Category Archives: Transfusion

VIVA SCENE: COMPATIBILITY IN BLOOD TRANSFUSIONS: RBC Vs FFP Vs PLATELETS AND OTHER QUESTIONS

Posted on by

COMPATIBILITY: RBC TRANSFUSION

In red cell transfusion, there must be ABO and RhD compatibility between the donor’s red cells and the recipient’s plasma.

All healthy normal adults of group A, group B and group O have ANTIBODIES IN THEIR PLASMA against the red cell types (antigens) that they have not inherited

Among the ABO blood groups:

Group A individuals have antibody to group B

Group B individuals have antibody to group A

Group O individuals have antibody to group A and group B

Group AB individuals do not have antibody to group A or B. So,

1 Group O individuals can receive blood from group O donors only ( as the antibodies against A or B in their plasma will react with any A or B antigens which enter the circulation)

2 Group A individuals can receive blood from group A and O donors

3 Group B individuals can receive blood from group B and O donors

4 Group AB individuals can receive blood from AB donors, and also from group A, B and O donors ( as their plasma don’t have any antibodies against any antigens)

RhD RED CELL ANTIGENS AND ANTIBODIES

Is the second most important group system. Out of the existing C,D and E antigens, D is the most antigenic one. Anti D antibodies are not normally found in the blood of Rh negative individuals; instead they develop it only when itcomes into contact with Rh positive blood during child birth or inappropriate transfusion. In case of subsequent transfusins or pregnancies with Rh positive blood- this can cause rapid destruction of RhD positive red cells (Hemolytic disease of the newborn[HDN] in subsequent pregnancies; to prevent this sensitization we should give Rhesus imunoglobulin= Anti-D prophylaxis- to the Rh negative mother who gave birth to an Rh positive baby). The fetal red cells are haemolysed, causing severe anaemia. HDN due to ABO incompatibility is usually less severe than Rh incompatibility.). FFP does not need to be Rh-compatible. Anti-D prophylaxis is not necessary in Rh D-negative recipients of Rh D-positive FFP. 

PLASMA TRANSFUSION: COMPATIBILITY

In plasma transfusion, group AB plasma can be given to a patient of any ABO group because it contains neither anti-A nor anti-B antibody.

1 Group AB plasma (no antibodies) can be given to any ABO group patients

2 Group A plasma (anti-B) can be given to group O and A patients

3 Group B plasma (anti-A) can be given to group O and B patients

4 Group O plasma (anti-A + anti-B) can be given to group O patients only

FFP does not need to be Rh-compatible (However, the unit will still be labelled as Rh +ve or Rh −ve) ; anti-D prophylaxis is not necessary in Rh D-negative recipients of Rh D-positive FFP

PLATELET TRANSFUSION: COMPATIBILITY

The Platelet Concentrates( PCs ) transfused must be ABO-identical, or at least ABO-compatible, in order to give a good yield ( Ideally, ABO identical units should be used but, in an emergency, ABO non-identical units can be used, although the improvement seen in platelet count post-transfusion may be less.)

Group O PC can be used for patients with blood groups A, B, and AB ONLY IF, they are resuspended in additive/preservative solutions, or if negative for high titre anti-A/A,B

ABO-incompatible PCs have reduced efficacy and, preferably, should not be used

Rh-negative patients, in particular women of childbearing age, should receive, if possible, RhD-negative PC

In the case of a transfusion of a RhD-positive PC to a RhD-negative women of childbearing age, 250 IU (50 μg) of anti-D immunoglobulin should be administered, a dose able to cover the transfusion of five therapeutic doses of PC in 6 weeks

ACUTE EMERGENCY : COMPATIBILITY

During an acute emergency, the blood bank may send group O (and possibly RhD negative) blood, especially if there is any risk of errors in patient identification. This may be the safest way to avoid a serious mismatched transfusion, in such situations.

HOW A GROUP AND SAVE IS PERFORMED? (P’s = Patient’s)

Screen Shot 2019-08-11 at 11.48.54 am

#BloodTransfusion , #ABO , #BloodGroup , #TransfusionMedicine , #Anaesthesia , #Anesthesia , #Bloodbank

Reference: The Clinical Use of Blood, Handbook, WHO,
Recommendations for the transfusion of plasma and platelets Giancarlo Liumbruno, Francesco Bennardello, […], and as Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party

15000768_1139329719436181_1357356490299776143_o14915305_1139329722769514_5358933164978110125_n

 

AAGBI GUIDELINES 2016

Screen Shot 2019-08-11 at 12.01.43 pm

HOW WILL YOU TRANSFUSE THE BLOOD?

Screen Shot 2019-08-11 at 1.16.04 pm

Also preoperatively the need for transfusion must have been explained and written informed consent should have been taken

A general Hb threshold of 7.0 g/dl should apply as a guide for red cell transfusion. 8.0 g/dl for patients with IHD

ALSO NOTE:

• A transfusion of 10 ml/kg of RBC should increase Hb by approximately 2.0 g/dl-

• Cryoprecipitate should be given in a dose of 5–10 ml.kg-1

• Platelets should be given in a dose of 10–20 ml.kg-1.

• Fresh frozen plasma may be given in doses of 10–15 ml.kg-1.

Tranexamic acid can be used in children: a loading dose of 15 mg.kg-1 followed by infusion 2 mg.kg-1.h-1 should be used in trauma

THE RIGHT WAY OF ADMINISTERING BLOOD PRODUCTS

Posted on by

Screen Shot 2018-09-01 at 5.22.07 PMPrefer a larger cannula: A doubling of the diameter of the cannula increases the flow rate of most fluids by a factor of 16.

In case of Whole blood, red cells, plasma and cryoprecipitate

>Use a new, sterile blood administration set containing an integral 170–200 micron filter

>Change the set at least 12-hourly during blood component infusion

>In a very warm climate, change the set more frequently and usually after every four units of blood, if given within a 12-hour period

In case of Platelet concentrates

Use a fresh blood administration set or platelet transfusion set, primed with saline.

WARMING BLOOD:

>There is no evidence that warming blood is beneficial to the patient when infusion is slow.

>At infusion rates greater than 100 ml/minute, cold blood may be a contributing factor in cardiac arrest. However, keeping the patient warm is probably more important than warming the infused blood.

>Warmed blood is most commonly required in:

[1]Large volume rapid transfusions:
–Adults: greater than 50 ml/kg/hour
-Children: greater than 15 ml/kg/hour

[2]Exchange transfusion in infants

[3]Patients with clinically significant cold agglutinins.

>Blood SHOULD ONLY BE WARMED in a blood warmer. Blood warmers should have a visible thermometer and an audible warning alarm and should be properly maintained.

>Blood should never be warmed in a bowl of hot water as this could lead to haemolysis of the red cells which could be life-threatening.

Severe reactions most commonly present during the first 15 minutes of a transfusion. All patients and, in particular, unconscious patients should be monitored during this period and for the first 15 minutes of each subsequent unit.

The transfusion of each unit of the blood or blood component should be completed within four hours of the pack being punctured. If a unit is not completed within four hours, discontinue its use and dispose of the remainder through the clinical waste system.

[ from “THE CLINICAL USE OF BLOOD”- HAND BOOK , World Health Organization & Blood Transfusion Safety , GENEVA ]

Practical issues in blood transfusion in pediatrics

Posted on by

1. Amount of transfusion to be given: It has been seen that transfusion with PRBC at a dose of 20 mL/kg is well tolerated and results in an overall decrease in number of transfusions compared to transfusions done at 10 mL/kg. There is also a higher rise in hemoglobin with a higher dose of PRBCs.

2. Properties of RBC products used in neonatal transfusion: a. RBCs should be freshly prepared and should not be more than 7 days old. This translates into a high 2, 3-DPG concentration and higher tissue extraction of oxygen.

3.Blood should be of newborn’s ABO and Rh group. It should be compatible with any ABO or atypical red cell antibody present in the maternal serum.

4. Volume and rate of transfusion:
a. Volume of packed RBC = Blood volume (mL/kg) x (desired minus actual hematocrit)/ hematocrit of transfused RBC
b. Rate of infusion should be less than 10 mL/kg/hour in the absence of cardiac failure.
c. Rate should not be more than 2 mL/kg/hour in the presence of cardiac failure.
d. If more volume is to be transfused, it should be done in smaller aliquots.