BLOOD TRANSFUSION Begashaw M MD Definition is the

BLOOD TRANSFUSION Begashaw M (MD)

Definition • is the procedure of introducing the blood of a donor, or pre-donated blood by a recipient into the recipient’s bloodstream

Indications In acute hemorrhage is based on: • volume lost >2000 • rate of bleeding • hemodynamic status

Indications In Chronic blood loss: -Healthy, younger individuals HCT<21% -Cardio respiratory compromised patients HCT < 25 -33% If severe , even <40%

Perioperative red blood cell transfusion criteria

Component therapy • specific factor deficiencies -factor VIII concentrates -classic hemophilia

ABO blood group system -Blood group O is the universal donor -Blood group AB is the universal recipient

Cross matching o Blood grouping -ABO and Rhesus antigens o Antibody screening • Detects atypical red cell antibodies in recipients serum o Crossmatching • Tests donor red cells against patients serum

Blood products • • • Whole blood Packed red cells Granulocyte concentrates Platelet concentrates fresh frozen plasma Plasma protein fraction Human albumin 25% Cryoprecipitate Clotting factors - Factor VIII / IX

Blood Components

Component therapy • Factor VIII for classic hemophilia • Platelet transfusion for patients with bone marrow suppression

preparation FRESH UNIT WHOLE BLOOD+CPDA PRBCs 80% HCT STORED AT 1 -6 degree celcius PLASMA AND 70% OF PLTS PLT PELLET and CLOTTING FACTORS EXCEPT FACTOR III PLASMA STORED AT -18 to-30 DEGREE CELCIUS THAW AT 4 degree celcius CRYOPRECIP ITATE PROTEIN S

Whole blood • is collected in citrate phosphate dextroseadenine solution (CPDA-) • 450 ml of whole blood and approximately 60 ml of anticoagulant preservative • within 24 hours-freshwhole blood • shelf life of 35 days • one unit of whole blood raises the recipient’s hematocrit by 3%

Whole blood

Packed RBC • are remains after plasma has been separated from whole blood • One unit raises the recipient’s hematocrit by 3% • warmed to a temperature not exceeding 37 c before transfusion • Shelf life is 35 days

Packed RBC

Platelet concentrate • Platelets are separated from one unit of blood • may be stored for 3 -7 days • One unit of platelet concentrate contains about 5. 5× 1010 platelets and increases the platelet count by 5000/ml • For a patient with platelet count below 25, 000/mm 3, 6 -8 units are usually given • Platelet concentrate must be administered through a special platelet filter

Fresh frozen plasma _is anti-coagulated plasma separated from a person’s blood and frozen within 6 hours _stored up to 1 year _contains all clotting factors _provides proteins for volume expansion

Cryoprecipitate _is a protein fraction removed from a unit of fresh frozen plasma that is thawed at 4 degree centigrade _white precipitate _shelf life of about 1 year _contains factor VIII, fibrinogen and factor XIII _treatment: -classic hemophilia -DIC

FRESH FROZEN PLASMA 21

Cryoprecipitate

Protein Albumin - for oncotic support and plasma expansion - disadvantage-rapid excretion & expense Plasma protein fraction -Similar to albumin but contains additional protein molecules

Complications of Blood Transfusion

Complications • Hemolytic transfusion reactions • Non-hemolytic transfusion reaction

Hemolytic transfusion reactions • • Intravascular hemolytic transfusion reactions life threatening reactions due to incompatibility of the ABO system are very rare occurring in 1 out of 15, 000 20, 000 transfusions

Pathophysiology • all donor cells hemolyze, leading to hemoglobinemia, hemoglobinuria and renal failure • activate the complement system with subsequent release of vasoacative amines causing hypotension • Complement activation -intravascular thrombosis, DIC & hemorrhage

Clinical features • • Patient feels unwell and agitated back pain and pain at infusion site shortness of breath, rigors hypotension, oliguria and bleeding from venepuncture sites • Urinalysis will show haemoglobinuria

Management • Discontinue transfusion immediately and remove giving set • Check unit of blood against patients identity • Give intravenous crystalloid • Transfer to ICU • Take blood for CBC, haemoglobin, clotting, repeat grouping • Monitor urine output

Non-hemolytic transfusion reaction • Febrile reaction: - in 0. 5% -1% - is usually treated with antipyretic drugs • Allergic reaction: - in 2 -3% - manifests by urticaria and rashes - Antihistamins, steroids or epinephrine

• - Transmission of disease-include: Hepatitis HIV Malaria Epstein- bar virus, cytomegalovirus Brucellosis

Other complications • Citrate toxicity • Acidosis • Hyperkalemia