Blood transfusion

  • Blood transfusion is the process of transferring blood or blood-based products from one person to another
  • Can be life saving as in massive blood loss due to trauma
  • Treatment for severe anemia
  • Thrombocytopenia

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  • First fully documented human blood transfusion by Dr. Jean-Baptiste Denis, physician to King Louis XIV of France in 1667.
  • Transfusion of blood from a sheep into a 15 year old boy that survived

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  • Dr. James Blundell, British Obstetrician, performed the first successful blood transfusion of human blood in 1818 for treatment of post partum hemorrhage.
  • Used the blood of the patient’s husband and directly infused into the patient.

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  • In the 1910’s it was discovered that by adding anticoagualnt and refrigerating the blood, it was possible to store the blood for several days..
  • First non-direct transfusion was performed in 1914

Dr. Luis Agote (2nd from right) overseeing one of the first safe and effective blood transfusions in 1914

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  • In the 1930’s and 1940’s Dr Charles Drew’s research led to discovery that blood could be separated into plasma and red blood cells.

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Indications for blood transfusion

  • ANEMIA: A decrease in red blood cells (rbc’s) secondary to blood loss or deficient production

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  • Normal Hgb Levels
  • Males: 14-18 g/dl
  • Females 12-16 g /dl
  • Hematocrit is the proportion of rbc’s in total volume of blood
  • Males: 40-54%
  • Females 38-48%

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  • Transfusions are generally ordered when Hgb 8 g/dl or less
  • OR
  • If patient is symptomatic

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  • Effects of Anemia and decreased O2 delivery:
  • Tachycardia, dyspnea, palpitations, fatigue, weakness, light headedness
  • If severe, anemia could lead to:
  • CVA, or MI secondary to decreased perfusion to heart and brain

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  • Causes of Anemia
  • Sudden blood loss
  • Chronic bleeding
  • Phlebotomy in critically ill patients (increases with blood draws 3 x greater in ICU patients)

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  • Whole Blood
  • Packed Red Blood Cells (prbc’s)
  • Platelets
  • Fresh Frozen Plasma (FFP)
  • Cryoprecipitate

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  • Rarely used in the US
  • Restores fluid volume and circulation
  • Contains rbc’s, wbc’s plasma and platelets

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  • Most common transfusion
  • Restores blood’s ability to carry O2
  • Contains few platelets and wbc’s
  • Generally 250- 350 mls per unit
  • Transfuse over 2-4 hours: based on pts need to receive blood and pts other issues
  • Shorter transfusion time: symptomatic
  • Longer transfusion time: CHF, ESRD
  • Increases the Hgb 1 g/Hct 3-4 %
  • Shelf life 42 days

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  • Platelets are thrombocytes
  • Restores clotting ability
  • Usual dose is 5-10 units
  • OK for rapid transfusion (1 unit over 10 min)
  • Increases platelet count by 5000 per one unit
  • 4-5 day shelf life

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  • Unconcentrated source of all clotting factors and proteins from a single unit of blood (contains albumin, fibrinogen, and antibodies)
  • Treats bleeding caused by factor deficiencies and for Liver failure, DIC, and reversal of coumadin/warfarin therapy
  • Is frozen and can be stored for up to 1 year
  • Notify blood bank 30 minutes prior to when needed in order for them to thaw the FFP
  • After thawing by blood blank must infuse within 6 hours
  • Generally 250-300 ml per unit ordered
  • OK for rapid transfusion (1 unit over 10 min)

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  • Concentrate of 4 clotting factors from FFP. Usually used for patients with specific bleeding disorders sucha as hemophilia, von Willibrands disease.
  • Storage and usage same as for FFP

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  • A+
  • B+
  • AB+
  • O+
  • A-
  • B-
  • AB-
  • 0-

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  • Universal Donor O- (only 6.6% of the population)
  • Universal Recipient AB+
  • Most prevalent blood type O+ (37% of the population)

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http://www.thebloodcenter.org/donor/BloodFacts.aspx

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  • Rh typing Looks at 8 different genes
  • Rh present (positive)
  • Rh absent (negative)
  • Typing is done to prevent complications from giving incompatible blood

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  • If transfusion reaction suspected
  • STOP the transfusion
  • Notify Physician
  • Give supportive treatment (per orders/protocol):
  • Normal saline fluids
  • Antipyretics
  • antihistamines

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  • Viral is the most common transfusion-transmitted infection
  • Hepatitis B
  • Hepatitis C
  • HIV (most feared)
  • Long period for seroconversion (25-45 days)
  • CMV which belongs to the herpes group (transmitted by whole blood and rbc’s)
  • Can cause immunosuppression leading to risk of pneumonia, gastroenteritis, and hepatitis particularly in the critically ill

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  • Stored units can become contaminated with bacteria and cause infection to recipient
  • Mortaility rate from bacteremia = 50%
  • Causes:
  • Inadequate skin prep at phlebotomy site, small leaks in blood containers, contaminated containers, asymptomatic bacteremia at time of donation

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  • Whole Blood ~ 35 days
  • PRBC’s ~ 42 days (after this there is a decline in the quality with an increase in inflammatory mediator release)
  • Can be frozen up to 10 years
  • WBC’s ~ <42 days (after this wbc’s begin to die and release toxic cell enzymes)
  • Platelets 5 days

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  • Autologous
  • Allogenic/Homologous
  • Cell Saver

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  • Safest
  • Giving pt their own blood
  • Can donate 72 hours before the scheduled surgery
  • Limiting factors:
  • Hgb < 12.5 g/dl
  • Age < 17
  • Weight < 110 lbs (50kg)
  • No chronic health problems
  • Tatoos/body piercing < 1 year

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  • All other donated blood, other than the patients own blood.

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  • Collects, Washes and spins blood that has been suctioned from patient during surgery
  • Debris and hemolytic by products removed
  • Reinfused into patient

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  • Malignancy
  • Sepsis
  • Enteric contamination
  • Coagulopathy
  • Pulmonary infection
  • Impaired renal function
  • Excessive hemolysis

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  • HIV – 1: 2 million
  • Hepatitis B – 1: 200,000
  • Hepatitis C – 1: 1-2 million
  • Creuzfeldt-Jacob disease – very rare




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