blood transfusion and transfusion reactions dr vaishali jain

BLOOD TRANSFUSION AND TRANSFUSION REACTIONS

DR VAISHALI JAINDR VAISHALI JAIN

LEARNING OUTCOMESLEARNING OUTCOMES

At the end of this topic, you should able to:At the end of this topic, you should able to:• Understand concept of Whole blood and blood Understand concept of Whole blood and blood

componentscomponents• Discuss types and indications of blood transfusionDiscuss types and indications of blood transfusion• Enlist tests to be performed prior to blood Enlist tests to be performed prior to blood

transfusiontransfusion• Understand transfusion reactions in briefUnderstand transfusion reactions in brief

LESSON CONTENTSLESSON CONTENTS• Whole blood and blood componentsWhole blood and blood components• What is blood transfusion?What is blood transfusion?• Blood transfusion- Types, IndicationsBlood transfusion- Types, Indications• Pre transfusion testingPre transfusion testing• Transfusion Reactions:Transfusion Reactions:

– ClassificationClassification– CausesCauses– Clinical featuresClinical features– InvestigationsInvestigations

WHOLE BLOOD AND BLOOD COMPONENTSWHOLE BLOOD AND BLOOD COMPONENTS• 350ml /450 ml of blood is collected from a donor into 350ml /450 ml of blood is collected from a donor into

a plastic bag containing an anticoagulanta plastic bag containing an anticoagulant

• This is called 1 “unit” of whole blood This is called 1 “unit” of whole blood

• Whole blood can be used as it is, or is separated into Whole blood can be used as it is, or is separated into “blood components”“blood components”

• Types of blood components:-Types of blood components:-– Red blood cell concentrate (packed red blood cells)Red blood cell concentrate (packed red blood cells)– Platelet concentratePlatelet concentrate– Fresh frozen plasmaFresh frozen plasma– CryoprecipitateCryoprecipitate

BLOOD COMPONENTSBLOOD COMPONENTS

BLOOD TRANSFUSION

Transfer of blood or blood components from one Transfer of blood or blood components from one person (donor) into another person (recipient)person (donor) into another person (recipient)

TYPES OF BLOOD TRANSFUSIONTYPES OF BLOOD TRANSFUSION

• FRESH BLOOD TRANSFUSIONFRESH BLOOD TRANSFUSION Blood less than 24 hours old from the time of collectionBlood less than 24 hours old from the time of collection • AUTOLOGOUS TRANSFUSIONAUTOLOGOUS TRANSFUSION Blood collected from a patient for re-transfusion at a later Blood collected from a patient for re-transfusion at a later

time into the same individualtime into the same individual

• MASSIVE TRANSFUSIONMASSIVE TRANSFUSION Number of units transfused in a 24 hours period exceeds the Number of units transfused in a 24 hours period exceeds the

recipient’s blood volumerecipient’s blood volume

• MULTIPLE TRANSFUSIONMULTIPLE TRANSFUSION Repeated transfusion of blood over a long period of time Repeated transfusion of blood over a long period of time

(months or year)(months or year)

INDICATIONS OF BLOOD TRANSFUSIONINDICATIONS OF BLOOD TRANSFUSION• Whole BloodWhole Blood::

– Acute blood lossAcute blood loss– ShockShock– Exchange transfusion in neonateExchange transfusion in neonate

• Packed red blood cells: Packed red blood cells: – Chronic severe AnemiaChronic severe Anemia– LeukemiaLeukemia– ThalassemiaThalassemia

• Platelets concentratePlatelets concentrate: : – ThrombocytopeniaThrombocytopenia– Bleeding due to platelet dysfunction Bleeding due to platelet dysfunction – MalignancyMalignancy– Major surgeryMajor surgery

INDICATIONSINDICATIONS (Contd.)(Contd.)

• Fresh frozen plasmaFresh frozen plasma::– Liver disordersLiver disorders– DICDIC– Coagulation factor deficiency (V, VII)Coagulation factor deficiency (V, VII)

• CryoprecipitateCryoprecipitate::– Hemophilia AHemophilia A– von Willebrand’s diseasevon Willebrand’s disease– Fibrinogen deficiencyFibrinogen deficiency

PRE-TRANSFUSION TESTINGPRE-TRANSFUSION TESTING

• ABO and Rh (D) blood groupingABO and Rh (D) blood grouping : :– Patient’s and donor’s blood samplePatient’s and donor’s blood sample

• Cross matching of blood sample:Cross matching of blood sample:– Major cross match- Pt’s serum + Donor cellsMajor cross match- Pt’s serum + Donor cells– Minor cross match- pt’s cells + Donor serumMinor cross match- pt’s cells + Donor serum

BLOOD GROUPINGBLOOD GROUPING

PRE-TRANSFUSION TESTING PRE-TRANSFUSION TESTING (contd.)(contd.)

• Screening for Screening for Transfusion transmitted diseasesTransfusion transmitted diseases (Donor Sample)(Donor Sample) HIV 1 and 2 AIDSHIV 1 and 2 AIDS HBsAg Hepatitis BHBsAg Hepatitis B HCV Hepatitis CHCV Hepatitis C Treponema pallidum SyphilisTreponema pallidum Syphilis Plasmodium species MalariaPlasmodium species Malaria

ADVERSE EFFECTS ADVERSE EFFECTS (TRANSFUSION REACTIONS) - (TRANSFUSION REACTIONS) - Immune mediatedImmune mediated

Acute Acute Onset <24 hoursOnset <24 hours

DelayedDelayedOnset within days/monthsOnset within days/months

1.1. HemolysisHemolysis HemolysisHemolysis

2.2. Febrile reactionsFebrile reactions AlloimmunisationAlloimmunisation

3.3. AllergicAllergic Post transfusion purpuraPost transfusion purpura

4. 4. AnaphylaxisAnaphylaxis Graft Vs Host diseaseGraft Vs Host disease

5.5. TR.Ac.lung injury TR.Ac.lung injury ImmunodilutionImmunodilution

AcuteAcute DelayedDelayed1.1. Bacterial contaminationBacterial contamination HIV 1 & 2HIV 1 & 2

2.2. Circulatory overloadCirculatory overload Hepatitis B & CHepatitis B & C

3.3. Physical damagePhysical damage SyphilisSyphilis

4.4. Chemical damageChemical damage MalariaMalaria

5.5. Thermal damageThermal damage Iron overloadIron overload

ADVERSE EFFECTS ADVERSE EFFECTS (TRANSFUSION REACTIONS) (TRANSFUSION REACTIONS) – Non-Immune mediated– Non-Immune mediated

CAUSES OF TRANSFUSION REACTIONSCAUSES OF TRANSFUSION REACTIONS

• Clerical errors:Clerical errors:– Inadequate labelingInadequate labeling– Wrong blood issuedWrong blood issued

• Technical errors:Technical errors:– Error in blood grouping & cross matchingError in blood grouping & cross matching– Incorrect interpretation of test resultsIncorrect interpretation of test results

• Others:Others:– Blood contamination during phlebotomyBlood contamination during phlebotomy– Blood infusion thr’ small bore needleBlood infusion thr’ small bore needle– Blood cooler to -30⁰C or warmed to > 42⁰ C Blood cooler to -30⁰C or warmed to > 42⁰ C – Concomitant administration blood & drugs thr’ common setConcomitant administration blood & drugs thr’ common set

CLINICAL FEATURESCLINICAL FEATURES

• Fever : Ag-Ab cytokine IL-1 FeverFever : Ag-Ab cytokine IL-1 Fever• Rigors: CytokinesRigors: Cytokines• Pain at infusion site: CytokinePain at infusion site: Cytokine• Hypotension: Neuroendocrine responseHypotension: Neuroendocrine response• HemoglobinuriaHemoglobinuria• OliguriaOliguria• AnuriaAnuria

LABORATORY INVESTIGATIONSLABORATORY INVESTIGATIONS

• Rule out Rule out Clerical errorsClerical errors: Identify blood sample: Identify blood sample• Compare Compare plasma colorplasma color on pt’s pre & post on pt’s pre & post

transfusion sampletransfusion sample - Pink: free Hb red cell destruction- Pink: free Hb red cell destruction - Yellow: increased bilirubin- Yellow: increased bilirubin• Check Check blood colorblood color of bag & attached tubing of bag & attached tubing - Purple color / clot in bag bacterial - Purple color / clot in bag bacterial

contaminationcontamination - Color change hemolysis - Color change hemolysis

LABORATORY INVESTIGATIONS LABORATORY INVESTIGATIONS (Contd)(Contd)

• Repeat Repeat blood groupingblood grouping on pt’s & donor sample on pt’s & donor sample ( Pre and post transfusion sample)( Pre and post transfusion sample)• Repeat Repeat cross matchingcross matching• Perform Direct antiglobulin test (Perform Direct antiglobulin test (DCTDCT))• Blood Blood smear and culturesmear and culture (Donor’s blood) (Donor’s blood)• Others: (Post transfusion sample) Others: (Post transfusion sample)

– Antibody screeningAntibody screening– Serum bilirubinSerum bilirubin– Free hemoglobinFree hemoglobin

TRANSFUSION REACTIONTRANSFUSION REACTIONINVESTIGATION RECORDINVESTIGATION RECORD

• Patient’s particularsPatient’s particulars• Blood bag detailsBlood bag details• Regrouping resultsRegrouping results• Re-cross matching resultsRe-cross matching results• Red cell antibody screening resultsRed cell antibody screening results• Urine investigationsUrine investigations• Microbiological resultsMicrobiological results• Signature of Technician in-chargeSignature of Technician in-charge

SUMMARYSUMMARY• What is it? Types IndicationsWhat is it? Types Indications

Pre-transfusion Pre-transfusion testingtesting

Record CausesRecord Causes Clinical features Laboratory Clinical features Laboratory

investigationsinvestigations

BLOOD BLOOD TRANSFUSIONTRANSFUSION

TRANSFUSIONTRANSFUSIONREACTIONSREACTIONS

THANK YOU…THANK YOU…