Blood TransfusionBlood Transfusion

Dr. SabirDr. Sabir

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Blood TransfusionBlood Transfusion

. Types :. Types : 1- whole blood1- whole blood 2- packed RBCs2- packed RBCs 3- fresh frozen plasma3- fresh frozen plasma 4- platelets4- platelets 5- granulocyte transfusion5- granulocyte transfusion 6- cryopercipitate transfusion6- cryopercipitate transfusion

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Fresh Frozen PlasmaFresh Frozen Plasma

. Stored frozen, when thawed to 37. Stored frozen, when thawed to 37ooC should be C should be transfused within 24 hrstransfused within 24 hrs

. unit = 200ml increases the level of each clotting . unit = 200ml increases the level of each clotting factor 2-3%factor 2-3%

. Dose = 10-15 ml\Kg. Dose = 10-15 ml\Kg . Indications : - isolated factor deficiency. Indications : - isolated factor deficiency - warfarin reversal- warfarin reversal - liver disease- liver disease - massive blood transfusion- massive blood transfusion - antithrombin III deficiency when - antithrombin III deficiency when

heparin is needed heparin is needed

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Platelets Platelets . Stored at 20-24. Stored at 20-240 0 C for 5 days (shelf life) , C for 5 days (shelf life) , . Unit 50-70 ml, survival only for 1-7 days. Unit 50-70 ml, survival only for 1-7 days . Each unit increase platelet count by 5000-10,000. Each unit increase platelet count by 5000-10,000 . Side effects :. Side effects : - Rh sensitization- Rh sensitization - Anti A, anti B reaction- Anti A, anti B reaction - HLA typing - HLA typing - proliferating bacteria- proliferating bacteria . Indications :. Indications : a- thrombocytopenia (DIC, massive transfusion, a- thrombocytopenia (DIC, massive transfusion,

prophylactic preop, ITP) prophylactic preop, ITP) b- thrombasthenia (bleeding, prophylactic preop,)b- thrombasthenia (bleeding, prophylactic preop,)

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Transfusion ReactionsTransfusion Reactions

Acute Hemolytic TRAcute Hemolytic TR Non-immune-mediated hemolysisNon-immune-mediated hemolysis Delayed Hemolytic TRDelayed Hemolytic TR Febrile Non-hemolytic TRFebrile Non-hemolytic TR Allergic TRAllergic TR Anaphylactic & anaphylactoid RAnaphylactic & anaphylactoid R Transfusion-related acute lung injuryTransfusion-related acute lung injury Transfusion-associated circulatory overloadTransfusion-associated circulatory overload Metabolic reactionsMetabolic reactions Transfusion-associated GVHDTransfusion-associated GVHD Iron overloadIron overload Post-transfusion hemosiderosisPost-transfusion hemosiderosis AlloimmunizationAlloimmunization Post-transfusion purpuraPost-transfusion purpura Bacterial contamination reactionBacterial contamination reaction Transfusion-transmitted diseasesTransfusion-transmitted diseases

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Signs and Symptoms of AHTR

Chills , fever Facial flushing Hypotension Renal failure DIC Chest pain Dyspnea Generalized

bleeding

Hemoglobinemia Hemoglobinuria Shock Nausea & vomiting Back pain Pain along infusion

vein

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Acute Hemolytic Transfusion ReactionsAcute Hemolytic Transfusion Reactions

Acute onset within minutes or 1-2 hours

after transfuse incompatible blood

Most common cause is ABO-incompatible

transfusion

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Management of AHTRManagement of AHTR

Stop the transfusionStop the transfusion Keep IV fluidKeep IV fluid Notify patient’s physician and blood bankNotify patient’s physician and blood bank Take care of patient Take care of patient Perform bedside clerical checksPerform bedside clerical checks Return unit, set to blood bankReturn unit, set to blood bank Collect appropriate post transfusion bloodCollect appropriate post transfusion blood

sample for evaluationsample for evaluation

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Non-Immune-Mediated HemolysisNon-Immune-Mediated Hemolysis

CausesCauses Physical or chemical destruction ofPhysical or chemical destruction of bood: freezing, heating, drugs bood: freezing, heating, drugs solutions added to bloodsolutions added to blood Bacterial contaminationBacterial contamination

TreatmentTreatment

– depends on the causesdepends on the causesmild reaction mild reaction supportive treatment supportive treatmentsevere reaction severe reaction intensive treatment intensive treatment

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Delayed Hemolytic Transfusion ReactionDelayed Hemolytic Transfusion Reaction

Signs & SymptomsSigns & Symptomsmild fever with chillmild fever with chillmild anemia mild anemia mild to moderate jaundicemild to moderate jaundiceUncommon Uncommon hemoglobinemia, hemoglobinemia,

Hemoglobinuria, shock, renal failureHemoglobinuria, shock, renal failure

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Febrile Nonhemolytic Transfusion ReactionFebrile Nonhemolytic Transfusion Reaction

Signs & SymptomsSigns & Symptoms Fever with or without chillsFever with or without chills most symptoms are mildmost symptoms are mild severe reaction :- hypotension, severe reaction :- hypotension,

cyanosis, tachycardia, tachypnea, cyanosis, tachycardia, tachypnea, dyspnea, cough etc.dyspnea, cough etc.

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Febrile Nonhemolytic ReactionFebrile Nonhemolytic Reaction

Treatment Treatment discontinue blood transfusion discontinue blood transfusion Antipyretic for feverAntipyretic for fever

PreventionPrevention using prestorage leukocyte –reduced red using prestorage leukocyte –reduced red

blood cell or plateletblood cell or platelet

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Allergic Transfusion ReactionsAllergic Transfusion Reactions

Signs & SymptomsSigns & Symptoms

- Urticaria- Urticaria

- severe reactions are rare- severe reactions are rare

Therapy & PreventionTherapy & Prevention

- Antihistamine- Antihistamine

- Plasma – deficient blood - Plasma – deficient blood componentscomponents

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Anaphylactic and Anaphylactoid Anaphylactic and Anaphylactoid reactionsreactions

Signs & SymptomsSigns & Symptoms

- - Anaphylactic Anaphylactic coughing, dyspnea, coughing, dyspnea, nausea, emesis, bronchospasm, flushing of nausea, emesis, bronchospasm, flushing of skin, chest pain, hypotension, abdominal skin, chest pain, hypotension, abdominal cramps, diarrhea, shock, and death.cramps, diarrhea, shock, and death.

- - AnaphylactoidAnaphylactoid (less severe) (less severe) urticaria, periorbital swelling, dyspnea, or urticaria, periorbital swelling, dyspnea, or perilaryngeal edemaperilaryngeal edema

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Anaphylactic and Anaphylactoid Anaphylactic and Anaphylactoid reactionsreactions

Therapy and PreventionTherapy and Prevention Stop transfusionStop transfusion Keep IV line openKeep IV line open Medication :- epinephrine, Medication :- epinephrine,

corticosteroidcorticosteroid Wash RBCs and blood componentsWash RBCs and blood components Transfuse IgA deficiency bloodTransfuse IgA deficiency blood

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Transfusion-related Acute Lung Injury Transfusion-related Acute Lung Injury (TRALI)(TRALI)

Acute and severe type of transfusion reactionAcute and severe type of transfusion reaction

Symptoms and signsSymptoms and signs FeverFever HypotensionHypotension TachypneaTachypnea DyspneaDyspnea Diffuse pulmonary infiltration on X-raysDiffuse pulmonary infiltration on X-rays Clinical of noncardiogenic pumonary Clinical of noncardiogenic pumonary

edemaedema

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Transfusion-related Acute Lung InjuryTransfusion-related Acute Lung Injury (TRALI)(TRALI)

Therapy and PreventionTherapy and Prevention Adequate respiratory and hemodynamic Adequate respiratory and hemodynamic

supportive treatmentsupportive treatment If TRALI is caused by pt. Ab If TRALI is caused by pt. Ab use LPB use LPB If TRALI is caused by donor Ab If TRALI is caused by donor Ab no special no special

blood componentsblood components

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Transfusion-associated Circulatory Transfusion-associated Circulatory Overload Overload (TACO)(TACO)

Patients at significant riskPatients at significant risk ChildrenChildren Elderly patientsElderly patients Chronic anemiaChronic anemia Cardiac diseaseCardiac disease Thalassemia major or Sickle cell Thalassemia major or Sickle cell

diseasedisease

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Symptoms and SignsSymptoms and Signs

DyspneaDyspnea CoughingCoughing CyanosisCyanosis OrthopneaOrthopnea Chest discomfortChest discomfort

HeadacheHeadache RestlessnessRestlessness TachycardiaTachycardia Systolic Systolic

hypertension hypertension increase > 50 increase > 50 mm.Hgmm.Hg

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TherapyTherapy

Rapid reduction of hypervolemiaRapid reduction of hypervolemia Respiratory and cardiac supportRespiratory and cardiac support Oxygen therapyOxygen therapy DiureticDiuretic Therapeutic phlebotomyTherapeutic phlebotomy

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Metabolic ReactionMetabolic Reaction

Citrate toxicityCitrate toxicity HyperkalemiaHyperkalemia HypothermiaHypothermia Coagulopathy in massive transfusionCoagulopathy in massive transfusion Air embolismAir embolism

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Transfusion-associated Graft-versus-HostTransfusion-associated Graft-versus-Host Disease Disease ( TA-GVHD)( TA-GVHD)

Patient at riskPatient at risk

Bone marrow transplantation

Chemotherapy

Radiation treatment

Newborn

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Graft-versus-Host ReactionGraft-versus-Host Reaction

Signs & SymptomsSigns & Symptoms

Onset ~ 3 to 30 days after transfusion Clinical significant – pancytopenia Other effects include fever, liver enzyme,

copious watery diarrhea,

erythematous skin erythroderma

and desquamation

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Graft-versus-Host ReactionGraft-versus-Host Reaction

TherapyTherapy

Drugs :- corticosteroids, methotrexate, azathioprine,Drugs :- corticosteroids, methotrexate, azathioprine,

antithymocyte globulinantithymocyte globulin

But no adequate therapyBut no adequate therapy

PreventionPrevention

Irradiation of Blood Components Irradiation of Blood Components

avoid potential fatalitiesavoid potential fatalities

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Iron overloadIron overload

1 unit of PRCs has ~ 250 mg of Iron

Removed by body 1 mg / day

accumulate iron Hemosiderosis

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Posttransfusion HemosiderosisPosttransfusion Hemosiderosis

Affected organ :- Affected organ :- heart, liver, endocrine glandsheart, liver, endocrine glands

Signs & SymptomsSigns & Symptoms - - muscle weakness, fatigue, weight loss, mild muscle weakness, fatigue, weight loss, mild

jaundice, anemia, mild diabetes, and cardiac jaundice, anemia, mild diabetes, and cardiac arrhythmiaarrhythmia

Therapy Therapy Iron – chelating agent Iron – chelating agent Prevention Prevention transfuse with young RBCs transfuse with young RBCs

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AlloimmunizationAlloimmunization

Signs & SymptomsSigns & Symptomsmild mild slight fever and Hb slight fever and Hbsevere severe platelet refractoriness platelet refractoriness with bleedingwith bleeding

Therapy & PreventionTherapy & Preventiondepends on type and severitydepends on type and severity

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Posttransfusion PurpuraPosttransfusion Purpura

Rare complicationRare complication Rapid onset of thrombocytopenia as Rapid onset of thrombocytopenia as

a result of anamnestic production of a result of anamnestic production of platelet alloantibodyplatelet alloantibody

Usually occurs in multiparous womanUsually occurs in multiparous womanPurpura and thrombocytopenia Purpura and thrombocytopenia occuroccur ~ 1-2 wk after transfusion~ 1-2 wk after transfusion

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Posttransfusion PurpuraPosttransfusion Purpura

Therapy and PreventionTherapy and PreventionCorticosteroidsCorticosteroidsExchange transfusionExchange transfusionPlasmapheresisPlasmapheresis

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Bacterial contamination reactionBacterial contamination reaction

Cause Cause gram –ve, gram +ve bacteriagram –ve, gram +ve bacteria

most frequentmost frequent – – Yersinia enterocoliticaYersinia enterocolitica

PathophysiologyPathophysiology Bacteria growing in cold temperatureBacteria growing in cold temperature

Produced Produced endotoxinendotoxin

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Symptoms & SignsSymptoms & Signs

Acute onset within ~ 30 minAcute onset within ~ 30 min after transfusionafter transfusion

Dryness and flushing skinDryness and flushing skin

Fever, hypotension, shaking chills, muscle pain, Fever, hypotension, shaking chills, muscle pain,

vomitting, abdominal cramps, bloody diarrhea, vomitting, abdominal cramps, bloody diarrhea,

hemoglobinuria, shock, renal failure, and DIC.hemoglobinuria, shock, renal failure, and DIC.

Treatment: broad-spectrum antibioticsTreatment: broad-spectrum antibiotics

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Transfusion – Transmitted DiseasesTransfusion – Transmitted Diseases

Viral InfectionsViral InfectionsHepatitis Viruses :- HBV, HCVHepatitis Viruses :- HBV, HCVRetroviruses :- HIVRetroviruses :- HIVHerpesviruses :- CMV, EBVHerpesviruses :- CMV, EBVParvovirus :- Parvovirus :- Human B19 parvovirusHuman B19 parvovirus

Prion :- infectious particle of CJD Prion :- infectious particle of CJD

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Transfusion – Transmitted DiseasesTransfusion – Transmitted Diseases

Bacterial InfectionBacterial InfectionGram -ve and +veGram -ve and +veSyphilisSyphilisLyme disease Lyme disease

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Transfusion – Transmitted DiseasesTransfusion – Transmitted Diseases

Parasitic InfectionsParasitic Infections– MalariaMalaria– Chagas diseaseChagas disease– ToxoplasmosisToxoplasmosis– LeishmaniasisLeishmaniasis

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Steps to take when a transfusion Steps to take when a transfusion reaction occursreaction occurs

Stop the transfusion immediatelyStop the transfusion immediately Leave the needle in the vein and Leave the needle in the vein and

begin infusing normal salinebegin infusing normal saline Obtain vital signsObtain vital signs Begin OBegin O

22 if pulmonary symptoms are if pulmonary symptoms are

prominentprominent Carry out PE : lung, heart, skin, signs Carry out PE : lung, heart, skin, signs

of abnormal bleedingof abnormal bleeding

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Steps to take when a transfusion Steps to take when a transfusion reaction occursreaction occurs

Obtain a new blood sample for Obtain a new blood sample for repeat RBC compatibility test and repeat RBC compatibility test and inspection for hemolysisinspection for hemolysis

Obtain a urine sample if the patient Obtain a urine sample if the patient can voidcan void

Obtain a chest x-ray if pulmonary Obtain a chest x-ray if pulmonary symptoms are prominentsymptoms are prominent

Begin definitive treatmentBegin definitive treatment