blood transfusion

1. BLOOD TRANSFUSION

2. introduction
• 80% of worlds population has access to only 20% of
the worlds safe blood that is properly collected and
tested.

3. One of the most important difficult tasks of the anesthetist is
to continually monitor and estimate blood loss.
So the most commonly used method for estimating blood
loss is measurement of blood in suction and visually
estimating blood on surgical sponge (10ml) and laparotomy
pads (100-150ml).

4. Blood group
 Human red cell blood are estimated to contain at
least 300 antigenic determinants and 20
separate blood group.
 Fortunately only the ABO and RH systems are
important in majority of blood transfusion.
 Anti bodies may occur naturally or in response to
sensitization from previous exposure

5. ABO system
Almost all individuals not having A or B antigen
naturally produces anti bodies against those
antigens.
Type A anti-B
Type B anti-A
Type AB _
Type O Anti A anti B
In incidence A 45% B 8% AB 4% O 43%.

6. RH system
• There are about 46 RH related antigens but in most clinical
settings the 5 principal antigens (D,C,c,E,e)account for
most issues involving the RH system.
• But only the presence or absence of D antigen is
considered. individuals lacking this are called RH-negative
and will develop antibody against D-antigen after exposure
to RH-positive.

7. compatibility
• Compatibility testing is to predict and prevent antigen-
antibody reaction as a result of red blood cell transfusion.
• Donor and recipient blood are typed and checked with
serum known to have antibodies against A and B to
determine blood type. And also tested with anti-D
antibodies to determine RH.

8. Cross matching
• Assures maximum safety. Performed for elective
procedures in which the probability of success is
high.
• Unlike screening donor cells are mixed with recipient
serum and this mimics the transfusion.
• This confirms ABO and RH typing in less than 5
minutes

9. Pre transfusion practices
• Blood donors are screened to exclude medical
conditions that might adversely affect the donor or
recipient.
• Hematocrit must be determined for donors.
• The blood is collected, typed, screened for
antibodies, tested for hepatitis and HIV.

10. ….. Cont
• Once blood is collected, a preservative anticoagulant
solution is added. The most commonly used is CPDA-1
citrate as an anti coagulant.
• Preserved blood can be stored for 35 days, after which
there viability rapidly decrease. 1unit of whole blood yields
250ml of packet RBC with 70% platelet.

11. … cont
• RBCs are stored at 1-6 degree C But if frozen in
hypertonic glycerol solution they may stay till 10
years.

12. Intra operative
transfusion practice
• Blood transfusion are given to increase oxygen carrying
capacity and intravascular volume.
• Should be given as packed red blood cell. Its ideal for
patients requiring red cells but not volume replacement.
• Surgical patients require volume as well as red cells.
Crystalloids can be infused simultaneously through a
second iv line for volume replacement.

13. • Prior to transfusion each unit should be carefully
checked against the blood bank slip and recipients
bracelet.
• The tube should contain a 170 micro meter filter to
trap any clots or debris.
• The blood should be warmed to 37 degree during
infusion. 2-3 units can cause profound hypothermia

14. RED CELL TRANSFUSION
TRIGGERS
Guidelines for the clinical use of red cell transfusions
• Hgb > 10g/dl – Transfusion is not indicated
• Hgb > 7-10g/dl – Transfuse only if clinically
indicated
• Hgb < 7g/dl – Transfusion is generally indicated

15. Red Cell Transfusion Triggers
cont…..
 Critical Care:
transfuse to maintain Hb >7 g/dl
 Post-chemotherapy:
transfusion threshold of 8 or 9 g/dl
 Radiotherapy:
transfuse to maintain Hb above 10 g/dl
 Chronic anaemia:
Transfuse to maintain Hb just above lowest conc.
not associated with symptoms of anaemia (usually
patients asymptomatic with Hb >8 g/dl)

16. Platelets
• Should be given to patients with thrombocytopenia (pre op
prophylaxis) or dysfunctional platelets in bleeding presence.
• Prophylactic platelet transfusion are also indicated in patients with
lowered platelet count because of an increased risk of spontaneous
haemorrhage.
• minor surgical procedures may be performed in patients with low
platelet count but of normal function.

17. Indications for Transfusion Fresh
Frozen Plasma
Prepared at the time that blood is obtained
from a donor.
Immediate reversal of warfarin effect in the
presence of life threatening bleeding
Acute DIC in the presence of bleeding and
abnormal coagulation results
Massive transfusion and surgical bleeding

18. Indications for Transfusion
Cryoprecipitate
• Contains all plasma protiens
• Acute DIC where there is bleeding and fibrinogen
level <1g/l
• Bleeding associated with thrombolytic therapy
causing hypofibrinogenaemia

19. Massive blood loss
Aim of treatment:
- restore adequate blood volume
- maintain blood composition within safe limits
Stem bleeding surgically
Use RBC’s, crystalloids / colloids to maintain
BP / BV / HB >7g/dl

20. Massive Transfusion Guidelines
Acute blood loss – Guidelines for clinical use of red cell
transfusions
Maintain circulating blood volume and Hb conc. >7g/dl in otherwise fit
patients & >9g/dl in older patients and those with known cardiovascular
disease
15-30% loss of blood volume (800-1500ml in an adult): transfuse
crystalloids or synthetic colloids. Red cell transfusion is unlikely to be
necessary.
30-40% loss of blood volume (1500-2000ml in an adult): rapid
volume replacement is required with crystalloids or synthetic colloids. Red cel
transfusion will probably be required to
maintain recommended Hb levels.
>40% loss of blood volume (>2000ml in an adult):
rapid volume replacement including red cell transfusion is required.

21. Massive bleed procedure
• Administer crystalloids / colloids until 1500ml loss of
blood
• Inform blood bank – degree of urgency
• Samples collected for cross matching and clotting.

22. 2 x O Rh (D) negative units available - always inform
blood bank
ABO Rh (D) group specific blood available 10 mins.
after sample arrives in blood bank
Medical staff must accept full responsibility for
administration of un-crossmatched blood
X-matched blood available after 40 mins.
Monitor FBC & clotting (inc. fibrinogen) to guide
blood component therapy

23. Taking Blood Samples
Only 1 patient at a time.
Identify the correct patient.
Confirm identification.
Full name.
sex
Address.
Date of birth.
Check the wristband with the request form.

24. Taking Blood Samples
Take the blood.
At the bedside label the sample bottle,using ink
First name
DOB
Hospital Registration Number (or casualty no.)
Date
Signature of person taking blood

25. DO NOT!
Do not ask someone else to label the sample.
Do not label the sample prior to phlebotomy.
Do not leave the bedside until you have labelled
the sample tube.
Do not use pre-printed labels to label the sample
tube.
Do not use the form details to label the sample
tube.

26. PRESCRIBING
Prescription chart must contain:
- Full patient identification details i.e
full name, date of birth, hospital
number
Must specify:
- Blood product to be administered, quantity,
duration and special instructions

27. Serious Adverse Reactions
ACTION
• Stop transfusion immediately
• Take down blood product / giving set
• Maintain IV access with infusion of 0.9% sodium
chloride
• Treat patient
• Inform Blood Bank

28. summary
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