Blood transfusion

It is the process of transferring blood or blood products in the circulatory

system.
Blood transfusion is a treatment arranged by doctor which involves giving
blood or any blood products to the vein.

Blood products

Over 90% of donated blood is separated into various constituents so that

individual components can be administered.
Blood: Cellular components

Product

Red blood cells

White blood cells (granulocytes)
Platelets

Plasma components

Fresh frozen plasma (FFP)

Plasma derivatives

Albumin
Immunoglobulin
Coagulation factors

Indication

Precautions

Storage life

Whole blood

Class III & IV hemorrhage

ABO & Rh

21 days at 4C

Red cell
concentrates
Granulocyte
concentrates

Severe anemia

ABO & Rh

21 days at 4C

Bone marrow depression

<24 hours at
room
temperature

Fresh frozen
plasma

Bleeding due to non-specified ABO

coagulation factor deficiency

1 year at

Platelets
concentrates
Factor VIII
Factor IX
Albumin

Thrombocytopenia
Hemophilia A
Hemophilia B
Hypoalbuminemia

ABO

-30 C
3 days at room
temperature
2 years
4 years

Blood groups
ABO system

Consists of three allelic genes - A, B and O.

A and B genes control synthesis of enzymes that add carbohydrate residues
to cell surface glycoproteins.
Six possible genotypes but only four phenotypes.
Naturally occurring antibodies are found in the serum of those lacking the
corresponding antigen.
ABO blood group system

Phenotype

Genotype

O
A
B
AB

OO
AA or AO
BB or BO
AB

Antigens on red
cells
None
A
B
A,B

Antibodies in
the plasma
Anti A & B
Anti-B
Anti-A
None

Frequency (%)
46
42
9
3

Blood group O Universal donor lacks both A & B antigen, which can be
transfused (as packed RBCs) in limited amounts in emergency cases with little risk
of agglutination.
Blood group AB Universal recipient has neither anti-A or anti-B antibodies,
so he/she can receive A, B, O (packed RBCs).
So,,
Blood group
A
B
AB
O

Can donate blood to

A and AB
B and AB
AB
All groups

Can receive blood from

A and O
B and O
All groups
O

Rhesus system

Rhesus antibodies are immune antibodies requiring exposure during

transfusion or pregnancy.
85% of population are rhesus positive (Rh +ve)
People with Rh-positive blood can get Rh-positive or Rh-negative blood, but
people with Rh-negative blood should get only Rh-negative blood.
90% of Rh-negative patients transfused with Rh-positive blood develop antiD antibodies.

Rhesus incompatibility

A Rh ve mother and Rh +ve father may produce a Rh +ve fetus.

If fetal red cells enter the maternal circulation, Anti-D will be produced
(IgG).
If these IgG antibodies cross the placenta in future pregnancies they will
destroy the fetal red cells, resulting in hemolytic disease of the newborn.
Sensitization can be prevented by administering a single dose of anti- Rh
antibodies in the form of Rh immunoglobulin.

Complications of blood transfusion

Early

Hemolytic reactions
Sepsis
Allergic reactions
Circulatory overload
Acute lung injury
Air embolism
Thrombophlebitis
Citrate toxicity
Hyperkalaemia
Clotting abnormalities

Early Late

Late

Infections
Iron overload
Immune sensitization

Hemolytic reactions

May occur after infusion of small volume of incompatible blood.

Associated with high morbidity and mortality.
Most ABO mismatched transfusions are due to human error.
Usually occurs soon after start of transfusion.
Patient feels unwell and agitated.
Clinically, the patient suffers of chills, fever, headache, backache, dyspnea,
cyanosis, chest pain, tachycardia, and hypotension.

Management

Discontinue transfusion immediately.

Check unit of blood against patients identity.
Consider transfer to the intensive care unit.

Sepsis

Due to administration of contaminated blood.

Manifested by high fever, chills, vomiting, diarrhea, and hypotension.

Management

Stop the transfusion.

Administer IV fluids, Antibiotics.
Obtain a blood specimen from the recipient for culture.

Allergic reactions

Caused by hypersensitivity to infused plasma protein.

Presented by flushing, itching, urticaria, and bronchial wheezing.
Circulatory collapse and cardiac arrest can occur in severe cases.

Management

Stop transfusion.
Administer antihistamines or corticosteroids.

Circulatory overload

Blood administered faster and with higher quantities than the circulation can
accommodate.
Manifested as cough, dyspnea, wheezes, distended neck veins, tachycardia,
and hypertension

Management

Place the recipient upright, with feet dependent.

Stop or slow the transfusion.
Administer diuretics or oxygen as ordered.

Hyperkalemia

Occurs following administration of a prolonged stored blood.

Citrate intoxication

Excess citrate will bind to the recipients calcium leading to hypocalcemia.

Massive blood transfusion can lead to:

Hypothermia.
Coagulation failure (dilutional)
Congestive heart failure.
Hyperkalemia.
Hypocalcemia (due to citrate intoxication).

Infections

HBV, HCV.
HIV.
Syphilis.
CMV.
Malaria (recent travel to malaria endemic region is CI to blood donation).