blood transfusions.pptx

Blood Transfusion
Dr. Danny Joy
JR-3
General Surgery IV

History
• Richard Lower, 1665: animal to human transfusion

• James Blundell, 1818:
 Transfusion of human blood to treat PPH
• Karl Landsteiner:
 1901: discovered three blood groups O,A & B
 1930: Nobel Prize in Physiology and Medicine
• George Washington Crile:
 1906: first surgery using a direct blood transfusion

• William Stewart Halsted:
 One of the first blood transfusions in the United States
• Albert Hustin:
 first non-direct transfusion
 Sodium citrate anticoagulant
• Levine and Stetson:
 1939: Rh grouping

Typing and cross-matching
• Serologic compatibility for A, B, O, and Rh groups is established routinely
• Major cross-match: between the donors’ red blood cells and the recipients’
sera
• Administration of Rh-positive blood is acceptable if Rh-negative blood is
not available except in women of child bearing age-group
• In emergencies, O-negative blood may be transfused to all recipients
 Increased chance of hemolysis when >4 units transfused

• Autologous Transfusion:
 Hb>11, PCV>34
 First procurement 40 days prior, last 3 days prior
 Upto 5 units
 Intervals of 3-4 days
 Recombinant Human Erythropoietin (rHuEPO) may be used

Blood products
Banked whole blood:
• Less commonly used now
Red blood cells and Frozen red blood cells
• One unit 330 ml– stored in SAG-M solution
• Shelf life 42 days at 2-6°C
• Frozen red blood cells
 Cant be used in emergencies
 Preparation time is several hours
 For patients who are known to have been previously sensitized
 Red blood cell viability is improved
 ATP and 2,3-DPG concentrations are maintained

Leukocyte-Reduced and Leukocyte-Reduced/Washed Red Blood Cells
• Filtration process that removes about 99.9% of the white blood cells and
most of the platelets
 Prevents almost all febrile, nonhemolytic transfusion reactions
 Prevents alloimmunization to HLA class I antigens, platelet transfusion
refractoriness and cytomegalovirus transmission
Platelet Concentrates
• shelf life: 120 hours at 20-24°C
• One unit approx. 50mL
Fresh Frozen Plasma
• Usual source of the vitamin K-dependent factors
• Only source of factor V
• Shelf life: 5 days

Cryoprecipitate
• Rich in factor VIII and fibrinogen
• −30°C—two year shelf life
• Low fibrinogen states or factor VIII deficiency
Prothrombin complex concentrate
• Factors II, IX and X
• Factor VII may be included or produced separately
• Emergency reversal of warfarin therapy

Indications for blood transfusion
• Acute blood loss, to replace circulating volume and maintain oxygen
delivery
• Perioperative anaemia, to ensure adequate oxygen delivery during the
perioperative phase
• Symptomatic chronic anaemia, without haemorrhage or impending surgery

• Perioperative red blood cell transfusion criteria

• Surgical blood loss replacement:
 In patients with normal preoperative values, blood loss up to 20% of total
blood volume can be replaced with crystalloid or colloid solutions

Massive blood transfusion
• ≥10 U RBCs in 24 h
• RBC:FFP:platelets ratio of 1:1:1 is presently recommended
• Use of fresh blood also encouraged in patients with acute trauma requiring
significant transfusion needs
• Forms the basis of damage control resuscitation:
 Permissive hypotension
 Minimizing crystalloid-based resuscitation
 Immediate release and administration of predefined blood products (red
blood cells, plasma, and platelets)

Complications of blood transfusion
• 10% of all transfusions
• <0.5% serious complications
• Deaths exceedingly rare:
 Transfusion-related acute lung injury (TRALI) (16%–22%)
 ABO hemolytic transfusion reactions (12%–15%)
 Bacterial contamination of platelets (11%–18%)

Nonhemolytic Reactions
• Febrile, nonhemolytic reactions:
 Defined as an increase in temperature (>1°C) associated with a transfusion
 Approximately 1% of all transfusions
 Preformed cytokines in donated blood and recipient antibodies reacting with
donated antibodies
 Pretreatment with acetaminophen
• Bacterial contamination:
 Rare
 25% mortality

Allergic Reactions
• 1% of all transfusions
• Usually mildrash, urticaria, and flushing
• Rarely severeanaphylaxis
• More commonly associated with FFP and platelets
• Transfusion of antibodies from hypersensitive donors or the transfusion of
antigens to which the recipient is hypersensitive
• Treatment and prophylaxis- antihistamines
• Severe- steroids, epinephrine

Respiratory Complications
• Transfusion-associated circulatory overload (TACO)
 Rapid infusion of blood, plasma expanders, and crystalloids
 Rise in venous pressure, dyspnea, and cough, rales over lung base
 Diuretics, slowing rate of transfusion, minimizing fluids
• Transfusion-related acute lung injury (TRALI)
 Noncardiogenic pulmonary edema related to transfusion
 Transfusion of any plasma-containing blood product
 Within 1-2 hr—always within 6 hrs
 Symptoms similar to circulatory overload
 Accompanied by fever, rigors, and bilateral pulmonary infiltrates on chest
x-ray
 Stop transfusion+pulmonary suport

Hemolytic Reactions
• Acute:
 ABO incompatibility—fatal in 6%
 Hemolysis, DIC
 Hemoglobinuriaacute tubular necrosisrenal injury
• Delayed:
 2 to 10 days after transfusion
 Extravascular hemolysis, mild anemia and unconjugated hyperbilirubinemia
 Low antibody titer at the time of transfusion, but the titer increases after
transfusion as a result of an immune response

Transmission of Disease
• Malaria, Chagas’ disease, brucellosis, syphilis
• Cytomegalovirus (CMV)
• Hepatitis C and HIV-1: reduced dramatically after introduction of antibody
and nucleic acid screening
• West Nile virus
• Prion diseases

Complications of massive transfusion
• Coagulopathy
• Hypocalcaemia
• Hyperkalaemia
• Hypokalaemia
• Hypothermia
Treatment of coagulopathy:
• Treatment indicated only if there is active bleeding
• FFP if PT or PTT >1.5 times normal
• Cryoprecipitate if fibrinogen <0.8 g/L
• Platelets if platelet count <50 × 109/mL

Blood substitutes
Oxygen carrying blood substitutes:
• Biomimetic:
 Mimic the oxygen carrying capacity of blood—Hemoglobin based
Diaspirin cross-linked hemoglobin (DCLHb)= HemAssist (Baxter)
HBOC-201 (Hemopure, Biopure)
PolyHeme
Liposome encapsulated hemoglobin
• Abiotic:
 Synthetic oxygen carriers—Perfluorocarbon based
 Applications in partial liquid ventilation
 Linear relationship to the partial pressure of oxygen-needs high FiO2
 Oxygent, OxyFluor, Oxycyte, Dermacyte

References
• Bailey and Love Short Practice of Surgery, 26th edition
• Schwartz’s Principles of Surgery, 10th edition
• Sabiston Textbook of Surgery, 19th edition

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