Blood transfusion involves receiving blood products intravenously from donors. The history of blood transfusion began in the 17th century with animal-human transfusions. Key developments included the discovery of blood groups in 1901 and identification of the Rhesus system in 1939. Indications for transfusion include acute blood loss, perioperative anemia, and symptomatic chronic anemia. Complications can include hemolytic reactions, febrile reactions, allergic reactions, infections, and transfusion-related lung injury. Proper blood typing and cross-matching is essential to prevent hemolytic transfusion reactions from incompatible blood groups.

1. Blood Transfusion
Prepared by :
Salar N. Sulaiman
Supervised by :
Dr. Dildar H. Musa

2. Objectives
• Introduction
• Bleeding
Types ,Classification , Management
• Blood transfusion
History
Definition
Indications
Blood products
Complications
Management of complications

3. Introduction
The transfusion of blood and blood products has become commonplace
since the first successful transfusion in 1818.
Although the incidence of severe transfusion reactions and infections is
now very low,
in recent years it has become apparent that there
is an immunological price to be paid from the transfusion of heterologous
blood,
leading to increased morbidity and decreased
survival in certain population groups (trauma, malignancy).

4. Hemorrhage
• Is blood escaping from the circulatory system.
• Bleeding can occur internally, where blood leaks
from blood vessels inside the body, or externally.

5. • Haemorrhage must be recognized and managed aggressively to
reduce the severity and duration of shock and avoid death and/or
multiple organ failure.
• Haemorrhage is treated by arresting the bleeding, and not by fluid
resuscitation or blood transfusion

6. • although necessary as supportive measures to maintain organ
perfusion.

7. Types
According:
• Obvious
• Onset
• Surgical or non surgical

8. Revealed haemorrhage :
• Is obvious external haemorrhage,
• Such as exsanguinations
• From an open arterial wound or
• From massive haematemesis
• From a duodenal ulcer

9. Concealed haemorrhage
• Is contained within the body cavity
• And it must be suspected, actively investigated and controlled.
• In trauma, hemorrhage may be concealed within the chest,
abdomen, pelvis or retro peritoneum or in the limbs, with contained
vascular injury or associated with long-bone fractures.

10. According to onset
• Primary haemorrhage is haemorrhage occurring
immediately as a result of an injury (or surgery).
• Reactionary haemorrhage is delayed haemorrhage (within
24 hours) and is usually caused by dislodgement of clot by
resuscitation , normalisation of blood pressure and
vasodilatation. Reactionary haemorrhage may also result
from technical failure such as slippage of a ligature.
• Secondary haemorrhage is caused by sloughing of the wall
of a vessel. It usually occurs 7–14 days after injury and is
precipitated by factors such as infection, pressure necrosis
(such as from a drain) or malignancy

11. • Surgical haemorrhage is the result of a direct injury and is amenable
to surgical control (or other techniques such as angioembolisation).
• Non-surgical haemorrhage is the general ooze from all raw
surfaces due to coagulopathy; it cannot be stopped by surgical means
(except packing) but requires correction of the coagulation abnormalities

12. Degree and Classification :
• The adult human has approximately 5 liters of blood
(70 ml /kg children and adults, 80 mL/kg neonates).
• Estimation of the amount of blood that has been lost is
difficult, inaccurate and usually underestimates the
actual value.

13. • Hemorrhage is broken down into four classes by the American College of
Surgeons' advanced trauma life support (ATLS) :
• Class I Hemorrhage involves up to 15% of blood volume
• Class II Hemorrhage involves 15-30% of total blood volume
• Class III Hemorrhage involves loss of 30-40% of circulating blood volume
• Class IV Hemorrhage involves loss of >40% of circulating blood volume

14. Management
• Identify haemorrhage
• Immediate resuscitative manoeuvres
• Identify the site of haemorrhage

15. identify the exact location but rather to define the next step in
haemorrhage control (operation, angioembolisation, endoscopic
control).
Clues may be in the history (previous episodes; known
aneurysm; non-steroidal therapy for gastrointestinal bleeding) or
examination (nature of blood: fresh, melaena; abdominal
tenderness; etc.).
For shocked trauma patients the external signs of injury may
suggest internal haemorrhage, but cavitary haemorrhage
must be excluded with rapid investigations (chest and
pelvic radiography, abdominal ultrasound or diagnostic peritoneal
aspiration)

16. Blood Transfusion
• Is defined as the process of
receiving blood product into one’s circulation
intravenously.
• Transfusion usually involve the use of two sources of
blood , one’s own (Autologous Transfusion) or
someone’s else (Allogenic Transfusion)

17. History
1492 Pope Innocent VIII suffers a stroke and receives a
bloodtransfusion from three ten-year-old boys (paid a
ducat
each). All three boys died, as did the pope later that year
1665 Richard Lower in Oxford conducts the first
successful
canine transfusions
1667 Jean-Baptiste Denis reports successful sheep–
human
Transfusions
1678 Animal–human transfusions are banned in France
because of the poor results
1818 James Blundell performs the first successful
documented human transfusion in a woman suffering
post-partum haemorrhage. She received blood from her
husband and Survived
1901 Karl Landsteiner discovers the ABO system
1914 The Belgian physician Albert Hustin performed the
first non-direct transfusion, using sodium citrate as an
Anticoagulant
1926 The British Red Cross instituted the first blood
transfusion service in the world
1939 The Rhesus system was identified and recognised
as the major cause of transfusion reactions

18. Indications for blood transfusion
Blood transfusions should be avoided if possible, and many
previous uses of blood and blood products are now no longer
considered appropriate use.
The indications for blood transfusion are as follows:
• acute blood loss, to replace circulating volume and maintain
oxygen delivery;
• perioperative anaemia, to ensure adequate oxygen delivery
during the perioperative phase;
• symptomatic chronic anaemia, without haemorrhage or
impending surgery.

19. Perioperative red blood cell transfusion criteria
Haemoglobin level (g/dL)
• <6
• 6-8
• >8
Indications
• Probably will benefit from
transfusion
• Transfusion unlikely to be of
benefit in the absence of bleeding
or impending surgery
• No indication for transfusion in the
absence of other risk factors.

20. Blood and blood products
Blood is collected from donors who have been previously
screened before donating, to exclude any donor whose blood
may have the potential to harm the patient or to prevent possible
harm that donating a unit of blood may have on the donor

21. Whole blood
Consists of RBC ,platelets ,plasma , anticoagulants and preservative
When stored it loses clotting factors and release potassium
Indication : to treat acute, massive blood loss but is rarely given.
Instead crystalloid and colloid solutions , red blood cells or other blood
components are usually given.
Contraindication : adequate blood volume, availability of specific
component.

22. • Cross match necessary? Yes must be ABO identical
• Standard unit volume : 400 to 500 ml
• Rate of Administration :
Adult : no more than 4 hours
Child : no more than 4 hours,
With the amount of blood infused and the rate of infusion dependent on
the child’s age size and condition.

23. Packed red cells
Packed red blood cells are spun-down and concentrated packs
of red blood cells. Each unit is approximately 330 mL and
has a haematocrit of 50–70 per cent. Packed cells are stored
in a SAG-M solution (saline–adenine–glucose–mannitol) to
increase shelf life to 5 weeks at 2–6°C. (Older storage regimens
included storage in CPD – citrate–phosphate–dextrose solutions
which have a shelf life of 2–3 weeks.)

24. Red blood cells
• Indications :
• Packed : blood loss and anemia
• To prevent febrile reaction from leukocyte antibodies
• To reduce the risk of febrile, non hemolytic transfusion reactions
• To prevent graft versus host disease in immunocompromised
patients
• Contraindication : anemia due to nutritional deficiency such as folic
acid iron vitamin B12
• Cross match necessary? Yes must be ABO identical

25. Fresh-frozen plasma
Fresh-frozen plasma (FFP) is rich in coagulation factors and is
removed from fresh blood and stored at −40 to −50°C with a
two-year shelf life. It is the first-line therapy in the treatment of
coagulopathic haemorrhage . Rhesus D-positive FFP may be given to a rhesus
D-negative woman although it is possible for seroconversion to
occur with large volumes due to the presence of red cell fragments,
and rhesus D immunization should be considered

26. Plasma
• Plasma : separated from red cells and frozen within 6 h after
collection
• Contains : plasma proteins , fibrinogen and factor V,VIII and IX
along with water ,electrolyte ,sugar ,proteins ,vitamins ,minerals ,
hormones and antibodies.
• Indication : to increase level of clotting factors , single factor def.
• Contraindications : when the specific components is available , for
nutritional supplementation or volume expansion
• Cross match necessary? Yes must be ABO identical
• Standard unit volume : 185 to 225 ml
• Rate of Administration: infused rapidly 10 to 20ml over 3 minutes or
infused slowly

27. Cryoprecipitate
• Cryoprecipitate is a supernatant precipitate of FFP and is rich
in factor VIII and fibrinogen. It is stored at −30°C with a two year
shelf life. It is given in low fibrinogen states or factor VIII
deficiency ,von Willbrand’s disease , hypofibrinogenemia or factor
XIII deficiency
• Contraindications : undefined coagulation deficiency
• Standard unit volume : 5-20 ml depending on preparation
method
• Cross match necessary? Yes must be ABO identical
• Rate of administration : rapidly 1-2ml per min
• Complication : Infection , allergy

28. Platelets
• Platelets are supplied as a pooled platelet concentrate and
contain about 250 × 10’/L. Platelets are stored on a special
agitator at 20–24°C and have a shelf life of only 5 days.
• Indications :
Platelet transfusions are given to patients with thrombocytopenia
or with platelet dysfunction who are bleeding or undergoing
surgery, prophylactically for platelet counts less than 10000 or
20000 per microliter and also given for aplastic anemia
Contraindications : Immune thrombocytopenic purpura unless
there is Life-threatening bleeding, bleeding not related to
decreased or abnormal platelets,von willbrand’s disease
• Cross match necessary? ABO compatibility preferred
• Standard unit volume : 50 to 70 ml
• Rate of administration : may be infused rapidly 1unit in 10
mins, must be infused within 4 hours

29. Prothrombin complex concentrates
• Prothrombin complex concentrates (PCC) are highly purified
concentrates prepared from pooled plasma. They contain factors
II, IX and X. Factor VII may be included or produced separately.
It is indicated for the emergency reversal of anticoagulant (warfarin)
therapy in uncontrolled haemorrhage
Autologous blood
It is possible for patients undergoing elective surgery to predonate
their own blood up to 3 weeks before surgery for retransfusion
during the operation. Similarly, during surgery blood can
be collected in a cell saver; this washes and collects red blood
cells, which can then be returned to the patient

30. Blood groups and cross-matching
• Human red cells have on their cell surface many different antigens.
Two groups of antigens are of major importance in surgical
practice – the ABO and rhesus systems

31. Cross-matching
The recipient’s serum is then mixed with
the donor’s cells to confirm ABO compatibility and to test for
rhesus and any other blood group antigen–antibody reaction.
Full cross-matching of blood may take up to 45 minutes in
most laboratories.
In more urgent situations, ‘type specific’ blood
is provided which is only ABO/rhesus matched and can be issued
within 10–15 minutes. Where blood must be given emergently,
group O (universal donor) blood is given (O− to females, O+
to males).

32. Complications of blood transfusion
• Complications from blood transfusion can be categorized as
those arising from a single transfusion and those related to massive
transfusion.
Complications from a single transfusion :
• incompatibility haemolytic transfusion reaction
• febrile transfusion reaction
• allergic reaction
• infection
– bacterial infection (usually due to faulty storage)
– hepatitis
– HIV
– malaria
• air embolism
• thrombophlebitis
• transfusion-related acute lung injury (usually from FFP).

33. Complications of blood transfusion
Complications from massive transfusion include:
• coagulopathy
• hypocalcaemia
• hyperkalaemia
• hypokalaemia
• hypothermia.

34. Transfusion reactions
If antibodies present in the recipient’s serum are incompatible
with the donor’s cells, a transfusion reaction will result. This
usually takes the form of an acute haemolytic reaction.
Febrile transfusion reactions are non-haemolytic and are
usually caused by a graft-versus-host response from leukocytes
in transfused components. Such reactions are associated with
fever, chills or rigors. The blood transfusion should be stopped
immediately.

35. Classification
• Acute (Immediate) reaction :
Symptoms appear within minutes or up to first 24 hours
after transfusion
• Delayed reaction :reactions occur more than 24 hours
following transfusion
(sometimes up to months)

36. Acute hemolytic Reaction
• Causes :
• Due to rapid transfused RBC destruction by performed recipient
Abs
• mostly due to ABO incompatibility – typically type O receiving non O
blood group
• IgM mediated complement fixation
• Clerical and procedural errors
• Complication :
• DIC,shock,Death

37. • Clinical Features :
Fever, flank pain, reddish brown urine
Acute renal failure
Early signs are : anxiety , pain at infusion site , back or chest pain
DIC can be presenting mode
• Management :
• Primary concerns :
Treatment of hypotension , promotion of renal blood flow
to prevent renal failure

38. • Stop transfusion
• Infuse normal saline , promote diuresis (frusemide)
• Supportive care : ABC
• Cardiac monitoring
• Management of DIC :
Heparin ,FFP ,Platelets ,cryoprecipitate

39. Febrile Non hemolytic transfusion reaction
• Definition :
• 1 C temperature rises associated with transfusion, no medical explanation
other than blood transfusion
• Clinical Features :
Fever after 30-90 mins , +/- rigors and headache

40. Management
• If temperature <40 + stable patient :
• Stop transfusion
• Antipyretic paracetamol
• Check the bag and cross match
• Exclude red urine or red plasma
• Resume transfusion at a slower rate
• If recurrent : leucodepleted transfusion in the future
• If temperature >40 + unstable patient :
• Stop transfusion
• Manage as possible acute hemolytic reaction
• till lab confirmation and exclusion

41. Anaphylactic reactions
• Life threatening condition :
• Occurs within a few seconds to minutes following transfusion of a
few ml of blood
• Clinical features :
• SOB and respiratory distress due to bronchospasm
• Cyanosis ,vomiting , cough, hypotension, convulsion , chest
tightness
• Initially mild (urticaria) but can progress to loss of consciousness
and shock in rare cases death

42. Mechanism
• Presence of class specific IgG and anti
IgA Abs in patient who are IgA def.
• Incidence :
1 in 20000-50000

43. Management
• Stop transfusion
• Keep IV line open
• Epinephrine IM or IV drip
• Steroids
• Antihistamines
• Supportive Rx : ABC

44. References
• Bailey And Love's Short Practice of
Surgery
• Pocket assessment guide
• Wikipedia