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 Acute haemorrhage – external or internal
 Major operations- blood loss is inevitable

ex: radical mastectomy

 Deep burns- as considerable haemolysis

and destruction of RBCs seen

 Preoperative blood transfusion in anaemic

condition, no time for iron replacement

 Post operative condition – patient anaemic

and debilitated due excessive bleeding or

 Anaemia- Hb level is below 10g/100ml
 Chronic anaemia- packed cell volume
 Severe malnutrition and hypoproteinaemia ,

BT before any surgery

 Coagulation disorders like haemophilia,

thrombocytopenic purpura, leukaemia

 Treating erythroblastosis featalis due to Rh

incompatibility, exchange transfusion is done

through umbilical vein of the new born baby
 During chemotherapy, if routine blood

examination shows considerable diminution

of RBC level
Collection of blood for blood
 Before collecting, make sure donor is not
suffering from any disease which transmits
through blood
HIV I and II viruses, HbsAg
 Position: donor lies down on bed
 Applied sphygmomanometer cuff to the

upper arm and inflated to a pressure of

80mm Hg
 15 gauge needle is introduced into the

median cubital vein

 Needle is connected to a plastic bag which

form a close sterile unit

 Blood from the donor is allowed to come out
and run into the sterile bag which already
contains 75 ml of anti coagulant solution
 During collection blood is constantly mixed

with the anti coagulant solution to prevent

 A specimen of blood is sent for grouping and

cross matching
 About 410ml of blood is taken in a single bag
 Anti coagulants:

1. CPD solution contains trisodium

citrate(dihydrate), citric acid(monohydrate) and
dextrose mixed with water to make solution
2. CPD solution and adenosine is added(CPDA-I) to
increase storage life of blood
Blood storage
 All blood that are collected from donor are
stored in blood bank in special refrigerator at
controlled temperature of 4°C ( ranging from 6°C to
 If blood is allowed to come in contact with

higher temperature, danger of transmitting

 During storage, RBCs which constitutes major

component, lose their ability to release oxygen

to the tissues of the recipient within & days
 If patient requires massive transfusion advisable

to use at least 1 or 2 units of bllod less than 7

days old
 WBCs are rapidly destroyed in stored blood
 Platelets are also destroyed considerably at

4°C. but few still functionally useful after 24 hrs

 Clotting factors V, VIII are quickly destroyed
 Shelf life of stored blood in:

 CPD solution is about 3 weeks

CPDA- I solution is 5 weeks
Types of blood transfusion
5 types of whole blood transfusion
1. Typical stored CPD blood from blood bank-
commonly used
2. Warm blood: during cardiopulmonary
operations , blood may be warmed by passing
the stored blood through a blood warming unit
to reduce the risk of cardiac arrest due to
transfusion of large volume of cold blood
direct from the blood bank
3. Filtered blood : used by filtering blood through
a membrane with 40µm pores to filter off
platelet aggregated and leucocytes in stored
4. Auto transfusion is an old method of
restoring the patient’s blood volume by
transfusing their own blood, who is
excessively loosing blood by injury as
spleenic rupture/ rupture of liver
 Blood is collected from peritonial cavity and

put into a sterile container

 Filtered through a few layers of gauge into a

container which is contained anti coagulant

CPD solution
 This blood is transfused immediately into

the patient
 Used where stored blood is not available
 Exchange / replacement transfusion :
 New born infants suffering from

erythroblastosis foetalis
 Transfusion is given through the umbilical

vein of the infant with a syringe with four

way adaptor
One to the infants’s body
One to the donor
One to the citrated saline
Other to the waste
 Rh negative blood is exchanged with the
infant’s blood 5 to 10ml at a time
Packed red cells
Indication :
 Patients with chronic anaemia: in elderly

and children and those patients whose

cardiac reserve is low , PC blood is used to
prevent over loading of heart
 If the whole blood is centrifuged at 2000 to

2500 g for 15 – 20 mins / stored blood is

allowed to stay idle, supernated plasma is
taken off, blood sediment is used for
packed cells
Amount of blood transfusion:
 70% of the amount of blood loss should be

replaced by blood transfusion of blood

 500ml of CPD stored blood will generally

raise haemoglobin by 10%

Complications of blood transfusion
1. Transfusion reactions
2. Transfusion of diseases

Transfusion reactions:
1. Incompatibility is most important
2. Pyrexial reactions
3. Allergic reactions
4. Sensitization of leucocytes and platelets
Transfusion reactions
1. Incompatibility:
a. incompatible transfusion
b. transfusion of blood which is already
haemolysed by heating, over freezing or
c. transfusion of blood after expiry date
Clinical features:
1. rigors and fever
2. headache, nausea and vomitting
3. pain in loins and tingling sensation of
4. feeling tightness of chest and
5. pt. gradually lose consciousness
6. urine out put gradually diminishes
and haemoglobinuria occurs within 2/
7. appearance of jaundice is a definite
sign of incompatible transfusion ,
appears within 24 to 36 hrs
8. Renal failure due to blockage of renal
tubules with haematin pigment
a. Transfusion should be stopped immediately

b. Blood and urine specimen of the patient sent

for laboratory along with rejected bottle of
c. Administration of IV fluids

d. Alkalisation of blood done with 10ml of

isotonic solution of sodium lactate and 10ml of
saturated solution of sodium bicarbonate
injected intravenously
e. Frusemide 80-120mg IV for diuresis. Repeated
if urine out put is not increased upto 30ml/hr
f. Antihistamine and hydrocortisone
g. haemodialysis
2. Pyrexial reactions:

a. improperly sterilised transfusion sets
b. presence of pyrogens in the donor apparatus
c. transfusion of infected blood
d. very rapid transfusion of blood
e. presence of sulphur compounds in the
rubber tubing
Clinical features:
a. pyrexia, chill, rigor
b. restlessness, headache
c. increased pulse rate
d. nausea and vomiting
 Prevention: use of plastic disposable
transfusion sets
 Treatment:

a. stop the transfusion immediately

b. patient is covered with blankets
c. antipyretics and antihistamine drugs
are injected immediately
d. when temperature comes down,
patient is feeling comfortable, transfusion is
again started with fresh plastic disposable
set at a slow rate
3. Allergic reactions:

Causes: allergic reaction to plasma product in

the donor’s blood

Clinical features:
a. tachycardia
b. urticarial rash
c. fever and dyspnoea
d. Acute cases, circulatory collapse- acute
anaphylactic shock
A. Stop the transfusion immediately

B. Anti histamine drugs eg: chlorophinaramine 10

C. Hydrocortisone

4. Sensitisation to luecocytes and platelets:

 many blood transfusion have been given in the

recent past
 Patient develops antibodies against the white

cells or platelets of the donated blood, causes


 Unusual reaction is avoided by giving packed

red cells, whenever blood transfusion is

 Antipyretics, antihistamines and steroids
Transmission of diseases:
1. Serum hepatitis:
 Non-A, non – B hepatitis, most common form

of transfusion related hepatitis in developed

 In India, mainly hepatitis-B

 All blood donors should be carefully tested for

the presence of hepatitis B virus associated

with antigen in the blood prior to transfusion
 Method of testing is not sensitive enough to

eliminate all cases bearing that virus

 1% of cases pass undetected

 s/s of serum hepatitis usually revealed within

3 months after
3. Bacterial infection:
- due to faulty storage technique
- donor’s blood when left in a warm room
for some more hours before transfusion
- bacterial infection is revealed by
septicaemia in the recipient
Reaction caused by massive transfusion:
1. Acid base imbalance:
- excessive transfusion usually result in
significant metabolic alkalosis
- citrate in anticoagulant solution present
as sodium citrate, becomes sodium
bicarbonate as the citrate is consumed
2. Hyperkalaemia:
3. Citrate toxicity: consume ionised calcium
from the patient’s body
4. hypothermia: drop in body temperature 3-4
5. Failure of coagulation: in massive
- dilution of platelets and various clotting
factors due to transfusion of large volume of
stored blood- as it has low platelets,
fibrinogen and various coagulator factors
- disseminated intravascular coagulation ,
complication of massive transfusion due to
incompatible blood transfusion
Treatment: transfusion of fresh frozen plasma,
platelet concentrate
- if DIC is the cause, heparine is used
Complications of over transfusion:

- noticed in chronic anaemia in children and

- because of whole blood transfusion instead of
packed red cell
- leads to congestive cardiac failure
- chronic anaemia, packed red cell should be
transfused with diuretics
transfusion rate: slow, 1 unit in 4-6 hrs
- transfusion should not be continuous, given
intervals between consecutive transfusion
- pt. above 60 years of age should be given
packed red cells with diuretics, not more than
300ml at atime
Complication of general intravenous
 Thrombophlebitis
 Air embolism

“Best amount of blood to give is the least

amount that is needed”