DEFINITION:

• It is the transfusion of whole blood or its components such as

blood cells and plasma from one person to another person.
• Blood transfusion is the intravenous administration of the
whole blood or a component such as plasma, packed red
blood cells or platelets to a patient from donor to the
recipient.
• This involves two procedures the collection of blood from the
donor and administration of blood to the recipient.
TYPES OF BLOOD TRNSFUSION:
• There are several common kinds of blood cell transfusions.
1.RED BLOOD CELLS
2.PLATELETS
3.PLASMA
4.CRAYOPRECIPITATE
 1)RED BLOOD CELL TRANSFUSION
• It may be used if there is anemia or an iron deficiency.
• Each unit of packed red blood cells (PRBCs) is expected to raise
circulating hemoglobin (HGB) by approximately 1 g/dL.
• One transfusion of red blood cells usually takes 2 to 4 hours.
• Each unit of Red Blood Cells contains approximately 147-278 mg
of iron.
• In neonates, a dose of 10-15 mL/kg.
• Standard pediatric dose is 10- 20 mL/kg.
• The drip rate of the infusion set is 15 drops per mL
2)PLATELETS: (8-9 days)
• These are tiny cells in the blood that help you stop bleeding.
• A platelet transfusion is used if body doesn’t have enough of
them.
• A 1 dose of random donor can be expected to increase the
platelet count by 5000/uL in a non-refractory patient
• For pediatric patients, 5 mL/kg body weight of a random
donor platelet concentrate should increase the platelet count
by 5000/uL.
• For children >8 kg, a standard dose of 1 unit/10 kg should be
used.
• transfused at a rate of 10 ml per minute.
3)PLASMA TRANSFUSION: (9-10 days)
• It helps to replace the proteins in your blood that help it clot. It
may be needed after severe bleeding or if you have liver disease.
• Fresh frozen plasma is the fluid portion of a unit of whole blood
that is frozen in a designated time frame, usually within 8 hours.
• FFP contains all coagulation factors except platelets. FFP
contains fibrinogen (400 to 900 mg/unit), albumin, protein C,
protein S, antithrombin, tissue factor pathway inhibitor.
• It takes 1 hour.
mL = wt (kg) x Hb (g/L) rise (desired Hb –
actual Hb) x 0.5
CONT…
• Each unit contains approximately 200- 250 ml.
• Administration of one 250 mL unit should raise the
fibrinogen level by 5 to 10 mg/dl.
• A standard dose of 10 to 20 mL/kg will raise factor levels by
approximately 20%.
• The typical dose for children weighing less than 15 kg is 10–
20 mL/kg.
• Children above 15 kg may receive a single donation
(approximately 300 mL).
 4) CRYOPRECIPITATE
 Cryoprecipitate a derivative of fresh frozen plasma thawed at 4°C,
contains fibrinogen (200 mg/unit), Factor VIII, fibronectin, factor
XIII, and von Willebrand Factor.
 Standard dose for all patients is 5 to 10 mL/kg although dosing based
on the recipient’s weight is also used.
• A single unit contains a mean of approximately 400-460mg
fibrinogen.
 Each unit of cryoprecipitate will raise the fibrinogen level 5–
10 mg/dl.
 It takes 15-30 minutes.
CONT…
• For older children the typical dose is 5-10 ml/kg.
• It can also be used in treatment of von Willebrand disease or
hemophilia.
• The shelf life is 1 year from the date of collection.
 PURPOSE:
 To restore the blood volume when there is a sudden loss of
blood due to hemorrhage trauma or burns
 To raise the hemoglobin level in cases of severe anemia which
are not corrected by the administration of vitamins and iron
therapy.
 To treat deficiencies of plasma proteins, clotting factors and
hemophilic globulin etc.
 To provide antibodies to those persons who are sick and having
lowered immunity by giving blood or plasma taken from
persons who just recovered from the same disease.
CONT..
 To replace the blood with hemolytic agents with fresh blood.
 To improve the leucocyte count of blood as in
agranulocytosis.
 To increase the circulating blood volume.
 FORMULA FOR CALCULATING
AMOUNT OF BLOOD TRANSFUSION

•mL = wt (kg) x Hb (g/L) rise (desired

Hb – actual Hb) x 0.5
GUIDELINES FOR
SAFE BLOOD
TRANSFUSION
Positive patient identification
• Last name, first name, date of birth, unique identification
number.
• Whenever possible ask patients to state their full themselves
(paediatric, unconscious, confname and date of birth. For
patients who are unable to identify used or language barrier)
seek verification of identity from a parent or carer at the
bedside. This must exactly match the information on the
identity band (or equivalent).
• All paperwork relating to the patient must include, and be
identical in every detail, to the minimum patient identifiers on
the identity band.
Patient information and consent for
transfusion
• Where possible, patients (and for children, those with
parental responsibility) should have the risks, benefits and
alternatives to transfusion explained to them in a timely and
understandable manner.
• Standardised patient information, such as national patient
information leaflets, should be used wherever possible.
Pre-transfusion documentation
• Minimum dataset in patient’s clinical record:
• Reason for transfusion (clinical and laboratory data).
• Summary of information provided to patient (benefits, risks,
alternatives) and patient consent.
Prescription (authorisation)
• The transfusion ‘prescription’ must contain the minimum
patient identifiers and specify:
• Components to be transfused
• Date of transfusion
• Volume/number of units to be transfused and the rate or
duration of transfusion
• Special requirements
Requests for transfusion

• Minimum patient identifiers and gender

• Diagnosis, any significant co-morbidities and reason for
transfusion
• Component required, volume/number of units and special
requirements
• Time and location of transfusion
• Name and contact number of requester.
Blood samples for
pre-transfusion testing
• All patients being sampled must be positively identified.
• Collection of the blood sample from the patient into the
sample tubes and sample labelling must be a continuous,
uninterrupted event involving one patient and one trained and
competency assessed healthcare worker.
• Sample tubes must not be pre-labelled.
• The request form should be signed by the person collecting
the sample.
Collection and delivery of blood
component to clinical area
• Before collection, ensure the patient (and staff) is ready to
start transfusion and there is good venous access.
• Only trained and competent staff should collect blood from
transfusion laboratory.
• Authorised documentation with minimum patient identifiers
must be checked against label on blood component.
• Minimum patient identifiers, date and time of collection and
staff member ID must be recorded.
• Deliver to clinical area without delay.
Administration to patient
• The final check must be conducted next to the patient by a
trained and competent healthcare professional who also
administers the component.
• All patients being transfused must be positively identified.
• Minimum patient identifiers on the patient’s identity band
must exactly match those on blood component label.
• All components must be given through a blood administration
set
• Transfusion should be completed within 4 hours of leaving
controlled temperature storage.
Monitoring the patient
• Patients should be under regular visual observation and, for
every unit transfused, minimum monitoring should include:
• Pre-transfusion pulse (P), blood pressure (BP), temperature
(T) and respiratory rate (RR).
• P, BP and T 15 minutes after start of transfusion – if
significant change, check RR as well.
CONT..
• If there are any symptoms or signs of a possible reaction –
monitor and record P, BP, T and RR and take appropriate
action.
• Post-transfusion P, BP and T should be taken.
• Inpatients observed over next 24 hours.
• Outpatients advised to report late symptoms (24-hour access
to clinical advice).
Completion of transfusion episode
• If further units are prescribed, repeat the
administration/identity check with each unit.
• If no further units are prescribed, remove the blood
administration set and ensure all transfusion documentation is
completed.
TYPES OF BLOOD TRANSFUSION
• Blood transfusions can be grouped into two main types
depending on their source:
• 1)Homologous transfusions- It is transfusion using the
stored blood of others.
• 2)Autologous transfusions- It is transfusion using one's own
stored blood.
• 3)Heterologous blood transfusions- These are those that
involve someone infusing blood and its components from a
different species.
2)Autologous transfusions
1- Predeposit autologous donation (PAD)
• This is the banking of red cell units from the patient before
planned surgery.
• Most healthy adult patients can donate up to three red cell
units before elective surgery.
• Patients may be given iron supplements, sometimes with
erythropoietin, to prevent anemia or allow more donations to
be collected.
CONT..
• The Blood Safety and Quality Regulations (BSQR, 2005)
require that donations for PAD must be performed in a
licensed blood establishment, rather than a routine hospital
setting.
2- Intraoperative cell salvage

• This is the collection and reinfusion of blood spilled during

surgery.
• Blood lost into the surgical field is filtered to remove
particulate matter and aspirated into a collection reservoir
where it is anticoagulated with heparin or citrate.
• If sufficient blood is collected and the patient loses sufficient
blood to require transfusion, the salvaged blood can be
centrifuged and washed in a closed automated system.
CONT..
• Red cells suspended in sterile saline solution are produced,
which must be transfused to the patient within 4 hours of
processing.
• The reinfusion bag should be labelled in the operating theatre
with the minimum patient identifiers.
3- Postoperative cell salvage (PCS)

• PCS is mainly used in orthopaedic procedures, especially

after knee or hip replacement and in correction of scoliosis.
Blood is collected from wound drains and then either filtered
or washed in an automated system before reinfusion to the
patient.
• The simple filtration systems for reinfusion of unwashed red
cells are mainly used when expected blood losses are
between 500 and 1000 mL.
4-Acute normovolaemic haemodilution (ANH)

• In ANH several units of blood are collected into standard

blood donation packs immediately before surgery (usually in
the operating room) and the patient’s blood volume is
maintained by the simultaneous infusion of crystalloid
(NS,RL)or colloid fluids(Albumin).
• The blood is stored in the operating theatre at room
temperature and reinfused at the end of surgery or if
significant bleeding occurs.
CONT..
• ANH is most often used in cardiac bypass surgery where the
immediate postoperative transfusion of ‘fresh whole blood’
containing platelets and clotting factors is seen as an
advantage
 PREREQUSITES FOR BLOOD
TRANSFUSION
• Verify that an order for the transfusion exists.
• Conduct a thorough physical assessment of the patient
(including vital signs) to help identify later changes.
• Document your findings. Confirm that the patient has given
informed consent.
• Teach the patient about the procedures associated risks and
benefits, what to expect during the transfusion, signs and
symptoms of a reaction, and when and how to call for
assistance.
CONT…
• Check for an appropriate and patent vascular access.
• Make sure necessary equipment is at hand for administering
the blood product and managing a reaction, such as an
additional free I.V. line for normal saline solution, oxygen,
suction, and a hypersensitivity kit.
CONT..
• Be sure you’re familiar with the specific product to be
transfused, the appropriate administration rate, and required
patient monitoring.
• Be aware that the type of blood product and patients
condition usually dictate the infusion rate.
• For example, blood must be infused faster in a trauma victim
who’s rapidly losing blood than in a 75-year-old patient with
heart failure, who may not be able to tolerate rapid infusion.
CONT..
• Know what personnel will be available in the event of a
reaction, and how to contact them. Resources should include
the on-call physician and a blood bank representative.
• Before hanging the blood product, thoroughly double-check
the patients identification and verify the actual product.
Check the unit to be transfused against patient identifiers, per
facility policy.
• Infuse the blood product with normal saline solution only,
using filtered tubing.
 WHAT TO CHECK…
- Each donor unit must be labeled in clear, readable letters,
bearing the following information to be verified at the time
of administration:
 Name of the recipient
 recipient number
 ABO grouping
 Rh typing
 Date of drawing blood
 Date of expiry
 Symptoms Of reaction:

- Symptoms may include any of the following:

• Back pain
• Bloody urine
• Chills
• Fainting or dizziness
• Fever
• Flank pain
• Flushing of the skin
 RISK AND COMPLICATIONS:

 Allergic reactions
 Acute immune hemolytic reaction
 Delayed hemolytic reaction
 Anaphylactic reaction
 Blood borne Infections
 Transfusion related acute lung injury.
IMMIDIATE MANAGEMENT OF
REACTION:
• Stop infusion
• Maintain IV line with Normal saline at a "keep vein open"
rate (KVO).
• Notify physician or other provider
• Reconfirm patient and unit identification to verify that the
correct unit is being given to the intended recipient
• Notify the Blood Bank; collect a type and screen specimen
and a first post-transfusion urine specimen. Send these along
with the remaining blood unit, and administration set with
attached solutions to the laboratory unless otherwise
instructed
CONT..
• Do not initiate another transfusion without Blood Bank
consultation.
• Monitor closely for any further signs or symptoms
• Document the reaction in the patient's chart as per institution
policy
 TREATMENT OF BLOOD TRANSFUSION
REACTION:
Hemolytic transfusion reactions are treated as follows:
 Stop transfusion as soon as a reaction is suspected
 Replace the donor blood with normal saline
 Examine the blood to determine if the patient was the
intended recipient and then send the unit back to the blood
bank.
 Furosemide may be administered to increase renal blood
flow
CONT..

• Low-dose dopamine may be considered to improve renal

blood flow
• Make
Minorefforts to maintain
allergic urine
reactions are output
treatedatwith
30-100 mL/h.
antihistamines.
• Although the necessity of stopping the transfusion is
unclear, in more severe cases and in uncertain cases, the
transfusion should be stopped.
Blood borne Infections
• Blood transfusion has been and continues to be a possible
source of disease transmission. An agents can potentially be
transmitted through blood transfusions, including bacteria,
viruses, and parasites. Of these, bacteria are the most
commonly transmitted
• Viral agents that are capable of being transmitted through
blood transfusion include the following:
• Human immunodeficiency virus (HIV)
• Hepatitis viruses
• West Nile virus (WNV)
• Cytomegalovirus (CMV)
• Parvovirus B19
 Transfusion-related acute lung injury is treated
as follows
• It is a rare but serious syndrome characterized by sudden acute
respiratory distress following transfusion. It is defined as new, acute
lung injury (ALI) during or within six hours after blood product
administration.
• Symptoms of TRALI typically develop during or within six hours of a
transfusion. Patients present with the rapid onset of dyspnea and
tachypnea. There may be associated fever, cyanosis and hypotension.
Clinical examination reveals hypoxic respiratory distress, and
pulmonary crackles may be present without signs of congestive heart
failure or volume overload
• TRALI is associated with a high morbidity and the majority
of patients require ventilator support. However, with
supportive care, the lung injury is generally transient, with
oxygen levels returning to pre-transfusion levels within 48 to
96 hours and CXR returning to normal within 96 hours
 Monitor oxygen saturation
 Provide supplemental oxygen to maintain oxygen saturation
above 92%
 Hypoxemia severe enough to require endotracheal intubation
and positive-pressure ventilation occurs in 70-75% of
patients
 No evidence supports the routine use of corticosteroids
 The blood bank should be notified
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