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THE INSIDE STORY OF BLOOD TRANSFUSION

THE INSIDE STORY OF BLOOD TRANSFUSION. DR.MOHAMED BILAL DELVI ASSISTANT PROFESSOR DEPT OF ANAESTHESIA COLLEGE OF MEDICINE KSU. Done by : 428 surgery team. What is blood?. A highly specialised circulating tissue which has several types of cells suspended in a liquid medium called plasma.

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THE INSIDE STORY OF BLOOD TRANSFUSION

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  1. THE INSIDE STORY OF BLOOD TRANSFUSION DR.MOHAMED BILAL DELVI ASSISTANT PROFESSOR DEPT OF ANAESTHESIA COLLEGE OF MEDICINE KSU. Done by : 428 surgery team 428 surgery team

  2. What is blood? • A highly specialised circulating tissue which has several types of cells suspended in a liquid medium called plasma. • Origins from Greek ‘haima’ • Blood is a life sustaining fluid 428 surgery team

  3. Blood is an amazing fluid! • Keeps us warm • Provides nutrients for cells, tissues and organs • Removes waste products from various sites 428 surgery team

  4. Blood Composition • Plasma: 55%. (50% water + 5% plasma substance) • Formed elements: 45%. • - RBC: live in circulation for 120 days. (near 45%) • - WBC: their life in circulation extends from months to years. • - Platelets: their life in circulation is 6-10 days. WBC + platelets less than 1% 428 surgery team

  5. Blood components • Blood Products: • Whole Blood • Packed red cells RBC. • Platelets concentrate. • White cell concentrate. • Plasma Products: • Fresh Frozen Plasma FFP. • Frozen plasma • Cryoprecipitate. • Albumin containing solution. • Human Immunoglobulins. • Prothrombin complex concentrate. • Factor VIII concentrates. 428 surgery team

  6. Whole Blood Centrifugation Platelet – rich Plasma Red Cell Concentrate Centrifugation Platele – poor Plasma Platelet Concentration Freezing - 30° C 428 surgery team

  7. Fresh Frozen Plasma (FFP) Cryoprecipitation 4° C Supernatant Precipitate (cryoprecipitate) Factor VIII Concentrate Precipitate (fibrinogen) Supernatant Plasma Protein Fraction (PPF) Albumin Prothrombin Complex Concentrate Immunoglobulins 428 surgery team

  8. Packed Red Blood Cells • One unit contains 300 ml. • Out of this, 70% are RBC. • Indicated in: • - Acute blood loss, • - Chronic anemias. • Shelf life 42 days at 4 C 428 surgery team

  9. Platelet Concentrate • One unit contains 50 x 109 platelets. • Usually 5-6 units are given as one pool. • Indicated in: • - Bleeding due to platelet deficiency. • - Bleeding due to platelet dysfunction. • Shelf life 5 day at 22 C 428 surgery team

  10. WBC Concentrate • Difficult to get sufficient quantities. • Half life is only 8 hours. • Rarely indicated because most patients respond to antibiotics and do not need white blood cells. • Nonhemolytic transfusion reactions are common. 428 surgery team

  11. Plasma Products • 1. Fresh frozen plasma (FFP): • Stored at – 30° C. • Shelf life 1 year. • Rich in all components of plasma. • Indicated in: • - Disseminated intravascular coagulation (DIC). • - Liver failure. • - Warfarin overdose. • - Massive RBC transfusions. 428 surgery team

  12. 2- Cryoprecipitate • Prepared from FFP after thawing it to 4° C. • When refrozen, the shelf life is 3 to 6 months. • Rich in factors VIII, XII, XIII and VWF (Von Willebrand factor). • 3- Factor VIII concentrate: • Prepared by fractionation of cryoprecipitate. • Large numbers of cryoprecipitate are required. • Indicated in hemophilia. Type A 428 surgery team

  13. 4- prothrombin complex concentrate: • Contains factors II, VII, IX, and X. • Indicated in hemophilia B. • 5- Human immunoglobulins: • Nonspecific immunoglobulins are used in: • - Congenital immunodeficiencies. • - Acquired immunodeficiencies. • - Idiopathic thrombocytopenia purpura (ITP). • Specific immunoglobulins are used in: • - Hepatitis B. • - Herpes zoster. • - Rubella. • - Rabies. • - Tetanus. • - Measles. 428 surgery team

  14. 6- Albumin containing solutions: • Used as plasma expander in severe hemorrhage while waiting for blood. • Also used to maintain plasma albumin levels in: • - Liver failure. • - Malnutrition. • - Protein losing states. 428 surgery team

  15. Blood Types: • O Rh-positive 38% • O Rh-negative 7% universal donor • A Rh-positive 34% • A Rh-negative 6% • B Rh-positive 9% • B Rh-negative 2% • AB Rh-positive 3% universal recipient • AB Rh-negative 1% 428 surgery team

  16. INDICATIONS FOR BLOOD TRANSFUSION • Massive blood loss – acute blood loss. • Different types of anaemia – chronic anemias. • Haemophilia & other clotting factor deficiency – chronic deficiency of any blood component. • Cancer patients • For surgeries 428 surgery team

  17. HISTORICAL ASPECTS * 15th century- unsuccessful attempts. • 1666- dog to dog transfusion (بعض الشباب قالوا جا عليها سؤال ) • 1667-animal to human • 1818- human to human • 1901- major breakthrough- discovery of A,B,O groups. 428 surgery team

  18. HISTORICAL ASPECTS • 1907- cross matching • 1914- anticoagulant discovered • 1936- first blood bank • 1939/40- Rh factor discovery • 1950- plastic blood containers. 428 surgery team

  19. DOG TO DOG TRANSFUSION 428 surgery team

  20. SHEEP TO HUMAN TRANSFUSION 428 surgery team

  21. HUMAN TO HUMAN TRANSFUSION 428 surgery team

  22. Theoretical Yield of components • 1 unit of blood theoretically gives • 1 unit FFP • 1 unit PRBC’s • 1 single donor unit cryoprecipitate, single donor unit platelets • Plasma for Ig and albumin 428 surgery team

  23. BLOOD GROUP SYSTEMS • ABO System Most studied & important • Rh system from clinical point of view. • Lewis • Kell • Duffy 428 surgery team

  24. BLOOD GROUP SYSTEMS • MNSs • Lutheran • P • Ii • kid 428 surgery team

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  26. DIFFERENT BLOOD GROUPS 428 surgery team

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  30. RHESUS MONKEYS 428 surgery team

  31. BLOOD DONATION CRITERIA • Good general condition. • Age: 18 to 60 years. • Weight- >45kg for 350ml, >55kg for 450ml. • BP: syst. 100-180mmHg diast. 50-100mmHg. • Pulse: 60 to 100beats/min. 428 surgery team

  32. BLOOD DONATION CRITERIA • Temp. >37.5deg.C • Hb. >12.5gm% • Jaundice • Malaria • High risk behaviour • Pregnancy 428 surgery team

  33. BLOOD DONATION CRITERIA • Surgeries • Last blood donation • Tattooing • Chronic diseases • Last blood transfusion 428 surgery team

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  35. INSTRUCTIONS TO DONOR AFTER DONATION More fluids than usual. Do not remain hungry. Do not smoke for 1hour. Remove bandage after 6 hours. If bleeding from puncture site, apply pressure. If feeling faint/dizzy, lie down. 428 surgery team

  36. MISCONCEPTIONS/ REASONS FOR NOT DONATING BLOOD • Fear of contracting some disease • I do not have enough blood/ I will become weak. • I am too old • I am too busy. 428 surgery team

  37. REASONS TO DONATE BLOOD • New blood formation . • Regular health check up. • Blood investigations done. • Satisfaction of noble work. 428 surgery team

  38. TESTS DONE IN BLOOD BANK • Blood grouping & Rh typing • Cross matching • Tests for irregular antibodies • HBsAg test& Anti-HBc • HCV test • HIV test (HIV1 & HIV2) • Test for syphilis • Test for malaria 428 surgery team

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  43. Screening tests on donors’ blood: • - Hepatitis B surface antigen (HBsAg). • - Hepatitis B core antibody (anti-HBc). • - Hepatitis C virus antibody (anti-HCV). • - HIV-1 and HIV-2 antibody (anti-HIV-1 and anti-HIV-2). • - HTLV-I and HTLV-II antibody (anti-HTLV-I and anti-HTLV-II). • Serologic test for syphilis. • Prerequisites: • Take samples for full blood count (FBC), serum iron or ferritin B, and folate levels. • Cross match. • Choose the appropriate blood group in emergency. • Appropriate IV access. 428 surgery team

  44. MISMATCHED TRANSFUSION Group A + Group B = Clumping of RBCs + 428 surgery team

  45. AUTOLOGOUS DONATION • Self help is the best help. • Planned gynaecological, orthopedic, plastic general surgeries • Individuals with rare blood groups/ irregular antibodies/ infectious disease positive. 428 surgery team

  46. AUTOLOGOUS DONATIONAdvantages • Safest blood. • Easy availability • No risk of TTDs • Best option in patients with irregular antibodies, rare blood groups, infectious disease positive. • Blood scarcity can be reduced to someextent. 428 surgery team

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  49. Blood Transfusion: • Autologous: • Blood donor and transfusion recipient are the same in order to avoid blood borne diseases or infections. • Four types: • 1. Preoperative donations: • - Donating the patient’s own blood before surgery. • - The blood bank draws the patient’s blood and stores it until he/she needs it during or after surgery. • - Only for elective surgery. • 2. Preoperative hemodilution: • - Immediately before surgery, some of the patient’s blood is taken and replace with IV fluids, i.e. normal saline. • - Only for elective surgeries. 428 surgery team

  50. 3. Perioperative (intraoperative) collection: • Recycling the patient’s blood during surgery. • Blood lost during surgery is filtered, and put back into the patient’s body during surgery. • Can be done in emergency and elective surgeries. • 4. Postoperative collection: • - Recycling the patient’s blood after surgery. • Blood lost after surgery is collected, filtered and returned to the patient’s body. • Can be done in emergency and elective surgeries. 428 surgery team

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