From understanding the types of blood products to the intricacies of compatibility testing and transfusion reactions, this presentation covers all essential aspects. Gain insights into the significance of blood transfusion in medical practice, ensuring safety, efficacy, and optimal patient outcomes.

1. BLOOD TRANSFUSION
BY: Dr. GUL SABA

2. Blood Transfusion:
Definition:
 Process of transferring whole blood or blood components from one person (donor)
to another (recipient).
Indications:
 Acute blood loss
▸ to replace circulating volume & O, deliver
 Perioperative anemia
▸ To ensure adequate O, delivery during perioperative phase.
 Symptomatic chronic anemia without haemorrhage or impending surgery
▸ Hb <6g/dl

3. Perioperative red blood cell transfusion
criteria:

4. Pre requisite for Blood transfusion:
 ABO blood grouping and Rh typing prior to transfusion.
 Collection of blood.
 Cross matching of donors blood with patients blood before transfusion.
 Detection of antibody by Coomb's test
 Screening for - HIV, HCV, HBV, Syphilis, Malaria

5. GROUPING AND CROSS MATCHING
 The individual from whom the blood is transferred is called the donor.
 The individual to whom the blood is transferred is known as the recipient.
 Indiscriminate transfusion may lead to serious conditions and even death.
This consequence is due to the process of clumbing or agglutination or
breaking up (haemolysis) of red corpuscles.
 Agglutination is due to the interaction between substances in red blood
corpuscles known as agglutinogens and those in the plasma called
agglutinins.
 Types of blood which get agglutinated in the transfusion is said to be
incompatible.

6. ABO BLOOD GROUPING
 Human blood is classified into 4 main groups (A, B, AB, and O) based
upon the type of antigens (agglutinogens) present in the erythrocytes, as
well as the type of antibodies (agglutinins) present in the plasma.
 Two major agglutinogens which have been identified are the 'antigen A'
and 'antigen B'.
 The persons with A type of blood have 'A' antigens in their red cells; and
persons with B type of blood have B' antigens.
 Persons with 'AB' blood have both A and B antigens while those with 'O'
type of blood do not have either A or B antigens in their red cells.

7. ABO BLOOD GROUPING
 The agglutinogen and the agglutinins of the same type will not be found in
the same person. Otherwise the person's own cells would have been
attacked by the antibodies found in his plasma.
 Thus group A blood contains beta agglutinins and group B contains
only alpha agglutinins.
 Group AB contains neither alpha nor beta agglutinins and group O
contains both alpha and beta agglutinins.

8. POSSIBLE COMBINATIONS

9. The Haemolytic Reactions
 When similar agglutinins and agglutinogens come in contact with each
other, clumbing (agglutination) and rupture (haemolysis) of the red cells
occurs. e.g. when type A " agglutinogen and alpha agglutinin or type B
agglutinogen and beta agglutinin come in contact with each other,
agglutination and haemolysis will take place.
 This produces a fatal response called haemolytic reaction.

10. Compatible blood:
 In order to avoid haemolytic reactions in blood transfusions, the blood cells
of the donor is cross matched with the plasma of the recipient and the
plasma of the donor with the cells of the recipient.
 If no agglutination is taking place, the blood is said to be compatible.

11. Rh factor:
 85 per cent of the world population is having the antigen D' of the Rh blood
group system.
 Those persons who possess this antigen is called 'Rh positive' and those
who do not inherit this antigen is called 'Rh negative'.
 The name Rh factor comes from the Rhesus monkeys whose blood
contains this antigen.
 This antigen was discovered in 1940 by Landsteiner and Wiener.

12. AUTO TRANSFUSION OF BLOOD:

13. AUTO TRANSFUSION OF BLOOD:
The advantages of auto transfusion are:
 The risk of technical errors of blood typing and cross matching eliminated.
 Possible adverse effects associated with homologous blood transfusion
can be avoided.
 Dependence on homologous blood blanks can be reduced.
 Reduce the incidence of exposure to blood-borne infections such as HIV,
serum hepatitis and others

14. Who can donate blood?
A blood donor must:
 Be in good general health
 Be aged 18 years or older but less than 60 years
 Weight at least 45 Kg
 Have a hemoglobin level of at least 12.5 g/dl
 Not have donated blood in the last 3 months.
 Donor shall be free of diseases of heart, kidneys, lungs, liver etc.

15. Who can donate blood?
 There should not be any history of cancer, jaundice, hepatitis,
tuberculosis, allergies or any transmissible diseases.
 Donors must have a normal temperature, pulse and blood pressure.
 They must not have been pregnant within the last 6 months.

16. Who cannot donate blood?
 Cold/ fever in the past 1 week
 Under treatment with antibiotics or any other medication
 Cardiac problems, hypertension, epilepsy, diabetes (on insulin therapy),
history of cancer, chronic kidney or liver disease, bleeding tendencies,
venereal disease
 Major surgery in the last 6 months or minor surgery in the past 3 months
 Jaundice or hepatitis or positivity for Hepatitis B or C viruses or HIV
 Tooth extraction less than 3 days back or dental surgery less than 1 month
back.

17. Who cannot donate blood?
 Fainting attacks during the last donation
 On therapy with regular blood transfusions
 Drug abuser or having multiple Sexual partners
 Don’t donate blood during pregnancy. Donate after 6 months following
delivery and when they are not breast feeding
 During heavy menstrual flow.
 Miscarriage in the last 6 months

18. Blood and blood products:

19. Blood and blood products:

20. Collection, storage and blood
transportation

21. Collection, storage and blood
transportation

22. Collection, storage and blood
transportation

23. Regarding administration of blood to
the recipient:
When sending the recipient's blood sample for grouping and cross matching, it must
be carefully labelled at the bedside of the recipient with the following identifications.
 Recipient's name
 Hospital number
 Bed number
 Ward number etc.
 Name of the physician
 Exact amount of blood component requested.
 Diagnosis of the patient
 Any blood transfusions given earlier, if so, the group and type of the blood
administered, any reactions observed etc.

24. Regarding administration of blood to
the recipient:
 Fresh samples, taken within 4 hours should be used for typing and cross
matching.
 It is recommended to use 18 gauge needle for infusion, to prevent damage
to the red cells and to provide an adequate rate of flow.

25. Regarding administration of blood to
the recipient:
 Prior to administration of blood, the patient's vital signs should be
recorded.
 Adjust the rate of flow to 5 to 10 ml per minute during the first 30 minutes
of transfusion, to detect any complications as early as possible.
 The subsequent flow rate depends upon the condition of the patient and
the need for rapid infusion.
 Give the blood at a slower rate if the patient is elderly, suffering from heart
and lung disease, anaemia, etc.

26. Regarding administration of blood to
the recipient:
 Whole blood and packed cells are administered cold.
 No attempt is made to heat the blood.
 However, blood may be allowed to stand at the room temperature for 30 to
45 minutes before it is administered to the patient.
 Once the blood is exposed to the atmosphere (the unit is opened), it
should be discarded.

27. Complications:
 Single transfusion:
 Incompatibility haemolytic transfusion reactions
• febrile transfusion reaction
• allergic reaction
 Infections:
• bacterial infection (usually as a result of faulty storage)
• hepatitis
• HIV
• malaria;
 Air embolism
 Thrombophlebitis
 Transfusion-related acute lung injury (usually from FFP).

28. Complications:
 Coagulopathy
 Hypocalcaemia
 Hyperkalaemia
 Hypokalaemia
 Hypothermia
 Iron overload
(Patients who receive repeated transfusions over long periods of time (e.g.
patients with thalassaemia) →develop iron overload).
Each transfused unit of red blood cells contains approximately 250 mg of elemental
iron.

29. Management of transfusion reactions:
 Stop the transfusion immediately
 O2 inhalation
 Check clerical details and send samples from the donor unit and recipient
for analysis for compatibility and haemolysis.
 Infuse Normal Saline or 5% dextrose to promote diuresis to prevent renal
failure.
 Check vitals every 15 min to assess shock.
 Record IO charting

30. Management of transfusion reactions:
 Intravenous steroids and antihistamines may be needed, with the use of
adrenaline (epinephrine) in severe cases.
 Cardiac monitoring, ICU care if respiratory distress and > 2 organ
dysfunction.
 Hemodialysis in case of renal failure.

31. Allergic reactions:
 It develops any time during transfusion or within one hour after transfusion.
 Allergic reactions are thought to be sensitivity of the individual to a plasma
protein in the transfused blood.
 It is characterized by rashes, itching, laryngeal oedema and bronchial
spasm in severe cases.
 The treatment normally consists of an injection of antihistamin and
corticosteroids as necessary.