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BLOOD
• Blood is considered as river of life, fluid of life, fluid of
growth, fluid of health.
• Average human has 5 liters of blood i.e. 8% of total body
weight.
• It is a transporting fluid.
• It carries vital substances to all parts of body.
Parent A B O
Allele
A AA AB AO
B AB BB BO
O AO BO OO
A A Anti-B AA or AO
B B Anti-A BB or BO
AB A and B Neither AB
O Neither Anti-A and anti-B OO
blood and blood transfusions 15
Blood Antigens Antibodies Can give Can
Group blood to receive
blood from
A A B A and AB A and O
B B A B and AB B and O
• They are named for the rhesus monkey in which they were first
discovered.
• RBCs that are "Rh positive“ Must express the antigen designated as
D.
25
Sampling Procedure
Step 1:
Ask the patient to tell you their:
Full Name + Date of Birth.
• Check this information against
the patient’s ID wristband.
• Be extra vigilant when checking
the identity of the unconscious /
compromised patient,
Labelling the venous blood sample
• Information to include:-
• Full name
• Date of birth
• Hospital number
• Gender
• Date
• Signature of person who has taken the
sample
• At the bedside
• By the person taking the sample
Cont.,.,
Step 2:
Check the patient’s ID wristband against
documentation
e.g., case notes or request form for:
• First name
• Surname
• Date of birth
• Hospital number
• Personal checks:
Wear personal protective equipment.
• Equipment checks:
Personal protective equipment is available and is clean
and sterile.
A correctly completed prescription chart.
Observation chart.
Giving set.
Disposable bags.
Trolley.
LEAKS
DISCOLOURATION
CLUMPING
EXPIRY DATE
Cont.,.,
Any discrepancies
DO NOT
TRANSFUSE !
Blood Component Bedside Check Procedure
SURNAME
FIRST NAME(s)
HOSPITAL NUMBER
D.O.B.BLOOD GROUP
(Patient and Unit)
DONOR NUMBER
EXPIRY DATE
Special Requirements
• Replace the unit and giving set with Normal Saline 0.9%.
• Based on composition :
• Whole blood.
• Blood fraction.
• Description
• Precipitate formed/collected when FFP is
thawed at 4°
• Storage
• After collection, refrozen and stored up to 1
year at -18°
• Indication
• Fibrinogen deficiency or dysfibrinogenemia
• vonWillebrands Disease
• Factor VIII or XIII deficiency
• DIC (not used alone)
• Considerations
• ABO compatible preferred (but not limiting)
• Usual dose is 1 unit/5-10 kg of recipient body
weight
Granulocyte Transfusions
• Prepared at the time for immediate transfusion
(no storage available)
• Indications – severe neutropenia assoc with
infection that has failed antibiotic therapy, and
recovery of BM is expected
• Donor is given G-CSF and steroids or
Hetastarch
• Complications
• Severe allergic reactions
• Can irradiate granulocytes for GVHD prevention
Leukocyte Reduction Filters
• Used for prevention of transfusion reactions.
• Filter used with RBC’s, Platelets, FFP,
Cryoprecipitate.
• Other plasma proteins (albumin, colloid
expanders, factors, etc.) do not need filters—
NEVER use filters with stem cell/bone marrow
infusions.
• May reduce RBC’s by 5-10%.
• Does not prevent Graft Verses Host Disease
(GVHD).
RBC Transfusions Preparations
• Type:
• Typing of RBC’s for ABO and Rh are
determined for both donor and recipient
• Screen:
• Screen RBC’s for atypical antibodies
• Approx 1-2% of patients have
antibodies
• Crossmatch:
• Donor cells and recipient serum are
mixed and evaluated for agglutination
RBC Transfusion Administration
• Dose
• Supplied in 250ml bags.
• Usual dose of 10 cc/kg infused over 2-4 hours
• Maximum dose 15-20 cc/kg can be given to hemodynamically
stable patient
• Procedure
• May need Premedication (Tylenol and/or Benadryl)
• Filter use—routinely leukodepleted
• Monitoring—VS q 15 minutes, clinical status
• Do NOT mix with medications
• Complications
• Rapid infusion may result in Pulmonary edema
• Transfusion Reaction
Platelet Transfusions Preparations
• ABO antigens are present on
platelets
• ABO compatible platelets are ideal
• This is not limiting if Platelets indicated
and type specific not available
• Rh antigens are not present on
platelets
• Note: a few RBC’s in Platelet unit may
sensitize the Rh- patient
Platelet Transfusions Administration
• Dose
• May be given as single units or as apheresis units
• Usual dose is approx 4 units/m2—in children using 1-2
apheresis units is ideal
• 1 apheresis unit contains 6-8 Plt units (packs) from a
single donor
• Procedure
• Should be administered over 20-40 minutes
• Filter use
• Premedicate if hx of Transfusion Reaction
• Complications—Transfusion Reaction
Autologous Blood Transfusions
• Collection/infusion of client’s own blood
Four types:
• Preoperative autologous blood donation
• Acute normovolemic hemodilution
• Intra-operative autologous transfusion
• Postoperative blood salvage
Tachycardia Hyper /
Hypotension Headache
Pyrexia
Rigors
Urticaria -
Itchy rash
Haemoglobinuria Collapse
Chest, abdominal,
Nausea / muscle, bone or loin
vomiting pain
Generally feeling
unwell
Breathlessness / Flushing
Restlessness
coughing
Agitation
Confusion
Transfusion-associated graft-versus-host
disease (TA-GVHD)
• Donor T-cells attack host tissues.
• Symptoms occur within 1-2 weeks.
• Thrombocytopenia.
• Anorexia.
• Nausea.
• Vomiting.
• Chronic hepatitis.
• Weight loss.
• Recurrent infection.
DISSEMINATED
INTRAVASCULARCOAGULATION(DIC)
• DIC is the abnormal activation of the coagulation and
fibrinolytic systems,resulting in the consumption of
coagulation factors and platelets.
• DIC may develop during the course of massive blood
transfusion, although its cause is less likely to be due to
the transfusion itself than related to the underlying
reasons for transfusion, such as:
• Hypovolemic shock.
• Trauma.
• Obstetric complications.
Management of DIC
• Treatment of DIC should be directed at correcting the
underlying cause and at correction of the coagulation
problems as they arise.
BLOOD BANKS
• Blood banks collect, test, and store blood.
• Autologous transfusion - If surgery is scheduled months
in advance, patients may be able to donate their own
blood and have it stored.
BLOOD 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.
Bio-Safety & Waste Management In
Relation to Blood Transfusion
Reduction.
Re‐use.
Recycling.
Waste segregation: