Blood Transfusion: Steps, Types, Complications, and its Necessity

Blood Transfusion: In this blog post, the overview of blood transfusion is given at the start. Then, its different types, steps, necessity are explained. And in the last, the Complications (Reactions) of blood transfusion are explained. 

What is a Blood transfusion?

    Blood transfusion is a medical procedure, in which donated blood is provided to an individual who is in need of that. A lot of processes are involved in a single transfusion. A healthy volunteer, who wants to donate blood, can donate 350 ml in which 49 ml of anti-coagulant solution should be present. A person is able to donate 450 ml of blood, with 63 ml of anti-coagulant solution. 

     The blood transfusion set has a needle of 18-19 gauge. The filter is of 170-200 microns, from it only the micro aggregates can enter, and most of the aggregates cannot cross the filter. 

 

Which anti-coagulants are used in blood bags, and Why?

     Different types and numbers of anticoagulants are used in the blood transfusion bags, some of them are given below:

 

1) ACD (Acid Citrate Dextrose): Acid citrate dextrose is used to increase the shelf life up to 3 weeks (21 days).

 

2) CPD (Citrate Phosphate Dextrose): Citrate phosphate dextrose is used to increase the shelf life of blood up to 3 weeks (21 days).

 

3) CPD-A (Citrate Phosphate Dextrose Adenine): Citrate phosphate dextrose adenine increases shelf life to 35 days (5 weeks).

 

4) SAGM (Saline Adenine Glucose Mannitol & Citrate & Phosphate): With the use of this anticoagulant, the shelf life increases to 6 weeks (42 days).

 

     The different factors present in the anticoagulants have different functions, each of them is given below:

 

• Saline: It makes the environment Isotonic by preventing the lysis and shrinkage of RBCs.
• Adenine: It generates ATP (Adenosine triphosphate).
• Glucose: It provides nutrition to the RBCs.
• Mannitol: It decreases the lysis of cells.
• Citrate: It decreases the calcium level, which leads to the inhibition of clot formation.
• Phosphate: Phosphate works as a buffer, and maintains the pH of the blood.

 

Steps involved in blood transfusion

     Blood donation is done through a sequence of steps, that are given below:

• Selection of a healthy donor having hemoglobin more than 12.5 g/dl, and must be free of infections.
• Then, Blood should be collected by phlebotomy in a sterile plastic bag, having anticoagulants as mentioned above.
• That bag should be stored at a particular room temperature of 2-6 degrees celsius.
• Testing of ABO-Rh grouping of the donor should be done, and also for infectious agents like HIV, Malaria, HCV, and HBV.
• Then the blood grouping of the recipient should be done.
• Pre-transfusion compatibility testing of both (recipient and donor) should be done as under:

1. Serum antibody screening of patient, to check are significant antibodies are present or not.
2. Cross-matching of donor red cells with the plasma of the patient, to check the compatibility of both.

• In the last, the transfusion should be supervised, so that if any reaction occurs, it can be prevented at once.

Types of Blood Transfusions

     There are four types of blood transfusions, all of them are given below:

1) RBC Transfusion:

     A patient suffering from Anemia (Iron deficiency anemia), can need red blood cells, to complete its need, Red blood cells are transfused, called RBC Transfusion.

2) Platelet Transfusion:

     Platelets are the components that are needed for clot formation in the body. If a patient is suffering from any type of disorder like Leukemia, or any other cancer, and that disorder leads to a decrease in the platelet counts, then ultimately he needs platelets to overcome that deficiency, that transfusion is called Platelet Transfusion.

3) Plasma Transfusion:

     The liquid part of blood is called Plasma, it contained different proteins like clotting factors and others. The plasma transfusion is done on patients having burns,  liver failure, and severe infections.

4) Whole blood transfusion:

     If a patient is gone through a severe traumatic hemorrhage and requires all the factors (Red blood cells, Platelets, and Plasma), then a whole blood transfusion is done to that patient. 

 

 

Blood Transfusion Complications

     The blood transfusion complications are divided into two groups, which are given below:

 

1) Complications of donor: Following are the blood transfusion complications of the donor,

• Pain, Bruises, and Hematoma.
• When a large amount of blood is collected, it may lead to Vasovagal syncopy, which causes a decrease in Blood pressure. It can be countered by raising the foot end of the donor and supplementary with fluids.
• If Apheresis occurs, leads to a decrease in citrate, which causes Transient hypocalcemia that gives Peri-oral numbness and Tingling sensation. It can be prevented by slow infusions, and also treated with Oral Calcium supplementation.

2) Complications of Recipient: Recipient complications are of two types, one is acute reactions and the other is delayed reactions.

Acute Blood Transfusion Reactions

     These reactions are those which can occur immediately after transfusion within seconds to hours. These reactions are given below:

 

1) Anaphylactic Reaction:

     This reaction occurs within seconds, in individuals having a deficiency of IgA antibodies, and when these patients are transfused with blood having IgA antibodies, they will form Anti-IgA antibodies that lead to a reaction called Anaphylactic reaction. Features of this reaction include Hypertension, wheezing, angioedema. It can be treated with Adrenaline.

2) Acute Hemolytic Reaction:

     This reaction occurs within 24 hours of transfusion. It occurs due to ABO incompatibility, as if an Individual having blood group A+ve is given B+ve, then B-antibodies present in the recipient leads to a reaction called Acute Hemolytic reaction.

     Clinical features of an acute hemolytic reaction include high-grade fever with chills and rigors, flank pain, hemoglobinemia with hemoglobinuria (hemolysis), Disseminated Intravascular Coagulation in severe cases, and Oozing of blood from Veni-puncture.

     Management of acute hemolytic reactions is done by following procedures:

• Immediate stop blood transfusion
• Maintain I.V line with normal saline
• Blood bank sampling for a mismatch.

3) Febrile Non-hemolytic transfusion reaction:

     This is the most common transfusion reaction, that occurs b/w 1-6 hours after transfusion. When blood is stored, WBCs produce cytokines, and that blood having cytokines is transfused that triggers the immune system of the recipient body. It results in symptoms of headache, fever, and chills.

 

4) Urticarial Reaction:

     If a patient presents with urticaria after transfusion, it is likely due to an Urticarial reaction. It take place b/w 2-3 hours after transfusion. IgE plays an important role in it.

 

 

5) Transfusion-related Acute lung Injury (TRALI):

     This reaction occurs within 6 hours of blood transfusion. It is seen more likely in cases of Multiporous women, previous transfusion, previous transplantation, and multiple pregnancies. It occurs due to antibodies against the WBCs. These anti-leukocyte antibodies are present in the blood of a donor. As the transfusion is done, these antibodies then attack the lungs. Symptoms of TRALI include respiratory distress, pulmonary edema after transmission.

 

6) Circulatory Overload:

     This disorder particularly occurs in patients of elder age and premature. It occurs due to rapid transfusion of blood, as it causes the heart to pump a large volume of blood. It leads to pulmonary edema. Prophylaxis will be slow the transfusion rate and decrease the volume of transfusion.

 

Delayed Blood Transfusion Reactions

     If the reaction occurs after days or weeks, then those reactions are called delayed transfusion reactions. Following are the delayed transfusion reactions:

 

1) Graft versus host disease:

     This reaction is seen after 8-10 days of transfusion. It is due to the donor T-cells immunocompetent. Prior irradiation can be effective to reduce graft versus host disease. Patient having graft versus host disease presents with pancytopenia, fever, rash, and GI symptoms.

 

2) Delayed Hemolytic Reaction:

     Delayed hemolytic reactions occur after days-weeks of transfusion. It is due to Anamnestic antibodies found against minor antigens on RBCs.

 

 

3) Post Transfusion Purpura (PPT):

     PPT occurs with platelet transfusion after 7-10 days. Normally Anti-human platelet-1 antigen is present in the platelet. But, if it is absent in an individual, and that individual receives a platelet transfusion (that platelet has AHP-1A). Then recipient body produces antibodies against that antigen, thus the destruction of platelets occurs.

 

4) Blood Borne Infections:

     It results from the introduction of a particular pathogen into a person through blood transfusion. A wide variety of pathogens like Hepatitis-B, C viruses, Human Immune viruses, Malaria, and Syphilis. These pathogen's introduction to the body can be prevented by Screening.

 

Massive Blood Transfusion

     Massive blood transfusion occurs when more than 1 volume of blood is transfused in 24 hours, or if more than 50% of blood volume is transfused within 3 hours. The complications of massive blood transfusion include:

1. Hypothermia: It is a condition in which the body loses heat very fast than normal. It can be prevented by inline warmers.
2. Electrolyte disturbance: Electrolytic disturbance causes an increase in potassium levels, which causes hyperkalemia that leads to hypomagnesemia. As it also causes a decrease in the level of citrate, that leads to hypocalcemia and liver problem. Then that liver problem causes an increase in HCO3-1 that leads to Metabolic Alkalosis.
3. Dilutional Coagulopathy: It leads to disseminated intravascular coagulation, which may lead to death. The protocol that can be protective against dilutional coagulopathy is the 1:1:1 ratio of RBC:Platelets: Plasma.

Why Blood Transfusion is necessary?

     These transfusions can be helpful for the cure of patients who need blood, may be RBCs, Platelets, Plasma, or even sometimes Whole blood. The need depends on what type of disorder they have.

     Following are the few disorders, in which patients need blood transfusions. These are Anemia, Hemophilia, Sickle cell anemia, Kidney disease, or Liver disease.