R.

Suhartono SpB(K)V
Vascular and Endovascular Surgeon ( Consultant)
Cipto Mangunkusumo General Hospital/Medical Faculty University Indonesia
• An adult human has about 4–6 liters of blood circulating
in the body. Among other things, blood transports oxygen
to various parts of the body.

• Blood consists of several types of cells floating around in

a fluid called plasma.
 Blood in History
China, 1000 BC
The soul was contained in the blood.

Egyptians bathed in blood for their health.

Pliny and Celsus describe Romans drinking the blood of

fallen gladiators to gain strength and vitality and to cure epilepsy.

Taurobolium, the practice of bathing in blood as it cascaded

from a sacrificial bull, was practiced by the Romans.
Animal to Human Transfusion

Early lamb blood transfusion

 A blood transfusion is the infusion of whole blood or a
blood component such as plasma, red blood cells, or
platelets into the patients venous circulation.
 You may need it if you loose too much bood, such:
 Injury or major surgery.
 An illness that causes bleeding, such as a bleeding
ulcer.
 An illness that destroys blood cells, such as hemolytic
anemia or thrombocytopenia.
PURPOSE OFBLOOD
 Cross matching is the process of dermining
compatibility between blood specimens
 WHAT IS BLOOD GROUP ?
Bloood group is an inherited trait,is
determined by the type of antigens
and antibodies present in the blood

BLOOD TYPES
A - B - AB - O
BLOOD GROUP ANTIGEN

A A antigen

B B antigen

AB A+B antigens

O -

Negative
RH
Positive
 WHAT IS ANTIGENS ?
An antigens is a substance that
causing the formation of antibodies

WHAT IS ANTIBODYS ?
Antibodies is a protein substance
develop in the body in response to
the presence of an antigen that has
entered the body
 Life Saving &

Life Threatening Process

• Hemolytic transfusion reaction
• Febrile non hemolytic transfusion reaction
• Alergic reaction
• Allo immunization
• Graft versus host response
• Infection
• Bacteria
• Volume overload
• Iron toxicity
• Acute transfusion-related acute lung injury (TRALI)
 Malaria
 Chagas disease
 West nile virus
 Variant Creutzfeldt-Jakob disease
 Hep B 1: 140,000
 Hep C 1: 225,000
 Hep A 1: 1,000,000
 HIV 1: 1,500,000
 HTLV 1: 650,000
 Bacterial 1: 1,000,000
 Malaria 1: 1,000,000
 Syphylis 1: 1,000,000
 Mistransfusion rate
 1 : 14.000 US
 1 : 28.000 UK
 Half in the clinical arena and 30 % in the laboratory
 Transfusion of mis-matched ABO cells
 1: 35,000
 ABO incompatible death rate
 1:600,000
 Transfusion of red cells to wrong patient
 1: 17,000
 Transfusion of pre-deposited blood to wrong
patient
 1:20,000
 The only true indication for red cell transfusions is a
need to rapidly increase the delivery of oxygen to the
tissues
 Hb > 10 Gr % rarely require transfusion
 Hb < 7 Gr% frequently require blood transfusion

NIH Consensus Conference. JAMA 1988; 260:2700 - 2706

 Hgb > 10 gr% rarely indicated
 Less than < 6 g/dl almost always indicated
 6 – 10 g/dl based on patient risk

Anesth 1996;84: 732 - 747

• Platelet Transfusion Indication
– Bone marrow failure
– Autoimmune thrombocytopenia
– Alloimmune thrombocytopenia
– Abnormalities of platelet function
– Dilutional thrombocytopenia
– Cardiopulmonary bypass surgery
• Contraindications to platelet transfusions
– thromboticthrombocytopenic purpura
– haemolytic uraemic syndrome
– heparin-induced thrombocytopenia
 Granulocyte Transfusion Indication

 Bone marrow failure caused by disease or myelotoxic treatment

 Abnormal neutrophil function and persistent infection
 To increase the level of clotting factor
It is abnormal signs and
symptoms that will occur during
or after transfusion and effects
the patiens health
 Clinical
Acute Reaction Causes Mainifestations Management
• Flushing • STOP TRANSFUSION
Sensitivity to • itching ,rash IMMEDIATELY
plasma • urticaria, hives
protein or • asthmatic • KEEP VEIN OPEN WITH NS
donor wheezing
antibody, • laryngeal • Notify doctor , infection
which reacts edema control, blood bank
Allergic with • anaphylaxis
recipient • Give antihistamine as
antigen directed.

• Send blood samples and blood

bags to blood bank. Collect
urine samples for testing.
 Prevention
•ASSESSMENT

•Before transfusion ask the patient

• About past reaction
• Have emergency drugs ( Bed Side)
Acute Reaction Causes Clinical Management
Mainifestations

hypersensitivity to • Flushing •STOP TRANSFUSION

donor white blood • sudden IMMEDIATELY
cells , platelets, or chills
plasma protein and fever • KEEP VEIN
•headache OPEN with NS
• anixiety
Febrile • Notify doctor , infection
non - control, blood bank
hemolytic • Give antipyretics as
directed.
• Check temperature every
1/2hrs.or as indicated
• send blood samples and
blood bags to blood
bank

Collect urine samples for

testing.
 Prevention

ASSESSMENT

• Give antipyretic before

transfusion as directed

• Leukocyte – poor blood

products may not be
recommended for future
transfusion
 Acute Causes Clinical Management
Reaction Mainifestations

• STOP TRANSFUSIOM
•Transfusion of • rapid onset of IMMEDIATEL
blood or blood chils
components •High fever • KEEP VEIN OPEN
contaminated with •Vomiting , with NS
bacteria diarrhea • Notify doctor , infection
Septic •Marked control, blood bank
reactions hypotension • give antipyretics as
directed.
• check temperature every
1/2hrs.or as indicated
• obtain cultures of
patients blood
• return blood bags &
blood set to blood bank.
• treat septicemia as
directed ( IV fluids.
Antibiotics...
 Prevention

 Donot permit blood to stand at

room temperature longer than
necessary.
Warm temperatures promote bacterial
growth.
Inspect blood for gas bubbles,
clotting or abnormal color.
 Acute Causes Clinical Management
Reaction Mainifestations

•Fluid • rise in venous • STOP TRANSFUSIOM

administreted at a pressure IMMEDIATEL
rate or volume • distended neck
greater than the veins. • KEEP VEIN OPEN
circulatory system •Dyspnea with NS
Circulatory can accommodate . •Cough • Notify doctor ,
overload Increased blood in •Crackles at base infection control, blood
pulmonary vessels of lunges bank
and decreased lung • place patient upright
compliance. with feet in dependent
posision.
• administer prescribed
diuretic, oxygen,
morphine , and
aminophylline.
 Prevention

•concentrated blood products

should be given whenever
positive.
• transfuse at a rate within the
circulatory reserve of the
patient.
• monitor central venous
pressure of patient with heart
disease.
 Clinical
Acute Reaction Causes Mainifestations
Infusion of incompatible
blood product. • chills, fever
Hemolytic • lower back pain
reaction • feeling of head fullness,
Antibodies in
flushing
RECIPIENTS
• oppressive feeling
plasma
•Tachycardia,tachypnea
• hypotension,vascular
DONORS RBCs collapes
•hemoglobinurea,hemog
Incompatible
lobinemia
PLASMA
• bleeding
OR • acute renal failure

Antibodies in DONOR
plasma

RECIPIENTS RBCs
Incompatible
RBCs
• MANAGEMENT • PREVENTION

• STOP TRANSFUSION •Verify patient identification from

• KEEP VEIN OPEN with 0.9% saline. sample collection to product
• Notify doctor , infection control, infusion.
blood bank •Begin infusion slowly and
• Treat shock if present observe closely for 30 min
• Draw testing samples, collect
urine samples.
• Maintain blood pressure with IV
colloid solutions.
• Administer prescribed diuretic,to
maintain blood flow, glomerular
filtration, and renal blood flow.
• Monitor urin output.
• Patient may require dialysis if
renal failure occur
DELAYED Causes Clinical Management
REACTION Mainifestations

Delayed •The destruction of •Fever •Generaly no acute

transfused flood cells •Mild jaundice treatment is required, but
hemolytic by antibody not •Decreased hemolysis may be enough
reaction detect hematocrit to cause shock and renal
falure

PREVENTION

The crossmatch blood sample should be drawn

within 3 days of blood transfusion. antibody
Formation may occur within 90 days of
transfusion
DELAYED Causes Clinical Management
REACTION Mainifestations

Iron •Deposition of iron in •Diabetes •Treat symptomatically

the heart, endocrine •Decreased thyroid • deferoximine which
overlood organs,liver,spleen,skin function removes accumulated iron
and other major organs •Heart failure and through the kidneys. I.V-
as a result of multiple, other symptoms I.M-S.C
long tearm transfusion related to major
. organ failure

NO PREVENTION
DELAYED CLINICAL
REACTION CAUSES MAINIFESTATIONS MANAGEMENT

•Elevated liver enzymes

Hepatitis B •Anorexia, malaise •Treat symptomatically
•Nausea and vomiting as instructed by
•Fever doctors
•Dark urine
•Jaundice

Hepatitis C INFECTED •Elevated liver

BLOOD enzymes •Treat symptomatically
•Chronic liver disease as instructed by
PRODUCT and cirrhosis may doctors
S develop

AIDS •Night sweats •As instructed by

•Unexplained weight loos doctors
•Diarrhea
•Etc
DELAYED CLINICAL
REACTION CAUSES MAINIFESTATIONS MANAGEMENT
•Generalized rash
Syphilis INFECTED •Regional •Penicillin therapy
BLOOD lymphadenopathy
PRODUCTS •Presence of chancre

Malaria INFECTED •Fever Rest and supportive

BLOOD •Fatigue management
PRODUCTS •Hepatomegaly
•Splenomegaly

PREVENTION OF DELAYED REACTION

•Proper blood screening
•In case of malaria – donor should be asked if he has
cold,flu or foreign travel
 GENERAL
CONCIDERATIONS
TO
PREVENT BLOOD
TRANSFUSION
REACTION
 DONORS

•Blood donors must be selected with care.

•Donors should be healthy & free of diseases.
•Donors should be examined carefully at the
time of donation.
•Blood donated from people who have allergies
or those with a history of a chronic diseases,
such as tuberculosis, certain types of cancer,
and hemophilia, is usually not used.
•For precaution some blood banks don’t
accept blood from a donor who has
been recently immunized because of a
possible allergic reaction

•Individuals may give blood only if their

blood count, temperature, pulse,
respiration, blood pressure, and weight
are within normal range
 LABORATORY
•Blood screening for
infectious diseases.
•Proper storage (4 ̊ C)
•Antibody screening
•Blood compatibility -RH
•To protect the donor from
possible risks of donation
and protect the patient
from the risk of transfusion
 PATIENT

•Previous allergic reaction

•Consent
•Name and phone number of a
contact person in case of emergency
 DOCTOR
The physicians order should specify
Blood component, volume, and
rate of transfusion
 NURSE
Only trained and qualified nurses are
allowed to perform the
blood transfusion steps
 NURSE
•Sending blood sample for cross
matching with CLEAR and CORRECT
Patient name, file number, room number,
age, sex, department, bed number,
date,time,nurse name and signature
 NURSE
BEFORE receiving blood

•Doctor order
•Consent
•Patient assessment
•Premedicate the PT.30min. before
transfusion for TABs & before transfusion is
initiated for IV