上海交通大学瑞金临床医学院 外科教研室

Blood Transfusion

History Type of Transfusion Indication Transfusion Reactions Autologous transfusion Component Transfusion Blood Transfusion

History and Significance

Lower Lower (1665) First blood transfusion

Philip (1825) First human blood transfusion

Landsteiner (1900) Discovery of ABO type

How to store blood longer? World war I

Is there any suitable Blood Substitutes World war II

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

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

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

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

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

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)

-- 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

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

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

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

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

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

Urticaria Abdominal cramps Dyspnea Vomiting Diarrhea Anaphylactic reactions ： Transfusion Reactions

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

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

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

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

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

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

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

Contamination: Fever Shock DIC Bacterial Contamination Reasons ： Transfusion Reactions

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

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

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 ：

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

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 ：