BLOOD TRANSFUSION Begashaw M (MD)

Definition is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream

Indications In acute hemorrhage is based on: • volume lost >2000 • rate of bleeding • hemodynamic status

Indications In Chronic blood loss: -Healthy, younger individuals HCT<21% -Cardio respiratory compromised patients HCT < 25-33% If severe ,even <40%

Perioperative red blood cell transfusion criteria

Component therapy specific factor deficiencies -factor VIII concentrates -classic hemophilia

ABO blood group system -Blood group O is the universal donor -Blood group AB is the universal recipient

Cross matching o Blood grouping -ABO and Rhesus antigens o Antibody screening Detects atypical red cell antibodies in recipients serum o Crossmatching Tests donor red cells against patients serum

Blood products Whole blood Packed red cells Granulocyte concentrates Platelet concentrates fresh frozen plasma Plasma protein fraction Human albumin 25% Cryoprecipitate Clotting factors - Factor VIII / IX

Blood Components

Component therapy Factor VIII for classic hemophilia Platelet transfusion for patients with bone marrow suppression

preparation FRESH UNIT WHOLE BLOOD+CPDA THAW AT 4 degree celcius PRBCs 80% HCT STORED AT 1-6 degree celcius PLASMA AND 70% OF PLTS PLT PELLET and CLOTTING FACTORS EXCEPT FACTOR III PLASMA STORED AT -18 to-30 DEGREE CELCIUS THAW AT 4 degree celcius CRYOPRECIPITATE PROTEINS

Whole blood is collected in citrate phosphate dextrose- adenine solution (CPDA-) 450 ml of whole blood and approximately 60ml of anticoagulant preservative within 24 hours-freshwhole blood shelf life of 35 days one unit of whole blood raises the recipient’s hematocrit by 3%

Whole blood

Packed RBC are remains after plasma has been separated from whole blood One unit raises the recipient’s hematocrit by 3% warmed to a temperature not exceeding 37 c before transfusion Shelf life is 35 days

Packed RBC

Platelet concentrate Platelets are separated from one unit of blood may be stored for 3-7 days One unit of platelet concentrate contains about 5.5×1010 platelets and increases the platelet count by 5000/ml For a patient with platelet count below 25,000/mm3, 6-8 units are usually given Platelet concentrate must be administered through a special platelet filter

Fresh frozen plasma _is anti-coagulated plasma separated from a person’s blood and frozen within 6 hours _stored up to 1 year _contains all clotting factors _provides proteins for volume expansion

Cryoprecipitate _is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 degree centigrade _white precipitate _shelf life of about 1 year _contains factor VIII, fibrinogen and factor XIII _treatment: -classic hemophilia -DIC

FRESH FROZEN PLASMA

Cryoprecipitate

Protein Albumin - for oncotic support and plasma expansion - disadvantage-rapid excretion & expense Plasma protein fraction -Similar to albumin but contains additional protein molecules

Complications of Blood Transfusion

Complications Hemolytic transfusion reactions Non-hemolytic transfusion reaction

Hemolytic transfusion reactions Intravascular hemolytic transfusion reactions life threatening reactions due to incompatibility of the ABO system are very rare occurring in 1 out of 15,000 -20,000 transfusions

Pathophysiology all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuria and renal failure activate the complement system with subsequent release of vasoacative amines causing hypotension Complement activation -intravascular thrombosis, DIC & hemorrhage

Clinical features Patient feels unwell and agitated back pain and pain at infusion site shortness of breath, rigors hypotension, oliguria and bleeding from venepuncture sites Urinalysis will show haemoglobinuria

Management Discontinue transfusion immediately and remove giving set Check unit of blood against patients identity Give intravenous crystalloid Transfer to ICU Take blood for CBC, haemoglobin, clotting, repeat grouping Monitor urine output

Non-hemolytic transfusion reaction Febrile reaction: - in 0.5% -1% - is usually treated with antipyretic drugs Allergic reaction: in 2-3% manifests by urticaria and rashes Antihistamins, steroids or epinephrine

Transmission of disease-include: Hepatitis HIV Malaria Epstein- bar virus, cytomegalovirus Brucellosis

Other complications • Citrate toxicity • Acidosis • Hyperkalemia