1. 上海交通大学瑞金临床医学院 外科教研室Dr. Moamar Mortada

2. Blood Transfusion

3. • History
• Type of Transfusion
• Indication
• Transfusion Reactions
• Autologous transfusion
• Component Transfusion
Blood Transfusion

4. History and Significance

5. Lower (1665)
First blood transfusion

6. Philip (1825)
First human blood transfusion

7. Landsteiner (1900)
Discovery of ABO type

8. How to store blood longer?
World war I

9. Is there any
suitable
Blood Substitutes
World war II

10. Successful blood transfusion is relatively recent
• Crossmatching
• Anticoagulation
• Plastic storage container
Blood Transfusion

11. Type of Transfusion：
 Whole Blood；
 Blood Component；
RBC PLT FFP Leukocyte concentrate
 Plasma Substitutes；
Use of whole blood is considered to be a waste of
resources
Blood Transfusion

12. • Symptomatic anemia (providing
oxygen-carrying capacity)
• Transfusion trigger
(HCT<30% ; HB<10g/dl)
• 1 Unit increases 3% HCT or 1g/dl
• Shelf life =42 d (1-6 ℃)
Red Blood Cells

13. • Thrombocytopenia
(< 50,000)
• Platelet dysfunction
• Each unit increase 5,000
PLTs after 1 H
Platelets

14. • Profoundly granulocytopenia (<500)
• Serious infection not responsive to antibiotic
therapy
Granulocytes

15. • Coagulation factor deficiencies
• 1 ml increases 1% clotting
factors
• Being used as soon as possible
• Albumin, hetastarch,
crystalliods are equally
effective volume expander but
safer than FFP
• After use of 5 U of RBCs,
matching 2 U of FFP
Fresh Frozen Plasma (FFP)

16. --Volume Expander
Dextran
• Most widely used
• Low/Middle M.W. (40,000-70,000)
• Massive transfusion could impair coagulation
• Occasional ALLERGIC reaction
Hydroxyethyl Starch Formulation (HES)
• More stable
• Containing essential electrolytes
• No allergic reaction
Plasma Substitutes

17. Indication：
 Acute massive blood loss;
 Anaemia and hypoalbuminemia;
 Overwhelming Infection;
 Dysfunction of Coagulation;
Blood Transfusion

18. Technique of Transfusion:
 Approach Route:
Peripheral Vein, Center Vein
 Filtration before Transfusion：
 Velocity of Transfusion：
5-10ml/min
Blood Transfusion

19.  Double Check: Name, Type and Crossmatch
 Storage Time: Citrate Phoshate Detrose
Acidic Citrate Detrose
21D, 35D
 Pre-heat：
 No any other Medication：
 Observation during / after Transfusion：
Attention：
Blood Transfusion

20. Incidence：2%
Chills, Fever 39-40.C
Headache, Sweatiness
Nausea, Vomiting, Flushing
15min-1hr
Febrile Reactions ：
Transfusion Reactions

21.  Immuno-reaction ：
 Endo-toxins：
 Contamination or Hemolysis：
 Analyze possible reasons：
 Stop Transfusion ：
 General Support：
Treatment：
Febrile Reactions ：
Transfusion Reactions

22. Urticaria
Abdominal cramps
Dyspnea
Vomiting
Diarrhea
Anaphylactic reactions：
Transfusion Reactions

23.  Immuno-reaction： IgE
 Hereditary Immunoglobulin： IgA
Reason：
 Administer antihistamines
 Administer epinephrine, diphenhydramine,
and corticosteroids：
 Support airway and circulation as necessary：
Treatment：
Anaphylactic reactions：

24. Burning at the intravenous (IV) line site
Fever, Chills, Dyspnea
Shock
Cardiovascular Collapse
Hemoglobinuria, Hemoglobinemia
Renal Failure
DIC
Hemolytic transfusion reactions
Transfusion Reactions

25.  ABO incompatibility
 Rh Incompatibility
 Non-immune Hemolysis
 Immune Hemolysis
Reasons：
Hemolytic Transfusion Reactions

26.  Stop Transfusion as soon as reaction is suspected
 Check the name, type and crossmatch
 Urine Exam
 Renal Protection
(Aggressive Fluid Resuscitation, Furosemide)
 DIC Monitor
Treatment：
Hemolytic Transfusion Reactions

27.  Double Check name,type and crossmatch
 Operate carefully and routinely
 Temperature Monitor
Prevention：
Hemolytic Transfusion Reactions

28. Massive transfusion complications:
Volume Overload
Congestive Heart Failure
Tachycardia
Tachypnea
Cyanopathy
Transfusion Reactions

29.  Volume Overload
 Heart Functional Failure
 Lung Functional Failure
Reasons：
 Stop Transfusion
 Heart Functional Support
 Diuresis (Furosemide)
Treatment：
Massive Transfusion
Complications:

30. Contamination:
Fever
Shock
DIC
Bacterial Contamination
Reasons：
Transfusion Reactions

31.  Stop Transfusion
 Bacterial Exam and Culture
 Antibiotics
Treatment：
 Double Check
 Operate carefully
Prevention：
Contamination:

32.  Hepatitis B, Hepatitis C
 HIV
 Cytomegalovirus (CMV)
 Syphilis
 Malaria
Acquired diseases ：
Transfusion Reactions

33.  No risk of infectious disease transmission
 No transfusion reactions
 No compatibility testing
 Reduced demand on blood bank stores
 An immediate source of autologous blood
Autotransfusion：

34.  Red Blood Cells
Packed RBC
 White Blood Cells
 Pooled Platelets
Blood Cell：
Component Transfusion：

35. • Saving blood source
• Less likely carrier of transmitted diseases
• Shortage of quality blood
• Greater shelf life than whole blood
• Helping to make blood safer by filtration
• Infusing regardless of ABO type in some blood
products
giving only essential/desired blood component
Component Transfusion：