7 blood transfusion dr. Haydar Muneer

Blood transfusion

In 1667, Jean-Baptiste Denis and a surgeon, Emmerez, transfused blood from a sheep into a 15-year-old boy who had been bled many times as treatment for fever

In 1668, transfusions in humans were forbidden unless approved by the Faculty of Medicine in Paris.

1829 James Blundell performs the first successful documentedhuman transfusion in a woman suffering post-partumhaemorrhage

Blood has been described as a vehicular organ that perfuses all other organs. It provides transportation of oxygen to satisfy the body's metabolic demands and removes the by-product carbon dioxide

Blood Product 1. Banked whole blood:• Shelf life 40 + - 5 days• Poor source of platelets • pH• potassium concentration • Ammonia concentration• O2 function transport

Blood Product 2. Fresh whole blood: • Within 24 hour• Administrated untested • poor source of platelets and factor VIII.

Blood Product 3. Fresh-frozen plasma:• 2-year shelf-life• It is the first-line therapy in the

treatment of coagulopathic haemorrhage

Blood Product 4. Platelets:• The preparations should be used within

120 hours of donation.• One unit of platelet concentrate has a

volume of approximately 50 mL• it is advisable to elevate the platelet

count to the range of 50,000 to 100,000 uL.

Autologous blood

It is possible for patients undergoing elective surgery to pre donate their own blood up to 3 weeks before surgery for re-transfusion during the operation

Indications of blood transfusion:

• acute blood loss, to replace circulating volume and maintain oxygen delivery

• perioperative anaemia, to ensure adequate oxygen delivery during the perioperative phase

• symptomatic chronic anaemia without haemorrhage or impending surgery

Transfusion trigger

• Historically, patients were transfused to achieve a hemoglobin level of > 10 g/dl

• A hemoglobin level of 6 g /dl is acceptable in patients who are not bleeding, not about to undergo major surgery and not symptomatic

ABO system

In 1900, Landsteiner introduced the concept of blood grouping and identified the major A, B, and O groups

ABO system

ABO system

In 1939, the Rh group was recognized by Levine and Stetson.

Blood cross match • The recipient’s serum is then mixed with the

donor’s cells to confirm ABO compatibility and to test for Rhesus and any other blood group antigen–antibody reactions

• Full cross-matching of blood takes 45 min in most laboratories. In more urgent situations, only ABO/Rhesus matched and can be issued within 10–15 min.

Complications of blood transfusion 1. Incompatibility2. Fibril reaction 3. Allergic reaction4. Infection5. Air embolism

Massive transfusion

The term massive transfusion implies a single transfusion greater than 2500 mL or 5000 mL transfused over a period of 24 Complications:• coagulopathy• hypocalcaemia• hypothermia

Blood product

1. Banked whole blood2. Fresh whole blood 3. Fresh frozen plasma4. Platelets

Indications of blood transfusion:1. to replace circulating volume and maintain oxygen delivery2. perioperative anaemia3. symptomatic chronic anaemia

Transfusion trigger

6 g /dl

ABO system

RH disease

Q: patient (26 years old) admitted in your ward, during preparation for surgery, preoperative blood transfusion needed in your call at night , when transfusion start everything went smoothly until after 15 mints patient start to develop shivering , and skin rash , your management ?