Transfusion Therapy AND its different types ,uses

PRE-TRANSFUSION TESTING

1-Determination of recipient ABO group.

2-Determination of  recipient Rh (D) type

3-Determination  of recipient serum alloantibodies

4-Crossmatch between patient serum & Donor RBCS

5-Coomb s test: "not routine"

6 - selection of blood product for transfusion:

Packed Rbcs:

*One unit increases Hgb by lgmldl

*Indication: chronic symptmatic anemia

                                         spesially  coronaryA.D.

                    Active bleeding  

*Not used to supply    Plts ,

                                  Adequate blood volume or

                                    coauqulstion factors 

Random-donor plt concatenate:

1unit whole blood   gives bag of plts contains

70ml plasma

1unit      plts increases plts count by 5xl09/L

Indication: 1- proplyact* no bleeding

                 2- bleeding

                   

HLA matched plts

-by hemapharesis   

 - contain 3× 1011 plts

-equal to 6:8 units radorn donor plt conc.

-Used in pt. need plts but refractory

 to plts Transfusion

Factor Vlll concentcrate

hemophilia A

factor 1X  concentcrate

hemophilia B

hemophilia A wit inhibitors to factor Vlll

congenital decrease of factor Vll and X 

Albumin:-

1- Acute   volume    expansion

                          Hyov. Schock   

                      Chronic Albumin depletion 

2- long term replacement (burn)

3- Cadiopulm. pypass priming

4- thesapeutic Plasmapharesis.

FFP.

1-multiple coagul. facter (DIC ,Liver disease )

2-Massive transfusion

3-Specific coag. factor deficiency(antithrombin 111, ll, V, Vll)

 4-warfarin overdose Adverse  effects of transfusion:.

I mmune mediated adverse effects:-

 1-Acute hemolytic transfusion reactions:

*Pathogenesis: transfusion of AB0incompatible whole bl. or RBcs

*c/p:. pain at tran. site, chest pain, back pain, fever, chills, nausia ,dyspnea ,oliguria hemoglobinuria, hypotension ,shock, excessive bleeding

*treatement- Discontinue -Fluid ,diuretic-treatDIC,hypotension&promote Renal blood flow

•                               - treatDIC

•          Investigation: -indirect serum bilirub.increased

•          -LDH -direct antigloulin test (+)

2-Delayed hemolytic transfusion reaction

Pathogenesis. Immunization against RBS alloantigen

C/P:-

-                        Subclincal

-          -           unexplained  Hgb decreased

                             Fever - chills - anemia -  Jundice

                             Hemoglobinuria

treatement: Renal function monitoring

                         (in Renal  diseased patient)     

                    serious sequalae are infrequent.

Investigation:

direct antigloulin test (+)

indirect antigloulin test (+)

3- febrile nonhemlytic transfusion reaction

                recipient develops cytotoxic antibodiesagainst antigens on donor granulocyte, lymphocytes or platelets (leukoagglutinins).

 Ag AB. interaction with complement activation,

pyrogens release &fever.

 Commonly seen in multitransfused pts.

C / p:          -during or shortly after transfusion.

                   -Fever chills or rigors

tretement: -Exclude hemolytic transf. reaction

       -discontinue tran.                           -       

                Antipyretic

.  

4- Non cardiogenic pulmonary oedama.

Pathogenesis:

Patient lenkoagglutinins leads to Ag – AB intcraction

and leuckocytes aggregation  trarring  in pulmonary

 Vasculature&increased vascular permeability.

C/P: fever ,chills, Acute pul. oedma.

         No evidence of lt ventricular dysfunction.

  tretement :

-                                             discontinue trans.

-                                             Rule out Acute hemolytic tran. reactions

-                                            I.V. steroids

-                                            Leukocyts free bl. products.

5- Allergic transfusion reaction

- **Urticarial reactions:

Pathogenesis:

Transfused soluble atopens

(commm in those with history of allrgy),

 histamie release from IgE ore IgG coated mast cells.

C/P. pruritis – usually without fever

treatement . temporary interruption of trans.

Antihistaminics

**Anaphylactic reactions:

-              relatively rare – commm in IGA deficient pts

-              may occur after only small dose transfusion

tretement: stop transf.  ,tretement hypoten ,epinephrine

Prevention:- RBcs extensively washed &free of plasma

-              autologous donor program before elective surgery.

.

6Allo imm unization:

Against alloantigenis compoments in blood products :

1--- Allo immuniZation to RBcs Antigens:-

 (Acute or delayed hlytic reactions).

2---Allo immuniZation to plts

***(Abs developed against plts associated HLA -Ags leads to

Refractoriness to plts transfusion

            typically seen in multitramsfued pts .

            tretement HLA matched plts.

***Abs  againt plts specific Ags leads to

-Neonatal alloimmune thrombocytopenia

-Post transf. purpura *5: 15 days after transf.                                       *tretement :

                                        plasma pharesis &  

                                       autologous transfusisn.

7- GVHD

c/p.

Develop:                              30days after transf.

fever                     liver dysfunction       

diarrhea infections       pancytopenia.

 tretement:ATG,  steroids,           methothexate.   

Cyclosporine, bl. Products irradiation

(2)  Infectious diseases transimission

*Viral:-

-hepatotropic, HCV,HBV,HDV

                -Herpes virus: CMV ,EBV

                -Retro Virus:--- HILV-1

                              (tropical Spastic  Parapares or

             Adult T cell leuk. Lymphoma. 

                                                                    ---HIV (AIDS

*Non Viral:
-Syphilis: (treponema pallidum)
-Brucellosis (brucella species)
                                                                                                               
-gram – ve  bact. Contamination                               (Yersinia &E-coli)
-Malaria
-Chagas' disease (trypanosoma cruzi)
-Toxoplamosis (toxoplasma gondii)
-Babesiosis (babesia microti)

(3) Complications related to massive transfusion.
-Replacement of pt bl. Volume by stored bl. In less than 24  h.
-Necessary in trama, liver transplant, vascular surgery.
1- hemostatic abnormalities.
Dilution plts & coag. Factors in circulation. → DIC
tretement- replacement Of coag. factors &plts.
2- citrate toxicuty:
Hypocalcemia → cardiac dysfunction.
tretement: calcium
3- hypothermia:

Massive tr. Of stored refrigerated bl.

→ candiac dysrrhythmia.

tretement– use warmer blood.

4- K imbalance:

---Hypokalemia

 If metabolic Alkalosis due to citsate.

---Hyperkalemia.

Due to ↑ plts & plasma k with storage. (uncommon)

5- Acid base imbalance:

Early → metabolic acidosis

Late → metabolic alkalasis

6. mechanical trauma  to BBs: → hemolysis.

(4)      other Non immunologic          complications

1- circulatory overload:

In carliopulmanary compromised pts.

C/p: dyspnea ,

        cyanosis ,

        penipheral oedema.

tretement:   discontinue,

                  tretement overload,

                   Slow infusion of single component

2- hemosiderosis:

1unit RBCS → contain 200 mg iron.

Chronic Transf. → cardiac,

                               endocrine&

                               hepatic dysfunction.

tretement: iron chelating agents.

Alternatives to homologous blood Transfusion

(1) Autologous blood Transfusion:

Is: any bl. Component donated by intended recipient.

Benefits:     (low risk of):

                                              Alloimmunlzation

                              GVHD

                                              Infections dis. transmission.    

                                           Febrile, hlytic, allergic reaction.

Categories:

(1) autologus whole bl. Or KBcs.

* preoperative donation:

- before elective surgery (anticipated  bl. loss)

- contraindication:

                - symptomatic angina, AS, Valvular HD.

                - recent seizures.

                - hematocrit ↓ 33%

 

 * Intraoperative hemodilution:

- in cardiopulmonary bypass procedure.

-          1 or 2 units of bl. Removed →

-          replaced by colloid or crystalloid

-          → after surgery →

-          transf. of autol. b1ood& diuretics

-          (to ↓ plasma volume).

-          * post operative blood. salvage

-          Significant drainage form cavity as

-          chest cavity drainge ,,

-          collect blood during 24: 48 h postoerative →

-           Filteration →

-           reisfuse within 6h of collection

-          (2) Autologous plts transfusion.

-          Preoperative Collection by hemapharis

-          → frozen for future use

-          as anticipation of BM suppression during chemotherapy.

-          (3) autologous FFP or csuopercipitate.

-          Very uncommon indication.

-          (4) autologus concenterated fibrinogn.

-          Separated from autologus plasma.

-          (2) Growth factors

-          Epo: ↑ RBs production& ↓ need RBs donation

-          GM- CSF or G – csf:

-          stimulate hematopoiesis

-          used with BMT&chemotherapy.

-          (3) blood substitutes