general surgery lecture hemorrhage resuscitation blood transfusion ABO system

1. Blood transfusion

2. In 1667, Jean-Baptiste Denis and a surgeon, Emmerez,
transfused blood from a sheep into a 15-year-old boy who had
been bled many times as treatment for fever

3. In 1668, transfusions in humans were forbidden
unless approved by the Faculty of Medicine in
Paris.

4. 1829 James Blundell
performs the first
successful
documented
human transfusion in
a woman suffering
post-partum
haemorrhage

5. Blood has been described as a vehicular
organ that perfuses all other organs. It
provides transportation of oxygen to
satisfy the body's metabolic demands and
removes the by-product carbon dioxide

6. Blood Product
1. Banked whole blood:
• Shelf life 40 + - 5 days
• Poor source of platelets
• pH
• potassium concentration
• Ammonia concentration
• O2 function transport

7. Blood Product
2. Fresh whole blood:
• Within 24 hour
• Administrated untested
• poor source of platelets and factor VIII.

8. Blood Product
3. Fresh-frozen plasma:
• 2-year shelf-life
• It is the first-line therapy in the
treatment of coagulopathic
haemorrhage

9. Blood Product
4. Platelets:
• The preparations should be used within
120 hours of donation.
• One unit of platelet concentrate has a
volume of approximately 50 mL
• it is advisable to elevate the platelet
count to the range of 50,000 to 100,000
uL.

10. Autologous blood
It is possible for patients undergoing
elective surgery to pre donate their own
blood up to 3 weeks before surgery for re-
transfusion during the operation

11. Indications of 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

12. Transfusion trigger
• Historically, patients were transfused to
achieve a hemoglobin level of > 10 g/dl
• A hemoglobin level of 6 g /dl is
acceptable in patients who are not
bleeding, not about to undergo major
surgery and not symptomatic

13. ABO system
In 1900,
Landsteiner
introduced
the concept
of blood
grouping and
identified the
major A, B,
and O groups

14. ABO system

15. ABO system

16. In 1939, the Rh group
was recognized by
Levine and Stetson.

18. Blood cross match
• The recipient’s serum is then mixed with
the donor’s cells to confirm ABO
compatibility and to test for Rhesus and
any other blood group antigen–antibody
reactions
• Full cross-matching of blood takes 45
min in most laboratories. In more urgent
situations, only ABO/Rhesus matched
and can be issued within 10–15 min.

19. Complications of blood transfusion
1. Incompatibility
2. Fibril reaction
3. Allergic reaction
4. Infection
5. Air embolism

20. Massive transfusion
The term massive transfusion implies a
single transfusion greater than 2500 mL or
5000 mL transfused over a period of 24
Complications:
• coagulopathy
• hypocalcaemia
• hypothermia

22. Blood product
1. Banked whole blood
2. Fresh whole blood
3. Fresh frozen plasma
4. Platelets

23. Indications of blood transfusion:
1. to replace circulating volume and
maintain oxygen delivery
2. perioperative anaemia
3. symptomatic chronic anaemia

24. Transfusion trigger
6 g /dl

25. ABO system

26. RH disease

27. Q: patient (26 years old) admitted in your
ward, during preparation for surgery,
preoperative blood transfusion needed in
your call at night , when transfusion start
everything went smoothly until after 15
mints patient start to develop shivering , and
skin rash , your management ?