The risk of blood transfusion

1. The risk of blood transfusion

2. INTRODUCTION: • Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. • It can be life-saving in some situations, such as massive blood loss due to trauma , or can be used to replace blood lost during surgery.

3. Blood transfusions may also be used to treat a severe anemia or thrombocytopenia caused by a blood disease. • People suffering from hemophilia or sickle-cell disease may require frequent B.T • Early transfusions used whole blood, but modern medical practice is to use only components of the blood.

4. History: • The first historical attempt at blood transfusion was described in 15th-century. • The first fully-documented human blood transfusion was administered by Dr. Jean- Denis, eminent physician to King Louis XIV of France, on June 15, 1667. He transfused the blood of a sheep into a 15-year old boy, who recovered

5. In 1818, Dr. James Blundell, a British obstetrician, performed the first successful blood transfusion of human blood, for the treatment of postpartum hemorrhage. • Many patients had died and it was not until 1901, when the Austrian( Karl) discovered human blood groups, that blood transfusions became safer &awarded the Nobel Prize in Physiology or Medicine

6. World War II syringe for direct interhuman blood transfusion

7. While the first transfusions had to be made directly from donor to receiver before coagulation, in the 1910s it was discovered that by adding anticoagulant and refrigerating the blood it was possible to store it for some days, thus opening the way for blood bank. • The first non-direct transfusion was performed on March 27, 1914 by the Belgian doctor Albert Hustin, who used sodium citrate as an anticoagulant .

8. Transfusion of blood products is one of the most common interventions in the hospital setting. • The number of blood components trans-fused in the United States was approximately 29 million in 2004 & This equates to nearly 80,000 units of blood components transfused every day.

10. Processing of blood prior to transfusion: The Donated blood is usually subjected to processing after it is collected • Component separation. • Leukoreduction, also known as Leukodepletion is the removal of white blood cell from the blood product by filtration. • Irradiation. • Viral screening

11. Although blood transfusion saves lives and reduces morbidities in many clinical diseases and conditions, it is associated with certain risks. • The most serious risks of blood transfusion are transfusion reaction which is include (immune-related reactions ,non immunereactions and infections).

12. The transfusion reaction: There are several types of reactions and some are more severe than others. Some reactions may happen as soon as the transfusion is started, while some take several days or even longer to develop.

14. Immune-related reactions: • occur when the immune system attacks components of the blood being transfused or when the blood causes an allergic reaction. • These reactions may be mild or severe. Most mild reactions are not life-threatening when treated quickly.

15. 1-Nonhemolytic fever reactions or febrile reaction: It is sudden fever during or within 24 hours of the transfusion may be associated with Headache, nausea, chills, or a general feeling of discomfort.

16. These reactions are a response by the body to white blood cells in the donated blood. • They are more common in people who have had transfusions before, and in women who have had several pregnancies. • The Acetaminophen (Tylenol) may help these symptoms.

17. Patients who have had febrile reactions or who are at risk for them are usually given blood products that are leukoreduced (This means that the white blood cells have been removed by filters or other means).

18. 2-The allergic reaction: • This is the most common type of reaction&It occurs during the transfusion because of the body's reaction to plasma proteins in the donated blood. • Usually the only symptoms are hives and itching, which can be treated with antihistamines such as diphenhydramine.

19. In rare cases these reactions can be more serious cause: • Anxiety • Chest and/or back pain • Trouble breathing • Fever, chills, flushing, and clammy skin • A high pulse or low blood pressure &nausea Which can be life-threatening(anaphylactic shock)

20. In this case we have to stop the transfusion immediately at the first signs of an allergic reaction. determines how mild or severe the reaction is, what treatments are needed, and if the transfusion can safely be restarted.

21. 3-Transfusion-related acute lung injury (TRALI): • This is a very serious transfusion reaction, which happens in about 1 out of every 5,000 transfusions. • It can happen with any type of transfusion, but those that contain more plasma, such as FFP or platelets

22. It often starts within 1 to 2 hours of the transfusion, but can happen anytime up to 6 hours after the transfusion. • The main symptom a patient will feel is trouble breathing • Doctors now believe that there are several factors involved in this illness such as(recent surgery, trauma, cancer treatment, transfusion, or have an active infection).

23. Most of the time TRALI goes away within 2 or 3 days if the breathing and blood pressure are supported, but even with support it can cause death in 5% to 10% of cases. • It is more likely to be fatal if the patient was already very ill before the transfusion.

24. Most often a patient will need oxygen, fluids, and sometimes support with a breathing machine. • If a patient who has had TRALI needs blood, we need to prevent future problems by "washing" the red cells in a dilute salt water solution to remove most of the plasma while saving the red blood cells.

25. 4- Acute immune hemolytic reaction: • is the most serious type of transfusion reaction, but it is very rare & It happens when donor and patient blood types do not match. • The patient's antibodies attack the transfused red blood cells, causing them to break open (hemolyze) and release harmful substances into the bloodstream.

26. Patients may have chills, fever, chest and lower back pain, and nausea. • The kidneys may be severely damaged, and dialysis may be needed. • It can be cause death if the transfusion is not stopped as soon as the reaction starts

27. :5-Delayed hemolytic reaction • This type of reaction happens when the body slowly attacks antigens (other than ABO antigens) on the transfused blood cells. • The blood cells break down days or weeks after transfusion& usually no symptoms, but the transfused red blood cells are destroyed and the patient's red blood cell count falls.

28. In rare cases the kidneys may be affected, requiring treatment. • People don't usually have these types of reactions unless they have had several transfusions in the past. • People who have this type of reaction need special blood testing before any more blood can be transfused.

29. 6-Graft-versus-host disease (GVHD): • occurs when white blood cells in transfused blood attack the tissues of a transfusion recipient who has a severely weakened immune system. • It is more likely to happen if the person getting the blood is a relative or has a similar tissue type to the donor

30. The recipient's immune system doesn't recognize the white blood cells in the transfused blood as foreign& This allows them to survive and attack the recipient's body tissues. • Within a month of the transfusion, the patient may have fever, liver problems, rash, and diarrhea

31. To prevent white blood cells from causing GVHD,the donated blood can be treated with radiation before transfusion. • Radiation stops white blood cells from working but does not affect red blood cells.

33. :Nonimmune reactions 1-Fluid overload: • it is a common type of nonimmune reaction & it occur when Pt receive too much fluid through transfusions, especially if he has not experienced blood loss before the transfusion. • It may require treatment with (diuretics) medications to rid the body of the excess fluid.

34. 2- Acquired hemochromatosis: • Very rarely, a person can develop iron overload after having many repeated blood transfusions. • People with a blood disorder like thlassemia which requires multiple transfusions, are at risk of iron overload and because of this they are usually on chelating agent to remove the extra iron from there body.

35. Infections: • Blood transfusions can transmit infections caused by bacteria, viruses, and parasites. • The chance of an infection being transmitted is very rare, but the exact risk for each type of infection varies.

36. Bacterial contamination: • Rarely, blood gets contaminated with tiny amounts of skin bacteria during donation. • Platelets are the most likely blood component to have this problem. Because platelets must be stored at room temperature, these bacteria can grow rapidly

37. It is affects about 1 in 1000 to 3000 units of platelets. • Patients receiving these platelets may develop serious illness within minutes or hours after the transfusion is started • In 2004, blood banks started testing platelets before they are given and throwing out affected units.

38. Hepatitis B and C: • Hepatitis is the most common disease transmitted by blood transfusions. • According to the American Red Cross, about 1 blood transfusion in 205,000 transmits a hepatitis B infection, and 1 blood transfusion in about 2 million transmits hepatitis C.

39. Several steps are routinely taken to reduce the risk of hepatitis from blood transfusion • People who are getting ready to donate blood are asked questions about hepatitis risk factors and symptoms of hepatitis & the Donated blood is also tested to find HBV,HCV and liver problems that might point to other types of hepatitis.

40. Human immunodeficiency virus (HIV): • Testing each unit of donated blood for HIV began in 1985, and tests for HIV are now used on all donated blood. • With improved testing for HIV, the number of transfusion-related AIDS cases continues to drop.

41. The risk of HIV transmission from a transfusion now is about one in 2,135,000 & In addition to testing, the risk is reduced by asking donors questions about HIV risk factors and symptoms.

42. Other infections tested: • In addition to the tests noted above, all blood for transfusion is tested for syphilis, as well as T-cell lymph tropic virus types I and II (HTLV-I/II) linked to human T-cell leukemia/lymphoma, (CMV), (EBV), TT virus (TTV), human herpes virus type 6 (HHV-6), SEN virus (SEN-V), and human parvovirus (HPV-B19). • Since 2003, donated blood has been tested for the West Nile virus too

43. Other possible infections: Diseases caused by certain bacteria, viruses, and parasites, such as Chagasdisease, malaria, Lyme disease, and others can also be spread by blood product transfusions But because potential donors are screened with questions about their health status and travel, such cases are very rare.

44. Classification of transfusion-related adverse events

46. Neonatal transfusion: • hospitals are taking additional precaution to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative forCMV. • There are pecific requirements place additional restrictions on blood donors who can donate for neonatal use.

47. Neonatal transfusions are usually top-up transfusions, exchange transfusions, partial exchange transfusions. • Top-up transfusions are for investigational losses and correction of mild degrees of anemia5-15 ml/kg ,removal of bilirubin, removal of antibodies and replacement of red cells • Ideally plasma-reduced red cells that are not older than 5 days are use.

49. Transfusion and Patient Outcomes • A large number of recent (within the last 7-10 years) studies have shown a profound association between transfusion and adverse outcomes. • Today there is mounting evidence that patients who are transfused do worse than patients who are not

50. In orthopedic surgery, patients who have received allogeneic (banked) blood have a 1.5- to 3.5-fold increased risk for preoperative major infection which includes wound infection, pneumonia, sepsis, and urinary tract infection which lead to prolonged hospital stay.