Blood Transfusion

Safety

Safety of blood (exclude)

• malignancy or disease of unknown cause
• drugs
  • teratogenic, carcinogenic, vaccines
• Infections
  • and contacts of infections
  • transfusion, ear piercing, tatoos
• CJD
  • growth hormone, gonadotrophin recipients
• haemoglobinopathies / G6PD deficiencies
  • although can give if not anaemic

Patient information leaflet -

• Never give blood if
  • if patient or partner HIV positive
  • HBV, HCV carrier
  • male homosexuals
  • prostitutes
  • injected drugs
• wait 12 months after sex with
  • male homosexual
  • prostitute
  • anyone who has injected drugs
  • haemophiliacs
  • anyone sexually active in Africa

Blood Tested for

• HIV 1/2
• HBV
• HCV
• Syphilis - marker of dangerous sexually behaviour

Ensure safety of DONOR

• 17-70, >50kg
• Haemoglobin test - density testing in copper sulphate solution
• exclude cardiovascular disease, hypertension
• respiratory disease
• epilepsy
• 12 months after surgery, illnesses, pregnancy
• avoid hazardous hobbies / work that day

Uses

• Whole Blood -  rarely used
• Red cells
• Platelets
• Fresh Frozen Plasma
• Cryoprecipitate

Hazards of blood transfusion

HUMAN ERROR

• General
  • fluid overload
  • cardiac failure
  • air embolism
  • Massive transfusion
    • dilutional thrombocytopenia
    • less factor V and VIII
    • hypothermia leading to platelet dysfunction
    • lack of 2,3 DPG leading to problems with oxygen delivery to tissues
    • citrate toxicity and hypocalcaemia
    • prolonged hypotension - can lead to DIC
• Acute non-immunological
  • hypothermia
  • hyperkalaemia
  • hypocalcaemia - citrate toxicity
  • bacterial shock
• Acute immunological
  • febrile non-haemolytic reaction
  • acute haemolytic reaction - ABO incompatibility
  • Allergic reactions
    • urticarial
    • anaphylactic - e.g. in congenital IgA deficiency
  • Transfusion Related Acute Lung Injury (TRALI)
    • anti-white cell antibodies leading to immune complex deposition
• Delayed immunologic
  • delayed haemolytic transfusion reaction
    • anti-duffy antibodies
  • Post-transfusion purpura
  • Transfusion graft vs host disease
    • uniformly fatal
    • occurs most often in immunosuppressed
  • Immune modulation
    • increased risk infection
    • increased risk of relapse of cancer
• Delayed non-immune
  • HIV
  • Hepatitis B,C
  • CMV
  • Parvovirus B19 - slapped cheek syndrome, leads to erythroid hypoplasia
  • Others
    • Hepatitis A, malaria, brucellosis, syphilis, trypanosomiasis
  • ??nvCJD - to avoid transfusions undergo leukodepletion

Risks

• HIV 1:3 million
• Hepatitis B 1:50,000
• Hepatitis C 1:200,000
• Death due to sepsis 1:500,000 after red blood cells, 1:50,000 after platelets
• nvCJD ?????

Reference - Haem. Lecture 3

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