2. Introduction
 Blood transfusion can be life-saving & many
areas of surgery could not be undertaken
without reliable transfusion support.
 Tansfusion of blood & its components carries
potential risks, which must be outweighed by
the patient’s need.

3. Criteria for Acceptability of
Blood Donors

6. Blood Group Systems
 There are more than 400 blood groups have
been found
 The two major blood groups:
(1) ABO system
(2) Rh system
 Others:
(Kell, Duffy, Kidd)

7. ABO System
Phenotype Antigens Naturally Frequency (%)
occuring
antibodies
O O Anti-A & Anti-B 46
A A Anti-B 42
B B Anti-A 9
AB AB Nil 3

8. Principles of Cross-match
 Blood is selected on the basis of ABO & Rh D
group.
 Check compatibility between potential donor
red cells & recipient serum.
 Takes about 40 minutes.
 O –ve group can be used in extreme
emergency situations.

10. Fresh whole blood
 Average volume of blood withdrawn is
470mls taken into 63ml of anticoagulant.
 Refers to the blood that is administered
within 24 hours of its donation.
 Rarely indicated.
 Poor source of platelets & factor VIII.

11.  Indications:
- Acute blood loss
- Sickle cell disease
- Cardiac surgery

12. Red cell concentrates
 Product of choice for most clinical situations.
 Concentrated suspension of RBCs can be
prepared by removing most of the
supernatant plasma after centrifugation.
 The preparation reduces but does not
eliminate reaction caused by plasma
components.
 Reduces Na+, K+, lactic acid & citrate
administered.
 Provides oxygen-carrying capacity.

13.  Indications:
- Severe anemia
- Haemolytic anemia
- Anaemia in pregnancy

14. Platelet concentrates
 Made either from centrifugation of whole
blood or from an individual donor using
apheresis.
 An adult dose is manufactured from 4
separate donations pooled together or 1
apheresis collection.
 Carry a greater risk of bacterial
contamination as they cannot be
refrigerated.

15.  Indications:
- Leukaemia
- Prophylactically to prevent bleeding in
patient with bone marrow failure

16. Fresh frozen plasma
 Some 200-300ml of plasma can be removed
from a unit of whole blood.
 Prepared by freezing the plasma from 1unit
blood at -30C within 6 hours of donation
 Contains all the coagulation factors present in
plasma

17.  Indications:
- Burns
- Liver disease
- Congenital coagulation disorders
- DIC

18. Cryoprecipitate
 A single unit of cryoprecipitate can be
removed from 1 unit of FFP after controlled
thawing.
 After resuspension in 10-20ml plasma, the
cryoprecipitate is frozen once more to -30oc &
can be stored for up to a year.
 Contains Factor VIII, fibrinogen &
von Willebrand factor.
 Indication: DIC

19. Factor VIII and IX
concentrates
 Freeze dried preparation of specific
coagulation factors prepared from large pools
of plasma
 recombinant coagulation factor
concentrates , treatment of choice for
inherited coagulation factor deficiencies.
 Haemophilia A (VIII)
 Haemophilia B (IX)

20. Human albumin
 Human albumin solution 20%
 200 g/L albumin and 130 mmol/L sodium
 Indicated for treatment of acute severe
hypoalbuminemia

21. Granulocyte concentrate
 Prepared from single donor using cell
separatos and are used for pt with severe
neutropenia with evidence of bacterial
infection.
 Numbers of granulocytes increase by treating
donors with G-CSF and steroids

22. Blood Storage
Blood products Storage Shelf life
Red cells 2-6 oc 35 days
Frozen red cells 2-6 oc 24 hours
Washed red cells 2-6 oc 6 hours
Platelet concentrate Room temperature 5 days
Fresh frozen plasma -20 to -40 oc 12 months
Cryoprecipitate -20 to -40 oc 12 months
Granulocyte concentrate Room temperature 24 hours

23. Types of Blood Transfusion
 Homologous
– from a volunteer donor ; interval between 2
donations of at least 2 months
 Autologous
– pre-operative collection & re-infusion on
requirement.
- possible if Hb > 11g%; No infection; Fit for
anesthesia.

24. Autologous transfusion
1. Pre-operative donation
2. Isovolemic haemodilution
3. Cell salvage
Pre-operative donation
- blood withdrawn pre-operatively & stored
for up to 35-42 days.
- up to 5 units of patient’s own blood made
available, with the last unit being collected
48-72 hours before surgery.

25. Isovolemic haemodilution
- restricted to patients anticipated with
significant blood loss (>1000ml).
- up to 1.5L of blood withdrawn + standard
anticoagulant  replaced by saline to
maintain blood volume.
- fall in Hct reduces the loss of RBCs
- withdrawn blood re-infused either during or
after surgery.

26. Cell salvage
- blood collected from the operation site
either directly during surgery or by the use of
collection devices attached to surgical drains.
- during surgery, blood collected by suction
 processed by a cell salvage machine
(anticoagulated + washed to remove clots &
debris)  returned to patient
- post-operative drainage returned to patient,
most commonly not washed.

27. Acute Blood Transfusion
Reactions
 Immunological:
- acute haemolytic transfusion reaction
- transfusion related acute lung injury
- febrile non-haemolytic transfusion reaction
- allergic reactions
 Non-immunological:
- bacterial contamination
- cardiac failure

28. Chronic Blood Transfusion
Reactions
 Immunological:
- delayed haemolytic transfusion reaction
- alloimmunization
- post-transfusion purpura
- transfusion associated graft-versus-host
disease
 Non-immunological:
- transfusion-transmitted infections (HIV, hepatitis, CMV,
Syphilis, Malaria)
- iron overload