Transcribed by: Romina Gallardo Arancibia.

Transfusion Medicine: Clinical Aspects

Dr. María Ángeles Rodriguez S.

Transfusion Medicine
Introduction
Blood safety
Clinical transfusion procedures
Instructions for the use of blood and blood derivatives
Current risks
Transfusion reactions

Basic Principles of Transfusion Therapy

The deficient component must be administered. The components are separated.
blood: at the bottom layer are the red blood cells, in the middle: leukocytes and platelets, and
Up the plasma. Each one is used separately.
Transfusion therapy should restore deficient function and not alter it.
quantitative or laboratory values.
The expected benefits must outweigh the risks.

A transfusion should never be performed unless it is absolutely necessary.

Karl Landsteiner

A transfusion should only be performed when the benefits outweigh the risks and not
Is there another therapy that can produce the same effect?

Blood Safety
The basic elements are:
Donor selection.
Microbiological screening: These are the tests done on the blood.
Effective clinical use of blood.

Appropriate use of blood

Is the transfusion of blood products safe to treat a condition that can
to lead to significant morbidity and mortality that cannot be treated
effectively in another way.

Clinical transfusion procedures

The reason for the transfusion must be recorded.
A trained person must monitor the transfused patient and respond.
immediately if any adverse effect occurs.
Blood products: Key points
Properly used blood products can save lives, but still
There are risks.
Blood or blood products cannot be administered if the have not been carried out
Mandatory microbiological studies in the country and their results are negative.
Each unit must be classified into ABO and Rh.

Requirements for the appropriate use of blood

The transfusion ALWAYS carries potential risks for the recipient, but these
they can be minimized with the appropriate use of blood.
The decision to transfuse blood or blood products must always be
based on a careful clinical and laboratory evaluation.
The responsibility for the indication lies with those who prescribe the blood.

Transfusion Therapy: Basic Principles

The transfusion is part of patient management.
The prescription of blood must be based on clinical guidelines, taking into account
the specific needs of the patient.
Blood loss should be minimized.
The patient who is bleeding should receive IV fluid replacement.
Hemoglobin is important, but it is not the only factor in deciding a
transfusion.

Blood products
It refers to any therapeutic substance prepared from human blood.
Blood can be separated into different components for various indications.

Transfusion request procedure

It must be carried out by the doctor.
The reason for the transfusion must be indicated.
The transfusion is a medical indication.
Any patient entering the operating room for surgery with the possibility of bleeding
must be classified beforehand.
The level of urgency of the request must be indicated. (The tests
Compatibility transfusions take at least 20 minutes. In these cases
they need blood quickly, use type 0 Rh (-) until the results are ready.
of the tests to proceed to provide the required blood.

Pre-transfusion tests
The patient is classified and detection of irregular antibodies or Coombs is performed.
indirect
Compatibility testing is performed.
 Every transfused patient must be strictly monitored, especially
in the first 15 minutes.

Clinical transfusion procedures: Key points

Each hospital must have its standard procedures for each stage of
process.
There must be clear communication and cooperation between clinical and staff.
blood bank.
The blood bank must not use blood for transfusion that has not been
correctly labeled and filled in the shipping documents.
Blood products must be kept under their conditions of
storage until the time of transfusion. The RBCs are kept at 4°C at
refrigerator, fresh frozen plasma and cryoprecipitates at -20 -30°C,
platelets in continuous agitation at 22°C and last for 5 days.
The transfusion of incompatible blood is the most common cause of reaction.
potentially fatal acute transfusion, to prevent it one must:
a) Carefully identify the patient.
b) Correctly label the samples for pre-transfusion testing.
c) Check the patient's identity again to verify the
correct blood administration to the right patient.

Transfusion procedure
The blood or red blood cell transfusion must be completed within a period
maximum of 4 hours from your office. This is because the GR is an excellent broth.
of culture for the bacteria, so when taken out of refrigeration, it increases the
risk of bacterial contamination.
No solutions or medications should be added to blood derivatives.
The patient must be monitored until the end of the transfusion.

Practical aspects
Do not ask for more than what is needed.
Ideally, do not transfuse more than one blood product simultaneously. Just in case the
the patient has a post-transfusion reaction and thus be clear which transfusion
that was the reaction.
Rational use of plasma.

Clinical transfusion procedures: Key points

Once the patient's identity is verified, the history product must be
to manage the blood product.
Register type and volume of the product, donation number and group of each
transfused component.
Start and end time of the transfusion.
Signature of the person responsible.
 The patient must be monitored during the transfusion.
Register the end time.
Identify, manage, and record any adverse effects.
Any patient who is going to undergo elective surgery in which there is
the probability of requiring a transfusion should have blood classification,
detection of irregular antibodies and sample for compatibility testing.

Instructions for the use of blood

Available products:
Red Blood Cells
Frozen fresh plasma
Platelets
Cryoprecipitates
Factor VIII concentrates: They are used in hemophilia, and they no longer store them in the
blood bank

Transfusion Medicine

Red Blood Cells

Characteristics:
300 ml
Hematocrit: 55 to 75%. (because they are concentrated, the plasma was removed).
Duration: 35 to 42 days. (at a temperature of 4 °C in the refrigerator).
Indications:
. Oxygen supply to the tissues or signs of tissue hypoxia,
generally with hemoglobin levels of 7–8 g/dL or Hct 21–
24%.
. Acute anemia with loss greater than 20% of blood volume
total after correcting the volemia.

Special Instructions
•Leukoreduced red blood cells: maintain only around 10% of the
initial leukocytes by removing the buffy coat or leukocyte layer.
Advantages:
Reduces the aloinmunization to leukocytes.
Reduce febrile transfusion reactions (leukocytes are the
responsible for this reaction). This is important in patients
politransfused.
It reduces the transmission of pathogens associated with leukocytes (HIV,
HTLV-I, CMV), Chagas.
Disadvantages: Higher cost and labor demand.
Leukodepleted red blood cells
99.9% of leukocytes are reduced through the use of filters.

Indications:
aloinmunization to leukocytes.
reduction of CMV transmission risk.
CMV (-) patient transplanted with bone marrow.
RN of low weight or immunodeficient.
Non-hemolytic febrile reaction.
Disadvantages: High cost.

Washed red blood cells

(Today they are hardly used, as leukocytes are eliminated with the buffy coat).

The maximum plasma is removed through washing with physiological saline.

Instructions:
• IgA deficiency.
• Anti-IgA antibodies.
• Paroxysmal Nocturnal Hemoglobinuria (Intravascular Hemolysis).
• Severe urticarial reactions.

Irradiated red blood cells

These red blood cells are subjected to irradiation to alter the function of T lymphocytes.
Indications:
• Bone marrow transplant recipients.
• Congenital or acquired immunodeficiency.
• Preterm newborn (low birth weight newborn).
• Intrauterine transfusion.
• Total exsanguinous transfusion.
• First-degree relative transfusion.

Frozen Fresh Plasma

Contains all the coagulation factors present in normal plasma.

Characteristics:
Volume 200-300 ml.
•Instructions:
Secondary hemorrhage due to CT scan (anticoagulant treatment) it is calculated with the TP and
The INR). The patient on anticoagulant treatment should be between 2 and 3. Patient with INR higher
(e.g. 6) those who are not bleeding should not be transfused. It should be
suspend anticoagulant, if the INR is very high use a small dose
of vitamin K (if a full ampoule is used, the patient will become refractory
the anticoagulant for about a week). This patient needs to
 to give plasma. Here it is used between 5 to 8 mL per kg of weight. The plasma
get used to asking for it in mL and not in units, as it should be remembered
that not all plasmas have the same volume, because it will depend
from the patient's height and other factors, so it is more standardized
ask for it in bulk.
Correction of defects in coagulation factors. (E.g., in defects of
coagulation factors such as Factor VII.
Microcirculation hemorrhage in massive transfusion.
. Massive transfusion refers to the transfusion of a volume
blood volume in less than 24 hrs. The blood volume in an adult
it is 70 ml per kg of body weight (about 5 L). Transfusion is also discussed.
massive when the patient in less than 3 hours has a
bleeding greater than 50% of blood volume.
Liver disease and bleeding.
Disseminated Intravascular Coagulation.
Replacement of AT III (Antithrombin III), protein C and S.
oPTT (Thrombotic Thrombocytopenic Purpura). These patients are treated
performing plasma exchange.
It is not recommended as a replacement fluid to correct hypovolemia due to:
Risk of transmission of infections.
There is little evidence that it offers benefits related to the use of
colloids or crystalloids in the management of hypovolemia.
It is expensive.

Dose:
Initial dose 15-20 ml/kg of body weight, then 5-8 ml/kg.
In hemorrhage due to TACO 5-8 ml/kg.
IT MUST BE ABO COMPATIBLE.

Frozen plasma subjected to viral inactivation

Treatment with Methylene Blue and UV Light reduces fibrinogen content.
60-80%.
Solvent-detergent treatment: plasma pools are treated. It is associated with
reduction of Protein C levels <20%.

Platelets
They can be prepared from a unit of whole blood or through apheresis.
Features:
of total blood:
. They contain 55 x 109platelets in 50-60 ml of plasma.
. Dosage: 1 unit for every 10 kg of weight.
From apheresis: (Machine through which I circulate the patient's blood, this
it is centrifuging, separating the platelets, for example, and returning them to the
patient the GR and the plasma. This way I can make a concentrate
 from 6 to 8 units of platelets from a single donor. Reducing the risk
the exposure of different donors to the patient.
. Contain 150-500 x109platelets in 150 to 300 ml of plasma.
. Storage: at 22°C with continuous stirring, lasts 5 days.
•Instructions:

a) Therapeutic Transfusion:
Hemorrhage attributable to thrombocytopenia.
Surgical or obstetric patients with microcirculation hemorrhage
attributable to thrombocytopenia.
Massive transfusion, microcirculation hemorrhage, and count <30,000
Thrombocytopathy and bleeding independent of the count.

b) Prophylactic Transfusion:
Medical pathology and count <10,000 or higher if there is associated coagulopathy.
In surgical patient count <50,000
Invasive procedures count <50,000
Recount <30,000 and bleeding.
Recount <50,000 in: RN, coagulopathy, sepsis, drugs that alter
platelet function.
oRecount <100,000 in coronary bypass surgery and within the first
48 hours post-operative.

Cryoprecipitates are obtained from fresh frozen plasma.

•They contain fibrinogen (150-300mg); factor VIII (80-100 U), von Willebrand factor,
factor XIII.
10-20 ml
Dosage: 1 unit for every 10 kg of weight.
Instructions:
Von Willebrand disease.
Hemophilia A.
Factor XIII deficiency.
oCID.

Clinical transfusion procedures: Key points

Transfusion times:
a) Blood or red blood cells maximum 4 hours.
Frozen fresh plasma: 20 minutes per unit.
c) Platelets 20 minutes maximum per concentrate.
Current risks of transfusion
Transmission of Infections:
HIV
Hepatitis A (it is rare because it is symptomatic and resolves), B (more associated with
promiscuity), C (more associated with drug addiction), G...
HTLV-I and II (Spastic Paraparesis)
•Syphilis (It is transmitted mainly through platelets)
Chagas disease
Malaria
Cytomegalovirus
•Parvovirus B19 (Fifth disease): It can cause aplastic crisis in red blood cells.
adults Severe anemia.
CJG (prions).
Bacterial contamination (Pseudomonas), Yersinia.

Transfusion Reactions

a) Non-hemolytic Febrile Reaction: Caused by leukocytes.

b) Urticarial reactions: Due to allergy to plasma proteins.
c) Circulatory overload: In cardiac patients, transfusing too quickly can
produce acute pulmonary edema.
d) Hemolytic reactions due to:
Classic group incompatibility.
Intra or extravascular hemolytic antibodies.
e) Anaphylactic reactions: For example, in patients with IgA deficiency, if we transfuse them
plasma where IgA goes can produce anaphylactic reactions.
f) Bacterial contamination and septic shock.
g) Transmission of infections.
h) Acute lung injury: Severe acute respiratory failure that leads to
mechanical ventilation. Chest X-ray: the lung appears white. This is caused by Acs against
the leukocytes that the blood donor has. This occurs through two mechanisms, either
due to previous transfusions or pregnancy. One way to prevent it is not to use plasma from
woman for transfusion, as she may have had pregnancies. Plasma today is
use little.
i) Graft-versus-host disease: T lymphocytes that are present in the transfusion
they are unaware of the tissues of the body of the immunocompromised host producing a
serious condition that can be fatal.

Never forget:
The transfusion should never be performed unless the benefits outweigh
the risks.
Zero risk transfusion does not exist.
Clinical guidelines must be respected.
Transfusion Medicine
BEFORE TRANSFUSING A PATIENT THINK:
If the patient were my son, would I give him the transfusion?
If after analyzing the situation you decide to transfuse, use the blood derivative.
correct in the appropriate amount.