Transfusion

1. Transfusion A blood transfusion is a safe, common procedure in which you receive blood through an intravenous (IV) line inserted into one of your blood vessels.

2. Transfusion To replace losses of: Circulating volume and Oxygen carrying capacity . To restore: Metabolic homeostasis. To replenish: Normal RBC’s (eg. Refractory anemias, Thalassemias, Sickle cell anemias etc) In cancer patients like ALL; AML; with /or after Chemothrapy drugs For emergency surgery, heart surgery

3. ABO groups • Your blood type is established before you are BORN, by specific GENES inherited from your parents. • You inherit one gene from your MOTHER and one from your FATHER. • These genes determine your blood type by causing proteins called AGGLUTINOGENS to exist on the surface of all of your red blood cells.

4. Blood groups • There are more than 20 geneticallydetermined blood group systems known today • The AB0 and Rhesus (Rh) systems are the most important ones used for blood transfusions. • MNS, Kell , Duffy, P, Lewis are the examples of other blood group systems • Not all blood groups are compatible with each other. Mixing incompatible blood groups leads to blood clumping or agglutination, which is dangerous for individuals.

5. Blood grouping • Blood group antigens are actually sugars attached to the red blood cell. • Antigens are “built” onto the red cell. • Individuals inherit a gene which codes for specific sugar(s) to be added to the red cell. • The type of sugar added determines the blood group.

6. Blood grouping • Blood group antigens are actually sugars attached to the red blood cell. • Antigens are “built” onto the red cell. • Individuals inherit a gene which codes for specific sugar(s) to be added to the red cell. • The type of sugar added determines the blood group.

7. Landsteiner’s Rule • Substances are present in nature which are so similar to blood group antigens which result in the constant production of antibodies to blood group antigens they do not possess. • Critical for understanding compatibility between ABO blood groups.

8. ABO blood group • According to this blood typing system there are four different kinds of blood types A,B ,AB, O • Blood group AIf you belong to the blood group A, you have A antigens on the surface of your RBCs and B antibodies in your blood plasma

9. AB0 grouping • Blood group B If you belong to the blood group B, you have B antigens on the surface of your RBCs and A antibodies in your blood plasma • Blood group O If you belong to the blood group O (null), you have neither A or B antigens on the surface of your RBCs but you have both A and B antibodies in your blood plasma.

10. Summary

11. Hemolysis • If an individual is transfused with an incompatible blood group destruction of the red blood cells will occur. • This may result in the death of the recipient.

12. Rh (D) Antigen • Of next importance is the Rh type. • Term “Rh” is a misnomer. • Rh is a blood group system with many antigens, one of which is D. • Rh refers to the presence or absence of the D antigen on the red blood cell.

13. Rh(D) system • Unlike the ABO blood group system, individuals who lack the D antigen do not naturally make it. • A person with Rh- blood can developRh antibodies in the blood plasma if he or she receives blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. • A person with Rh+ blood can receive blood from a person with Rh- blood without any problems

14. 08 blood groups present in our population

15. ABO group Blood type O Rh- is the only type of blood that people of all other blood types can receive, so it is used in situations when patients need a transfusion but their blood type is unknown. People with blood type O Rh- are called Universal donor. AB blood group is universal recipient.

16. Hemolytic Disease of the Neborn – How it Occurs • A child is Rh pos • B during pregnancy fetal Rh pos rbc’s escape into maternal circulation • C Mother produces antibodies to Rh (D) antigen • D Second pregnancy with Rh (D) pos child results in destruction of fetal D pos rbcs

17. Transfusion reaction • Blood Transfusion is also a tissue transplant • Immune reactions ( Anaphylaxis) possible, in both directions (host vs. graft, or graft vs. host) • Transmission of diseases malaria, acute bacterial, HepB, HepC, , HIV, Prion mediated Creutzfeldt-Jakob (“mad cow”). • Over load and cardiac failure • And many hazards of Immunological reactions

19. Transfusion reaction • Transfusions of blood products are associated with several complications, many of which can be grouped as immunological or infectious Acute hemolytic reactions • This is due to destruction of donor erythrocytes by preformed recipient antibodies. Most often this occurs due to clerical errors or improper typing and crossmatching. • Symptoms include fever, chills, chest pain, back pain, hemorrhage, increased heart rate, shortness of breath, and rapid drop in blood pressure.

20. Transfusion reaction • Immunological reactions occur when the receiver of a blood transfusion has antibodies that work against the donor blood cells. • Then the red blood cells from the donated blood will clump, or agglutinate. • The agglutinated red cells can clog blood vessels and stop the circulation of the blood to various parts of the body. • The agglutinated red blood cells can also crack open, leaking toxic contents out in the body, which can have fatal consequences for the patient.

21. Transfusion reaction • Delayed hemolytic reactions occur more frequently and are due to the same mechanism as in acute hemolytic reactions. However, the consequences are generally mild and a great proportion of patients may not have symptoms.

22. Transfusion reaction • Allergic reactions may occur when the recipient has preformed antibodies to certain chemicals in the donor blood, and does not require prior exposure to transfusions. Symptoms include urticaria, pruritus, and may proceed to anaphylactic shock. Treatment is the same as for any other type 1 hypersensitivity reactions

23. Transfusion-associated acute lung injury (TRALI) It is an increasingly recognized adverse event associated with blood transfusion. TRALI is a syndrome of acute respiratory distress, often associated with fever, non-cardiogenic pulmonary edema, and hypotension, which may occur as often as 1 in 2000 transfusions.

24. Infectious • Rarely, blood products are contaminated with bacteria. This can result in life-threatening infection, also known as transfusion-transmitted bacterial infection

25. Other hazards • Transfusion-associated volume overload is a common complication simply due to the fact that blood products have a certain amount of volume • Hypothermia • Metabolic alkalosis can occur with massive blood transfusions due to the breakdown of citrate stored in blood into bicarbonate • Hypocalcemia can also occur with massive blood transfusions due to the complex of citrate with serum calcium

26. Blood donation • Blood is taken ONLY from Voluntary Donors • Using sterile, disposable blood bags & • instruments • Donated Blood is tested and separated into • components benefiting 3-4 patients • It is safe to donate every 3 months • It is quick and safe. • It doesn’t hurt. • It saves 3 to 4 lives.

27. Who can donate? Age: Blood donors must be at least 17-18 years old in most countries • Weight : > 45 kgs • Hemoglobin level: >12 gms/dl for men and 12.5 gms/dl for women • In good health

28. screening • Blood collected at the BDC is screened using highest quality screening tests • HIV 1 • Hepatitis B • Hepatitis C • VDRL (syphilis) • Malaria

29. Blood is taken ONLY from Voluntary Donors • Using sterile, disposable blood bags & • instruments • Donated Blood is tested and separated into • components benefiting 3-4 patients • It is safe to donate every 3 months • It is quick and safe. • It doesn’t hurt. • It saves 3 to 4 lives.

30. Blood products • Transfusions are used in a variety of medical conditions to replace lost components of the blood. • Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors and platelets. • Units of packed red blood cells are typically only recommended when a person's hemoglobin levels fall below 7g/dL

31. Measures taken in transfusion reaction • . When suspected, transfusion should be stopped immediately, and blood sent for tests to evaluate for presence of hemolysis. Treatment is supportive. Kidney injury may occur due to the effects of the hemolytic reaction (pigment nephropathy

32. Autologus transfusion • When a patient's own blood is salvaged and reinfused during a surgery (e.g. using a cell salvage machine such as a Cell Saver), this can be considered a form of autotransfusion

33. Benefit • Regular donation (2-3 times a year….) • Lowers cholesterol • Lowers lipid levels • Decreases incidence of heart attacks, strokes-