TRANSFUSION OF BLOOD AND

RED CELLS
 General consideration
• Blood donation: avoid adverse effect
Autolog donation
directed donation
apharesis donation
• Expiration of stored blood component
RBC : 21-42 days Whole blood 21-35
• Effect of storage on blood component
 Determination of compatibility
• Test performed :
ABO/Rh,
antibody screen
Type and screen
Cross match
• Determination of compatibility
• Audit/review
 STORAGE AND PRESERVATION
• Erythrocyte are storage by liquid storage
at 4C or by frozen storage at -80C or -
150C
• Preservative solution: glucose,citrate,
phosphate, adenin
• Storage lesion: reduced ATP level, 2,3
biphoshoglycerate level, potassium leaks
• Frozen storage : require cryoprotective
agent to avoid hemolysis (glycerol)
 WHOLE BLOOD PREPARATION
• 1 U = 435-500 ml blood and 14-15 ml
preservative-anticoagulant per 100 ml.
• Blood collected with CDP-adenin may be
used after storage up to 35 days
• Very few indication: symptomatic deficit in
oxygen carrying capacity
• 1 U of RBC increases Hg by 1 g/dL
 FRESH BLOOD
• Stored blood  platelet decreases in 48
hours, depletion of FV, VIII, IX
• Fresh blood is required in certain condition

PACKED RED CELL

• PRC can be prepared from stored blood
by centrifugation and removal of plasma
• PRCs and electrolyte solutions are as effective
as whole blood
 Leukocyte-poor RBC
• Best prepared by passing PRC or blood
cells through a special filter that remove
the leukocytes/ filtration
• Used to prevent non hemolytic febrile
reaction in previously sensitized patients,
to minimized transmission of viral disease,
and in patients awaiting kidney transplant
 WASH RED CELLS
• Obtained from whole blood by
centrifugation, wash with salin and remove
almost all plasma
• Must be used in 24 hours of preparation
• Indicated for hypersensitivity to plasma
sometimes (allergy, urticaria,
anaphylactic); used in neonatal
transfusion
 FROZEN RED CELLS
• Stored for years, using glycerol and stored
to -80C. After thawing and removal of
glycerol, 80% of RBC is recovered
• Leukocyte poor and free of plasma
• Used for auto transfusion, to ensure a
supply of rare blood, to reduce
sensitization to HLA for potential transplant
patients
 IRRADIATED RBC
• RBC and component are irradiated
2500cGy, it can be stored 28 days
• Indication : prevent GvH reaction, NHL HL,
acute leukemia, Low birth weight
 Transfusion of platelets
• Random donor platelets are prepared by
centrifugation that yield from 7-10 x 1010
platelets per unit of blood
• Platelets count of > 5000-10000/μl are
adequate to protect against spontaneous
bleeding
• Invasive procedure may require platelet
count > 60000/ μl
 FRESH FROZEN PLASMA
• Separated from whole blood and frozen
within 8 hours
• Indication : replenish clotting factor, rapid
reversal of warfarin effect, DIC, TTP, liver
disease, coagulopathy in massive
transfusion
• Dose: 12-15 ml/kg
 Cryoprecipitate
• Prepared from whole blood, volume 5-20 ml per
bag
• Each bag contain 100 U FVIII;
von Willebrand
200-250 fibrinogen
F XIII
fibronectin
• Dose: 10 bags increase fibrinogen by 75 mg/dl
and F VIII by 30%
 Albumin and Plasma protein
donors
• Concentration of 5%, 25%
• Indication: hypoalbuminemia, restore
intravascular volume, following thermal
injury, following large volume
paracentesis, undergoing plasma
exchange procedures
 Factor VIII concentrate
• Indicated for the treatment of hemophilia
A, and von Willwbrand multimer
• Dose and infusion rate depend to the
indication.
• 1 unit of F VIII /kg will increase FVIII level
by 2 %
• Rate as fast as tolerated
 Factor IX concentrate
• Indicated to treat patients with FIX
deficiency
• Doses is calculated to the site of bleeding
and clinical condition of patients
• 1 unit of F IX / kg increase the factor IX
level by 1 %
• The rate of infusion is as fast as tolerated
 AT III concentrate
• Indicated for patients with AT III deficiency
DIC
• Dose should be designed to achieved post
infusion AT III level of 120%
 Immune globulins
• IV IG or IM IG are available.
• Indicated for primary immunodeficiency or
passive immune protection, hypogamma
globulinemia, graft vs host , renal
transplant, CLL, ITP ,GBS, autoimmune
hematologic disorders
• Dose : 2 g/kg BB
INDICATION FOR TRANSFUSION
Informed consent should be obtained before
transfusion is given

• Hemorrhage and shock

• Surgery burns
• anemia
 MODE OF ADMINISTRATION
• Read the label
• Use sterile set
• Does not need to be warmed unless total
amount of 3 L should be given in rate of 100
ml/min or 50 ml/kg/ h or transfusing patient has
significant cold aglutinin
• Changing the giving set
• Should be given slowly in the first 30 minute
• Drugs or medications should not be added
• Blood transfusion compatibility should be noted
in patient’s medical records
 RECOMMENDATION
• Staff responsible for caring and monitoring for
transfused patients
• Informed consent
• Visual observation
• start and finish time of the transfusion
• Vital sign, separated from routine observation
note
• Temperature and pulse are checked 15 minute
after the start of each blood transfusion
 TRANSFUSION REACTION
• Fatal transfusion are due to management-
clerical errors
• Up to 20% of all transfusion may lead to
some type of adverse reaction
• Transfusion reaction can be divided into:
immediate reaction
delayed reaction
 Immediate reaction of transfusion
• Acute hemolytic reaction
• Febrile reaction
• Pulmonary hypersensitivity reaction
• Allergic reactions
• Anti IgA in IgA deficient recipient
• Bacterial contamination
• Circulatory overload
• Microaggregate in blood
• Citrate intoxication
 Delayed reaction
• Delayed hemolytic reaction
• Post transfusion purpura
• Transmission of disease
• Others : GvH reaction, iron overload,
alloimmunization
TERIMA KASIH