BLOOD TRANSFUSION

1. BLOOD TRANSFUSION DR.FV OYEYIOLA

2. OUTLINE • Introduction • Safe transfusion • Indications • Suitable donors • Storage and use of blood components • Procedure • Massive blood transfusion • Complications • Blood substitutes • Management of transfusion reactions • conclusions

3. INTRODUCTION • 1829- 1ST successful blood transfusion by JAMES BLUNDELL in a woman with post-partum haemorrhage • 1900- Discovery of the ABO blood group system by KARL LANDSTEINER. • 1839- Rhesus blood group system discovered and found to be a major cause of blood transfusion reactions. • Types- heterologous, autologous( pre-op/ intra-op)

4. SAFE TRANSFUSION • 4 PILLARS • -VOLUNTARY blood donation by donors who are selfless and concerned about human well being • -QUALITY SCREENING and testing of donated blood • -SAFE STORAGE • - NECESSARY TRANSFUSIONS ONLY

5. INDICATIONS • Increase the oxygen carrying capacity of a patient with red cells e.g in haemorrhagic shock • Pre-operative anaemia • Symptomatic chronic anaemia without haemorrage or impending surgery • Enhance primary haemostasis with platelet concentrates e.g in HELLP, thrombocytopaenias • Enhance secondary haemostasis with cryoprecipitate and other plasma fractions e.ghaemophilia, VWD

6. SUITABLE DONORS • Age 18-65 yrs • Weight > 51kg • Haemoglobin > 12g/dL • No pregnancy, blood transfusion or tissue/organ transplantation, body piercings, tattoos or needle stick injury in the last 12 months • No major operation in last 6 months • No blood donation in the last 4 months • No severe hypertension, asthma, splenomegaly, hepatomegaly, bleeding disorder , unexplained recent weight loss 4.5kg or more, HIV, hepatitis, syphilis, CJD, CMV, HTLV, trypanosomiasis, brucellosis, commercial sex working or clients, homosexuals, IV drug abusers

7. STORAGE AND USE OF BLOOD COMPONENTS • WHOLE BLOOD- • Limited use – acute blood loss, trauma, centres lacking facilities for component separation.1 unit raises PCV by 3 % • Stored at 2-6 0C • Stored in • ---CPD lasts 21 days • ---CPD-A lasts 35 days • SAG-M lasts 35 days • CPD =citrate- phosphate- dextrose • CPDA= citrate- phosphate- dextrose- adenine • SAGM= saline- adenine- glucose- mannitol

8. STORAGE AND USE OF BLOOD COMPONENTS • PACKED RED CELLS- • Indication- all anaemic patients • Washed packed cells used for patients awaiting organ transplantation, known with previous febrile or allergic non-haemolytic transfusion reactions • Centrifuging donated blood at 3000 revs/min and extracting the plasma away to give haematocrit of about 75% • 1 unit raises Hb by 1g/dL • Storage at 2-6 0C, in CPD or SAG-M

9. STORAGE AND USE OF BLOOD COMPONENTS • FRESH FROZEN PLASMA- • Indications- 1st line therapy in coagulopathichaemorrhage(e.g thrombotic thrombocytopaenia), DIC, warfarinoverdosage, vit k deficiency • Stored at -40 to -50 0C with shelf life of 2 years • Can Rh D positive FFP be given to Rh D negative woman ? YES • Can we justify use of FFP to replace nutrients, albumin or immunoglobulins ? NO

10. STORAGE AND USE OF BLOOD COMPONENTS • PLATELET CONCENTRATE- • Indication- thrombocytopaenia, platelet dysfunction, bleeding patients on clopidogrel • Stored at 20- 24 OC or room temperature in a special agitator to prevent aggregation and maintain physiologic function • Shelf life is only 5 days after collection

11. STORAGE AND USE OF BLOOD COMPONENTS • CRYOPRECIPITATE- • Indication- haemohilia A, hypofibrinogenaemia, VWD • Supernatant drained from top of FFP when it thaws at 4 0C • Stored at -30 OC with shelf life of 2yrs • 1 unit of platelet raises count by 5-10 cells x 10 9/ L

12. STORAGE AND USE OF BLOOD COMPONENTS • GRANULOCYTE CONCENTRATE- • Indication- sepsis, severe neutropenia • Produced by leukopharesis • Irradiated to prevent GVHD

13. PROCEDURE • Personal details of pt cross-checked with blood to be transfused • Pre-transfusion vital signs • IV access secured • 500ml typically admin over 4hrs • IV furosemide 20mg stat given (pt @risk of circulatory overload • Parenteral Antihistamine/steroid • Close monitoring of vital signs

14. MASSIVE BLOOD TRANSFUSION • >1/2 blood vol in 1hr or >total blood vol in <48hrs • Problems- • Technical & clerical errors • -Circulatory overload • -Cardiac arrhythmias/arrest • -Resp complications • -Bleeding diathesis • -Reduced oxygen delivery

15. COMPLICATIONS • Immediate- • Febrile non-hemolytic reaction • -Allergic/anaphylactic reaction • -Hemolytic reaction • -Bacterial contamination • -Circulation overload • -Air embolism

16. Complications • Delayed- • Thrombophlebitis • -Delayed hemolytic reaction • -Post-transfusion thrombocytopenic purpura • -Transmission of dxs • -Iron overload • -Immunosuppression • GVHD- graft-versus-host-disease

17. Blood Substitutes • Stable plasma protein • Albumin • Dextran • Synthetic gelatin colloids( hemaccel, gelofusine) • Hydroxyethyl starch preparations( hetastarch, pentastarch)

18. MANAGEMENT OF TRANSFUSION REACTIONS • Stop transfusion immediately • IV normal saline 1L stat • IV hydrocortisone 100mg stat • IM promethazine 25mg stat • Inform senior doctors • Send transfused blood and patients blood for a re-grouping and crossmatching

19. Conclusion • Blood transfusion remains an invaluable therapeutic measure, but utmost precautions must be taken to avoid the possible complications.

20. THANK YOU! • …