BLOOD TRANSFUSION AND
TRANSFUSION REACTIONS
DR VAISHALI JAIN
LEARNING OUTCOMES
At the end of this topic, you should able to:
• Understand concept of Whole blood and blood
components
• Discuss types and indications of blood transfusion
• Enlist tests to be performed prior to blood
transfusion
• Understand transfusion reactions in brief
LESSON CONTENTS
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Whole blood and blood components
What is blood transfusion?
Blood transfusion- Types, Indications
Pre transfusion testing
Transfusion Reactions:
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Classification
Causes
Clinical features
Investigations
WHOLE BLOOD AND BLOOD COMPONENTS
• 350ml /450 ml of blood is collected from a donor into
a plastic bag containing an anticoagulant
• This is called 1 “unit” of whole blood
• Whole blood can be used as it is, or is separated into
“blood components”
• Types of blood components:–
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Red blood cell concentrate (packed red blood cells)
Platelet concentrate
Fresh frozen plasma
Cryoprecipitate
BLOOD COMPONENTS
BLOOD TRANSFUSION
Transfer of blood or blood components from one
person (donor) into another person (recipient)
TYPES OF BLOOD TRANSFUSION
• FRESH BLOOD TRANSFUSION
Blood less than 24 hours old from the time of collection
• AUTOLOGOUS TRANSFUSION
Blood collected from a patient for re-transfusion at a later
time into the same individual
• MASSIVE TRANSFUSION
Number of units transfused in a 24 hours period exceeds the
recipient’s blood volume
• MULTIPLE TRANSFUSION
Repeated transfusion of blood over a long period of time
(months or year)
INDICATIONS OF BLOOD TRANSFUSION
• Whole Blood:
– Acute blood loss
– Shock
– Exchange transfusion in neonate
• Packed red blood cells:
– Chronic severe Anemia
– Leukemia
– Thalassemia
• Platelets concentrate:
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Thrombocytopenia
Bleeding due to platelet dysfunction
Malignancy
Major surgery
INDICATIONS (Contd.)
• Fresh frozen plasma:
– Liver disorders
– DIC
– Coagulation factor deficiency (V, VII)
• Cryoprecipitate:
– Hemophilia A
– von Willebrand’s disease
– Fibrinogen deficiency
PRE-TRANSFUSION TESTING
• ABO and Rh (D) blood grouping :
– Patient’s and donor’s blood sample
• Cross matching of blood sample:
– Major cross match- Pt’s serum + Donor cells
– Minor cross match- pt’s cells + Donor serum
BLOOD GROUPING
PRE-TRANSFUSION TESTING (contd.)
• Screening for Transfusion transmitted diseases
(Donor Sample)
HIV 1 and 2
HBsAg
HCV
Treponema pallidum
Plasmodium species
AIDS
Hepatitis B
Hepatitis C
Syphilis
Malaria
ADVERSE EFFECTS (TRANSFUSION REACTIONS) Immune mediated
Acute
Onset <24 hours
Delayed
Onset within days/months
1.
Hemolysis
Hemolysis
2.
Febrile reactions
Alloimmunisation
3.
Allergic
Post transfusion purpura
4.
Anaphylaxis
Graft Vs Host disease
5.
TR.Ac.lung injury
Immunodilution
ADVERSE EFFECTS (TRANSFUSION REACTIONS)
– Non-Immune mediated
Acute
Delayed
1.
Bacterial contamination
HIV 1 & 2
2.
Circulatory overload
Hepatitis B & C
3.
Physical damage
Syphilis
4.
Chemical damage
Malaria
5.
Thermal damage
Iron overload
CAUSES OF TRANSFUSION REACTIONS
• Clerical errors:
– Inadequate labeling
– Wrong blood issued
• Technical errors:
– Error in blood grouping & cross matching
– Incorrect interpretation of test results
• Others:
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Blood contamination during phlebotomy
Blood infusion thr’ small bore needle
Blood cooler to -30⁰C or warmed to > 42⁰ C
Concomitant administration blood & drugs thr’ common set
CLINICAL FEATURES
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Fever : Ag-Ab
cytokine
IL-1
Fever
Rigors: Cytokines
Pain at infusion site: Cytokine
Hypotension: Neuroendocrine response
Hemoglobinuria
Oliguria
Anuria
LABORATORY INVESTIGATIONS
• Rule out Clerical errors: Identify blood sample
• Compare plasma color on pt’s pre & post
transfusion sample
- Pink: free Hb
red cell destruction
- Yellow: increased bilirubin
• Check blood color of bag & attached tubing
- Purple color / clot in bag
bacterial
contamination
- Color change
hemolysis
LABORATORY INVESTIGATIONS (Contd)
• Repeat blood grouping on pt’s & donor sample
( Pre and post transfusion sample)
• Repeat cross matching
• Perform Direct antiglobulin test (DCT)
• Blood smear and culture (Donor’s blood)
• Others: (Post transfusion sample)
– Antibody screening
– Serum bilirubin
– Free hemoglobin
TRANSFUSION REACTION
INVESTIGATION RECORD
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Patient’s particulars
Blood bag details
Regrouping results
Re-cross matching results
Red cell antibody screening results
Urine investigations
Microbiological results
Signature of Technician in-charge
SUMMARY
• What is it?
Types
BLOOD
TRANSFUSION
Record
TRANSFUSION
REACTIONS
Clinical features
Indications
Pre-transfusion
testing
Causes
Laboratory
investigations
THANK YOU…