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Blood…??• RED BLOOD CELLS (Erythrocytes) – The most abundant

cells in our blood; they are produced in the bone marrow and contain a protein called hemoglobin that carries oxygen to our cells.

• WHITE BLOOD CELLS (Leukocytes) – They are part of the immune system and destroy infectious agents called pathogens.

Blood …??PLASMA – This is the yellowish liquid portion of blood that contains electrolytes, nutrients and vitamins, hormones, clotting factors, and proteins such as antibodies to fight infection.

PLATELETS (Thrombocytes) are carried in the plasma; they clot together in a process called coagulation to seal a wound and prevent a loss of blood.

The average adult has about FIVE liters of blood which makes up 7-8% of their body weight.

Blood is living tissue that carries oxygen and nutrients

to all organs and carries carbon dioxide and other waste products back to the lungs, kidneys and liver for disposal.

It also fights against infection.

Coagulation.

Genetics of Blood Types

blood type is established by specific GENES inherited from parents. one gene from MOTHER and one from FATHER.

• These genes determine your blood type by causing proteins called AGGLUTINOGENS to exist on the surface of all of your red blood

cells.

blood types

There are 3 alleles or genes for blood type: A, B, & O. Since we have 2 genes, there are 6 possible combinations.

•Blood Types

AA or AO = Type ABB or BO = Type B

OO = Type OAB = Type AB

•How common is your blood type?

•46.1%

•38.8%

•11.1%

•3.9%

Rh Factors

The presence of the protein, or lack of it, is referred to as the Rh (for Rhesus) factor.

Rh positive (Rh+). If your blood

Rh negative (Rh-).

A+ A-B+ B-

AB+ AB-O+ O-

Blood Transfusions

•Universal Donor

•Universal Recipient

•Who can give you blood?

•People with TYPE O blood are called Universal Donors, because they can give blood to any blood type.

•People with TYPE AB blood are called Universal Recipients, because they can receive any blood type.

•Rh + Can receive + or - •Rh - Can only receive -

Blood Transfusions

• Blood samples – Can be analyzed to determine blood type and DNA, which can be matched to possible suspects.

For a blood transfusion to work, the For a blood transfusion to work, the donated donated blood must matchblood must match that of the that of the recipient’s.recipient’s.

If the blood is not matched properly, If the blood is not matched properly, then the immune system of the then the immune system of the recipient will attack the donated blood.recipient will attack the donated blood.

.•Immune System Immune System ResponseResponse

After birth the immune system makes After birth the immune system makes antibodiesantibodies that act against the that act against the antigens not found on the RBCs.antigens not found on the RBCs.

Antibodies are present on the white Antibodies are present on the white blood cells (WBCs).blood cells (WBCs).

Blood Types

Blood Transfusion

Who

When

Where

Why

Patient Details required on form• Full names• DOB• Hospital Number• Location • Blood Group (if known)• Previous transfusion and obstetric history

Transfusion details• Reason for request; Present Hb (if known)• Location, Date and Time of expected transfusion• Date of request• Type of blood (Packed cells, whole blood, G&S only); Number of

units.

• Name, Bleep number and Signature of person requesting the

blood

LABELS ARE NEVER

ALLOWED ON THE

FORMS OR THE

BOTTLES

Sample Collection • Check patient details on wrist band vs form.• Use Pink cross match bottle (In use nationally)

• Details required on Blood Sample tube- Full names of patient- DOB; Gender; Hospital number- Signature of person taking blood- Date and Location

• Take blood tube down to the blood bank if required urgently – you will also meet the cross match team.

PATIENT LABELS WILL NOT BE ACCEPTED!

Setting up the Transfusion

• Units of blood are stored in the ‘blood bank’ fridge or theatre fridge.

• You will need all the patient’s details prior to going to collect any blood products

• Check details of blood report form against unit of blood.

• You will need to sign for the unit in blood bank register.

• Start transfusion within 30 minutes of blood being removed from the fridge.

Blood Bank

•http://www.bloodbankofalaska.org/about_blood/index.html

•The Wright, Wright ,Wright Rule

•The Right Blood,

•The Right Patient,

•The Right Time!

Most haematology labs can cross match blood in 20 minutes

Blood Transfusion

TWO to check details of blood unit

Check details on the unit of blood against those written on the form

against patient’s wrist band.

ALL MUST BE CORRECT.

Check

•http://www.bloodbankofalaska.org/about_blood/index.html

Blood Transfusion

Prescribe Transfusion on IV chart

Rate of each unit (slowest approx 4 hours)

Saline (100ml+) Before – After

Laxis(40mg) is often given with each or every other unit (IV or PO) to stop potential fluid overload. Not required when patient is hypovolaemic.

Blood Transfusion

•http://www.bloodbankofalaska.org/about_blood/index.html

START

Allergic reactions

Allergic reactions to an unknown component in donor blood are common, usually due to allergens in donor plasma or, less often, to antibodies from an allergic donor. These

reactions are usually mild.

Simultaneous fever is common

Time…???

During or immediately after the transfusion.

Allergic Reactions

CHECK

Febrile Nonhemolytic Reaction

Febrile reaction without hemolysis.

Antibodies directed against WBC from otherwise compatible donor blood are one possible cause. This cause is most common in multitransfused or multiparous patients.

.

The most common Complications of transfusion are

Febrile Nonhemolytic & Chill-

Rigor Reactions.

•Blood Transfusion complication

Clinically, febrile reactions consist of a increase of T ≥ 1° C, chills, and sometimes headache and back pain.

Simultaneous symptoms of allergic reaction are common. Because fever and chills also herald a severe hemolytic transfusion reaction.

All febrile reactions must be investigated as above, as with any transfusion reaction.

Febrile Nonhemolytic Reaction

Occurs towards the end of

or up to hours after transfusion

Paracetamol and Cooling.

Blood Transfusion complication

The Most serious complications Aacute Hemolytic Reaction

due to ABO incompatible transfusion and transfusion-related acute lung injury, which have very high mortality rates

most common cause is transfused of non-matched blood mostly to clerical error

How …???

• The most common symptoms are chills, rigors, fever, dyspnea, light-headedness, urticaria, itching, and flank pain.

• If any of these symptoms (other than localized urticaria and itching) occur, the transfusion should be stopped immediately and the IV line kept open with normal saline. The remainder of the blood product and clotted and anticoagulated samples of the patient's blood should be sent to the blood bank for investigation

Occurs within a few mls of starting transfusion

(Mortality 10%)

STOP THE BLOOD!

Supportive treatment

Treat complications – ARF and DIC

What is the action ?

Early Recognition of symptoms suggestive of a

transfusion reaction &

Prompt Reporting to the blood bank are essential.

•.

The remainder of the blood product and clotted and anticoagulated samples of the patient's blood should be sent to the blood bank for investigation.

Volume Overload

Acute lung injury TRALI

Delayed hemolytic transfusion reaction

(usually in 1 to 4 wk) and cause a delayed hemolytic transfusion reaction.

Infectious Complications

Lastly- malaria

• Malaria is transmitted easily through infected RBCs. Many donors are unaware that they have malaria, which may be latent and transmissible for 10 to 15 yr. Storage does not render blood safe. Prospective donors must be asked about malaria or whether they have been in a region where it is prevalent. Donors who have had a diagnosis of malaria or who are immigrants, refugees, or citizens from countries in which malaria is considered endemic are deferred for 3 yr; travelers to endemic countries are deferred for 1 yr. Babesiosis has rarely been transmitted by transfusion.