blood transfusion by dr.syed alam zeb

BLOOD TRANSFUSIONBLOOD TRANSFUSION

Dr. Syed Alam ZebSurgical B,Kth Peshawar

THE DISCOVERY OF BLOOD THE DISCOVERY OF BLOOD GROUPSGROUPS

In 1901 Sir Austrian Karl Landsteiner discovered blood groups.

He was awarded nobel prize for this discovery in 1930.

WHAT IS BLOOD MADE OF?WHAT IS BLOOD MADE OF?

RBCs WBCs PLATELTS PLASMA

BLOOD GROUPINGBLOOD GROUPING

ABO & Rh System. ABO group depends

which antigen is on the RBC & what antibody is in plasma.

ABO BLOOD GROUPSABO BLOOD GROUPS

Blood group A: They have A antigen on cell surface and B antibody in plasma.

ABO BLOOD GROUPSABO BLOOD GROUPS

Blood group B: They have B antigens on cell & A antibody in plasma.

ABO BLOOD GROUPSABO BLOOD GROUPS

Blood group AB: They have both the A & B antigens on cell surface and no anti-body in plasma.

ABO BLOOD GROUPSABO BLOOD GROUPS

Blood group O: They have no antigen on cell surface but have both A & B antibodies in plasma.

RH factor grouping:RH factor grouping:

Rh+ : n They have Rh antigen on RBC surface but don’t have Rh antibody.

RH factor groupingRH factor grouping

Rh-ve: They don’t have Rh antigens on cells & normally don’t have Rh antibodies BUT they develop Rh antibodies if trasfused with RH +ve blood.

RH factor groupingRH factor grouping

Rh-ve cant receive blood from Rh+ve.

Rh+ve can receive blood from Rh-ve.

BLOOD GROUP NOTATIONBLOOD GROUP NOTATION

A Rh +ve B Rh +ve AB Rh +ve O Rh +ve

A Rh -ve B Rh -ve AB Rh -ve O Rh -ve

WHO CAN RECEIVE BLOOD FROM WHO CAN RECEIVE BLOOD FROM WHOMWHOM

BLOOD GROUP

Antigens Antibody Can give blood to

Can receive blood from

AB A & b None AB AB,A,B,O

A A B A & AB A & O

B B A B & AB B & O

O None A & b AB,B,A,O

O

People with group O are universal donors and those having group AB are universal acceptors.

INDICATIONS FOR BLOOD INDICATIONS FOR BLOOD TRANSFUSIONSTRANSFUSIONS

Severe blood loss in trauma or from pathological lesion like bleeding ulcer.

During major operative procedures.Severe burns.Severe anemia preoperatively.Severe anemia postoperatively.Surgery on hemophiliacs or

thrombocytopenics.

PREPARATION OF BLOOD PRODUCTS PREPARATION OF BLOOD PRODUCTS FOR TRANSFUSIONFOR TRANSFUSION

Donor should be fit & screened.Blood is collected in sterile bags.Donor is lying on a couch, median cubital

vein is cannulated.410 ml of blood is run in to a bag

containing 75 ml of anticoagulant solution.Blood is constantly mixed with

anticoagulant to prevent clotting.

BLOOD STORAGEBLOOD STORAGE

Blood products must be stored at 4C +- 2C.Stored blood has a shelf life of 3 weeks.After a storage time of 24-72 hr RBCs have

reduced capability to release oxygen to tissues.

If the patient needs massive transfusions its better to give blood that’s less than 7 days old.

BLOOD PRODUCTSBLOOD PRODUCTS

Packed Red cells: They are advised for elderly, chronic anemia's, patients in CCF or small children. Packed cells are obtained by centrifugation.

Platelet concentrates: Platelets rarely survive in stored blood for more than 24 hrs. If separated by centrifugation can survive for 72 hrs.

BLOOD PRODUCTSBLOOD PRODUCTS

White blood cells: They are rapidly destroyed in the stored blood.

Plasma: This is removed after centrifugation of whole blood & may be further processed or fractionated.

BLOOD PRODUCTSBLOOD PRODUCTS

Human Albumin 4.5%: Obtained by repeated fractionation of plasma followed by heat treatment.It can then be stored for months.

Fresh-frozen plasma: Removed from fresh blood & stored at –40 to –50C. It’s a good source of coagulation factors. Used when doing surgery on cirrhotics, hemophiliacs or patients having Christmas disease.

BLOOD PRODUCTSBLOOD PRODUCTS

Cryoprecipitate: Allow FFP to thaw at 4C, the supernatant plasma is removed to obtain the precipitate. It’s a rich source of factor VIII & fibrinogen.

Factor VIII & factor IX concentrates: They are available in fresh dried form.

AUTOTRANSFUSIONAUTOTRANSFUSION

Transfusion with patient’s own blood. Used in emergency situations. Blood is collected from abdominal cavities,

filtered and transfused. For a planed elective procedure patient can donate

his own blood 3 weeks in advance to be transfused later on.

Minimal chances of disease transmission and reactions.

COMPLICATIONS OF BLOOD COMPLICATIONS OF BLOOD TRANSFUSIONSTRANSFUSIONS

CCFTransfusion reaction.Transmission of infections.Thrombophlebitis.Air embolism.Coagulation failure.

Hemolytic ReactionsHemolytic Reactions

Most serious complication due to ABO incompatibility ie transfusion of wrong blood group.

Symptoms include apprehension, headache, fever, chills, pain at the injection site or pain in the back, chest & abdomen.

Symptoms in anesthetized patients are changes in the vital signs & spontaneous bleeding from different sites.

Hemolytic Reactions cont:Hemolytic Reactions cont:

There is hemoglobinuria & oliguria.Free hemoglobin can be detected in plasma

in minutes.Coombs test becomes positive.Treatment is with diuretics ie mannitol iv

infusion; 12.5 g is administered in 3-5 min, followed by cont. infusion to have a urinary out put of 60 ml/hr.

Pyrogenic ReactionsPyrogenic Reactions

Fever is the most common immediate transfusion reaction.

Recipient reaction against white cells in the donor blood.

Treated with antipyretics.Leucocytes-poor blood is considered for

patients with repeated pyretic reactions.

Allergic ReactionsAllergic Reactions

Symptoms are itching, urticaria and bronchospasm.

Usually mild but can be fatal.There is antigen, antibody reaction between

the proteins I the donor plasma & a corresponding antibody in the patient.

Treated with anti-histamines and corticosteroids.

INFECTIONS TRANSMISSIONINFECTIONS TRANSMISSION

Viral hepatitis: Hepatitis B and C can be transmitted through blood. The risk through screened blood is 1:63,000 per unit for B and from 1: 1,00,000 to 1: 500,000 for C. About half will develop chronic liver disease.

INFECTIONS TRANSMISSION cont:INFECTIONS TRANSMISSION cont:

HIV : Improved screening has reduced the transmission of HIV to about 1 in500,000 per unit. Hemophiliacs are especially at risk because of the repeated required transfusions.

Bacterial infections: If blood is left in a warm room for hours bacteria grow in it and can result in severe septicemia in the recipient.

INFECTIONS TRANSMISSION contINFECTIONS TRANSMISSION cont

Malaria: The disease can be transmitted through blood transfusions in endemic areas.

The donor should be screened and treated before donating blood.

In emergency situations the recipient should get prophylactic antimalarials.

Rare ProblemsRare Problems

Thrombophlebitis. Coagulation failure: When large volumes of store

blood is used for replacement. Old blood is deficient in platelets, factor VIII& factor V.

DIC: Occurs after incompatible ABO transfusion or after massive transfusions. Its treated with FFP, cryoprecipitate & platelets concentrates.

HAEMOPHILIAHAEMOPHILIA

Congenital deficiency of factor VIII. X-linked, only men are affected. Patient presents with epistaxis, gums bleed,

swollen joints. Treatment is with fresh blood, FFP, factor VIII

concentrates to bring the factor VIII levels to 20%. Surgery on hemophiliacs is possible if the factor

VIII levels are raised to >50% .

CHRISTMAS DISEASECHRISTMAS DISEASE

Hemophilia B.Congenital deficiency of factor IX.

(Christmas Factor).Presentation is similar to hemophilia.Treatment is FFP, dried concentrates of

human factor IX.

Von Willibrand’s DiseaseVon Willibrand’s Disease

Low plasma levels of factor VIII compliment, factor VIII related antigen and abnormal platelets.

Patient has episodic bleeding manifestations.

THANKS