Blood, Blood Products and Blood Transfusion
By;SITI AFIFAH
MARDHIYYAH
Supervisor;DR SALEHUDIN
Contents
• Definition• Functions of the blood• Blood products• Indication for transfusion• Maximum surgery blood order schedule (MSBOS)• blood transfusion: hemovigilance• Blood transfusion reaction and its management• Other complications of blood transfusion• Take home massage
Definition:
• Blood - connective tissue (fluid) consisting of plasma and cellular component.
• 8% of total BW
Functions of the blood• supplies o2 and substances absorbed from the GIT to
the tissues.• returns co2 to the lungs, and other products of body
metabolism to the kidneys.• Transport hormones produced by respective glands of
endocrine systems
Transportation
• White cells- preotection of the body againts pathogen• Platelets- limiting blood lossProtection
• Body temperature• blood pressure• pH balanceRegulation
Blood product & Blood Transfusion
• Blood product- A blood product is any component of the blood which is collected from a donor for use in a blood transfusion
• Blood transfsusion-is the process of transferring blood or blood components from one person into the circulatory system of another
WHOLE BLOOD
CELLULAR FRESH COMPONENTS PLASMA
• RED CELLS• PLATELETS• WHITE
BLOOD CELLS
FRESH FROZEN PLASMA
CRYOPERCIPITATE
CRYOSUPERNATANT
FACTOR VIIICONCENTRATE
•ALBUMIN•IMMUNOGLOBULIN•OTHER CONCENTRATES
Blood products
Blood productsWhol
e bloo
d
• Blood taken from a suitable donor using a pyrogen free anticoagulant container. The major use is used for blood component separation.
Packed red cells
• A component derived by removing part of the plasma from whole blood
Platelet
• A component derived from fresh whole blood by centrifugation which contain majority of the platelets content in theraputically effective form.
Fresh frozen plasma
• A component prepared either from fresh whole blood or from plasma collected by apheresis, frozen at an appropiate temperature to preserve the activity of labile coagulation factors.
Cryoprecipitat
e
• A component containing the cryoglobulin fraction of plasma obtained by further processing of fresh frozen plasma prepared from hard spun cell free plasma and concentrated to a final volumes required.
Cryosupernatqant
• A component prepared from plasma by removal of cryoprecipitate
Indication for transfusion of blood product
1. Packed red cells
2. Platelet
Hematological malignancies To maintain platelet > 20x 109
Massive transfusion Acute bleeding, multiple trauma
DIVC Acute DIC, aim to maintain platelet >50x109
CABG/ Ruptured AAA Reserved for post op bleeding
Immune thrombocytopaenia
Platelet function disorders If all other measures fail to control the bleeding
3. Fresh Frozen Plasma
4. Cryoprecipitate
Maximum surgery blood order schedule (MSBOS)
• Reference used to guide clinicians in ordering blood before surgery.
• The Maximum Surgical Blood Order Schedule (MSBOS) is a table of elective surgical procedures which lists the number of units of blood routinely requested, and cross-matched for them pre-operatively.
MSBOS
• For cases where blood;–Not likely to be transfused – GSH is
perfomed.– Likely to be transfused – GXM is performed.
*However when antibody screen is positive, compatible blood must be made available in all cases before surgery
Group Crossmatch• The patient's serum is
screened and tested directly for compatibility with the red cells of the units of blood to be transfused.
• Crossmatched blood will retained for 48hours in blood bank.
Group, Screen, Hold• Consist of process ABO,
Rh D grouping and antibody screen
• Serum/plasma is retained for 48 hours in the blood bank.
MSBOS ; General surgery
Abdominal – perineal resection
4
cholecystectomy GSH
Gastectomy 2
Hemicolectomy, small bowel resection
GSH
Hiatus hernia repairAbdominalTransthoracic
2GSH
Inguinal hernia repair
GSH
Laparotomy GSH
Perforated viscus 2
Mastectomy GSH
Oesophagectomy 4
Pancreatectomy 4
Portocaval shunt 4
Spelenectomy 2
Thyroidectomy, Parathyroidecomy
GSH
Varicose vein GSH
Vagotomy GSH
Whipples procedure
4
C:T Ratio
• Crossmatch : transfusion ratio• An indicator to assess the appropriateness of
cross matching of blood to the units of blood transfused
• Standard value ≤2.5
C: T ratio
• C: T ratio surgical department for the year 2013
JAN FEB MAC APR MAY JUN JUL AUG SEP OKT NOV DIS
GXM 467 497 626 341 569 550 495 538 509 315 270 547
TRANSFUSION 231 235 379 158 289 280 260 280 253 301 231 268
RATIO 2.0 2.1 1.7 2.2 2.0 2.0 1.9 1.9 2.0 1.0 1.2 2.0
Consent of blood transfusion
• Written consent• Patient should be explained regarding the benefits and
risks of blood transfusion• Explain:– Indication– Complications
• Infection• Reaction
• The patient’s consent should be obtained for the planned transfusion and recorded in the patient’s medical chart.
Hemovigilance
• Haemovigilance is a system of surveillance and alarm, from blood collection to the follow-up of the recipients.
1. Blood taking2. Giving blood
3 3
2
1
2
1
BLOOD BANK
Monitor adverse effects
VITAL SIGN SYMPTOMS• BP• PR/HR• RR• Temperature
• Fever• Chills and rigors• Pain at infusion
site/abdomen/chest• Respiratory distress• Urticaria/rashes• Nausea/vomiting
COMPLICATION OF BLOOD TRANSFUSION
• Acute – during transfusion/within 24 hours• Delayed – after 24 hours
IMMUNE MEDIATED NON-IMMUNE MEDIATED
ACUTE DELAYED ACUTE DELAYED• Hemolytic
reaction• Febrile non-
hemolytic• Urticaria• Anaphylactic
• Hemolytic Reaction
• Post Transfusion Purpura
• Graft Vs Host Disease
• Septic• Circulatory
Overload• Metabolic• Hyperkalemia• Hypocalcaemia• Metabolic
alkalosis
• Infection• Iron Overload
Management of transfusion reactionADVERSE EFFECT
STOP TRANSFUSION
Pruritus
Urticaria, Rashes
Chest pain, pain at infusion site,
respiratory distress, loin/back pain
Hypotension, hematuria, DIC
Anxiety, SOB, Palpitation, Headache
Flushing, Rigor, Fever, Tachycardia,
Restless
• Antihistamine
• If symptoms subside : resume
transfusion at slower rate
• Maintain A, B, C
• AdrenalineFurosemide/
corticosteroid/bronchodilator/
antibiotic
• Antihistamine and/or
Antipyretic
• Withold transfusion
LIFE THREATENINGMODERATEMILD
Investigations
• Blood reaction kit (immediate & post 24hr)
• 4ml in plain tube for antibody identification• 2ml in EDTA tube for FBP• >10ml urine sample- may have haemoglobin and albumin
• The remaining blood bag, containing the partially transfused blood, and all the blood bags cross-matched for the same patient at the same time of the request should be examined for the presence of free haemoglobin or discolouration before being sent to the laboratory.
• The “Report of Reaction to Blood or Plasma Transfusion” form must be completed.
• Fill up the “Transfusion Adverse Event” form in duplicate and send to the blood bank. Send also a copy of this form to the National Blood Centre.
• Other adverse transfusion reactions include:– Fluid overload– Metabolic disturbances e.G. Hyperkalaemia and
hypocalcaemia.– Hypothermia– Embolism– Iron overload– Alloimmunisation to red cell, white cell or platelet antigen.– Immunosuppression and immunomodulation– Transmission of viral infection
Transmitted Infection Incident
HIV 1 : 1,900,000
Hep A 1 : 1,000,000
Hep B 1 : 1,800,000
Hep C 1 : 1,600,000
Bacteria Infection 1 : 3,000
Take home massages
1. Blood product mainly consist of cellular component and fresh plasma.
2. The decision to transfuse depends on many factors such as haemoglobin level, anemic symptoms and risk of bleeding.
3. MSBOS used to guide clinicians in ordering blood before surgery.
4. The patient’s consent should be obtained for the planned transfusion and recorded in the patient’s medical chart.
Take home massage
4. 1 person take blood and label- confirm patient’s name and identification before label.
5. Confirm patient’s name and identification with patient’s note, compatibility label and request form before transfusion.
6. If an adverse transfusion reaction is suspected, the transfusion should be stopped immediately and must be reported.
References
1. Transfusion Practice Guidelines for Clinical and Laboratory Personnel 3rd edition March 2008. National Blood Centre, Ministry of Health Malaysia
2. Guidelines for the rational use of blood and blood products. National Blood Centre, Ministry of Health Malaysia
3. Blood Transfusion guideline (2006), National Users’ Board Sanquin Blood Supply
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