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HISTORY OF BLOOD TRANSFUSION

HISTORY OF BLOOD TRANSFUSION. 1616 - CIRCULATION OF BLOOD- WILLIAM HARVEY 1818– FIRST MAN TO MAN TRANSFUSION - JAMES BLUNDELL 1900– BLOOD GROUP - KARL LANDSTEINER.

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HISTORY OF BLOOD TRANSFUSION

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  1. HISTORY OF BLOOD TRANSFUSION • 1616 - CIRCULATION OF BLOOD- WILLIAM HARVEY • 1818– FIRST MAN TO MAN TRANSFUSION - JAMES BLUNDELL • 1900– BLOOD GROUP - KARL LANDSTEINER Torloni MD - 97

  2. Requirements for a blood bank • 100 sq m area + 50 sq m for component separation • Clean, well lit, air-conditioned. • Separate rooms for - Donor registration, screening & examination - Blood collection - Rest & refreshment - Store & records - Component preparation - Serology- ELISA - Refrigerators • Staff: MO ,Blood bank technicians, registered nurses. Torloni MD - 97

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  5. BLOOD DONORS Torloni MD - 97

  6. TYPES OF DONORS • VOLUNTARY/ NONRENUMERATED - best • RELATIVES / REPLACEMENT/DIRECTED • PROFESSIONAL DONORS Male- every 3 months Female- every 4 months • AUTOLOGOUS TRANSFUSION – blood is collected and reinfused from the same patient during surgeries • used in case of rare blood groups or in lack of blood supply. • No reactions/ incompatibility • best method. Torloni MD - 97

  7. DONOR SELECTION • Based on medical history physical examination laboratory tests. • Donor should be in good health so as to avoid any untoward effect to either the donor or the recipient. Torloni MD - 97

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  9. DON0R SELECTION CRITERIA • AGE 18-60 yrs WEIGHT >45 kg • B.P WNL • PULSE WNL • TEMP WNL • Hb >12.5 gms Torloni MD - 97

  10. DONOR DEFERRAL • H/O BLOOD TRANSFUSION 6 mth • MAJOR SURGERY 1 yr • H/O MALARIA 3mth TYPHOID 1 yr • IMMUNIZATION ( TT ,HEP B) 24 hr • RABIES VACCINATION /DOG BITE 1yr • H/O HEPATITIS A 1yr Torloni MD - 97

  11. DONOR REJECTION • DIABETES • HEART DISEASE • HEPATITIS B • SIGNS & SYMPTOMS OF HIV • EPILEPSY • ANY MAJOR ILLNESS Torloni MD - 97

  12. LABORATORY TESTS • HEMOGLOBIN • Should not be < 12.5g/dl • Males – 13.5 gm • Females – 12.5 gm • Copper sulphate specific gravity test is widely used as a Hb screening procedure. • It is simple, quick and inexpensive. Torloni MD - 97

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  14. Blood collection Torloni MD - 97

  15. EQUIPMENTS AND MATERIALS • Blood containers should be sterile and contain sufficient anticoagulant depending on the quantity of blood to be collected. • Anticoagulant used citrate -phosphate-dextrose adenine CPDA -1 - 35 DAYS citrate -phosphate-dextrose CPD – 21 DAYS Torloni MD - 97

  16. Anticoagulants & Preservatives • Acid citrate dextrose (ACD) :- 21 days Trisodium citrate – anticoagulant Citric acid –prevents carmelisation of dextrose Dextrose-provides energy to cells Distilled water-1L. 2. Citrate phosphate dextrose(CPD) :- 21 days +Na dihydrogen phosphate 3. CPD adenine 1 & 2 :- 35 days Adenine - provides ATP 4. Anticoagulants + Additive( adsol/ nutricel) solutions:- 42 days Contain adenine, mannitol, NaCl. Torloni MD - 97

  17. Blood collection monitor Torloni MD - 97

  18. Identification • Each bag of blood should be identified by donor number at the time of collection of blood so that it can be traced back to the donor and also to the recipient. • Also date of collection and date of expiry should be written on the label. Torloni MD - 97

  19. BLOOD MIXERTUBE SEALER Torloni MD - 97

  20. Blood bank refrigerators Torloni MD - 97

  21. Storage of Blood • Constant temperature 2-60 C • Alarm • STORAGE – 35 days • Whole blood • Packed Cells • Single donor plasma Transfuse at room temperature (22-260 C) Torloni MD - 97

  22. Storage of Blood- freezer • Temperature –18 to –860 C • STORAGE • 1 year – FFP Cryoprecipitate • 5 years – Frozen plasma single donor • Issued after thawing • Transfuse without delay Torloni MD - 97

  23. Changes occuring in stored blood Biochemical Changes  pH level (7.6 – 6)  Potassium level (3.3 – 17) Cellular changes RBC 100% WBC & platelets   Lymphocytes persist Coagulation factor V & VIII < 50% Torloni MD - 97

  24. Whole Blood Def: Unseparated Anticoagulated blood Indication: Acute blood loss >30%. Exchange transfusion Contraindication: Severe anaemia. Shelf life: 35 days at 4-6ºc Torloni MD - 97

  25. BLOOD COMPONENTS Torloni MD - 97

  26. Why desired? • Allow optimal survival of each constituent. • Allow specific transfusion as per patient requirement. • Transfusion of unnecessary component avoided. • Optimal use of every unit of donated blood. • To overcome the shortage of blood. • To increase the shelf life of various components. • To minimize the complications. Torloni MD - 97

  27. Blood component separator Refrigeratedcentrifuge Torloni MD - 97

  28. Refrigeratedcentrifuge Torloni MD - 97

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  30. APHERESIS - INDICATIONS : • To collect components for transfusion purpose: - Platelets – Plateletpheresis - Leucocytes – Leucopheresis / Granulocytapheresis - Plasma – Plasmapheresis - Peripheral blood stem cells • To remove pathological component - Therapeutic pheresis Torloni MD - 97

  31. Apheresis Torloni MD - 97

  32. Types of blood components Cellular • Red cell concentrates. • Platelets • Granulocytes Special products cord blood peripheral stem cell Plasma Fresh frozen plasma Cryoprecipitate Single donor plasma Cryopoor plasma Torloni MD - 97

  33. Red cell component Def: Removal of approximately 3/4th of plasma from whole blood. Hematocrit and oxygen carrying capacity is same as whole blood. Types: Packed red cells Leucodepleted red cells Torloni MD - 97

  34. platelets Torloni MD - 97

  35. Platelet Components Types • Platelet rich plasma (PRP) • Platelet concentrate Preparation • Prepared from whole blood within six hours of collection. Storage • 20 to 24ºc room temp. for 5 days with continuous agitation. Never refrigerate Torloni MD - 97

  36. Platelet Incubator & Agitator Torloni MD - 97

  37. Granulocyte Concentrate Clinical use • neutropaenic patients ( <500 PMN/l) with septicemia. • Myeloid Hypoplasia Torloni MD - 97

  38. Fresh Frozen Plasma Torloni MD - 97

  39. Fresh Frozen Plasma Def: plasma frozen within 6 hrs of blood collection . Stored at -20ºc Contents: all coagulation factors Shelf life: 1 yr. Torloni MD - 97

  40. FFP Indication: • Multiple coagulation factor deficiencies. • Eg: DIC, Liver disease, Massive transfusion • Reversal of Anti-coagulant Therapy. Torloni MD - 97

  41. Cryoprecipitate Def: It is the insoluble portion of plasma remaining after the FFP has been thawed at 4-6ºc. Contents: Factor VIII ,Von Willebrand factor and fibrinogen. Indications: • Haemophillia • Von Willebrand disease • Congenital or acquired fibrinogen deficiency. Torloni MD - 97

  42. Components - INDICATIONS Torloni MD - 97

  43. Pre-transfusion testing • ABO Grouping • Rh Typing • Cross matching • Testing for diseases • HIV 1& 2 • HBsAg, HCV • Syphilis • Malaria Torloni MD - 97

  44. Blood Group Systems Major blood group systems: ABO, Rh Minor blood group systems: Lewis, MNS, Kell, Duffy, SSU, Kidd and Lutheran, P, I , Karl Landsteiner discovered the ABO blood group system in 1901. Rh system discovered by Landsteiner & Weiner in 1940. Torloni MD - 97

  45. Landsteiner’ s Law • When a particular antigen is present on the surface of a red blood cell, the corresponding antibody is absent in the serum and vice-versa • i.e... When a particular antibody is present in the serum, the corresponding antigen is absent on the surface of a red blood cell. • Exception- the Rh system. Torloni MD - 97

  46. ABO Blood Group System Torloni MD - 97 Table 19.2

  47. BLOOD GROUPS Torloni MD - 97

  48. . Torloni MD - 97

  49. Subgroups A – A1 - A2 Torloni MD - 97

  50. Rh Antigens E D c D e c D c D d e Torloni MD - 97

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