HAEMATOLOGY DEP.

LECTURE 2
/
Transfusion Therapy

Transfusion Therapy
Blood transfusion:
The process of transferring blood or blood-based products from one person into the
circulatory system of another.

Blood Bank:
A bank of blood or blood components, gathered as a result of blood donation, stored and
preserved in plastic bags (packs) for later use in blood transfusions.
N.B.
-

An early development leading to the establishment of blood banks occurred in

1915, when Richard Lewison of Mount Sinai Hospital, New York initiated the use of
sodium citrate as an anticoagulant. This discovery transformed the blood transfusion
procedure from direct (vein-to-vein) to indirect.
- Further extending the shelf life of stored blood was an anticoagulant preservative,
CPDA-1 (Citrate, Phosphate, Dextrose, Adenine) in 1979. Adenine helped extend the
shelf life of red cells to 42 days.
- Fresh Frozen Plasma (FFP) can be stored for up to a year if kept frozen.
- Platelets are typically stored for only five days since they are stored at room temperature
and are considered to be at high risk for bacterial contamination.

Types of blood collection bags (packs):

1. Single:
To collect whole blood

2. Double or triple:
1- To separate blood components
1. Plasma
2.RBCs
3. Platelets
4. Cryoprecipitate
2- To store separate blood components

HAEMATOLOGY DEP.
LECTURE 2
/
Transfusion Therapy

Tests before transfusion:

1. Blood grouping: For both the donor & the recipient
2. Cross- matching ( ) :
A test for compatibility between major antigens (ABO system & Rh typing)
Recipient
A
B
AB
O

Donor
A, O
B, O
A, B, AB, O
O

It is better to give each patient his/her own blood group & Rh.

N.B.

3. Serological tests:
Help to avoid diseases that may be transmitted through blood transfusion.
1- Hepatitis B surface antigen (HBs-Ag)
2- Hepatitis C Virus Antibody (HCV-Ab)
3- Human Immunodeficiency Virus types 1 & 2 ( HIV-1 & HIV-2)
4- RPR , screening test for syphilis .Treponema pallidum (The causative agent of
Syphilis S )
Other micro-organisms may include:
Brucella, Malaria, Leishmania, Trypanosoma, Hep. A, Cytomegalovirus "CMV

Donor Selection:
1234-

Age: 18-50
Normotensive
No history of past diseases (Asthma, Jaundice, epilepsy, diabetes, anemia)
Non- pregnant, non- lactating & non- menstruating females

In general, the donor must not be receiving any medications even hematinics.

HAEMATOLOGY DEP.
LECTURE 2
/
Transfusion Therapy

Indications of blood transfusion:

a) Whole blood:
1- Volume replacement:
After major blood loss (> 1 liter) after accidents or majoroperation.
In case of major burns (of 3rd or 4th degree & covering 40-50 % of the body
surface), fresh whole blood transfusion (within 6 hrs. of donation) is indicated to
N.B.
improve oxygen- carrying capacity.
2- Exchange transfusion:
In neonates with hyperbilirubinemia (neonatal jaundice) which does not respond to
phototherapy (treatment with light).e.g : Hemolytic disease of newborn to remove
sensitized red cells and lower bilirubin levels .N.B. : blood less than 48 hours must be
used to avoid hyperkalemia as well as to supply labile clotting factors .
3- Priming:
Priming of heart-lung machines and some renal dialysis equipments. Heparinized blood
is used in heart- lung machines to avoid deionization of calcium.
Ex: For patients with open heart surgery.
4- Sickle cell disease to raise Hb level , suppress erythropoiesis and reduce incidence of
criesis .
N.B.
If not indicated, whole blood transfusion should be avoided to avoid volume
overload.
b) Packed RBCs:
1- Refractory anemia (not responding to treatment ).
2- Chronic renal failure (due to the lack of erythropoietin of which >90% is synthesized
in the kidney).
3- Polytransfused patients (patients who receive blood so often ex. Thalassemia major)
N.B.

Those patients may require platelet transfusion if their spleen gets enlarged and
starts destroying their own platelets "hypersplenism".
4- G6PD deficient patients (in acute hemolytic crisis only)
5- Autoimmune hemolytic anemia
c) Granulocyte concentrates
3

HAEMATOLOGY DEP.
LECTURE 2
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Transfusion Therapy

1- Infections unresponsive after 24 hours of treatment with broad spectrum antibiotics in

patients with severe neutropenia.
2- Prophylaxis in patients with severe transient neutropenia due to drugs, chemicals, or
radiation.
3- Granulocytes are a category of white blood cells characterized by the presence of
granules
in their cytoplasm. They include Neutrophils, Eosinophils,& Basophils.
plasma:
N.B. d) Old
1- Vol. replacement until whole
Bloo
blood is available for transfusion.
d
2- Burns (1st & 2nd degrees) to
improve hemoconcentration. &
plasma loss.
Fresh
Old
3- Marasmus (A form of proteinWithin 6 hours of
Stored for
energy malnutrition. It may occur
donation
more than 6
after dehydration).
hours
e) Fresh frozen plasma & Fresh
plasma:
Fresh Plasma
Old
Patients with bleeding tendencies as
(Contains
Plasma
1- Hemophilia (A&B)
coagulation factors
2- Patients with liver cirrhosis
II,V,VII,VIII, IX,X)
bleeding due to vit. K deficiency
(measured by prothrombin time)
Since both albumin
N.B.
&prothrombin are synthesized
Freezing at -20 to -70 oC
the liver, therefore, FFP
transfusion helps improve
Fresh Frozen
bleeding tendency and also
Plasma
hypoalbuminemia which may
result in ascites and edema in lower limbs. (FFP)
3- Bleeding due to an overdose of oral anticoagulants.
Patients administering oral anticoagulants are often subjected to the risk of
bleeding which is most common in urine "Hematuria" in males & females or
N.B.
during menses (duration & quantity) in females.
4- Multi-transfused patients:
Patients who receive > 4 units of banked blood (free from coagulation factors) must
receive 2 units of FFP for every 4 units of whole blood to guard against deficiency of
labile (coagulation) factors V and VIII .
5- Von Willebrand disease:

in:

in

HAEMATOLOGY DEP.
LECTURE 2
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Transfusion Therapy

It is the most common hereditary coagulation abnormality described in humans that

arises from the deficiency of Von Willebrand factor "VWF" required for platelet
adhesion.
It's more common in females than in males.
Cryoprecipitate:
- It is a blood product prepared from fresh frozen plasma. Each 15 ml unit contains
about 100 U of factor VIII, 350 mg of fibrinogen, von Willebrand factor, factor XIII,
and fibronectin.
- Thawing 250 ml FFP overnight (18-20 hrs) at 4 0C (in the fridge) 15 ml of Cryoppt.
- Most indicated for patients with disseminated intravascular coagulopathy (DIC), Von
Willebrand disease & Hemophilia to avoid vol. overload, but it can be given to any
patient requiring FFP.
Recombinant technology now facilitates the separation of each coag. factor alone.
N.B.
Platelet-rich plasma (10,000- 20,000)
f) Platelets:
Platelet concentrate (very expensive)
1- Indicated in severe thrombocytopenia (very low platelet count associated with
bleeding ) 2- Prophylaxis in severe thrombocytopenia ( Platelets < 20 X 109/ l )
if surgery is anticipated .
2- Bleeding associated with qualitative platelet defects .
N.B. : Platelet transfusion may be associated with reaction .

N.B.

g) Others:
1. Factor VIII concentrate:
Suitable for home therapy
2.
123-

Factor IX fraction concentrate:

Hemophilia B (Factor IX deficiency)
Liver diseases
Correcting anticoagulant deficiency

3. Dried Fibrinogen:
1- Congenital fibrinogen deficiency
2- Low fibrinogen levels (< 1gm/L)
It is composed of 1.5- 2 gm of fibrinogen reconstituted with 200 ml of sterile, pyrogenfree distilled water.

Complications of blood transfusion:

5

HAEMATOLOGY DEP.
LECTURE 2
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Transfusion Therapy

1- Hemolytic reactions (serological, mechanical, or thermal)

2- Circulatory overload
3- Febrile reactions
4- Allergic reactions
5- Infection (Hepatitis A,B,C, CMV, IM, & Syphilis )
6- K+ & citrate toxicity
7- Air embolism
8- Thrombophlebitis (vein inflammation related to a blood clot or thrombus)
9- Transfusion siderosis (deposition of iron in tissues)
10- Immunological sensitization
11- Complications of massive transfusion (Citrate toxicity, Hyperkalemia, Acidosis, &
Thrombocytopenia).