Blood Transfusion

What is a Blood Transfusion?

•Administration of blood or one of its
components through an intravenous
line (IV)
•Reaches patient’s blood vessels and
enters the circulatory system
 Purpose of a Blood Transfusion
•Restore blood volume
•Replace clotting factors
•Improve oxygen carrying capacity
•Restore blood elements that are
depleted
•Prevent complications
 Question
•What would indicate the need for a
blood transfusion?
 Lab Test Normal Results Why is this ordered?
Type and crossmatch
Lab Tests
Based on ABO systemTo determine the primary blood group,
Positive = incompatibility screen for antibodies and determine
Negative = probable donor-recipient compatibility.
compatibility
Hbg (hemoglobin) Male 140-175 g/L Hbg carries oxygen in the blood. It can
Female 123-153 g/L decrease due to blood loss.
Critical Value:
Male <130 g/L
Female <110 g/L

Hct Male 41.5%-50.4% Hct measures the proportion of blood

(hematocrit) Female 25.9%-44.6% volume occupied by RBCs. It decreases
Critical Value: with blood loss and anemia.
<18% or >54%

Platelet count 150,000-400000 cells/uL Platelets initiate the coagulation process.

Critical Value: A decreased amount increases the risk
<50,000 cells/uL for hemorrhage.
 Whole Blood
• Composition:
- Red Blood Cells
- White Blood Cells
- Plasma
- Platelets
- Hematocrit
- Clotting Factors

• Purpose:
- Volume replacement
- Increase oxygen-carrying capacity

• Indications:
- Significant blood loss (>25% blood lost, i.e. hemorrhage)
- Newborn babies with hemolytic disease
 Packed Red Blood Cells (RBCs)
• Composition:
- RBCs with little plasma (hematocrit about 75%)
- Some platelets and WBCs remain

• Purpose:
- Increase RBC mass and oxygen-carrying capacity
- Assists the body to rid carbon dioxide and other waste
products

• Indications:
- Symptomatic and chronic anemia
- Blood loss due to injury or surgery
 Platelets
• Composition:
- Platelets
- Plasma
- WBCs

• Purpose:
- Helps to stop bleeding (restore clotting ability)
- Essential for coagulation of blood

• Indications:
- Decreased platelet count
- Hemophilia
- Thrombocytopenia
- Platelet dysfunction (End stage renal disease, DIC)
 White Blood Cells (WBCs)
• Composition:
- WBCs or leukocytes suspended in 20% of the plasma

• Purpose:
- Increase number of WBC’s
- Replaces WBC’s that are functioning abnormally

• Indications:
- Sepsis (not responsive to antibiotics)
- Persistent fever
- Granulocytopenia
 Fresh Frozen Plasma
• Composition:
- Plasma
- All coagulation factors

• Purpose:
- Increase blood plasma
- Replenish clotting factors

• Indications:
- Bleeding in patients with coagulation factor deficiencies;
plasmapheresis
- Burn
- Liver Failure
- Severe Infection
 Albumin
• Composition:
- Albumin

• Purpose:
- Volume expansion leading to increased blood volume

• Indications:
- Hypoproteinemia
- Burns
- Shock
- Trauma
- Surgery
- Infections
Differential Centrifugation
Differential Centrifugation
Complications
 Acute haemolytic reaction

Mechanism Onset Signs and Symptoms

Increased temperature, increased
5-15 heart rate, heat and pain surrounding
minutes vein, chills, headache, nausea, chest
ABO, Rh
following or back pain, chest tightness, dyspnea,
incompatibil bronchospasm, hypotension, anxiety,
initiation of
ity vascular collapse, hemoglobinemia,
blood
hemoglobinuria, disseminated
transfusion intravascular coagulation
 Delayed haemolytic reaction

Mechanism Onset Signs and Symptoms

Immune
response Fever, decrease in Hgb/Hct,
against non- 2-14 days increased bilirubin levels,
ABO donor jaundice
antigens
 Febrile, nonhaemolytic reaction

Mechanism Onset Signs and Symptoms

30 minutes
Sensitivity to after initiation
leukocytes or to 6 hours Fever, chills, headache, muscle
platelets in after pain
donor’s blood completion of
transfusion
 Allergic reaction

Mechanism Onset Signs and Symptoms

5-15 minutes Local erythema,urticaria,
Allergy to a
following pruritus, coughing, nausea,
plasma
initiation of
protein or
blood
vomiting, respiratory distress,
antigen in hypotension, loss of
transfusion, up
donor’s blood
to 1 hour after consciousness, cardiac arrest
 Graft-versus-host disease

Mechanism Onset Signs and Symptoms

Attack of
transfused Skin rash, fever, jaundice, liver
Days to
lymphocytes dysfunction, bone marrow
on host weeks
suppression
lymphocytes
 Circulatory overload

Mechanism Onset Signs and Symptoms

Any time Dyspnea, cough, crackles,
Transfused at
during or headache, hypertension,
an excessive
within 1-2 tachycardia, increased central
volume or
hours after venous pressure, distended neck
rate
transfusion veins
 Sepsis

Mechanism Onset Signs and Symptoms

Bacterial During Fever, chills, abdominal
transfusion to
contaminati cramping, vomiting, diarrhea,
2 hours after
on transfusion hypotension
 Lab Test
Antiglobulin (DAT) Negative
Lab Tests
Normal Results Why is this ordered?
Direct use is for post transfusion work-up to detect
RBC incompatibility. Positive result = hemolytic
transfusion reaction.
Bilirubin Indirect: 0.1-1.0 mg/dL An elevated indirect value may indicate ABO
incompatibility.
Urinary Hemosiderin Negative Used to measure hemoglobin in urine resulting from
intravascular hemolysis. Positive reaction = blood
transfusion reaction.
CBC (Complete Blood Count) WBC 4.8-10.8 x10 9/L To assess cellular characteristics of blood cells in
RBC 4.2-5.4x10 12/L response to transfusion i.e. ABO compatibility
HGB 120-160G/L through  WBC.
HCT 0.370-0.470
MCV 78-98 FL
MCH 25-24 PG
MCHC 320-360 G/L
RDW 0.110-0.150
Platelets 130-400 x10
MPV 7.0-11.0 FL
Lymphocyte 0.15-0.41 x10
Neutrophil 0.6-0.7 x10
Monocyte 0.06-0.41 x10
Esoinophil 0-0.04 x10
Basophil 0-0.2 x10
Luc 0-0.4 x10 9/L
 Treatment during Reaction
• Stop transfusion
• Remove tubing that contains blood product
• Infuse with 0.9% normal saline
• Monitor vital signs
• Notify physician
• Notify blood bank and return blood component
• Administer medication depending on type of
reaction
– Epinephrine, antihistamines, antibiotics, antipyretics,
analgesics, diuretics, corticosteroids
 References
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