This document discusses blood, blood products, and blood transfusion. It defines blood and its components and functions in transportation, protection, and regulation. Blood products include whole blood, packed red cells, platelets, fresh frozen plasma, and cryoprecipitate. Indications for transfusion of specific products are provided. The document also discusses the maximum surgery blood order schedule, blood transfusion reactions and their management, complications of transfusion, hemovigilance, and important takeaways regarding proper transfusion procedures.

1. Blood, Blood Products and Blood
Transfusion
By;
SITI AFIFAH
MARDHIYYAH
Supervisor;
DR SALEHUDIN

2. Contents
• Definition
• Functions of the blood
• Blood products
• Indication for transfusion
• Maximum surgery blood order schedule (MSBOS)
• blood transfusion: hemovigilance
• Blood transfusion reaction and its management
• Other complications of blood transfusion
• Take home massage

3. Definition:
• Blood - connective tissue (fluid) consisting of
plasma and cellular component.
• 8% of total BW

4. Functions of the blood
• supplies o2 and substances absorbed from the GIT to
the tissues.
• returns co2 to the lungs, and other products of body
metabolism to the kidneys.
• Transport hormones produced by respective glands of
endocrine systems
Transportation
• White cells- preotection of the body againts pathogen
• Platelets- limiting blood lossProtection
• Body temperature
• blood pressure
• pH balanceRegulation

5. Blood product & Blood Transfusion
• Blood product- A blood product is any
component of the blood which is collected
from a donor for use in a blood transfusion
• Blood transfsusion-is the process of
transferring blood or blood components from
one person into the circulatory system of
another

6. WHOLE BLOOD
CELLULAR FRESH
COMPONENTS PLASMA
• RED CELLS
• PLATELETS
• WHITE
BLOOD CELLS
FRESH FROZEN PLASMA
CRYOPERCIPITATE
CRYOSUPERNATANT
FACTOR VIII
CONCENTRATE
•ALBUMIN
•IMMUNOGLOBULIN
•OTHER
CONCENTRATES
Blood products

7. Blood products
Whole blood
• Blood taken from a suitable donor using a pyrogen
free anticoagulant container. The major use is used
for blood component separation.
Packed red
cells
• A component derived by removing part of the
plasma from whole blood
Platelet
• A component derived from fresh whole blood by
centrifugation which contain majority of the
platelets content in theraputically effective form.

8. Fresh frozen
plasma
• A component prepared either from fresh whole blood or from plasma
collected by apheresis, frozen at an appropiate temperature to preserve
the activity of labile coagulation factors.
Cryoprecipitate
• A component containing the cryoglobulin fraction of plasma obtained by
further processing of fresh frozen plasma prepared from hard spun cell
free plasma and concentrated to a final volumes required.
Cryosupernatqant
• A component prepared from plasma by removal of cryoprecipitate

9. Indication for transfusion of blood
product
1. Packed red cells

10. 2. Platelet
Hematological malignancies To maintain platelet > 20x 109
Massive transfusion Acute bleeding, multiple trauma
DIVC Acute DIC, aim to maintain platelet
>50x109
CABG/ Ruptured AAA Reserved for post op bleeding
Immune thrombocytopaenia
Platelet function disorders If all other measures fail to control the
bleeding

11. 3. Fresh Frozen Plasma

12. 4. Cryoprecipitate

13. Maximum surgery blood order
schedule (MSBOS)
• Reference used to guide clinicians in ordering
blood before surgery.
• The Maximum Surgical Blood Order Schedule
(MSBOS) is a table of elective surgical
procedures which lists the number of units of
blood routinely requested, and cross-matched
for them pre-operatively.

14. MSBOS
• For cases where blood;
–Not likely to be transfused – GSH is
perfomed.
–Likely to be transfused – GXM is performed.
*However when antibody screen is positive,
compatible blood must be made available in all cases
before surgery

15. Group Crossmatch
• The patient's serum is
screened and tested
directly for
compatibility with the
red cells of the units of
blood to be transfused.
• Crossmatched blood
will retained for
48hours in blood bank.
Group, Screen, Hold
• Consist of process ABO,
Rh D grouping and
antibody screen
• Serum/plasma is
retained for 48 hours in
the blood bank.

16. MSBOS ; General surgery
Abdominal –
perineal resection
4
cholecystectomy GSH
Gastectomy 2
Hemicolectomy,
small bowel
resection
GSH
Hiatus hernia repair
Abdominal
Transthoracic
2
GSH
Inguinal hernia
repair
GSH
Laparotomy GSH
Perforated viscus 2
Mastectomy GSH
Oesophagectomy 4
Pancreatectomy 4
Portocaval shunt 4
Spelenectomy 2
Thyroidectomy,
Parathyroidecomy
GSH
Varicose vein GSH
Vagotomy GSH
Whipples
procedure
4

17. C:T Ratio
• Crossmatch : transfusion ratio
• An indicator to assess the appropriateness of
cross matching of blood to the units of blood
transfused
• Standard value ≤2.5

18. C: T ratio
• C: T ratio surgical department for the year
2013
JAN FEB MAC APR MAY JUN JUL AUG SEP OKT NOV DIS
GXM 467 497 626 341 569 550 495 538 509 315 270 547
TRANSFUSIO
N
231 235 379 158 289 280 260 280 253 301 231 268
RATIO 2.0 2.1 1.7 2.2 2.0 2.0 1.9 1.9 2.0 1.0 1.2 2.0

19. Consent of blood transfusion
• Written consent
• Patient should be explained regarding the
benefits and risks of blood transfusion
• Explain:
– Indication
– Complications
• Infection
• Reaction
• The patient’s consent should be obtained for the
planned transfusion and recorded in the patient’s
medical chart.

21. Hemovigilance
• Haemovigilance is a system of surveillance and
alarm, from blood collection to the follow-up
of the recipients.
1. Blood taking
2. Giving blood

23. 3 3
2
1
2
1
BLOOD BANK

24. Monitor adverse effects
VITAL SIGN SYMPTOMS
• BP
• PR/HR
• RR
• Temperature
• Fever
• Chills and rigors
• Pain at infusion
site/abdomen/chest
• Respiratory distress
• Urticaria/rashes
• Nausea/vomiting

25. COMPLICATION OF BLOOD
TRANSFUSION
• Acute – during transfusion/within 24 hours
• Delayed – after 24 hours
IMMUNE MEDIATED NON-IMMUNE MEDIATED
ACUTE DELAYED ACUTE DELAYED
• Hemolytic
reaction
• Febrile non-
hemolytic
• Urticaria
• Anaphylactic
• Hemolytic
Reaction
• Post
Transfusion
Purpura
• Graft Vs Host
Disease
• Septic
• Circulatory
Overload
• Metabolic
• Hyperkalemia
• Hypocalcaemia
• Metabolic
alkalosis
• Infection
• Iron Overload

26. Management of transfusion reaction
ADVERSE EFFECT
STOP
TRANSFUSION
Pruritus
Urticaria, Rashes
Chest pain, pain at
infusion site,
respiratory distress,
loin/back pain
Hypotension,
hematuria, DIC
Anxiety, SOB,
Palpitation,
Headache
Flushing, Rigor,
Fever, Tachycardia,
Restless
• Antihistamine
• If symptoms
subside : resume
transfusion at
slower rate
• Maintain A, B, C
• Adrenaline
Furosemide/
corticosteroid/
bronchodilator/
antibiotic
• Antihistamine
and/or
Antipyretic
• Withold
transfusion
LIFE
THREATENINGMODERATEMILD

27. Investigations
• Blood reaction kit
(immediate & post 24hr)
• 4ml in plain tube for antibody identification
• 2ml in EDTA tube for FBP
• >10ml urine sample- may have haemoglobin and
albumin
• The remaining blood bag, containing the partially
transfused blood, and all the blood bags cross-matched
for the same patient at the same time of the request
should be examined for the presence of free
haemoglobin or discolouration before being sent to the
laboratory.

28. • The “Report of Reaction to Blood or Plasma
Transfusion” form must be completed.
• Fill up the “Transfusion Adverse Event” form
in duplicate and send to the blood bank. Send
also a copy of this form to the National Blood
Centre.

32. • Other adverse transfusion reactions include:
– Fluid overload
– Metabolic disturbances e.G. Hyperkalaemia and
hypocalcaemia.
– Hypothermia
– Embolism
– Iron overload
– Alloimmunisation to red cell, white cell or platelet
antigen.
– Immunosuppression and immunomodulation
– Transmission of viral infection

33. Transmitted Infection Incident
HIV 1 : 1,900,000
Hep A 1 : 1,000,000
Hep B 1 : 1,800,000
Hep C 1 : 1,600,000
Bacteria Infection 1 : 3,000

34. Take home massages
1. Blood product mainly consist of cellular
component and fresh plasma.
2. The decision to transfuse depends on many
factors such as haemoglobin level, anemic
symptoms and risk of bleeding.
3. MSBOS used to guide clinicians in ordering
blood before surgery.
4. The patient’s consent should be obtained for the
planned transfusion and recorded in the
patient’s medical chart.

35. Take home massage
4. 1 person take blood and label- confirm
patient’s name and identification before
label.
5. Confirm patient’s name and identification
with patient’s note, compatibility label and
request form before transfusion.
6. If an adverse transfusion reaction is
suspected, the transfusion should be stopped
immediately and must be reported.

36. References
1. Transfusion Practice Guidelines for Clinical
and Laboratory Personnel 3rd edition March
2008. National Blood Centre, Ministry of
Health Malaysia
2. Guidelines for the rational use of blood and
blood products. National Blood Centre,
Ministry of Health Malaysia
3. Blood Transfusion guideline (2006), National
Users’ Board Sanquin Blood Supply