1. Ismail M. Siala

2. By the end of this talk you should be able to: 1- Understand the blood components and plasma derivatives. 2- Indications of blood transfusion 3- Time limits of blood transfusion. 4- Preparing the patient for transfusion. 5- How to monitor blood transfusion. 6- Diagnosis and management of common transfusion reactions.

3. Whole Blood Plasma Platelets Packed RBCs

4. Definition: Definition: Any therapeutic substance made from human blood.

6. Haemorrhage. Anaemia causing severe symptoms. Thrombocytopenic bleeding Coagulation disorders Hypofibrinogenemia Haemorrhage. Anaemia causing severe symptoms. Thrombocytopenic bleeding Coagulation disorders Hypofibrinogenemia

8. The donated blood should be tested for: 1- Blood Grouping (ABO, RhD)2- Infection Screen (Safety Testing) Hepatitis B Hepatitis C HIV Others relavant to area Syphilis HTLV Malaria Etc…

9. Storage Temperature Shelf Life Whole Blood and Red Cell Concentrate 2-6 o C35 days Platelet Concentrate 22 o C5 days Fresh Frozen Plasma- 30 o C12 months

10. Collect Blood Screen for infection Blood group Store blood

11. Clinical ConditionBlood Product Type HaemorrhageWhole Blood/ packed cells + colloid Symptomatic AnaemiaPacked Red Blood Cells Bleeding due thrombocytopeniaPlatelet Transfusion HypovolemiaPlasma Coagulation DefectsFresh Frozen Plasma/Cryoprecipitate

16. Complete infusionStart infusion Whole blood\ Red cells ImmediatelyPlatelet concentrates immediately Fresh frozen plasma Cryoprecipitate

18. Large volume rapid transfusions; Exchange transfusion in infants. Patients with clinically significant cold agglutinins. Large volume rapid transfusions; Exchange transfusion in infants. Patients with clinically significant cold agglutinins.

19. Positively identify patient at the bedside Check the blood pack again. Make sure that the iv line is patent and not infected Record in the patients file The indication of transfusion. The type of blood product requested. Number of units. The time of start the transfusion The patient vital signs before starting transfusion.

20. 0 15min 1hr 2hr 3hr 4hr

21. Monitor all patients closely for the first 15 minutes 15 Severe reactions most commonly present during the first 15 minutes of a transfusion. 4 hours Complete transfusion of whole blood or packed cells within 4 hours. Monitor all patients closely for the first 15 minutes 15 Severe reactions most commonly present during the first 15 minutes of a transfusion. 4 hours Complete transfusion of whole blood or packed cells within 4 hours.

25. While transfusion is running, the patient became anxious, dyspnic. His pulse is raised and he started running fever. He suffered an acute transfusion reaction. How to manage him?

27. CBC.Urea/creatinine/electrolytes. Repeat blood grouping and cross matching. Blood culture. LFT LDH Haptoglobin Hemoglobinaemia Coagulation screen Urine for hemoglobinuria Screening for hemolysis: Arterial Blood Gas sample Chest X ray Screening for heart failure and transfusion related lung injury:

28. Hemoglobinemia Hemoglobinuria  LDH  Bilirubin  Haptoglobin  BUN, Cr. in ARF Positive culture of the blood pack. Raised JVP Chest X ray suggesting pulmonary edema. Hypoxia Normal/Low JVP Chest X ray suggesting pulmonary edema. Hypoxia

30. Common reaction Causes: – Alloimmunisation to HLA antigens – Bacterial contamination of blood component Common reaction Causes: – Alloimmunisation to HLA antigens – Bacterial contamination of blood component Definition: ~1 o C rise in temperature and/or chills with no evidence of hemolysis.

31. Risk of bacterial growth ↑ with the increase in time out of refrigerator  Risk in platelet concentrate is higher

32. A 32 year patient developed severe itching during blood transfusion. Associated with the development of rash. There was no fever and patient did not look ill. What Happened?

33. Signs/Symptoms – Pruritis-itching – Urticaria – upper trunk and neck Signs/Symptoms – Pruritis-itching – Urticaria – upper trunk and neck 1-3% of transfusions Management: – Slow/Stop the transfusion rate – Administer iv antihistamines e.g chlorpheniramine 10 mg iv slowly – If no further progression after 30 mins transfusion may proceed normally Prevention: Prevention: prophylactic antihistamines

34. Rare More likely to occur with: – Rapid transfusion – Fresh frozen plasma Occurs within minutes Clinical features;  Cardiovascular collapse  hypotension  Respiratory distress, bronchospasm  Angioedema  Abdominal pain.  NO fever Fatal if not managed urgently and aggressively. Rare More likely to occur with: – Rapid transfusion – Fresh frozen plasma Occurs within minutes Clinical features;  Cardiovascular collapse  hypotension  Respiratory distress, bronchospasm  Angioedema  Abdominal pain.  NO fever Fatal if not managed urgently and aggressively.

35. May occur when: – Too much fluid is transfused – Too rapid transfusion – Impaired renal function. It is more likely to occur in; – Chronic severe anaemia – Cardiovascular disease – Young children and elderly It will result in: – Heart failure/pulmonary oedema May occur when: – Too much fluid is transfused – Too rapid transfusion – Impaired renal function. It is more likely to occur in; – Chronic severe anaemia – Cardiovascular disease – Young children and elderly It will result in: – Heart failure/pulmonary oedema Prevention: – Monitoring fluid balance – Diuretics with infusion – Slow transfusion Usually 4 hours, can be extended to 6 hours Prevention: – Monitoring fluid balance – Diuretics with infusion – Slow transfusion Usually 4 hours, can be extended to 6 hours

36. A 54 year old man, who received blood transfusion for a symptomatic anemia. He received one unit of packed cells and was discharged immediately after finishing the transfusion. 2 hours later the patient was brought in a serious condition with sever dyspnea, he was cyanotic and hypotensive. He was transferred immediately to intensive care unit for management. His chest X ray is shown. Unfortunately, the patient died 30 minutes after arrival to ICU. Could you explain what happened? Is there a way to avoid it?

37. Donor’s plasma Ab reaction with patient’s leucocytes. Presents within 1-4 hours from starting transfusion. Onset of acute dyspnea Diffuse opacity on chest x-ray Donor’s plasma Ab reaction with patient’s leucocytes. Presents within 1-4 hours from starting transfusion. Onset of acute dyspnea Diffuse opacity on chest x-ray

38. A 29 year old patient who has aplastic anemia and is on regular blood transfusion. He was admitted to receive blood and he received 2 units of packed red cells one from his sister and the other from his brother. He was discharged in a good general condition. Three weeks later he was brought to the emergency room ill with fever, diarrhea, vomitting and maculopapular rash allover his body. This was progressed to the lesions shown on the picture. What could be the problem of this patient?

39. Transfusion Related Graft Versus Host Disease

40. Rare 0.1-1% Almost always fatal 80-90% May occure 4-30 days post transfusion. Rare 0.1-1% Almost always fatal 80-90% May occure 4-30 days post transfusion.

41. Transfusion from 1 st Degree relative Homozygous for HLA Haplotype Hiterozygous for HLA Haplotype

42. A 46 year old female, previously healthy. No past history of any illness before. History of blood transfusion 18 years ago following a post partum hemorrahge. Now presented with fatigue, abdominal distension. Clinically she has ascites Ultrasound examination: cirrhotic liver, portal hypertension and ascites Her hepatitis C virus test was positive. Could her hepatitis be explained by her blood transfusion 18 years ago?

43. yes, hepatitis could be a delayed complication of blood transfusion.

44. Hepatitis B AIDS Hepatitis c others Hepatitis B AIDS Hepatitis c others It can be early or late Risk of transmission is low with pre transfusion screening but it is not zero Bacterial contamination may rarely occur causing very severe and often lethal transfusion reactions Test for contamination of platelet units may reduce the risk

45. Transmission of infection Graft Versus Host Disease