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Blood Transfusion

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Blood Transfusion Blood Transfusion Dr. Arkaprovo Roy Associate Professor Department of Surgery Medical College Kolkata Discussions on • Definition and indications of blood transfusion • Blood banking • Blood grouping and cross matching • Blood products • Blood substitutes • Auto transfusion • Complications of blood transfusion • Massive blood transfusion Definition • It is the transfusion of the whole blood or its components such as blood corpuscles or plasma from one person to another Indications for blood transfusions 1. Blood loss greater than 20% of blood volume 2. Haemoglobin level < 8g/dl without any risk factors 3. Haemoglobin level <10g% with major diseases /major surgery How to prepare blood for transfusion • Screening for blood borne infections • Blood grouping and compatibility testing RBC Contains >300 antigens, 20 blood group antigens are well known Blood Banking • In 1937 Bernard Fantus, director of therapeutics at the Cook County Hospital in Chicago, established one of the first hospital blood banks in the United States. • It preserved, refrigerated and stored donor blood - Fantus originated the term "blood bank". • Blood banking is the process that takes place in the lab to make sure that donated blood, or blood products, are safe for blood transfusions and other medical procedures. • Blood banking includes typing the blood for transfusion and testing for infectious diseases. Blood group systems Major system- • ABO system • Rhesus system Minor system • H-antigen • MNS antigen system • Lutheran system • Kell system • Duffy system Blood Grouping • Here are 4 main blood groups (types of blood) – A, B, AB and O. • The ABO and Rh blood grouping system is based on agglutination reaction. • When red blood cells carrying one or both the antigens are exposed to the corresponding antibodies they interact with each other to form visible agglutination or clumping. Forward and reverse blood grouping • In this method, both forward (cell), as well as reverse (serum) grouping is carried out. • The forward grouping suggests the presence or absence of A and B antigens in RBCs • Reverse grouping indicates the presence or absences of anti-A and anti-B in serum. Rh blood group system • It is a human blood group system • It contains proteins on the surface of red blood cells • It is the second most important blood group system, after the ABO blood group system. • The Rh blood group system consists of 49 defined blood group antigens, among which the five antigens D, C, c, E, and e are the most important. • Rh(D) status of an individual is normally described with a positive or negative suffix after the ABO type (e.g., someone who is A Positive has the A antigen and the Rh(D) antigen, whereas someone who is A Negative lacks the Rh(D) antigen). • The terms Rh factor, Rh positive, and Rh negative refer to the Rh(D) antigen only. • Antibodies to Rh antigens can be involved in hemolytic transfusion reactions and antibodies to the Rh(D) and Rh antigens confer significant risk of hemolytic disease of the fetus and newborn. Cross matching in Blood banks • Cross Matching is a procedure performed prior to a blood transfusion to determine whether donor blood is compatible (or incompatible) with recipient blood • Compatibility is determined through matching of different blood group systems • Most important of which are the ABO and Rh system, and/or by directly testing for the presence of antibodies against a sample of donor tissues or blood Purpose of Cross-matching • The crossmatch is routinely used as the final step of pretransfusion compatibility testing. • The purposes of compatibility testing are to detect: Irregular antibodies; Errors in ABO grouping, Clerical errors in patient identification and result recording. • The cross-match will detect the following: Most recipient antibodies directed against antigens on the donor red blood cells. Major errors in ABO grouping, labeling, and identification of donors and recipients. Compatibility testing • Major crossmatch- between donor’s blood and recipient’s plasma • Minor crossmatch- between donor’s plasma and recipient’s blood Emergency transfusion • Give o negative blood when blood group is available then switch over to transfusion of specific blood group Storage of blood • In the refrigerator at 2 degree celcius • Blood stored in preservative anticoagulants— – Acid citrate dextrose(ACD)- upto 21 days – CDPA-1 (citrate, dextrose, phosphate, adenine)- upto 35 days- most commonly used in india – ADSOL(adenine, glucose, mannitol, sodium chloride) – 42 days – NUTRICE (adenine, glucose, citrate, NaCl) – 42 days – OPTISOL – 42 days Blood Products Whole blood- specific indications • Hypovolemic shock and hemorrhagic shock • Burns Packed Red Blood Cells(PRBC) • Preferred over Whole blood transfusion because- – Cardiac overload can be avoided – Infectious and allergic reactions related to plasma can be avoided – Increase in Hb per pack of PRBC is 1 g/dL – Whole Blood can be utilized to extract other products like FFP, platelets, factor concentrate • 1 unit = 200-250 ml Common uses • Additional factors: • Acute blood loss anemia Fibrinogen 10-75 mg • Massive blood Clotting factors – none transfusion • Surgical blood loss Fresh Frozen Plasma • Volume- 180 - 300 mL • Plasma is separated from the blood corpuscles by centrifugation and then frozen within 6 hours of collection. • Contains all coagulation factors and plasma proteins. • ABO compatibility not necessary but highly desirable • Indications: • Coagulopathies associated with liver disease or which is to be corrected immediately(eg-With active bleeding) • Reversal of Warfarin Therapy • Antithrombin III deficiency • Plasma protein deficiency(poor man’s albumin) Platelet concentrates • Volume-50mL • Only blood products which are stored at room temperature for 4-5 days • At 2°C survives for only 24-48 hrs • Transfused Platelets survive in the circulation for 2-7 days • Indications- – Platelet count<10,000 in absence of active bleeding – <50,000 with active bleeding or patient undergoing major surgery • 1 unit platelet increases the count by 5000-10,000 • ABO compatibility is not necessary but desirable SDP VS RDP • Single donor platelet or SDP is when it is derived from a single donor’s blood • Random Donor Platelet or RDP is when it is derived from pooled plasma of multiple donors • One unit SDP = 6 units of pooled RDP • Chances of disease transmission is high with RDP Cryoprecipitate • Volume = 10 ml • Supernatant precipitate of FFP • Contains 80-145 units of Factor VIII and 1200-1500 unit of Fibrinogen • Also contains Von Willebrand Factor and Factor XIII. • Pooled from many donors • Indications: vWD DIC Haemophilia A Disadvantage- • Maximum chance of disease transmission • Must be infused within 6 hours Leukocyte-Reduced Red Blood Cells • An association between immunosuppression and allogeneic transfusion has found • This effect, termed transfusion-related immunomodulation, is thought to be principally related to exposure to leukocytes • Can be decreased or prevented with leukocyte-reduced components Leukocyte-Reduced Red Blood Cells Uses • To decrease the incidence of subsequent refractoriness to platelet transfusion. Caused by HLA alloimmunization in patients requiring long-term platelet support • To provide blood components with reduced risk for transmission of cytomegalovirus (CMV) • To prevent subsequent febrile nonhemolytic transfusion reactions in patients who have had one documented episode • To decrease the incidence of HLA alloimmunization in non-hepatic solid-organ transplant candidates Granulocyte Concentrate • Used in profound granulocytopenia (<500/mm3) with evidence of infection (e.g., positive blood culture, persistent temperature higher than 38.5°C) unresponsive to antibiotic therapy • Daily transfusions are given until the infection is under control or the granulocyte count is greater than 1000/mm3 • Such products have a shelf life of 24 hours and are not routinely available Blood Substitutes • A blood substitute (also called artificial blood or blood surrogate) is a substance used to mimic and fulfill some functions of biological blood • It aims to provide an alternative to blood transfusion, which is transferring blood or blood based products from one person into another • There are no well-accepted oxygen-carrying blood substitutes, which is the typical objective of a red blood cell transfusion • There are widely available non-blood volume expanders for cases where only volume restoration is required. • These are helping avoid the risks of disease transmission and immune suppression, address the chronic blood donor shortage, and address the concerns of Jehovah's Witnesses and others who have religious objections to receiving transfused blood. Characteristics of an ideal blood substitute The most important adverse effects of blood transfusion relate to the antigenicity of donor blood and its ability to transmit infections. An ideal blood substitute - • Should lack antigenicity and eliminate, or at least substantially reduce, the ability to transmit infections • Readily available • Long half-life • Capable of being stored at room temperature • The biologic properties of an ideal blood substitute should include a reasonable amount of oxygen delivery, when compared to normal human red blood cells Classification • First-Generation Products Perfluorocarbon emulsions • Stroma-Free Hemoglobin • Next-Generation Blood Substitutes Polyethylene glycol (PEG) hemoglobin Raffinose-x-linked HB Plasma substitutes Colloid solutions: • Albumin 5%
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