BLOOD TRANSFUSION. Dr Lumka Ntabeni

BLOOD TRANSFUSION Dr Lumka Ntabeni

Blood transfusion definition SAFE transfer of BLOOD COMPONENTS from a DONOR to a RECEPIENT

CONTENT Brief history of blood transfusion How is safety guaranteed? How do we get the different blood components? Indications of use for the different components Donors who and how are they protected? Recipient who and how are they protected? Role of doctors in transfusion Ethical issues

DONOR safety Voluntary Age 17 70yrs (maximum 60 at 1 st donation) Wt >50kg Hb >13 M and >12 F Minimum donation interval Pregnancy Exclusion criteria medical Vaccinations Acupuncture and body piercing

Donor testing Blood group and Rh status HIV 1 and 2 HBV,HCV HTLV,CMV MALARIA Bacteria

Recipient safety Donor selection Donor exclusion Arm cleaning Testing of donations leucodepletion Post viral inactivation Safest possible sources of donor for plasma products

Responsibilities of the doctor Transfuse only when indicated Informed consent Correct identification of patient and blood Ensure crossmatching has been performed Quality control unit Correct handover to nursing staff Management of transfusion reactions Reporting of untoward reactions or death Look back programme

Ethics principles Beneficence Non maleficence Autonomy Justice Dignity Truthfulness and honesty

TYPE: YOU CAN GIVE BLOOD TO: BLOOD TYPE YOU CAN RECEIVE: A+ A+ AB+ A+ A- O+ O- A- A- A+ AB- AB+ A- O- B+ B+ AB+ B+ B- O+ O- B- B+ B- AB+ AB- B- O- AB+ AB+ EVERYONE AB- AB+ AB- AB- A- B- O- O+ O+ A+ B+ AB+ O+ O- O- EVERYONE O- O NEGATIVE IS UNIVERSAL DONOR AB POSITIVE IS UNIVERSAL RECIPIENT

Administration of blood Preparation of patient Correct identification and verification of patient and blood Correct aseptic technique Observation of patient during transfusion Special precautions

Red cell concentrate indications Acute blood loss Surgery Anaemia symptomatic Obstetric haemorrhage Washed red cells? Irradiated red cells?

Leucodepletion Avoidance of febrile reactions Avoidance of platelet refractoriness Reduces risk of transfusion transmittable CMV No reduction in cancer recurrance No reduction in post op infections

Leucodepletion indications Patients on chronic transfusion regimens Risk of CMV infection Organ and stem cell transplant patients Infants <1yr Patients undergoing cardiac surgery

Gamma irradiation indications Transfusion from relatives HLA matched platelets Intra uterine transfusions Exchange transfusion Congenital immunodeficiency states Post allogeneic transplants Hodgkins disease Patients treated with purine analogues

Platelet transfusion indications Bone marrow failure Massive transfusion Acute disseminated intravascular coagulation Congenital disorders of platelets

Platelet transfusion contraindications ITP unless bleeding TTP Heparin induced thrombocytopaenia (HIT)

PLATELETS Expected increment 20 40 x10^9/l Exceptions Platelet refractoriness> an increment of less than 10 on more than one occasion in the absence of..

Plasma products FFP Cryoprecipitate Coagulation factor concentrates Human albumin Immunoglobulins

FFP indications Replacement of inherited single factor deficiencies (if single factor unavailable) Multiple coagulation deficiency TTP Reversal of warfarin if active bleeding Vitamin K def HDN Scoline apnoea

Coagulation factor concentrates Haemophilia Haemosolvate factor VIII Haemosolvex factor IX

COMPLICATIONS OF BLOOD TRANSFUSION EARLY Haemolytic reactions(acute and delayed) Bacterial contamination Anaphylactic reaction Febrile non haemolytic transfusion reaction TRALI Allergic reaction Electrolyte imbalances LATE TA GvHD Transmission of infection Post transfusion purpura alloimmunisation

Investigation immediate reaction STOP transfusion Repeat identification and verification of patient and unit Specimens admin set, unit of blood, posttransfusion patient sample (one clotted and one anticoagulated), urine sample, Laboratory repeat ABO and Rh of pretransfusion, repeat ABO and Rh posttransfusion, DAT, crossmatch using pre and post samples, check for haemolysis Blood cultures, haptoglobin, FBC, urine haemosiderin Complete reaction report form

CONCLUSION SAFE BLOOD SAVES LIVES!!!!!!!!!!!!!!!!!!!