion of large amount of cold bloods
– Pediatric patients
– Warming may not be necessary if 1 or 2 units of
blood are slowly transfused to normo thermic
adult patients
• A standard blood transfusion set with a pore
size of 170 m to trap any clots or debris
Compatibility testing
To demonstrate harmful antigen-antibody interaction in vitro so that
harmful in Vivo antigen-antibody interaction could be prevented
• ABO-Rh type
• Cross match: donor red blood cells are mixed with recipient serum(45-60
min) ; 3 phase : immediate phase, incubation phase, antiglobulin phase
- Trial transfusion in test tube
- preventing serious hemolytic transfusion reaction
• Antibody screen
- To screen donor serum for unexpected antibodies in order to prevent
their introduction into the recipient serum.
- also carried in 3 phases
Emergency Transfusion
• Type specific partially crossmatched blood
* ABO – Rh typing
* immediate phase of cross match
adding the pt’s serum to donor red cells at
room temp, centrifuging it and then reading it
for macroscopic agglutination(1-5 min)
Emergency……………
• Type specific, Un cross matched Blood
- ABO-Rh typing
- First time transfusion is successful
- previous exposure might be hazardous
• Type O Rh Negative (universal donor)
- When no time for typing and cross match
Blood Products (contd)
• plasma substitutes
-include gelatin solutions (gelofusin,
haemaccel)
-used to restore circulating volume until
blood becomes available
-crystaloids
Indication of blood transfusion
• whole blood in case of surgical condition
– during a major operation
– severe blood loss or hemorrhage
– post operatively in a severe debilitated and anemic
patient
– as a prophylactic measure preoperatively in
hemorrhagic tendencies as in haemophilia,ITP
Indication………
• American college of surgeons classes of acute
haemorrage:
- Class I : 750 ml, 15%, crystalloid
- Class II : 750-1500 ml, 15-30%, crystalloid
- Class III : 1500-2000 ml, 30-40%, crystalloid +
Blood
- Class IV : > 2000ml, > 40%, Blood
Indication……
• The Practice Guidelines for Blood component
therapy developed by the ASA state that: “Red blood
cell transfusion is rarely indicated when the
haemoglobin concentration is greater than 10 gm/dl
and is almost always indicated when it is less than 6
gm/dL”
• Clinical judgement-Cardiovascular status,nature of
surgical/medical illness,Age,anticipated additional
blood loss,arterial O2tension,etc
• EABL =
(Hct starting – Hct allowable ) TBV
-------------------------------------------
Hct starting
• Blood volume to be transfused =
(Hct desired – Hct present ) TBV
-------------------------------------------
Hct transfused
-Estimated total Blood volume= weight in Kg x blood volume in ml/kg
Complications
• Immune
– Hemolytic Reaction
– Non hemolytic Reaction
• Infective
• Due to massive blood transfusion
• Others
Immune related reactions
Treatment
– Stop the transfusion immediately
– Send both recipient and donor blood
specimen for repeat grouping and X
matching
– Treat hypotension aggressively with iv
fluids
Acute Intravascular Hemolysis
Treatment contd..
– Maintain urine output : iv fluid, diuretics,
dopamine, (induce diuresis)
– Monitor K level : Massive hemolysis can
release K
– Check for hemoglobinuria, bilirubin,
coagulation profile (PT, PTT, Platelet count,
fibrinogen level)
Delayed Hemolytic and serological
transfusion reaction
Allergic Reaction
Immune suppression
• Viral:
– HBV,
– AIDS (1:250 000 and 1:500 000)
– CMV
• Parasitic: malaria, toxoplasma
• Bacteria :staphylococcus, salmonella,
yersinia
• Spirochetes
Massive Blood Transfusion
• Coagulopathy:
– Dilutional thrombocytopenia
– Lack of coagulation factors V & VIII
– DIC associated with hypoperfusion or
hemolytic reaction
Massive Blood Transfusion (contd)