TRANSFUSI
ON
PRACTICES
MIRABELE A. CAMORO,
RMT
OBJECTIVES
1. Identify the organizations that regulate or accredit the
immunohematology laboratory.
2. State the acceptable levels of different parameters in
allogeneic and autologous blood donation.
3. Describe the procedure for a whole blood donation,
including arm preparation, blood collection, and post
phlebotomy care instructions for the donor.
OBJECTIVES
4. Describe the pathology and laboratory testing of the
various transfusion- transmitted diseases.
5. Identify the method of preparation, storage
conditions, shelf life, and quality control requirements of
the different blood components.
6. Determine the appropriate blood product for patients
with specific disorders.
OBJECTIVES
7. Specify the steps involved in the proper
administration of blood.
8. Compare the relative risks of adverse events due to
transfusion.
9. Define apheresis and describe the physiology of the
process.
TOPICS
Donor Selection
Component Preparation
TransfusionTransmitted Diseases
Transfusion Therapy
TOPICS
Adverse Effects of Blood
Transfusion
Apheresis
Donor
Selection
Physical
Examination
General
Appearance
 Weight
 Temperature
 Hemoglobin

Physical Examination:
Weight



Volume to collect = (donor’s weight in kg/50) ×
450 mL.
Blood vol. needed
Volume to collect/450 × 63 mL = reduced
volume of anticoagulant.
AC needed
63 mL – above calculated volume = amount of
solution to be removed.
AC to be
removed
How much anticoagulant
would have to be
removed from the
collection bag given a
donor who weighs 40 kg?

Volume to collect = (donor’s weight in kg/50) × 450
mL.
= 40 kg /50 kg x 450 mL
= 0.8 x 450 mL
= 360 mL
needed
Blood vol.

Volume to collect/450 × 63 mL
= 360 mL / 450 mL x 63 mL
= 0.8 x 63 mL
= 50.4 mL
Anticoagulant needed

63 mL – above calculated volume
= 63 mL – 50.4 mL
= 12.6 mL or 13 mL
removed
1 kg = 2.20 lbs
Anticoagulant to be
Autologous Donation
Preoperative
collection
Acute
normovolemi
c
hemodilution
Intraoperativ
e collection
Postoperativ
e collection
The
collecting
facility
must
determine
the
ABO and Rh of the
blood,
but
antibody
screening
is
optional.
If the collecting
and the
transfusing
facilities are the
same, then viral
marker testing is
not required.
The transfusing facility
must reconfirm the ABO
and Rh of the unit, but a
crossmatch is optional.
However, an immediate
spin crossmatch would
be a good safety check
confirming that the
selected unit is identified
properly.
Directed Donation
Collected under the same requirements as
those for allogeneic donors.
The unit collected is directed toward a
specific patient.
Apheres
is
Donatio
n
Collecting a specific
blood component
while returning the
remaining whole blood
components back to
the patient.
Separates blood
into components
based on
differences in
density
Whole Blood Collection
Donor
Identificatio
n
Aseptic
Technique
Postdonati
on
Instruction
s
Donor Reactions
MODERAT
E
MILD
SEVER
E
HEMATOM
A localized collection
A of blood
under the skin, resulting in a
bluish discoloration Caused by
the needle going through the
vein, with subsequent leakage of
blood into the tissue.
Donor Processing
ABO/Rh
Antibod
y
Screen
Bacterial
and/or Viral
Serologic
Tests
Donor Records
The minimum
retention time
for donor
records varies
from 5 to 10
years to
indefinitely.
TransfusionTransmitted Diseases
TTDs
TransfusionAssociated
Hepatitis
HIV Types 1 and
2
Human T-Cell
Lymphotropic
Viruses Types I/II
(HTLV-I/II)
Other Viruses
West Nile Virus
Zika Virus
(CMV, EBV, Parvovirus B19, HHV 6 & 8, CHIKV, DENV,
EV)
TTDs
Bacterial
Contamination
(Syphilis, Tick- borne
bacterial agents)
TransfusionAssociated
Parasites
Prion Disease
Transfusion-Associated Hepatitis
HAV
Picornavirida
e
Jaundice is more common in older
children and adults
HBV
Hepadnavirida
e
HBsAg is used to screen blood
donor.
HCV
Flaviviridae
Today, anti-HCV testing via enzyme
immunoassay (EIA) or chemiluminescent
immunoassay (ChLIA) methodology and HCV
RNA testing are performed on all donor units.
HDV
Defective
ssRNA virus
Requires HBsAg in order to synthesize
an envelope protein and replicate
HEV
Caliciviridae
Fecal- oral route of transmission.
(HAV & HEV)
HGV
Flaviviridae
Parenteral route of transmission
(HBV, HCV,HDV)
Transfusion-Associated Hepatitis
Transfusion-Associated Hepatitis
KILLED
VACCINES/TOXOIDS
GAMMA GLOBULIN
HIV Types 1 & 2
HIV Types 1 & 2
- Etiologic agents of AIDS
- A retrovirus
- When the CD4 count is less than
200/µL, the patient is classified as
having clinical AIDS.
HIV Types 1 & 2
- Possibility of transmitting HIV remains
when the donor has not yet
seroconverted and the level of virus in
the blood is low
- The risk of HIV-1 infection through
transfusion is 1:1,000,000 per unit
transfused
Human T-Cell Lymphotropic Viruses Types I/II
(HTLV-I/II)
- RNA retroviruses
- HTLV-I: causes a T-cell proliferation
with persistent infection
: first retrovirus to be
associated with a human disease (ATL)
Human T-Cell Lymphotropic Viruses Types I/II
(HTLV-I/II)
- Transmission: Vertical, sexual,
parenteral
- The risk of HTLV-I/II transmission
through transfusion is less than
1:2,000,000 units transfused.
West Nile Virus
- A member of the Flavivirus family
and is a human, avian, and equine
neuropathogen.
- A member of the Japanese
encephalitis virus antigenic complex
West Nile Virus
- All Flaviviruses are antigenically similar,
cross-reactivity has been observed in
testing
- Plaque reduction neutralization test is
the most specific test for arthropodborne Flaviviruses
Zika Virus
- An arbovirus in the Flaviviridae
family
- Transmitted by the Aedes aegypti
and Aedes albopictus mosquitoes.
Cytomegalovirus
- A member of the herpesvirus group
- To prevent CMV transmission,
leukocyte-reduced blood or blood
from seronegative donors may be
used
Epstein- Barr Virus
- A ubiquitous member of the
herpesvirus family
- Infection in B lymphocytes
- Causes infectious
mononucleosis
Parvovirus B- 19
- Causes a common childhood
illness called “fifth disease” and
is usually transmitted through
respiratory secretions.
Parvovirus B- 19
- Fifth disease presents with a mild
rash described as “slapped cheek”.
- B19 parvovirus enters the red blood
cell (RBC) via the P antigen and
replicates in the erythroid
progenitor cells.
Chikungunya Virus (CHIKV)
-Vector borne, transmitted
through mosquitoes
mainly from the Aedes
family.
Dengue Virus (DENV)
- Vector borne by the mosquitoes
Aedes aegypti and Aedes
albopictus.
Dengue Virus (DENV)
- Vector borne by the mosquitoes
Aedes aegypti and Aedes
albopictus.
Ebola Virus
- A member of the family Filoviridae and
can cause severe hemorrhagic fever.
- Transmission occurs via exposure to
blood or body fluids, contaminated
needles, and infected primates.
Bacterial Contamination
- Common sources: Donor skin or
from asymptomatic donor blood
- Platelets: most frequent source
of septic transfusion reactions
Bacterial Contamination
- Staphylococcus epidermidis or
Staphylococcus aureus: the
most common bacterial
contaminants of blood
Bacterial Contamination
- Yersinia enterocolitica: most
common isolate found in RBC
units, followed by the
Pseudomonas species according
to CDC.
Bacterial Contamination
- Propionibacterium acnes:
common isolate of human skin,
was the most common bacterial
contaminant in RBCs (by
Kunishima and colleagues)
Syphilis
- Treponema pallidum: causative
agent of syphilis, is a spirochete.
- It is usually spread through sexual
contact but can be transmitted
through blood transfusions
Syphilis
- Screening tests include:
❖ Rapid plasma reagin (RPR)
❖ Venereal Disease Research
Laboratory (VDRL) test
*Positive result: Visible
flocculation
Syphilis
- Confirmatory test for
syphilis:
❖ FTA-ABS or fluorescent
treponemal antibody
absorption test
Tick- Borne Bacterial Agents
- Lyme disease: caused by the
spirochete Borrelia burgdorferi
- RMSF: Rickettsia rickettsii and
- Ehrlichiosis (Ehrlichia species)
Transfusion- Associated Parasites:
Babesia microti
-Transmitted by the bite of
an infected deer tick
-Infects the RBC
Transfusion- Associated Parasites:
Trypanosoma cruzi
- A flagellate protozoan that is the
etiologic agent of Chagas
disease (American
trypanosomiasis)
Transfusion- Associated Parasites:
Trypanosoma cruzi
- Naturally acquired by the bite of a
reduviid bug, thus making it a
zoonotic infection.
- The reduviid bug bite produces a
localized nodule, referred to as a
“chagoma”.
Transfusion- Associated Parasites:
Trypanosoma cruzi
Transfusion- Associated Parasites:
Malaria (Plasmodium species)
- Natural transmission occurs through the bite of a
female Anopheles mosquito, but infection may also
occur following transfusion of infected blood.
- Plasmodium can survive in blood components stored at
room temperature or 4°C for at least a week, and
deglycerolized RBCs can transmit disease.
Transfusion- Associated Parasites:
Malaria (Plasmodium species)
Prion Disease
Prion: self-replicating protein
-It does not contain nucleic acid but is
formed when the confirmation of the
normal cell surface glycoprotein, the
prion protein, is changed to an
abnormal form.
Prion Disease:
Creutzfeldt-Jakob Disease
- One of the transmissible spongiform encephalopathies
(TSEs).
- Transmissible spongiform encephalopathies (TSEs): rare
diseases characterized by fatal neurodegeneration that
results in sponge-like lesions in the brain.
- In humans, sporadic CJD is the most common form
Pathogen Inactivation
Plasma
Cellular
Heat inactivation
•
Pasteurization
•
Heat treatment + solvent and
detergent treatment + nanofiltration
•
•
•
Psoralen activated by ultraviolet light
Photochemical process (riboflavin and
UV light)
Quarantine &
Recipient
Tracing (LookBack)
A process mandated by the FDA
that directs collection facilities to
notify donors who test
positive for viral markers, to
notify prior recipients of the
possibility of infection, and to
quarantine or discard
implicated components
currently in inventory.
Component
Preparation &
Transfusion Therapy
Transfusion Medicine
Encompasses all aspects of blood donation,
blood component preparation, blood serology
and transfusion therapy.
Operationally, transfusion medicine is divided:
A. Blood Centers
B. Transfusion Services
Component Preparation
The main goal of component preparation are
to:
A. Maintain viability and function (esp. during
storage)
B. Prevent detrimental changes or
contamination of desired components
Method of Component
Preparation
• Collecting whole blood and transforming
into components using centrifugation
• Collecting targeted components using
apheresis (centrifugation of whole blood
at the donor’s bedside and the return of
blood fractions that are not collected.)
Equipment:
Centrifuge
Either large floor units or large
tabletop units that can spin a
maximum of 6 to 12 units of whole
blood at once.
Equipment:
Centrifuge
HEAVY SPIN
5000 g for 5 minutes (pRBC, plt conc)
5000 g for 7 minutes (cryo, cell free
plasma)
LIGHT SPIN
2000 g for 3 minutes (plt-rich
plasma)
 For preparation of PLT conc, centrifugation is done at room
temperature.
 For all other blood components, centrifugation is carried out between 16ºC
Equipment:
Centrifuge
Equipment:
Plasma Expressors
Mechanical devices that apply
pressure to the blood bag, which
allows blood components to flow
from one bag to another by way of
the integrated tubing system.
Equipment:
Plasma Expressors
Equipment:
Scale
Equipment:
Tubing Sealer
Blood component tubing sealers,
sometimes incorrectly referred to as
“heat sealers,” use a combination of
targeted radio frequency energy and
pressure to melt and seal the tubing.
Equipment:
Tubing Sealer
Equipment:
Sterile Connection Devices
Allow two separate blood bags
to be connected via their PVC
tubing without breaching the
integrity of either container.
Equipment:
Sterile Connection Devices
Equipment:
Plasma Freezers
To freeze plasma, liquid
components may be placed in
a standard –18°C or colder
freezer and allowed to freeze
until solid.
Equipment:
Plasma Freezers
Equipment:
Storage Devices
Storage devices include
refrigerators, freezers,
and platelet agitators.
Equipment:
Storage Devices
ANTICOAGULANTS AND
RED CELL ADDITIVES
CITRATE
DEXTROSE
BINDS CALCIUM
GIVES ENERGY TO RBCS
CITRIC ACID
PREVENTS CARAMELIZATION
PHOSPHATE BUFFER
PREVENT FALL OF PH
ADENINE
IMPROVE SURVIVAL OF RBCS
PRESERVATIVE
DAYS OF
STORAGE
ACD
21 DAYS
CPD
21 DAYS
CPD A1
35 DAYS
CP2D
21 DAYS
CPDA2/AS
42 DAYS
- The maximum allowable
storage time for RBCs is
defined by the requirement for
recovery of 70% of transfused
cells 24 hours after transfusion.
(HENRY’s Clinical Diagnosis and Management by
Laboratory Methods 22nd Edition)
Additive Solutions
SALINE
ADENINE
GLUCOSE
WHERE SOLUTES ARE SUSPENDED
MANNITOL
RBC STABILIZING AGENT
IMPROVES RBC SURVIVAL
ATP PRODUCTION
Additive Solutions
Adsol (AS-1)
Nutricel (AS-3)
Optisol (AS-5)
Adds 7 Days
Rejuvenation Solutions
•
•
Used to regenerate ATP
and 2,3 DPG
RBCs stored in liquid state
fewer than 3 days after
their outdate are
rejuvenated for 1 to 4
hours at 37°C with the
solution
PIPA
Phosphate, Inosine,
Pyruvate, Adenine
PIGPA
Phosphate, Inosine,
Glucose, Pyruvate, Adenine
REJUVESOL
STORAGE LESION DURING RBC
STORAGE
BLOOD COMPONENTS
BLOOD COMPONENTS
WHOLE BLOOD
INDICATION
STORAGE
TRANSPORT
SHELF LIFE
PROVIDE BLOOD
VOLUME EXPANSION
AND RBC MASS IN
ACUTE BLOOD LOSS
1-6 DEGREES CELSIUS
1-10 DEGREES CELSIUS
DEPENDS ON THE
ANTICOAGULANT
BLOOD COMPONENTS
BLOOD COMPONENTS
PACKED RBCs
INDICATION
INCREASE RBC MASS OF
SYMPTOMATIC,
NORMOVOLEMIC PATIENTS
STORAGE
1-6 DEGREES CELSIUS
SHELF LIFE
DEPENDS ON THE
ANTICOAGULANT- CLOSED
SYSTEM
24 HOURS- OPEN SYSTEM
BLOOD COMPONENTS
LEUKOCYTE REDUCED RBCs
INDICATION
INCREASE RBC MASS IN PATIENTs
WITH SEVERE AND/OR RECURRENT
FEBRILE TRANSFUSION REACTIONS
DUE TO LEUKOCYTE ANTIBODIES.
INCREASE RBC MASS IN PATIENTS AT
RISK FOR HLA ALLOIMMUNIZATION
TO HLA ANTIGENS OR SUSCPETIBLE
TO CMV.
STORAGE
1-6 DEGREES CELSIUS
SHELF-LIFE
OPEN SYSTEM- 24 HOURS
CLOSED SYSTEM- SAME AS WB
BLOOD COMPONENTS
• Prestorage leukoreduction- leukoreduction
performed shortly after collection, usually
within 72 hours
• Leukoreduced RBCs and whole blood are
prepared using special filters (multiple layers
of polyester or cellulose acetate nonwoven
fibers) that trap leukocytes and platelets but
allow RBCs to flow through
BLOOD COMPONENTS
• Two major filter types available in
prestorage leukoreduction:
o Whole blood is passed through the
leukoreduction
filter
before
centrifugation.
*FILTER then CENTRIFUGE
BLOOD COMPONENTS
o Whole blood is centrifuged, the
plasma is removed from the whole
blood unit, and then the packed
cells are passed through the
leukoreduction filter.
*CENTRIFUGE then FILTER
BLOOD COMPONENTS
BLOOD COMPONENTS
BLOOD COMPONENTS
WASHED RBCS
INDICATION
INCREASE RBC MASS OF
SYMPTOMATIC ANEMIC
PATIENTS WITH HISTORY
OF ALLERGIC, FEBRILE,
URTICARIAL, AND
ANAPHYLACTIC RXNs
STORAGE
SHELF-LIFE
1-6 DEGREES CELSIUS
24 HOURS
BLOOD COMPONENTS
FROZEN RBCS
INDICATION
STORAGE OF RARE
BLOOD AND
AUTOLOGOUS UNITS
STORAGE
-65 degree Celsius
SHELF-LIFE
10 years
BLOOD COMPONENTS
Cryoprotective agents can be categorized as:
• Penetrating
• Nonpenetrating
o Penetrating cryoprotective agent
- Involves small molecules that cross the cell membrane into the
cytoplasm
- Osmotic force of the agent prevents water from migrating outward
as extracellular ice is formed, preventing intracellular dehydration
- E.g., glycerol
BLOOD COMPONENTS
o Nonpenetrating cryoprotective agent
- Made of large molecules that do not enter the
cell but instead form a shell around it,
preventing loss of water and subsequent
dehydration.
- E.g., Hydroxyethyl starch and dimethylsulfoxideused to freeze hematopoietic progenitor cells
BLOOD COMPONENTS
METHOD
40%
GLYCEROL
“SLOW
FREEZING”
STORED AT
EQUIPMENT
HIGH GLYCEROL
-80 DEGREE
CELSIUS
-65 DEGREES
CELSIUS
MECHANICAL
FREEZER
LOW GLYCEROL
-196 DEGREE
CELSIUS
-120 DEGREES
CELSIUS
LIQUID
NITROGEN
AGGLOMERATIO
N
-80 DEGREE
CELSIUS
-65 DEGREES
CELSIUS
MECHANICAL
FREEZER
20%
GLYCEROL
“FAST
FREEZING”
79.2%
GLYCEROL
FROZEN AT
BLOOD COMPONENTS
PLATELET CONCENTRATES (RDP)- CONTAINS 5.5X1010
PER UNIT
INDICATION
FOR BLEEDING DUE TO
THROMBOCYTOPENIA
STORAGE
20-24 DEGREES CELSIUS
W/ CONTINUOUS
AGITATION
SHELF-LIFE
5 DAYS
BLOOD COMPONENTS
PLATELET CONCENTRATE (SDP)- CONTAINS 3.0X1011
PLATELET PER UNIT
INDICATION
FOR THROMBOCYTOPENIC
PATIENTS
ALLOIMMUNIZED TO HLA
OR PLATELET ANTIGEN
STORAGE
20-24 DEGREES CELSIUS W/
CONTINUOUS AGITATION
SHELF-LIFE
5 DAYS
BLOOD COMPONENTS
FRESH FROZEN PLASMA (FFP)
INDICATION
CORRECT MULTIPLE
COAGULATION FACTOR
DEFICIENCY
STORAGE
-18 DEGREES CELSIUS OR COLDER
SHELF-LIFE
1 YEAR
FFP IS PREPARED 6-8 HOURS AFTER COLLECTION
37 DEGREES CELSIUS THAWING AND TRANSFUSED W/IN 24 HOURS
BLOOD COMPONENTS
CRYOPRECIPITATE
INDICATION
FOR TREATMENT OF
FIBRINOGEN DEFICIENCY,
HEMOPHILIA A, VON
WILLEBRAND’S DISEASE AND
FACTOR XIII DEFICIENCY
STORAGE
-18 DEGREES OR COLDER
SHELF-LIFE
1 YEAR
ADMINISTERED 6 HOURS AFTER THAWING
ADMINISTERED 4 HOURS AFTER POOLING
BLOOD COMPONENTS
Cryoprecipitated antihemophilic factor
(AHF): cold- precipitated concentration of
factor VIII, also known as the antihemophilic
factor.
• Process for isolating factor VIII also harvests
fibrinogen, factor XIII, von Willebrand
factor (vWF), cryoglobulin, and fibronectin.
(Cryoprecipitate)
BLOOD COMPONENTS
• Treatment of factor XIII deficiency,
as a source of fibrinogen for
hypofibrinogenemia, and as a
secondary line of treatment for classic
hemophilia (hemophilia A) and von
Willebrand’s disease
BLOOD COMPONENTS
Cryoprecipitate- reduced plasma:
plasma from which the cryoprecipitate
concentrate has been harvested. (Cryopoor plasma or CPP)
• CPP contains the residual albumin;
factors II, V, VII, IX, X, XI; and
ADAMTS13
BLOOD COMPONENTS
•
Most often used for transfusion or
plasma exchange in patients with
Thrombotic Thrombocytopenia
Purpura (TTP) who have been initially
treated using FFP without an
adequate response.
BLOOD COMPONENTS
GRANULOCYTE PHERESIS- CONTAINS 1 × 1010
GRANULOCYES/UNIT
INDICATION
PATIENTS WITH
GRANULOCYTE
DYSFUNCTION OR MYELOID
HYPOPLASIA WHO ARE
UNRESPONSIVE TO
ANTIBIOTICS
STORAGE
20-24 DEGREES CELSIUS W/O
AGITATION
SHELF-LIFE
24 HOURS
BLOOD COMPONENTS
FACTOR VIII CONCENTRATE
INDICATION
PREVENT OR CONTROL
BLEEDING IN HEMOPHILIA
A PATIENTS
STORAGE
1-6 DEGREES CELSIUS
(LYOPHILIZED)
SHELF-LIFE
VARIABLE
BLOOD COMPONENTS
Sources:
•Human source
•Porcine Factor VIII
•Recombinant Factor VIII
BLOOD COMPONENTS
FACTOR IX CONCENTRATE
INDICATION
PREVENT OR CONTROL
BLEEDING IN HEMOPHILIA B
PATIENTS
STORAGE
1-6 DEGREES CELSIUS
(LYOPHILIZED)
SHELF-LIFE
VARIABLE
BLOOD COMPONENTS
Available in three forms:
o Prothrombin complex
concentrates (PCCs),
o Factor IX concentrates, and
o Recombinant FIX
BLOOD COMPONENTS
ALBUMIN, PLASMA PROTEIN FRACTION
INDICATION
REPLACE LOSS OF COLLOIDS IN
HYPOVOLEMIC SHOCK, SEVERE
BURNS, OR FOR PRESSURE
SUPPORT DURING HYPOTENSIVE
EPISODES
STORAGE
1-6 DEGREES CELSIUS
(LYOPHILIZED)
SHELF-LIFE
VARIABLE
BLOOD COMPONENTS
• Normal Serum Albumin (NSA)
- Prepared from salvaged plasma,
pooled and fractionated by a cold
alcohol process, then treated with
heat inactivation (60°C for 10 hours)
BLOOD COMPONENTS
• Normal Serum Albumin (NSA)
- Composed of 96% albumin and
4% globulin.
- It is available in 25% or 5%
solutions.
BLOOD COMPONENTS
• Plasma Protein Fraction
- PPF contains 83% albumin and
17% globulins.
- Available in a 5% preparation
TRANSFUSION THERAPY IN
SPECIAL CONDITIONS
•
Emergency Transfusion
-
Group O RBCs are selected for patients
for whom transfusion cannot wait until
their ABO and Rh type can be
determined.
TRANSFUSION THERAPY IN
SPECIAL CONDITIONS
•
Emergency Transfusion
-
Group O-negative RBC units should
be used if the patient is a female of
child- bearing potential.
TRANSFUSION THERAPY IN
SPECIAL CONDITIONS
• Massive Transfusion
- Replacement of one or more blood
volumes within 24 hours, or about
10 units of blood in an adult.
TRANSFUSION THERAPY IN
SPECIAL CONDITIONS
•
Neonatal Transfusion
-
A dose of 10 mL/kg will increase the
hemoglobin by approximately 3 g/dL.
Blood units less than 7 days old are
preferred.
-
BLOOD
ADMINISTRATION
LABELING OF
FDA recognizes
two acceptable languages for
COMPONENTS
blood component labeling:
✓ ABC Codabar and
✓ ISBT 128 - an acceptable labeling symbology in
2000 but has become the standard
- Blood components are most
commonly labeled with ISBT 128.
LABELING OF
COMPONENTS
ADVERSE EFFECTS
OF BLOOD
TRANSFUSION
The recognition and evaluation of suspected
transfusion reactions involves two critical
components:
• Clinical recognition by the person
administering the transfusion
• Laboratory investigation of a transfusion
reaction
HEMOVIGILANCE
• Has been developed in
response as a way to
improve the recognition and
reporting of adverse events
HEMOVIGILANCE
•
Describes a process to standardize the
definition of different transfusion
reactions and data collection regarding the
incidence of transfusion reactions in order to
improve the safety of blood transfusion
HEMOVIGILANCE
HEMOVIGILANCE
TRANSFUSION
IMMEDIATE
DELAYED
REACTIONS
IMMUNE
IHTR
DHTR
FNHTR
ALLOIMMUNIZATION
ALLERGIC TR
PTP
ANAPHYLACTIC/ANAPHYLACT
OID
TRALI
NON IMMUNE
BACTERIAL CONTAMINATION
TACO
IRON OVERLOAD
IMMEDIATE HEMOLYTIC TR
ABO Incompatible blood are transfused
4 common Antibodies
- Anti-A (most common)
-Anti-Kell
-Anti-Jka
-Anti-Fya
IMMEDIATE HEMOLYTIC TR
IMMEDIATE HEMOLYTIC TR
Acute hemolysis with accompanying presenting
symptoms within 24 hours of transfusion.
• Severe, rapid onset, fever, chills, flushing, pain at
site of infusion, tachycardia, hemoglobinemia,
hemoglobinuria
• DIC, Renal Failure, Irreversible Shock, Death
• Intravascular hemolysis
DELAYED HEMOLYTIC TR
•
Positive DAT and gradual drop in patient's
hemoglobin and hematocrit, mild jaundice
ANTIBODIES: Rh, MNS, KELL, KIDD and DUFFY
EXTRAVASCULAR HEMOLYSIS- PRIMARY
MECHANISM OF DHTR
•
FEBRILE NONHEMOLYTIC
Any 1 C temperature TR
rise associated w/ transfusion
0
and having no medical explanation other than blood
component transfusion.
• PYROGEN from transfused WBC
• Self-limiting
• Fever will resolve within 2-3 hrs.
PREVENTION:
 use LEUKOREDUCED blood components
ALLERGIC (URTICARIAL)
TR protein (allergen) w/
The donor plasma has a foreign
which antibodies is present in patient’s
plasma causing it to react.
The donor plasma has reagin that react with the
allergen present on patient plasma.
Prevention:
 use WASHED RBCs
ANAPHYLACTIC/ANAPHYLACTOI
D TR
Can range from mild urticaria and pruritus to severe
shock and death
2 significant features:
a. fever is absent
b. clinical signs and symptoms occur after
transfusion of just few milliliters of plasma containing
blood components.
ANAPHYLACTIC/ANAPHYLACTOI
D TR
•
Hypersensitivity reaction is divided:
a. Anaphylactic- patient deficient in IgA
b. Anaphylactoid- patient has normal levels
of IgA but a limited type-specific IgA that reacts
with the donor's IgA
Prevention:
 REMOVE PLASMA from blood
component before transfusion
•
TRANSFUSION RELATED ACUTE LUNG
Consists of an acuteINJURY
transfusion(TRALI)
reaction presenting with
respiratory distress and severe hypoxemia during or within 6
hours of transfusion in he absence other causes of acute lung
injury.
•
Anti-leukocyte antibodies (anti-human neutrophil antigen
(HNA) and anti-HLA antibodies) in donor or patient plasma
could initiate complement-mediated pulmonary capillary
endothelial injury.
Prevention:

use LEUKOREDUCED blood components
TRANSFUSION ASSOCIATED CIRCULATORY
OVERLOAD (TACO)
•
A good example of iatrogenic transfusion reaction.
•
The usual rate of transfusion is 200ml/hr.
Patients at significant risk:
1.
Children
2.
Elderly
3.
Cardiac disease
4.
Patient with chronic normvolemic anemia
Prevention:

use WASHED/FROZEN RBC
Transfusion-Transmitted Bacterial Infections
(TTBI)
•
•
•
•
Also known as transfusion- associated
sepsis
Clinically, this type of reaction is termed
“warm”
Dryness and flushing in patient's skin
According to CDC, most common
pathogen is Yersinia enterocolitica.
Transfusion-Transmitted Bacterial Infections
(TTBI)
•
•
The most frequent infection associated
with transfusion especially for
platelets.
RBC units: gram-negative rods in the
Enterobacteriaceae family that produce
endotoxin during storage.
Transfusion-Transmitted Bacterial Infections
(TTBI)
•
Platelet units: gram-positive cocci
and are from normal skin flora
introduced into the product during
venipuncture.
POST TRANSFUSION
PURPURA (PTP)
•
•
•
Rapid onset of thrombocytopenia
as a result of anamnestic production
of platelet alloantibody
Usually 7-14 days lag time
Self limiting
TRANSFUSION ASSOCIATED
GRAFT VS HOST DISEASE
(TAGVHD)
• Typically manifests 2-50 days after transfusion
• Defined as a delayed immune transfusion reaction due to an
immunologic attack by viable donor lymphocyte contained in
the transfused blood component against the recipient
Prevention
 Use Irradiated Blood Components
IRON OVERLOAD
•
Long term complication of RBC transfusion
•
Known as “Hemosiderosis”
•
Accumulated iron begins to affect function of
heart, liver and endocrine glands.
ADVERSE METABOLIC
EFFECTS
•
CITRATE TOXICITY
•
HYPERKALEMIA
TRANSFUSION REACTIONS
❖ Most common adverse reactions:
1. Allergic transfusion reactions and
2. Febrile nonhemolytic transfusion
reactions
TRANSFUSION REACTIONS
❖ Most common transfusion reactions
associated with mortality:
1. Transfusion-related acute lung injury (TRALI)
and
2. Transfusion-associated circulatory overload
(TACO)
APHERESIS
APHERESIS
(plural aphereses; from the
ancient Greek aphairesis, “a
taking away”
APHERESIS
•
Whole blood is removed from the body
and passed through an apparatus that
separates out one (or more) particular
blood constituent. It then returns the
remainder of the constituents to the
individual’s circulation.
APHERESIS
•
•
Allows a larger volume of specific
components to be collected.
The separation of blood components is
based on the specific gravity or
weight of each individual blood
constituents.
APHERESIS
•
•
Can be performed on a donor to collect
a specific blood component (donor
apheresis), or
Can be performed on a patient to
remove a particular blood component
for therapeutic purposes (therapeutic
apheresis)
HISTORY & DEVELOPMENT
•
Dr. Edwin J. Cohn: A Harvard biochemist devised a large-
scale method, based on a simple dairy centrifuge (the
Cohn centrifuge), for purifying albumin from pooled
human plasma.
* Later modifications: Led to its use in deglycerolizing frozen
red blood cells
HISTORY & DEVELOPMENT
•
A. Solomon and J.L. Fahey: Used
centrifugation technology to separate whole
blood into plasma and red blood cells to
perform the first reported therapeutic
plasmapheresis procedure in 1960
HISTORY & DEVELOPMENT
•
Emil J. Freireich & George Judson: Developed the
first continuous flow apheresis machine in 1965.
•
1970s: Apheresis was used to extract one cellular
component and return the remainder of the blood
to the donor.
HISTORY & DEVELOPMENT
•
1978: Membrane plasma separator was introduced
as a method for performing therapeutic plasma
exchange
PRINCIPLE
PRINCIPLE
METHOD OF
CENTRIFUGATION
•
Intermittent Flow Centrifugation
•
Continuous Flow Centrifugation
COMPONENT COLLECTION
RED BLOOD CELLS
• Typically collected as a double unit (termed a 2RBC or
double RBC procedure)
• Hematocrit must be at least 40% regardless of gender,
and the level (hemoglobin or hematocrit) must be
determined by a quantitative method; the use of copper
sulfate is not acceptable
PLASMA
• Each apheresis unit (“jumbo” plasma) is the
volume equivalent of at least two whole
blood–derived plasma units.
• RBC loss must not be greater than 25 mL
per week.
PLATELETS
• A routine plateletpheresis procedure
typically takes 45 to 90 minutes.
• Donor qualification: The platelet
count must be at least 150,000/µl.
GRANULOCYTES
• Apheresis is the only effective method
for collecting leukocytes or, more
specifically, granulocytes.
GRANULOCYTES
• In order to collect a large enough volume of leukocytes
(more than 1 × 1011 granulocytes),
1. The donor must be given certain drugs or sedimenting
agents
2. Specific informed consent must be obtained from the
donor prior to administering these drugs
GRANULOCYTES
• Hydroxyethyl starch (HES): common sedimenting
agent ► Enhances the separation of the white blood
cells from the red blood cells during centrifugation,
which increases the amount of leukocytes collected and
decreases the amount of RBC contamination in the final
product.
GRANULOCYTES
• Corticosteroids such as prednisone or dexamethasone
can also be used.
► Given to the donor prior to the collection procedure
► Pulls the granulocytes from the marginal pool into the
general circulation, thus increasing the supply of cells
available for collection.
GRANULOCYTES
• Hematopoietic growth factors: newest agents
► Can produce four to eight times the volumes of
cells in each collection compared with other
agents & quite well tolerated by the donor.
THERAPEUTIC
• The rationalePROCEDURES
of therapeutic apheresis (TA) is based on
the following:
 A pathogenic substance exists in the blood that
contributes to a disease process or its symptoms.
 The substance can be more effectively removed by
apheresis than by the body’s own homeostatic
mechanisms.
THERAPEUTIC
PROCEDURES
• GENERAL CONSIDERATIONS:
The indication categories for therapeutic apheresis are as follows:
Category I. Apheresis is a first-line treatment, alone or in conjunction
with other therapies.
Category II. Apheresis is a second-line treatment, alone or in
conjunction with other therapies.
THERAPEUTIC
PROCEDURES
• GENERAL CONSIDERATIONS:
Category III. The optimal role for apheresis has not been established.
Treatment should be individualized based on clinical evaluation and
assessment of the anticipated risks and benefits.
Category IV. Apheresis is reported as either of no benefit or harmful in
these conditions. Clinical applications should be undertaken only under
an approved research protocol.
PHYSIOLOGICAL
CONSIDERATION
• The patient’s extracorporeal blood volume
(ECV) should be less than 15% of the
total blood volume (TBV) in order to
minimize the risk of hypovolemia.
PLASMAPHERESIS (PLASMA
EXCHANGE)
• This is the most common TA
procedure performed.
PLATELETPHERESIS
• Can be used to treat patients who have
abnormally elevated platelet counts (at
least 500,000/µL) with related symptoms.
LEUKAPHERESIS
• Has been used to treat patients with
hyperleukocytosis, defined as a WBC or
circulating blast count of over
100,000/µL.
ERYTHROCYTAPHERESIS
(RED BLOOD CELL EXCHANGE)
• Most commonly performed in patients with
sickle cell disease in order to decrease the
number of hemoglobin S–containing RBCs.
ERYTHROCYTAPHERESIS
(RED BLOOD CELL EXCHANGE)
• Can be considered for treatment of
overwhelming malaria or Babesia infections
(parasite load is greater than 10%)
• Can be used to remove incompatible RBCs
from a patient’s circulation.
FLUID REPLACEMENT
• The most common replacement
fluid for TPE is human serum
albumin (HSA) as a 5% solution.
SPECIAL PROCEDURES:
HPCsblood stem cells (PBSCs)
• Also referred to as peripheral
• The procedure is much like donor leukapheresis, with
the selective collection of mononuclear cells, since
HPCs are found in the upper portion of the buffy
coat during centrifugation.
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