By Prof. Datin Dr. G. Duraisamy Clinical Consultant (Haematology)
Blood is a limited resource and it is important to rationalize and optimize transfusion practice. The right product should be given to the patient for maximum benefit, to improve the clinical outcome, minimizing the incidence of adverse reactions and decreasing the cost.
Adverse reactions include heamolytic transfusion reactions, febrile non-haemolytic transfusion reactions (FNHTR), transfusion transmitted diseases like HIV, Hepatitis B or C (HBV, HCV), immune modulation and rarer conditions like transfusion related Graft versus Host Disease (TRGvH) or transfusion related acute lung injury (TRALI).
The increased awareness of potential complications of blood transfusion has resulted in the practice of judicious use of blood and blood products. Component transfusion rather than the use of whole blood is now routine in most hospitals.
Use of Components
Blood components have the advantage that the components is in small volumes with higher concentration of a particular product for specific indications.
- Thus anaemic patients are given packed red cells (instead of whole blood) to improve the oxygen carrying capacity 250mlpRBC ↑Hb by 1 g/dl in a 70kg man.
- Platelet concentrates are used for thrombocytopenic patients and patients having qualitative defective platelets (as in patients on aspirin who are bleeding) to stop/prevent bleeding. However platelet concentrates should not be given when there are platelet antibodies present as in patients with ITP (Immune thrombocytopenic purpura). 1 bag platelet conc ↑platelet count by 5-10x109/dl
The final decision to Tx depends on the clinical judgement. Document reason for transfusion
- Cryoprecipitate is given to DIC (disseminated intravascular coagulation) & afibrinogenaemia patients to provide them with adequate fibrinogen for coagulation.
- Cryosupernatant is used for patients with bleeding due to liver failure or vitamin K deficiency
- Fresh Frozen Plasma (FFP) is given to patients with coagulation factor deficiencies. It should not be used as a plasma expander as there are safer alternatives like Colloids (eg haemocaele) and crystalloids (Saline).
Judicious Use of Blood
- Identify the cause of the anaemia & treat the underlying cause.
- Bleeding - Secure haemostasis. Stop the bleeding, do not transfuse if Hb is stable & satisfactory.
- Use alternatives - Give haematinics to improve Hb if there is iron/folate/vitamin B12 deficiency. Anaemia in patients with chronic renal failure may respond to erythropoietin.
Safer Alternatives for Transfusion
(carry no risk of transmitting viral infections like HIV)
- Plasma expanders - crystalioids, colloids, albumin
- I/V IgG immunoglobulin
- Specific IgG like anti-hepatitis B immunoglobulin
- Antithrombin III concentrates
- Virally inactivated plasma products like FVIII concentrates, FIX concentrates
- Recombinant product like rFVIII, rFIX, rFVIIa
- Cytokines like erythropoietin (for rbc), G-CSF & GM-CSF (for neutrophils), Interleukins
Suggested Regimen for DIC
- Treat the underlying cause of the DIC
- Give 6 bags of cryoprecipitate (180ml) in <15 minutes, then 4 bags platelet concentrate (200ml), 2 bags FFP (400 to 500ml)
Blood Group O
- Group O has H antigens in the rbc
- and anti-A & anti-B antibodies in the sera/plasma
Rhesus D+ means there are D antigens on the rbc.
Is this "Emergency" O blood? Can it be transfused to Group A persons?
No, because it has regular antibodies, anti-A & anti-B. Packed RBC can be used as emergency blood as it has no plasma and therefore no regular antibodies, anti-A and anti-B.
Packed RBC can be tranfused to group A, B and AB persons.
All donor information and screening results must be recorded & records kept for 20 years. September 2006 EU regulations states that records must be kept fo 30 years! Transfused patient information should also be kept.
- Records of tests done should be kept for future reference
Screening Tests Done on Donor Blood in Malaysia
- Hepatitis B - HBsAg by ELISA
- Hepatitis C - anti-HCV by ELISA
- HIV test - anti-HIV by ELISA
- Syphilis - VDRL & TPHA
- Malaria - in some states a Blood film for malaria (Bfmp) is done
- ABO & RhD test is done twice
- Indirect AHG - for irregular Ab
Group, Screen and Hold
- Group the patient
- Screen for Antibodies (Ab) in the serum (AHG test)
- No need to reserve crossmatched blood if AHG is negative
- If no Ab are present (AHG negative), if its necessary, transfuse group specific packed RBC of the same ABO & RhD blood group as the patient
- If Ab are present (AHG positive) in the patient full crossmatch must be done to find compatible blood.