Blood Transfusion

Dr. Mahmoud Al-Balas, MBBS

Higher Specialty Certificate of General
Surgery JUST
Jordanian Board of General Surgery
E.C.F.M.G. Certificate
MRCS Ireland

Blood Products
Cellular Components
Red cell concentrate
Platelet concentrate
Granulocyte Concentrate
Plasma Components
FFP
Cryoprecipitate
Plasma Derivatives
Albumin
Immunoglobulin
Coagulation Factors

Blood Volume

Premature
Full term
Infant
Children
Adults

85
72
76
80

100 ml/kg
ml/kg
ml/kg
ml/kg
ml/kg

Whole Blood

Whole Blood = Donor Blood + Anticoagulant

1 unit = 450 ml
Anticoagulant = 63 ml
No functional platelets
No labile anticoagulants
Used for component preparation
Hct = 45%
Stored at 2-6 C
Shelf life = 35 days

Whole Blood
Indications for transfusion
Hypovolemic Blood loss
CABG
Exchange transfusion (e.g. anemia,
Hyperbilirubinemia)
Massive transfusion

Dosage of transfusion = 20 ml/kg

1 unit increase Hb 1 g/dl

Whole Blood
Transfusion
Considerations
ABO compatible
Cross match
compatible
Start transfusion slowly

Adverse effects

Hemolytic
Febrile
Allergic, Anaphylactic
Infectious
Sepsis
Fluid overload
TRALI
TA-GVHD

Red Cell Concentrate

Packed red cells

Platelets and plasma are removed
1 unit = 200-250 ml
Hct= 65-75%
Shelf life 35 days
Storage 2-4 C

Leucoreduced Red Blood

Cells
Indications

Symptomatic anemia
Repeated transfusions
Prevent febrile non hemolytic anemia

Characteristics

WBC < 5* 108/L

HCT = 50-60%
Volume = 350 ml
Shelf life = 42 days
Stored at 2-6 C

Washed RBC

RBC washed with 1-2L of N.S.

RBS 20% reduced
WBC 90% reduced
Platelet 90 reduced
Prevent febrile non hemolytic reactions
Transfuse within 6 hours
Antibodies and plasma components are
removed

Washed RBS

Indications

Multitransfused patients with febrile reactions

Urticarial reactions
Anaphylactic reactions
IgA deficiency with IgA antibodies
Paroxysmal nocturnal hemoglobinurea

Platelet Concentrates

Random donor
platelets (RDP)
From unit of Whole
blood
1 unit = 50*109
platelets
Volume = 50 cc

Single donor
platelets (SDP)
From Single donor
1 unit = 300*109
platelets
= 6 RDP
Volume = 200-350 cc

Platelet Concentrates
Storage = 20-24 C
Shelf life = 5 days
Should be AB compatible
Contraindications
TTP
HIT

Granulocytes
Granulocyte
Concentrates
Prepared by apheresis
1 unit = 1*109
granulocytes
Volume 200-300 ml
Dose = 1 or more / day

Buffy Coat
Layer between RBC and
plasma
1 unit = 1-2 *109
granulocytes
Volume 50 ml
Dose = 10/ day
Shelf life 1 day
Storage 22-24 C
Should be irradiated,
ABO and Rh specific

Irradiated Blood Products

Inactivate T-Lymphocytes
Prevent GVHD
Shelf life 28 days
Indications
Bone marrow/ stem cell transplant
Intrauterine transfusion

Blood warming
Not indicated for routine transfusion
Indicated for:
Rapid infusion through CVP lines
Presence of cold agglutinins
Exchange transfusion in neonates

Warming increase RBC metabolism and

bacterial growth

FFP
Contain all coagulation factors and plasma
protiens
Indications

Massive transfusion
TTP, DIC
Warfarin overdose
Clotting factor or factors deficiency

FFP

Dosage = 12-15 ml/kg

1 unit = 200-250 cc
Must be ABO compatible
Storage = < - 30 C

CRYO
1 unit contain
Factor 8, 13
vWF
Fibrinogen

1 unit = 15 cc
Storage = (- 30 C)

Stored Plasma
Anticoagulant factors containing
preservative solution
Contain stable clotting factors
NO labile clotting factors
Volume 200-250 cc
Shelf life 1 year

Adverse Effects of
Blood Transfusion

Causes

Incorrect blood component transfusion

Errors in Collection, Storage, blood administration
Lab. Errors
Compatibility testing errors
Acute Vs. Delayed

Acute Transfusion Reactions

Immunologic

Non Immunologic

Hemolytic
transfusion reaction
Febrile nonhemolytic reaction
Allergic
Anaphylactic
TRALI

Marked fever with shock

Atypical reaction with
hypotension
CHF
Air embolism
Hypocalcaemia
Hypothermia
Hypo-/Hyperkalemia
thrombophlebitis

Delayed Transfusion
Reactions
Immunologic

Non Immunologic

Alloimmunization to
RBC, WBC, Platelets,
Proteins and HLA
Hemolytic reactions
Post-transfusion
purpura

Iron overload
Transfusion
transmitted diseases

THANK
YOU