Post on 11-Apr-2017
BLOOD TRANSFUSIONS Matching and Transfusing
ABO Karl Landsteiner identified the O, A, and B
blood types in 1900.
Alfred von Decastello and Adriano Sturli discovered the fourth type, AB, in 1902.
Antigen – marker expressed on the call wall
Antibodies – used by the immune system to neutralize pathogens
ABO Type A blood has type A antigen expressed on its
surface.
Type B has type B antigen expressed on its surface.
Type AB has type A & B antigen expressed on its surface.
Type O (sometimes referred to as type zero outside North America) has no antigen expressed on its surface.
Depending on the blood type different antibodies (anti-A, anti-B, or anti-A & anti b) will be present in the blood.– Type A: anti-B antibodies– Type B: anti-A antibodies– Type AB: no antibodies– Type O: anti A & anti B antibodies
RHESE FACTOR Discovered in 1937 by Karl Landsteiner and
Alexander S. Wiener.
Rh positive indicates that the type D antigen is expressed.
Rh negative indicates that the type D antigen is not expressed.
You need to be exposed to antigen D (Rh +) to develop antibodies (i.e. mother-fetus)
Furthermore, many other antibodies exists and many be tested for in unique clinical situations.
ABO +/-TYPE ANTIGEN ANTIBODIESA + A & D Anti-B antibodies
A - A Anti-B antibodies
B + B & D Anti-A antibodies
B - B Anti-A antibodies
AB + A, B & D No antibodies
AB - A & B No antibodies
O + Zero Anti-A and Anti B antibodies
O - Zero Anti-A and Anti B antibodies
Therefore, PRBC must be matched to prevent a hemolytic reaction.
ABO +/- Blood Transfusions:
• AB+ is the universal recipient because the RBC expresses the A, B and D antigen. Therefore, any type of blood can be transfer without an antibody reaction.
• O- is the universal donor. Type O or type ‘zero’ has no A, B or D antigens expressed on its surface. Therefore, when transfused it won’t create an antibody reaction.
• Rh (+) recipients may receive a type specific Rh (-) transfusion (A+ received A-).
• However, Rh (-) recipients may not receive a Rh (+) transfusion. D antibodies will develop causing a transfusion reaction.
BLOOD TRANSFUSIONS Initially, whole blood was transfused.
Modern transfusion medicine developed component therapy.
Whole blood is broken down into different products (PRBC / FFP / PLT / CRYO / ALB / ect).
Whole blood used in military trauma centers.
Massive Transfusion Protocol attempts to mimic whole blood (ratio of PRBC:FFP:PLT)
PRBC ABO Rh specific Improve oxygen delivery (VO2) Replace lost volume (↑ Hgb & HCT) Cold (4C) Leukocyte reduced (reduces transfusion
reactions) Contains citrate Storage: 35 days K+↑ and 2,3 DGP ↓ with age Limited ATP stores Shape changes during storage (oval shaped)
TRANSUSION REACTIONS Acute Hemolytic Transfusion Reaction (AHTR) Delayed Hemolytic Transfusion Reaction (DHTR) Febrile Non-hemolytic Reaction Allergic Reaction Anaphylaxis Transfusion Related Acute Lung Injury Acute Non Hemolytic Reaction
!! DANGER !!
TRANSUSION REACTIONSAcute Hemolytic Transfusion
Reaction:
• ABO incompatibility (40% lab error / 60% bedside error)
• Fever, chills, chest pain, shock, bleeding, death
• Rapid onset (antibody mediated)
TRANSFUSION REACTIONS
Delayed Hemolytic Transfusion Reaction:
• Seen in patients with multiple previous transfusion or pregnancy.
• Antibodies develop to other antigens (not A, B or O).
• Develops days to weeks after the transfusion.
TRANSFUSION REACTIONS
Allergic Reaction Anaphylaxis:
• Allergic reactions are common in transfusion recipients (1-3%).
• Reaction to the donor proteins, leukocytes and antigens.
• Anaphylaxis (rare): severe life threating allergic reaction.
TRANSFUSION REACTIONSTransfusion Related Acute Lung Injury:
• Transfusion of inflammatory cytokines, active lipids, and/or antibodies.
• Immune and inflammatory response in the patient’s lungs (diffusing problems).
• Respiratory distress (secondary ARDS)
• Sick patient + transfusion = TRALI
TRANSFUSION REACTIONS
Acute Non-Hemolytic Reaction:
Delayed onset (<1 hour)
Leukocyte mediated
Cooled donor leukocytes less active.
Leukocytes become more active as they warm up.
TRANSFUSION COMPLICATIONS Transfusion associated sepsis
Fluid Overload
Metabolic Effects:• Hyperkalemia (especially in patient with acidosis and renal failure)• Citrate Toxicity: ↓Ca+ and metabolic alkalosis
Hypothermia • Associated with poor outcomes• Warm blood when possible
Thank You!