Blood and blood transfusions

BLOOD &
BLOOD
TRANSFUSIONS
DR.SHALINI SINGH
(PG)

BLOOD
blood and blood transfusions 2

OBJECTIVES
• Properties and functions of blood
• Plasma proteins
• Bone marrow
• Red blood cells
• White blood cells
• Platelets

• 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.
4blood and blood transfusions

Properties Of Blood
• Color range
• Oxygen-rich blood is scarlet
red bright crimson
• Oxygen-poor blood is purple
red.
• Red color comes from the
several million red cells, present
in it
• pH must remain between 7.35–
7.45
• Temp 38 c or 100.4 F

• Blood is 5 times more viscous
than water.
• Blood is a specialized type of
connective tissue in which living
blood cells, (formed elements),
are suspended in a non living fluid
matrix called plasma.
• Cellular Part (Formed
Elements)
• Non cellular part (Plasma)

Functions of blood
Blood performs a number of functions.
• Distribution
• Regulation
• Protection
Distribution Functions
Nutritive Function:
Respiratory Function:
Excretory Function:
Transport Function:
8
blood and blood transfusions

Regulation Functions
• Maintainance Functions
• Buffering Functions
Protection Functions
• Preventing blood loss
• Defensive function

PLASMA
• Plasma is the fluid portion of the blood. It constitutes about
5% of the body weight.
• If blood is allowed to clot, then a clear, straw colored fluid
oozes out. This is the serum .
• Serum is similar to plasma, except that serum does not
have clotting factors.
• SERUM = PLASMA - FIBRINOGEN

• It contain all the vital substances.
• These vital substances include digested
food, salts, hormones, enzymes,
substances essential for clotting of blood,
and antibodies , which are important for
defense.

Separation Of Plasma Proteins
• Precipitation method
• Salting out method
• Electrophoretic method
• cohn’s fractional precipitation method
• Ultracentrifugation method
• gel filtration chromatography
• Immunoelectrophoretic method

PROPERTIES
• Molecular weight Albumin- 69,000
globulin- 1,56,000
fibrinogen- 4,00,000
• Oncotic pressure- about 25 mm Hg
• Specific gravity- 1.026
• Buffer capacity- 1/6 of total buffering action
of blood
ORIGIN
• In embryo – synthesized by mesenchymal
cells.
• In adults – mainly from reticuloendothelial
cells of liver

Functions of plasma
• Helps in transport of substances in the
body
• Maintains colloid osmotic pressure of
blood
• Causes blood clotting because it contains
the fibrinogen and prothrombin
• Stores proteins for supply in needs
• Helps provides viscosity to blood
• Contains antibodies and antitoxins

BONE MARROW
• The bone marrow is present in the bone cavities.
• It can be considered as one of the largest organs in the
body, and also one of the most active.
• In children, blood cells are produced in the marrow
cavities of all the bones.
• Gradually, it gets replaced by fat (yellow marrow).
• In the adult blood cells are produced in the bone marrow
of selected bones (e.g. backbone – vertebral column,
ribs, bones of the skull, etc.)

Bones require their own blood supply which travels through the
periosteum to the inner bone marrow.

RED BLOOD CELLS
• RBCs are also called
erythrocytes .
• They are tiny (7.5u in diameter,
2u thick) biconcave discs.
• They survive for about 120
days.
• RBCs are non nucleated
formed elements in the blood.
• The average normal RBC count
is –
• for men 5.4 million/uL
• for women 4.5 million/uL
19

Production of Erythrocytes: Erythropoiesis

• Hemoglobin is the most important
component of red blood cells.
• It is composed of a protein called
heme, which binds oxygen.
• In the lungs, oxygen is
exchanged for carbon dioxide.
• Abnormalities of an individuals
hemoglobin value can indicate
defects in red blood cell balance.
• Both low and high values can
indicate disease states.

Formation of RBCs
• Takes place in the bone marrow.
• A feedback exists – if the RBC count
rises, further increases are inhibited.
• Low levels of oxygen in the
atmosphere stimulate the formation
of RBCs.
• This is an important part of the
body’s adjustment to high altitudes.
People living in the mountains
actually do have higher RBC counts
than usual.
• RBC formation is regulated by a
substance secreted by the kidneys.
22

• Destruction of RBCs
• About 5 X 10 11 RBCs are
destroyed everyday, in the liver
and spleen.
• Functions of RBCs
• Carriage of oxygen.
• Hemoglobin (Hb) – the red pigment
– acts as the vehicle for the
transport of oxygen from the lungs,
via the heart to the rest of the
body.
• Also carries CO2, though greater
amounts of CO2 are transported
dissolved in plasma.
• Average Hb level in normal men
16gdL and 14gdL in normal
women.

• Iron is essential for the synthesis of Hb.
• Hence after excessive bleeding iron supplements (tonics)
plus a diet rich in iron are necessary for more Hb to be
formed.
• Carriage of CO2 (less significant) – as described above,
most of the CO2 is dissolved in plasma.
• Presence of specific substances on their surface, which
are responsible for ‘typing’ blood into different groups.

Variations in number of RBCs
PHYSIOLOGIC VARIATIONS
• Increase
• Age
• Sex
• High altitude
• Muscular exercise
• Emotional conditions
• Increased environmental
temperatureAfter meals
• Decrease—
• High barometric pressure
• During sleep
• pregnancy
27

PATHOLOGIC VARIATIONS
• Increase– polycythemia
• Decrease-- anemia

WHITE BLOOD CELLS
• WBCs or leukocytes consists of 5
categories of cells.
• Each category has a distinct shape and
appearance.
• Some cells are smaller than RBCs (5u in
diameter) whereas others are definitely
bigger (15 u in diameter).

Formation and destruction of WBCs
• The WBCs are formed in the bone marrow.
• The different categories of cells have different stimuli
for production. For e.g. one category (called
neutrophils ) are produced in large number whenever
there is short or severe (acute) infection.
• There life span also differs. Some categories (e.g.
neutrophils) may survive upto 7 hours.
• In contrast other cells ( lymphocytes ) are called ‘
memory cells .’

• They are able to ‘ remember’ an invader
for several months, even years.
• If the invader enters the body again, these
memory cells are alerted, and the body’s
response to the second invasion is much
more extensive and rapid.

Functions of WBCs
• WBCs are concerned with defense .
• Some of them are concerned with fighting acute (short,
severe) infections, whereas others fight chronic infections.
• Some WBCs are capable of moving in the tissues, acting
like vigilant guards.
• If they encounter a bacterium, they may consume it or
make it inactive.
• The pus which may be seen oozing out of an infected
wound, is made up of dead WBCs .
• A particular category of WBCs – the eosinophils – are
increased in allergic reactions and also in cases of worm
infestation. blood and blood transfusions 34

PLATELETS
• The platelets are tiny bodies, 2-4um in diameter.
• There are about 0.25 to 0.4 million/uL of circulating blood.
• They have a half life of about 7 days.
• The platelets are called thrombocytes , because they
release thrombin , which aids in blood clotting.

Platelets (Thrombocytes)
Formation Large multinucleated cells that
pushes against the wall of the capillary.
Cytoplasmic extensions stick through and
separate.

OBJECTIVES
• Provide overview of transfusion therapy.
• Describe pre-transfusion responsibilities.
• Describe transfusion responsibilities.
• Describe post-transfusion responsibilities.
• Describe types of transfusions.
• Describe transfusion reactions.
• Describe autologous transfusions.

OVERVIEW
• It is a procedure in which a patient
receives a blood product through an
intravenous line.
• It is the introduction of blood components
into the venous circulation.
• Process of transferring blood-based
products from one person into the
circulatory system of another.

HISTORY OF BLOOD
TRANSFUSION
• Before The Nobel Prize
awarded, Karl Landsteiner
discovered the ABO
human blood groups in
1901, it was thought that
all blood was the same.
This misunderstanding led
to fatal blood transfusions
and many death.

• Prof. Karl Landsteiner discovered that blood
clumping was an immunological reaction
• Karl Landsteiner's work made it possible to
determine blood types
• For this discovery he was awarded the Nobel Prize
in Physiology or Medicine in 1930.

• 450ml of blood can save as many as
three lives.
• Every two seconds, someone in India
needs blood.
• One out of every three of us will need
blood in our life time.
• Even with all of today’s modern
technology, there is no substitute for
blood.
Someone has to give blood
in order for someone to
receive blood.blood and blood transfusions 42

•A person has 5 - 6 liters of blood in their
body.
•A person can donate blood every 90 days (3
months).
Body recovers the Blood very quickly:
• Blood plasma volume– within 24 - 48
hours
• Red Blood Cells – in about 3 weeks
• Platelets & White Blood Cells – within
minutes

Purposes
•To replace losses of: Circulating volume
Oxygen carrying capacity .
•To restore: Metabolic homeostasis.
•To replenish: Normal RBC’s (eg. Refractory
anemias, Thalasemias, Sickle cell anemias
etc)
•In cancer patients like ALL; AML; with /
orafter Chemothrapy drugs
• For emergency surgery, heart surgery

Typical Situations in which blood
products are given
• Major injuries after an accident or disaster
• Surgery on an organ such as the liver and
the heart
• Severe Anemia
• Bleeding such as Haemophilia and
Thrombocytopenia
• Pre-mature, pre term babies
• Cancer patients

What are the different blood
groups?
•There are more than 20 genetically
determined blood group systems known today
• The AB0 and Rhesus (Rh) systems are the
most important ones used for blood
transfusions.
• Not all blood groups are compatible with each
other. Mixing incompatible blood groups leads
to blood clumping or agglutination, which is
dangerous for individuals.

ABO blood grouping system
• According to
the ABO
blood typing
system there
are four
different
kinds of blood
types: A, B,
AB or O
(null).

AB0 blood grouping system
• Blood group A If you belong to
the blood group A, you have A
antigens on the surface of your
RBCs and B antibodies in your
blood plasma.
• Blood group B If you belong to
the blood group B, you have B
RBCs and A antibodies in your
blood plasma.

Blood group O
If you belong to the blood group
O (null), you have neither A or B
RBCs but you have both A and B
antibodies in your blood plasma.

Possible Blood group Genotypes
Parent
Allele
A B O
A AA AB AO
B AB BB BO
O AO BO OO

The ABO blood groups
• The most important thing is in assuring a safe blood
transfusion.
• The table shows the four ABO phenotypes ("blood groups")
present in the human population and the genotypes that give
rise to them.
Blood
Group
Antigens
on RBCs
Antibodies in Serum Genotypes
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

The Rhesus (Rh) System
• Well, it gets more complicated here, because
there's another antigen to be considered always -
the Rh antigen.
• Some of us have it, some of us don't have.
• If it is present, then blood is RhD positive, if not it's
RhD negative.
• So, for example, some people in group A will have
it, and will therefore be classed as A+ (or A
positive).
• While the ones that don't, are A- (or A negative).
• And so it goes for groups B, AB and O.

What is that Rh antigens?
•Rh antigens are transmembrane proteins with
many loops exposed at the surface of red blood cells.
• They appear to be used for the transport of carbon
dioxide and/or ammonia across the plasma
membrane.
• 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.
• A person with Rh- blood does not have Rh
antibodies naturally in the blood plasma

• According to above blood grouping systems, you
can belong to either of following 8 blood groups:

• A person with Rh- blood can develop Rh antibodies
in the blood plasma if he or she receives blood from
a person with Rh+ blood, whose Rh antigens can
trigger the production of Rh antibodies.
• A person with Rh+ blood can receive blood from a
person with Rh- blood without any problems.

Laboratory Determination of the
ABO System

Blood
Group
Antigens Antibodies Can give
blood to
Can
receive
blood from
AB A and B None AB AB, A, B, O
A A B A and AB A and O
B B A B and AB B and O
O None A and B AB, A, B, O O

• Rh+ can receive blood from: Rh+ and Rh-
• Rh- can receive blood from: Rh- only

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.

Requesting Procedure
• Check the patient’s case note
• Transfusion history
• Special requirements
• e.g., irradiated, CMV
negative
• Complete request form or
order communications

Casenote
Surname
Forename
DOB
Ethnic Origin
Location
Consultant
Sex
Patient Category NHS
Date of Request
Entered by
Originator
Date of Specimen
Service (Type of Request)
Blood Group
Previous Transfusion
Units (amount) Date Reqd
Reaction
Specimen type
Vacutainer 7mls pink + 4.5 mls EDTA
Antibodies
Specimen taken by Sign and print Name Requesting Medic Sign and Print name
Copy of this request must be filed in the notes. See Trust Transfusion policy
Diagnosis, referral reason, relevant medication
Information found on the Request
Forms

PRE-TRANSFUSION
RESPONSIBILITIES
• Assess laboratory values
• Verify the medical prescription.
• Assess the client’s vital signs, urine
output, skin color and history of
transfusion reactions.
• Obtain venous access. Use a
central catheter or at least a 20-
gauge needle, if possible.

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

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

Sampling Procedure
 Only bleed one patient at a time using Aseptic
non touch technique
 Do NOT use pre-labeled tubes
 Label the sample tube beside the patient
 Send the sample to the laboratory in the most
appropriate way for the clinical situation, i.e.
routine / emergency
 Remember emergency requests must
always be phoned through to the
Transfusion Laboratory.

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

IV Blood/ Blood Component
Chart

Prescribing a transfusion
• Each unit must be entered separately on
the patient’s prescription sheet.
• The entry must specify the type of product
any special requirements the rate of
transfusion – max 4hrs/unit

Blood Transfusion
Administration

• Obtain blood products from a blood bank;
transfuse immediately.
• With another registered nurse, verify the
patient by name and number, check blood
compatibility and note expiration time.
• Administer the blood product using the
appropriate filtered tubing.

Good Documentation
Minimum Transfusion Dataset: the following should be
documented in the notes
• Reason for transfusion
• Current blood results
• Component type and amount to be prescribed
• Anticipated outcome
• Any reported transfusion adverse events/reactions
• Review following the transfusion including how
much blood has been transfused

Warming Blood
• STORED BLOOD IS COLD 4*C
• PATIENTS UNDERGOING SURGERY WILL
ALREADY BE LOSING BODY HEAT DUE TO
WOUND OR CAVITY EXPOSURE
• LARGE VOLUMES OF COLD BLOOD MAY
INDUCE HYPOTHERMIA OR CARDIAC
ARYTHMIA

• AT INFUSION RATES>100ml/minute, COLD BLOOD MAY BE A
CONTRIBUTING FACTOR IN CARDIAC ARREST. HOWEVER,
KEEPING THE PATIENT WARM IS PROBABLY MORE IMPORTANT
THAN WARMING THE INFUSEDBLOOD !
• WARMED BLOOD IS MOST COMMONLY REQUIRED IN
LARGEVOLUME RAPID TRANSFUSIONS & EXCHANGE
TRANSFUSION IN INFANTS.
• BLOOD SHOULD ONLY BE WARMED IN A BLOOD WARMER THAT
HAVE A VISIBLE THERMOMETER AND AN AUDIBLE WARNING
ALARM AND SHOULD BE PROPERLY MAINTAINED.

Can the Patient be Safely
Transfused ?
• Is the product clearly prescribed?
• Are any drugs required before or during
transfusion? i.e. antibiotics
• Is the rate of transfusion appropriate?
• Does the patients condition require medical review prior to
transfusion
All patients having a blood transfusion MUST have a NAMEBAND
containing all of their required details

Monitoring of Patient
Base line observations – Temperature, pulse and blood
pressure
Further observations (as above) at 15 minutes
A set of observations at the end of transfusion
More frequently if the patient is unwell, unobservable,
unconscious or a child.

MONITORING PATIENTS
• Ensure the venflon is secure, patent and there are no
signs of inflammation
• Give the patient the call bell
• Patients should remain in a clinical area for the
duration of the Transfusion
• Review the patients fluid balance and medication.

Pre-administration Procedure
• Step 1: Check the blood component has
been prescribed
• Step 2: Undertake baseline observations
• Step 3: Undertake visual inspection
LEAKS
DISCOLOURATION
CLUMPING
EXPIRY DATE

Pre-administration checks
• Personal checks:
- ANTT
- 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

Administration Procedure
• Step 1: Ask the patient to tell you their
Full Name + Date of Birth
• Check this information against the
patient’s ID wristband

• Step 2: Check the patient’s
– First name
– Surname
– Date of birth
– Hospital number
• on the compatibility/
traceability label against
the patient’s ID wristband

• Step 3: Check the
compatibility/traceability label
with the blood bag label
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

• Remain with the patient during
the first 15-30 minutes of the
infusion.
• Infuse the blood product at the
prescribed rate.
• Monitor vital signs.

Reporting Incidents/Transfusion
Reactions
• Stop the Transfusion and seek Medical Input and inform the
Transfusion Laboratory staff
• Check the Blood component matches the patient details
• Replace the unit and giving set with Normal Saline 0.9%
• Send the discontinued unit with giving set attached back to
transfusion capped off at the end with a white venflon cap – and any
previous transfused bags sealed with the blue plugs all in biohazard
bags
• Documentation (complete the checklist)
• Complete a Trust Incident form

TYPES OF TRANSFUSION

Types of BT
• Based on time of transfusion
• Fresh whole blood transfusion
• Stored CPD Blood
• Based on composition
• Whole blood
• Blood fraction
• Based on the donor
• Autologous blood transfusion
• Blood from diff donor

Whole Blood
Packed Red Blood Cells Platelet Rich Plasma
Slow Centrifugation
High Speed Centrifugation
1 Unit of Random Donor
Platelets
1 Unit of Fresh Frozen Plasma
Cryoprecipitate
Thawing precipitates the
plasma proteins
BLOOD COMPONENTS

Whole Blood
• Storage
• 4 for up to 35 days
• Indications
• Massive Blood Loss/Trauma/Exchange
Transfusion
• Considerations
• Use filter as platelets and coagulation
factors will not be active after 3-5 days
• Donor and recipient must be ABO
identical

RBC Concentrate
• Storage
• 4 for up to 42 days, can be frozen
• Indications
• Many indications—ie anemia, hypoxia,
etc.
• Considerations
• Recipient must not have antibodies to
donor RBC’s (note: patients can
develop antibodies over time)
• Usual dose 10 cc/kg (will increase Hgb
by 2.5 gm/dl)
• Usually transfuse over 2-4 hours
(slower for chronic anemia

Platelets
• Storage
• Up to 5 days at 20-24
• Indications
• Thrombocytopenia, Plt <15,000
• Bleeding and Plt <50,000
• Invasive procedure and Plt <50,000
• Considerations
• Contain Leukocytes and cytokines
• 1 unit/10 kg of body weight increases Plt count
by 50,000
• Donor and Recipient must be ABO identical

Plasma and FFP
• Contents—Coagulation Factors (1 unit/ml)
• Storage
• Comes in 200ml bags.
• FFP--12 months at –18 degrees or colder
• Indications
• Coagulation Factor deficiency, fibrinogen
replacement, DIC, liver disease, exchange
transfusion, massive transfusion
• Considerations
• Plasma should be recipient RBC ABO
compatible
• In children, should also be Rh compatible
• Account for time to thaw
• Usual dose is 20 cc/kg to raise coagulation
factors approx 20%

Cryoprecipitate
• 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 Transfusions
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

Preoperative autologous blood
donation
• Collecting whole blood from the client,
dividing it into components and storing it
for later use
• Can be collected weekly as long as client’s
H&H are within safe range
• Can be stored up to 40 days; up to 10
years for rare blood types.

Acute normovolemic
hemodilution
• Withdrawal of client’s RBCs and volume
replacement just before a procedure
• Goal is to decrease RBC loss during
surgery
• Blood is stored at room temperature for up
to 6hrs and reinfused after surgery.
• Not for anemic clients or those with poor
kidney function.

Intra-operative autologous
transfusion & Post operative
blood salvage
• Recovery/reinfusion of client’s own blood
from operative field or bleeding wound.
• Special devices collect, filter, drain blood
into transfusion bag
• Used for trauma or surgical patients with
severe blood loss
• Blood must be reinfused within 6 hours.

TRANSFUSION REACTIONS

Observing / Monitoring the Patient During a Blood / Blood
Component Transfusion is part of safe transfusion
Rigors
Haemoglobinuria
Tachycardia Hyper /
HypotensionPyrexia
Nausea /
vomiting
Breathlessness /
coughing Restlessness
Agitation
Confusion
Chest, abdominal,
muscle, bone or loin
pain
Flushing
Urticaria -
Itchy rash
Headache
Collapse
Generally feeling
unwell

112

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:
• Hypovolaemic shock
• Trauma
• Obstetric complications

MANAGEMENT
• Treatment of DIC should be directed at
correcting the underlying cause and at
correction of the coagulation problems as
they arise.

Transfusions of blood & blood components
are labour intensive & expensive but are
frequently life saving
In a few patients, however they can result in
potentially fatal complications.
It is therefore essential that they are only
given when the benefits outweigh the risks
Conclusion

THANX

Blood and blood transfusions

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