Blood transfusion

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Blood transfusion_table_infobox_0

Blood transfusionBlood transfusion_header_cell_0_0_0
ICD-9-CMBlood transfusion_header_cell_0_1_0 99.0Blood transfusion_cell_0_1_1
MeSHBlood transfusion_header_cell_0_2_0 Blood transfusion_cell_0_2_1
OPS-301 codeBlood transfusion_header_cell_0_3_0 Blood transfusion_cell_0_3_1
MedlinePlusBlood transfusion_header_cell_0_4_0 Blood transfusion_cell_0_4_1

Blood transfusion is the process of transferring blood or blood products into one's circulation intravenously. Blood transfusion_sentence_0

Transfusions are used for various medical conditions to replace lost components of the blood. Blood transfusion_sentence_1

Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets. Blood transfusion_sentence_2

Red blood cells (RBC) contain hemoglobin, and supply the cells of the body with oxygen. Blood transfusion_sentence_3

White blood cells are not commonly used during transfusion, but are part of the immune system, and fight infections. Blood transfusion_sentence_4

Plasma is the "yellowish" liquid part of blood, which acts as a buffer, and contains proteins and important substances needed for the body's overall health. Blood transfusion_sentence_5

Platelets are involved in blood clotting, preventing the body from bleeding. Blood transfusion_sentence_6

Before these components were known, doctors believed that blood was homogenous. Blood transfusion_sentence_7

Because of this, many patients died because incompatible blood was transferred to them. Blood transfusion_sentence_8

Medical uses Blood transfusion_section_0

Red cell transfusion Blood transfusion_section_1

Main article: Packed red blood cells Blood transfusion_sentence_9

Historically, red blood cell transfusion was considered when the hemoglobin level fell below 10 g/dL or hematocrit fell below 30%. Blood transfusion_sentence_10

Because each unit of blood given carries risks, a trigger level lower than that, at 7 to 8 g/dL, is now usually used, as it has been shown to have better patient outcomes. Blood transfusion_sentence_11

The administration of a single unit of blood is the standard for hospitalized people who are not bleeding, with this treatment followed with re-assessment and consideration of symptoms and hemoglobin concentration. Blood transfusion_sentence_12

Patients with poor oxygen saturation may need more blood. Blood transfusion_sentence_13

The advisory caution to use blood transfusion only with more severe anemia is in part due to evidence that outcomes are worsened if larger amounts are given. Blood transfusion_sentence_14

One may consider transfusion for people with symptoms of cardiovascular disease such as chest pain or shortness of breath. Blood transfusion_sentence_15

In cases where patients have low levels of hemoglobin due to iron deficiency, but are cardiovascularly stable, parenteral iron is a preferred option based on both efficacy and safety. Blood transfusion_sentence_16

Other blood products are given where appropriate, e.g., to treat clotting deficiencies. Blood transfusion_sentence_17

Procedure Blood transfusion_section_2

Before a blood transfusion is given, there are many steps taken to ensure quality of the blood products, compatibility, and safety to the recipient. Blood transfusion_sentence_18

In 2012, a national blood policy was in place in 70% of countries and 69% of countries had specific legislation that covers the safety and quality of blood transfusion. Blood transfusion_sentence_19

Blood donation Blood transfusion_section_3

Main article: Blood donation Blood transfusion_sentence_20

Blood transfusions use as sources of blood either one's own (autologous transfusion), or someone else's (allogeneic or homologous transfusion). Blood transfusion_sentence_21

The latter is much more common than the former. Blood transfusion_sentence_22

Using another's blood must first start with donation of blood. Blood transfusion_sentence_23

Blood is most commonly donated as whole blood obtained intravenously and mixed with an anticoagulant. Blood transfusion_sentence_24

In developed countries, donations are usually anonymous to the recipient, but products in a blood bank are always individually traceable through the whole cycle of donation, testing, separation into components, storage, and administration to the recipient. Blood transfusion_sentence_25

This enables management and investigation of any suspected transfusion related disease transmission or transfusion reaction. Blood transfusion_sentence_26

In developing countries, the donor is sometimes specifically recruited by or for the recipient, typically a family member, and the donation occurs immediately before the transfusion. Blood transfusion_sentence_27

It is unclear whether applying alcohol swab alone or alcohol swab followed by antiseptic is able to reduce contamination of donor's blood. Blood transfusion_sentence_28

Processing and testing Blood transfusion_section_4

Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. Blood transfusion_sentence_29

Collected blood is then separated into blood components by centrifugation: red blood cells, plasma, platelets, albumin protein, clotting factor concentrates, cryoprecipitate, fibrinogen concentrate, and immunoglobulins (antibodies). Blood transfusion_sentence_30

Red cells, plasma and platelets can also be donated individually via a more complex process called apheresis. Blood transfusion_sentence_31

Blood transfusion_unordered_list_0

  • The World Health Organization (WHO) recommends that all donated blood be tested for transfusion transmissible infections. These include HIV, Hepatitis B, Hepatitis C, Treponema pallidum (syphilis) and, where relevant, other infections that pose a risk to the safety of the blood supply, such as Trypanosoma cruzi (Chagas disease) and Plasmodium species (malaria). According to the WHO, 25 countries are not able to screen all donated blood for one or more of: HIV; Hepatitis B; Hepatitis C; or syphilis. One of the main reasons for this is because testing kits are not always available. However the prevalence of transfusion-transmitted infections is much higher in low income countries compared to middle and high income countries.Blood transfusion_item_0_0
  • All donated blood should also be tested for the ABO blood group system and Rh blood group system to ensure that the patient is receiving compatible blood.Blood transfusion_item_0_1
  • In addition, in some countries platelet products are also tested for bacterial infections due to its higher inclination for contamination due to storage at room temperature. Presence of cytomegalovirus (CMV) may also be tested because of the risk to certain immunocompromised recipients if given, such as those with organ transplant or HIV. However, not all blood is tested for CMV because only a certain amount of CMV-negative blood needs to be available to supply patient needs. Other than positivity for CMV, any products tested positive for infections are not used.Blood transfusion_item_0_2
  • Leukocyte reduction is the removal of white blood cells by filtration. Leukoreduced blood products are less likely to cause HLA alloimmunization (development of antibodies against specific blood types), febrile non-hemolytic transfusion reaction, cytomegalovirus infection, and platelet-transfusion refractoriness.Blood transfusion_item_0_3
  • Pathogen Reduction treatment that involves, for example, the addition of riboflavin with subsequent exposure to UV light has been shown to be effective in inactivating pathogens (viruses, bacteria, parasites and white blood cells) in blood products. By inactivating white blood cells in donated blood products, riboflavin and UV light treatment can also replace gamma-irradiation as a method to prevent graft-versus-host disease (TA-GvHD).Blood transfusion_item_0_4

Compatibility testing Blood transfusion_section_5

Main articles: ABO blood group system, Rh blood group system, and Cross-matching Blood transfusion_sentence_32

Before a recipient receives a transfusion, compatibility testing between donor and recipient blood must be done. Blood transfusion_sentence_33

The first step before a transfusion is given is to type and screen the recipient's blood. Blood transfusion_sentence_34

Typing of recipient's blood determines the ABO and Rh status. Blood transfusion_sentence_35

The sample is then screened for any alloantibodies that may react with donor blood. Blood transfusion_sentence_36

It takes about 45 minutes to complete (depending on the method used). Blood transfusion_sentence_37

The blood bank scientist also checks for special requirements of the patient (e.g. need for washed, irradiated or CMV negative blood) and the history of the patient to see if they have previously identified antibodies and any other serological anomalies. Blood transfusion_sentence_38

A positive screen warrants an antibody panel/investigation to determine if it is clinically significant. Blood transfusion_sentence_39

An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been phenotyped for antigens that correspond to commonly encountered and clinically significant alloantibodies. Blood transfusion_sentence_40

Donor cells may have homozygous (e.g. K+k+), heterozygous (K+k-) expression or no expression of various antigens (K−k−). Blood transfusion_sentence_41

The phenotypes of all the donor cells being tested are shown in a chart. Blood transfusion_sentence_42

The patient's serum is tested against the various donor cells. Blood transfusion_sentence_43

Based on the reactions of the patient's serum against the donor cells, a pattern will emerge to confirm the presence of one or more antibodies. Blood transfusion_sentence_44

Not all antibodies are clinically significant (i.e. cause transfusion reactions, HDN, etc.). Blood transfusion_sentence_45

Once the patient has developed a clinically significant antibody it is vital that the patient receive antigen-negative red blood cells to prevent future transfusion reactions. Blood transfusion_sentence_46

A direct antiglobulin test (Coombs test) is also performed as part of the antibody investigation. Blood transfusion_sentence_47

If there is no antibody present, an immediate spin crossmatch or computer-assisted crossmatch is performed where the recipient serum and donor rbc are incubated. Blood transfusion_sentence_48

In the immediate spin method, two drops of patient serum are tested against a drop of 3–5% suspension of donor cells in a test tube and spun in a serofuge. Blood transfusion_sentence_49

Agglutination or hemolysis (i.e., positive Coombs test) in the test tube is a positive reaction and the unit should not be transfused. Blood transfusion_sentence_50

If an antibody is suspected, potential donor units must first be screened for the corresponding antigen by phenotyping them. Blood transfusion_sentence_51

Antigen negative units are then tested against the patient plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read. Blood transfusion_sentence_52

In urgent cases where crossmatching cannot be completed, and the risk of dropping hemoglobin outweighs the risk of transfusing uncrossmatched blood, O-negative blood is used, followed by crossmatch as soon as possible. Blood transfusion_sentence_53

O-negative is also used for children and women of childbearing age. Blood transfusion_sentence_54

It is preferable for the laboratory to obtain a pre-transfusion sample in these cases so a type and screen can be performed to determine the actual blood group of the patient and to check for alloantibodies. Blood transfusion_sentence_55

Compatibility of ABO and Rh system for Red Cell (Erythrocyte) Transfusion Blood transfusion_section_6

This chart shows possible matches in blood transfusion between donor and receiver using ABO and Rh system. Blood transfusion_sentence_56

Blood transfusion_table_general_1

Blood transfusion_cell_1_0_0 Blood transfusion_cell_1_0_1 DonorBlood transfusion_cell_1_0_2
Blood transfusion_cell_1_1_0 Blood transfusion_cell_1_1_1 O-Blood transfusion_cell_1_1_2 O+Blood transfusion_cell_1_1_3 B-Blood transfusion_cell_1_1_4 B+Blood transfusion_cell_1_1_5 A-Blood transfusion_cell_1_1_6 A+Blood transfusion_cell_1_1_7 AB-Blood transfusion_cell_1_1_8 AB+Blood transfusion_cell_1_1_9
RecipientBlood transfusion_cell_1_2_0 AB+Blood transfusion_cell_1_2_1 Blood transfusion_cell_1_2_2 Blood transfusion_cell_1_2_3 Blood transfusion_cell_1_2_4 Blood transfusion_cell_1_2_5 Blood transfusion_cell_1_2_6 Blood transfusion_cell_1_2_7 Blood transfusion_cell_1_2_8 Blood transfusion_cell_1_2_9
AB-Blood transfusion_cell_1_3_0 Blood transfusion_cell_1_3_1 Blood transfusion_cell_1_3_2 Blood transfusion_cell_1_3_3 Blood transfusion_cell_1_3_4 Blood transfusion_cell_1_3_5 Blood transfusion_cell_1_3_6 Blood transfusion_cell_1_3_7 Blood transfusion_cell_1_3_8
A+Blood transfusion_cell_1_4_0 Blood transfusion_cell_1_4_1 Blood transfusion_cell_1_4_2 Blood transfusion_cell_1_4_3 Blood transfusion_cell_1_4_4 Blood transfusion_cell_1_4_5 Blood transfusion_cell_1_4_6 Blood transfusion_cell_1_4_7 Blood transfusion_cell_1_4_8
A-Blood transfusion_cell_1_5_0 Blood transfusion_cell_1_5_1 Blood transfusion_cell_1_5_2 Blood transfusion_cell_1_5_3 Blood transfusion_cell_1_5_4 Blood transfusion_cell_1_5_5 Blood transfusion_cell_1_5_6 Blood transfusion_cell_1_5_7 Blood transfusion_cell_1_5_8
B+Blood transfusion_cell_1_6_0 Blood transfusion_cell_1_6_1 Blood transfusion_cell_1_6_2 Blood transfusion_cell_1_6_3 Blood transfusion_cell_1_6_4 Blood transfusion_cell_1_6_5 Blood transfusion_cell_1_6_6 Blood transfusion_cell_1_6_7 Blood transfusion_cell_1_6_8
B-Blood transfusion_cell_1_7_0 Blood transfusion_cell_1_7_1 Blood transfusion_cell_1_7_2 Blood transfusion_cell_1_7_3 Blood transfusion_cell_1_7_4 Blood transfusion_cell_1_7_5 Blood transfusion_cell_1_7_6 Blood transfusion_cell_1_7_7 Blood transfusion_cell_1_7_8
O+Blood transfusion_cell_1_8_0 Blood transfusion_cell_1_8_1 Blood transfusion_cell_1_8_2 Blood transfusion_cell_1_8_3 Blood transfusion_cell_1_8_4 Blood transfusion_cell_1_8_5 Blood transfusion_cell_1_8_6 Blood transfusion_cell_1_8_7 Blood transfusion_cell_1_8_8
O-Blood transfusion_cell_1_9_0 Blood transfusion_cell_1_9_1 Blood transfusion_cell_1_9_2 Blood transfusion_cell_1_9_3 Blood transfusion_cell_1_9_4 Blood transfusion_cell_1_9_5 Blood transfusion_cell_1_9_6 Blood transfusion_cell_1_9_7 Blood transfusion_cell_1_9_8

Adverse effects Blood transfusion_section_7

In the same way that the safety of pharmaceutical products is overseen by pharmacovigilance, the safety of blood and blood products is overseen by haemovigilance. Blood transfusion_sentence_57

This is defined by the World Health Organization (WHO) as a system " identify and prevent occurrence or recurrence of transfusion related unwanted events, to increase the safety, efficacy and efficiency of blood transfusion, covering all activities of the transfusion chain from donor to recipient." Blood transfusion_sentence_58

The system should include monitoring, identification, reporting, investigation and analysis of adverse events near-misses and reactions related to transfusion and manufacturing. Blood transfusion_sentence_59

In the UK this data is collected by an independent organisation called SHOT (Serious Hazards Of Transfusion). Blood transfusion_sentence_60

Transfusions of blood products are associated with several complications, many of which can be grouped as immunological or infectious. Blood transfusion_sentence_61

There is controversy on potential quality degradation during storage. Blood transfusion_sentence_62

Immunologic reaction Blood transfusion_section_8

Blood transfusion_unordered_list_1

  • Acute hemolytic reactions are defined according to Serious Hazards of Transfusion (SHOT) as "fever and other symptoms/signs of haemolysis within 24 hours of transfusion; confirmed by one or more of the following: a fall of Hb, rise in lactate dehydrogenase (LDH), positive direct antiglobulin test (DAT), positive crossmatch" This is due to destruction of donor red blood cells by preformed recipient antibodies. Most often this occurs because of clerical errors or improper ABO blood typing and crossmatching resulting in a mismatch in ABO blood type between the donor and the recipient. Symptoms include fever, chills, chest pain, back pain, hemorrhage, increased heart rate, shortness of breath, and rapid drop in blood pressure. When suspected, transfusion should be stopped immediately, and blood sent for tests to evaluate for presence of hemolysis. Treatment is supportive. Kidney injury may occur because of the effects of the hemolytic reaction (pigment nephropathy). The severity of the transfusion reaction is depended upon amount of donor's antigen transfused, nature of the donor's antigens, the nature and the amount of recipient antibodies.Blood transfusion_item_1_5
  • Delayed hemolytic reactions occur more than 24 hours after a transfusion. They usually occur within 28 days of a transfusion. They can be due to either a low level of antibodies present prior to the start of the transfusion, which are not detectable on pre-transfusion testing; or development of a new antibody against an antigen in the transfused blood. Therefore, delayed haemolytic reaction does not manifest until after 24 hours when enough amount of antibodies are available to cause a reaction. The red blood cells are removed by macrophages from the blood circulation into liver and spleen to be destroyed, which leads to extravascular haemolysis. This process usually mediated by anti-Rh and anti-Kidd antibodies. However, this type of transfusion reaction is less severe when compared to acute haemolytic transfusion reaction.Blood transfusion_item_1_6
  • Febrile nonhemolytic reactions are, along with allergic transfusion reactions, the most common type of blood transfusion reaction and occur because of the release of inflammatory chemical signals released by white blood cells in stored donor blood or attack on donor's white blood cells by recipient's antibodies. This type of reaction occurs in about 7% of transfusions. Fever is generally short lived and is treated with antipyretics, and transfusions may be finished as long as an acute hemolytic reaction is excluded. This is a reason for the now-widespread use of leukoreduction – the filtration of donor white cells from red cell product units.Blood transfusion_item_1_7
  • Allergic transfusion reactions are caused by IgE anti-allergen antibodies. When antibodies are bound to its antigens, histamine is released from mast cells and basophils. Either IgE antibodies from the donor's or recipient's side can cause the allergic reaction. It is more common in patients who have allergic conditions such as hay fever. Patient may feel itchy or having hives but the symptoms are usually mild and can be controlled by stopping the transfusion and giving antihistamines.Blood transfusion_item_1_8
  • Anaphylactic reactions are rare life-threatening allergic conditions caused by IgA anti-plasma protein antibodies. For patients who have selective immunoglobulin A deficiency, the reaction is presumed to be caused by IgA antibodies in the donor's plasma. The patient may present with symptoms of fever, wheezing, coughing, shortness of breath, and circulatory shock. Urgent treatment with epinephrine is needed.Blood transfusion_item_1_9
  • Post-transfusion purpura is an extremely rare complication that occurs after blood product transfusion and is associated with the presence of antibodies in the patient's blood directed against both the donor's and recipient's platelets HPA (human platelet antigen). Recipients who lack this protein develop sensitization to this protein from prior transfusions or previous pregnancies, can develop thrombocytopenia, bleeding into the skin, and can display purplish discolouration of skin which is known as purpura. Intravenous immunoglobulin (IVIG) is treatment of choice.Blood transfusion_item_1_10
  • Transfusion-related acute lung injury (TRALI) is a syndrome that is similar to acute respiratory distress syndrome (ARDS), which develops during or within 6 hours of transfusion of a plasma-containing blood product. Fever, hypotension, shortness of breath, and tachycardia often occurs in this type of reaction. For a definitive diagnosis to be made, symptoms must occur within 6 hours of transfusion, hypoxemia must be present, there must be radiographic evidence of bilateral infiltrates and there must be no evidence of left atrial hypertension (fluid overload). It occurs in 15% of the transfused patient with mortality rate of 5 to 10%. Recipient risk factors includes: end-stage liver disease, sepsis, haematological malignancies, sepsis, and ventilated patients. Antibodies to human neutrophil antigens (HNA) and human leukocyte antigens (HLA) have been associated with this type of transfusion reaction. Donor's antibodies interacting with antigen positive recipient tissue result in release of inflammatory cytokines, resulting in pulmonary capillary leakage. The treatment is supportive.Blood transfusion_item_1_11
  • Transfusion associated circulatory overload (TACO) is a common, yet underdiagnosed, reaction to blood product transfusion consisting of the new onset or exacerbation of three of the following within 6 hours of cessation of transfusion: acute respiratory distress, elevated brain natriuretic peptide (BNP), elevated central venous pressure (CVP), evidence of left heart failure, evidence of positive fluid balance, and/or radiographic evidence of pulmonary edema.Blood transfusion_item_1_12
  • Transfusion-associated graft versus host disease frequently occurs in immunodeficient patients where recipient's body failed to eliminate donor's T cells. Instead, donor's T cells attack the recipient's cells. It occurs one week after transfusion. Fever, rash, diarrhoea are often associated with this type of transfusion reaction. Mortality rate is high, with 89.7% of the patients died after 24 days. Immunosuppressive treatment is the most common way of treatment. Irradiation and leukoreduction of blood products is necessary for high risk patients for prevent T cells from attacking recipient cells.Blood transfusion_item_1_13

Infection Blood transfusion_section_9

The use of greater amount of red blood cells is associated with a high risk of infections. Blood transfusion_sentence_63

In those who were given red blood only with significant anemia infection rates were 12% while in those who were given red blood at milder levels of anemia infection rates were 17%. Blood transfusion_sentence_64

On rare occasions, blood products are contaminated with bacteria. Blood transfusion_sentence_65

This can result in a life-threatening infection known as transfusion-transmitted bacterial infection. Blood transfusion_sentence_66

The risk of severe bacterial infection is estimated, as of 2002, at about 1 in 50,000 platelet transfusions, and 1 in 500,000 red blood cell transfusions. Blood transfusion_sentence_67

Blood product contamination, while rare, is still more common than actual infection. Blood transfusion_sentence_68

The reason platelets are more often contaminated than other blood products is that they are stored at room temperature for short periods of time. Blood transfusion_sentence_69

Contamination is also more common with longer duration of storage, especially if that means more than 5 days. Blood transfusion_sentence_70

Sources of contaminants include the donor's blood, donor's skin, phlebotomist's skin, and containers. Blood transfusion_sentence_71

Contaminating organisms vary greatly, and include skin flora, gut flora, and environmental organisms. Blood transfusion_sentence_72

There are many strategies in place at blood donation centers and laboratories to reduce the risk of contamination. Blood transfusion_sentence_73

A definite diagnosis of transfusion-transmitted bacterial infection includes the identification of a positive culture in the recipient (without an alternative diagnosis) as well as the identification of the same organism in the donor blood. Blood transfusion_sentence_74

Since the advent of HIV testing of donor blood in the mid/later 1980s, ex. Blood transfusion_sentence_75

1985's ELISA, the transmission of HIV during transfusion has dropped dramatically. Blood transfusion_sentence_76

Prior testing of donor blood only included testing for antibodies to HIV. Blood transfusion_sentence_77

However, because of latent infection (the "window period" in which an individual is infectious, but has not had time to develop antibodies) many cases of HIV seropositive blood were missed. Blood transfusion_sentence_78

The development of a nucleic acid test for the HIV-1 RNA has dramatically lowered the rate of donor blood seropositivity to about 1 in 3 million units. Blood transfusion_sentence_79

As transmittance of HIV does not necessarily mean HIV infection, the latter could still occur at an even lower rate. Blood transfusion_sentence_80

The transmission of hepatitis C via transfusion currently stands at a rate of about 1 in 2 million units. Blood transfusion_sentence_81

As with HIV, this low rate has been attributed to the ability to screen for both antibodies as well as viral RNA nucleic acid testing in donor blood. Blood transfusion_sentence_82

Other rare transmissible infections include hepatitis B, syphilis, Chagas disease, cytomegalovirus infections (in immunocompromised recipients), HTLV, and Babesia. Blood transfusion_sentence_83

Comparison table Blood transfusion_section_10

Blood transfusion_table_general_2

Comparison of symptoms of blood transfusion reactions characterized by fever.Blood transfusion_table_caption_2
+ =Occasionally present   ++ =Frequently presentBlood transfusion_cell_2_0_0
Blood transfusion_header_cell_2_1_0 Febrile nonhemolyticBlood transfusion_header_cell_2_1_1 TRALIBlood transfusion_header_cell_2_1_2 Acute hemolyticBlood transfusion_header_cell_2_1_3 Bacterial contaminationBlood transfusion_header_cell_2_1_4
Appearance of symptoms during or after transfusionBlood transfusion_header_cell_2_2_0 Usually toward end. 5-10% appear up to 2 hours after.Blood transfusion_cell_2_2_1 Early (after 10-15 ml)Blood transfusion_cell_2_2_2 Early (after 50-100 ml)Blood transfusion_cell_2_2_3 Up to 8 hours after transfusionBlood transfusion_cell_2_2_4
FeverBlood transfusion_header_cell_2_3_0 +Blood transfusion_cell_2_3_1 ++Blood transfusion_cell_2_3_2 ++Blood transfusion_cell_2_3_3 ++Blood transfusion_cell_2_3_4
ChillsBlood transfusion_header_cell_2_4_0 ++Blood transfusion_cell_2_4_1 ++Blood transfusion_cell_2_4_2 ++Blood transfusion_cell_2_4_3 +++Blood transfusion_cell_2_4_4
ColdBlood transfusion_header_cell_2_5_0 ++Blood transfusion_cell_2_5_1 -Blood transfusion_cell_2_5_2 +Blood transfusion_cell_2_5_3 -Blood transfusion_cell_2_5_4
DiscomfortBlood transfusion_header_cell_2_6_0 ++Blood transfusion_cell_2_6_1 -Blood transfusion_cell_2_6_2 -Blood transfusion_cell_2_6_3 -Blood transfusion_cell_2_6_4
RigorsBlood transfusion_header_cell_2_7_0 +Blood transfusion_cell_2_7_1 -Blood transfusion_cell_2_7_2 -Blood transfusion_cell_2_7_3 -Blood transfusion_cell_2_7_4
HeadacheBlood transfusion_header_cell_2_8_0 +Blood transfusion_cell_2_8_1 -Blood transfusion_cell_2_8_2 +Blood transfusion_cell_2_8_3 -Blood transfusion_cell_2_8_4
Nausea and/or vomitingBlood transfusion_header_cell_2_9_0 +Blood transfusion_cell_2_9_1 -Blood transfusion_cell_2_9_2 ++Blood transfusion_cell_2_9_3 -Blood transfusion_cell_2_9_4
DyspneaBlood transfusion_header_cell_2_10_0 +Blood transfusion_cell_2_10_1 ++Blood transfusion_cell_2_10_2 ++Blood transfusion_cell_2_10_3 -Blood transfusion_cell_2_10_4
CyanosisBlood transfusion_header_cell_2_11_0 -Blood transfusion_cell_2_11_1 ++Blood transfusion_cell_2_11_2 ++Blood transfusion_cell_2_11_3 -Blood transfusion_cell_2_11_4
Hypotension / circulatory shockBlood transfusion_header_cell_2_12_0 -Blood transfusion_cell_2_12_1 ++Blood transfusion_cell_2_12_2 ++Blood transfusion_cell_2_12_3 ++Blood transfusion_cell_2_12_4
Disseminated intravascular coagulationBlood transfusion_header_cell_2_13_0 -Blood transfusion_cell_2_13_1 -Blood transfusion_cell_2_13_2 ++Blood transfusion_cell_2_13_3 ++Blood transfusion_cell_2_13_4
HemoglobinuriaBlood transfusion_header_cell_2_14_0 -Blood transfusion_cell_2_14_1 -Blood transfusion_cell_2_14_2 ++Blood transfusion_cell_2_14_3 +Blood transfusion_cell_2_14_4
Renal failureBlood transfusion_header_cell_2_15_0 -Blood transfusion_cell_2_15_1 -Blood transfusion_cell_2_15_2 ++Blood transfusion_cell_2_15_3 ++Blood transfusion_cell_2_15_4
Back painBlood transfusion_header_cell_2_16_0 -Blood transfusion_cell_2_16_1 -Blood transfusion_cell_2_16_2 ++Blood transfusion_cell_2_16_3 -Blood transfusion_cell_2_16_4

Inefficacy Blood transfusion_section_11

Transfusion inefficacy or insufficient efficacy of a given unit(s) of blood product, while not itself a "complication" per se, can nonetheless indirectly lead to complications – in addition to causing a transfusion to fully or partly fail to achieve its clinical purpose. Blood transfusion_sentence_84

This can be especially significant for certain patient groups such as critical-care or neonatals. Blood transfusion_sentence_85

For red blood cells (RBC), by far the most commonly transfused product, poor transfusion efficacy can result from units damaged by the so-called storage lesion – a range of biochemical and biomechanical changes that occur during storage. Blood transfusion_sentence_86

With red cells, this can decrease viability and ability for tissue oxygenation. Blood transfusion_sentence_87

Although some of the biochemical changes are reversible after the blood is transfused, the biomechanical changes are less so, and rejuvenation products are not yet able to adequately reverse this phenomenon. Blood transfusion_sentence_88

There has been controversy about whether a given product unit's age is a factor in transfusion efficacy, specifically about whether "older" blood directly or indirectly increases risks of complications. Blood transfusion_sentence_89

Studies have not been consistent on answering this question, with some showing that older blood is indeed less effective but with others showing no such difference; these developments are being closely followed by hospital blood bankers – who are the physicians, typically pathologists, who collect and manage inventories of transfusable blood units. Blood transfusion_sentence_90

Certain regulatory measures are in place to minimize RBC storage lesion – including a maximum shelf life (currently 42 days), a maximum auto-hemolysis threshold (currently 1% in the US, 0.8% in Europe), and a minimum level of post-transfusion RBC survival in vivo (currently 75% after 24 hours). Blood transfusion_sentence_91

However, all of these criteria are applied in a universal manner that does not account for differences among units of product. Blood transfusion_sentence_92

For example, testing for the post-transfusion RBC survival in vivo is done on a sample of healthy volunteers, and then compliance is presumed for all RBC units based on universal (GMP) processing standards (of course, RBC survival by itself does not guarantee efficacy, but it is a necessary prerequisite for cell function, and hence serves as a regulatory proxy). Blood transfusion_sentence_93

Opinions vary as to the "best" way to determine transfusion efficacy in a patient in vivo. Blood transfusion_sentence_94

In general, there are not yet any in vitro tests to assess quality or predict efficacy for specific units of RBC blood product prior to their transfusion, though there is exploration of potentially relevant tests based on RBC membrane properties such as erythrocyte deformability and erythrocyte fragility (mechanical). Blood transfusion_sentence_95

Physicians have adopted a so-called "restrictive protocol" – whereby transfusion is held to a minimum – in part because of the noted uncertainties surrounding storage lesion, in addition to the very high direct and indirect costs of transfusions. Blood transfusion_sentence_96

Of course, restrictive protocol is not an option with some especially vulnerable patients who may require the best possible efforts to rapidly restore tissue oxygenation. Blood transfusion_sentence_97

Although transfusions of platelets are far less numerous (relative to RBC), platelet storage lesion and resulting efficacy loss is also a concern. Blood transfusion_sentence_98

Other Blood transfusion_section_12

Early attempts Blood transfusion_section_13

Animal blood Blood transfusion_section_14

Working at the Royal Society in the 1660s, the physician Richard Lower began examining the effects of changes in blood volume on circulatory function and developed methods for cross-circulatory study in animals, obviating clotting by closed arteriovenous connections. Blood transfusion_sentence_99

The new instruments he was able to devise enabled him to perform the first reliably documented successful transfusion of blood in front of his distinguished colleagues from the Royal Society. Blood transfusion_sentence_100

According to Lower's account, "...towards the end of February 1665 [I] selected one dog of medium size, opened its jugular vein, and drew off blood, until its strength was nearly gone. Blood transfusion_sentence_101

Then, to make up for the great loss of this dog by the blood of a second, I introduced blood from the cervical artery of a fairly large mastiff, which had been fastened alongside the first, until this latter animal showed … it was overfilled … by the inflowing blood." Blood transfusion_sentence_102

After he "sewed up the jugular veins", the animal recovered "with no sign of discomfort or of displeasure". Blood transfusion_sentence_103

Lower had performed the first blood transfusion between animals. Blood transfusion_sentence_104

He was then "requested by the Honorable [Robert] Boyle … to acquaint the Royal Society with the procedure for the whole experiment", which he did in December 1665 in the Society's Philosophical Transactions. Blood transfusion_sentence_105

The first blood transfusion from animal to human was administered by Dr. Jean-Baptiste Denys, eminent physician to King Louis XIV of France, on June 15, 1667. Blood transfusion_sentence_106

He transfused the blood of a sheep into a 15-year-old boy, who survived the transfusion. Blood transfusion_sentence_107

Denys performed another transfusion into a labourer, who also survived. Blood transfusion_sentence_108

Both instances were likely due to the small amount of blood that was actually transfused into these people. Blood transfusion_sentence_109

This allowed them to withstand the allergic reaction. Blood transfusion_sentence_110

Denys's third patient to undergo a blood transfusion was Swedish Baron Gustaf Bonde. Blood transfusion_sentence_111

He received two transfusions. Blood transfusion_sentence_112

After the second transfusion Bonde died. Blood transfusion_sentence_113

In the winter of 1667, Denys performed several transfusions on Antoine Mauroy with calf's blood. Blood transfusion_sentence_114

On the third account Mauroy died. Blood transfusion_sentence_115

Six months later in London, Lower performed the first human transfusion of animal blood in Britain, where he "superintended the introduction in [a patient's] arm at various times of some ounces of sheep's blood at a meeting of the Royal Society, and without any inconvenience to him." Blood transfusion_sentence_116

The recipient was Arthur Coga, "the subject of a harmless form of insanity." Blood transfusion_sentence_117

Sheep's blood was used because of speculation about the value of blood exchange between species; it had been suggested that blood from a gentle lamb might quiet the tempestuous spirit of an agitated person and that the shy might be made outgoing by blood from more sociable creatures. Blood transfusion_sentence_118

Coga received 20 shillings (equivalent to £173 in 2019) to participate in the experiment. Blood transfusion_sentence_119

Lower went on to pioneer new devices for the precise control of blood flow and the transfusion of blood; his designs were substantially the same as modern syringes and catheters. Blood transfusion_sentence_120

Shortly after, Lower moved to London, where his growing practice soon led him to abandon research. Blood transfusion_sentence_121

These early experiments with animal blood provoked a heated controversy in Britain and France. Blood transfusion_sentence_122

Finally, in 1668, the Royal Society and the French government both banned the procedure. Blood transfusion_sentence_123

The Vatican condemned these experiments in 1670. Blood transfusion_sentence_124

Blood transfusions fell into obscurity for the next 150 years. Blood transfusion_sentence_125

Human blood Blood transfusion_section_15

The science of blood transfusion dates to the first decade of the 20th century, with the discovery of distinct blood types leading to the practice of mixing some blood from the donor and the receiver before the transfusion (an early form of cross-matching). Blood transfusion_sentence_126

In the early 19th century, British obstetrician Dr. James Blundell made efforts to treat hemorrhage by transfusion of human blood using a syringe. Blood transfusion_sentence_127

In 1818 following experiments with animals, he performed the first successful transfusion of human blood to treat postpartum hemorrhage. Blood transfusion_sentence_128

Blundell used the patient's husband as a donor, and extracted four ounces of blood from his arm to transfuse into his wife. Blood transfusion_sentence_129

During the years 1825 and 1830, Blundell performed 10 transfusions, five of which were beneficial, and published his results. Blood transfusion_sentence_130

He also invented a number of instruments for the transfusion of blood. Blood transfusion_sentence_131

He made a substantial amount of money from this endeavour, roughly $2 million ($50 million real dollars). Blood transfusion_sentence_132

In 1840, at St George's Hospital Medical School in London, Samuel Armstrong Lane, aided by Dr. Blundell, performed the first successful whole blood transfusion to treat haemophilia. Blood transfusion_sentence_133

However, early transfusions were risky and many resulted in the death of the patient. Blood transfusion_sentence_134

By the late 19th century, blood transfusion was regarded as a risky and dubious procedure, and was largely shunned by the medical establishment. Blood transfusion_sentence_135

Work to emulate James Blundell continued in Edinburgh. Blood transfusion_sentence_136

In 1845 the Edinburgh Journal described the successful transfusion of blood to a woman with severe uterine bleeding. Blood transfusion_sentence_137

Subsequent transfusions were successful with patients of Professor James Young Simpson after whom the Simpson Memorial Maternity Pavilion in Edinburgh was named. Blood transfusion_sentence_138

The largest series of early successful transfusions took place at the Edinburgh Royal Infirmary between 1885 and 1892. Blood transfusion_sentence_139

Edinburgh later became the home of the first blood donation and blood transfusion services. Blood transfusion_sentence_140

20th century Blood transfusion_section_16

Only in 1901, when the Austrian Karl Landsteiner discovered three human blood groups (O, A, and B), did blood transfusion achieve a scientific basis and became safer. Blood transfusion_sentence_141

Landsteiner discovered that adverse effects arise from mixing blood from two incompatible individuals. Blood transfusion_sentence_142

He found that mixing incompatible types triggers an immune response and the red blood-cells clump. Blood transfusion_sentence_143

The immunological reaction occurs when the receiver of a blood transfusion has antibodies against the donor blood-cells. Blood transfusion_sentence_144

The destruction of red blood cells releases free hemoglobin into the bloodstream, which can have fatal consequences. Blood transfusion_sentence_145

Landsteiner's work made it possible to determine blood group and allowed blood transfusions to take place much more safely. Blood transfusion_sentence_146

For his discovery he won the Nobel Prize in Physiology and Medicine in 1930; many other blood groups have been discovered since. Blood transfusion_sentence_147

George Washington Crile is credited with performing the first surgery using a direct blood transfusion in 1906 at St. Alexis Hospital in Cleveland while a professor of surgery at Case Western Reserve University. Blood transfusion_sentence_148

Jan Janský also discovered the human blood groups; in 1907 he classified blood into four groups: I, II, III, IV. Blood transfusion_sentence_149

His nomenclature is still used in Russia and in states of the former USSR, in which blood types O, A, B, and AB are respectively designated I, II, III, and IV. Blood transfusion_sentence_150

Dr. William Lorenzo Moss's (1876–1957) Moss-blood typing technique of 1910 was widely used until World War II. Blood transfusion_sentence_151

William Stewart Halsted, M.D. (September 23, 1852 – September 7, 1922), an American surgeon, performed one of the first blood transfusions in the United States. Blood transfusion_sentence_152

He had been called to see his sister after she had given birth. Blood transfusion_sentence_153

He found her moribund from blood loss, and in a bold move withdrew his own blood, transfused his blood into his sister, and then operated on her to save her life. Blood transfusion_sentence_154

Blood banks in WWI Blood transfusion_section_17

Main article: Blood bank Blood transfusion_sentence_155

While the first transfusions had to be made directly from donor to receiver before coagulation, it was discovered that by adding anticoagulant and refrigerating the blood it was possible to store it for some days, thus opening the way for the development of blood banks. Blood transfusion_sentence_156

John Braxton Hicks was the first to experiment with chemical methods to prevent the coagulation of blood at St Mary's Hospital, London in the late-19th century. Blood transfusion_sentence_157

His attempts, using phosphate of soda, however, proved unsuccessful. Blood transfusion_sentence_158

The Belgian doctor Albert Hustin performed the first non-direct transfusion on March 27, 1914, though this involved a diluted solution of blood. Blood transfusion_sentence_159

The Argentine doctor Luis Agote used a much less diluted solution in November of the same year. Blood transfusion_sentence_160

Both used sodium citrate as an anticoagulant. Blood transfusion_sentence_161

The First World War (1914-1918) acted as a catalyst for the rapid development of blood banks and transfusion techniques. Blood transfusion_sentence_162

Canadian doctor and Lieutenant Lawrence Bruce Robertson became instrumental in persuading the Royal Army Medical Corps to adopt the use of blood transfusion at the Casualty Clearing Stations for the wounded. Blood transfusion_sentence_163

In October 1915 Robertson performed his first wartime transfusion with a syringe to a patient suffering from multiple shrapnel wounds. Blood transfusion_sentence_164

He followed this up with four subsequent transfusions in the following months, and his success was reported to Sir Walter Morley Fletcher, director of the Medical Research Committee. Blood transfusion_sentence_165

Robertson published his findings in the British Medical Journal in 1916 and, with the help of a few like-minded individuals (including the eminent physician Edward William Archibald (1872-1945), who introduced the citrate anticoagulant method), was able to persuade the British authorities of the merits of blood transfusion. Blood transfusion_sentence_166

Robertson went on to establish the first blood-transfusion apparatus at a Casualty Clearing Station on the Western Front in the spring of 1917. Blood transfusion_sentence_167

Oswald Hope Robertson, a medical researcher and U.S. Blood transfusion_sentence_168 Army officer, was attached to the RAMC in 1917, where he became instrumental in establishing the first blood banks in preparation for the anticipated Third Battle of Ypres. Blood transfusion_sentence_169

He used sodium citrate as the anticoagulant; blood was extracted from punctures in the vein and was stored in bottles at British and American Casualty Clearing Stations along the Front. Blood transfusion_sentence_170

Robertson also experimented with preserving separated red blood cells in iced bottles. Blood transfusion_sentence_171

Geoffrey Keynes, a British surgeon, developed a portable machine that could store blood to enable transfusions to be carried out more easily. Blood transfusion_sentence_172

Expansion Blood transfusion_section_18

The secretary of the British Red Cross, Percy Oliver, established the world's first blood-donor service in 1921. Blood transfusion_sentence_173

In that year, Oliver was contacted by King's College Hospital, where they were in urgent need of a blood donor. Blood transfusion_sentence_174

After providing a donor, Oliver set about organizing a system for the voluntary registration of blood donors at clinics around London, with Sir Geoffrey Keynes appointed as a medical adviser. Blood transfusion_sentence_175

Volunteers were subjected to a series of physical tests to establish their blood group. Blood transfusion_sentence_176

The London Blood Transfusion Service was free of charge and expanded rapidly in its first few years of operation. Blood transfusion_sentence_177

By 1925 it was providing services for almost 500 patients; it was incorporated into the structure of the British Red Cross in 1926. Blood transfusion_sentence_178

Similar systems developed in other cities, including Sheffield, Manchester and Norwich, and the service's work began to attract international attention. Blood transfusion_sentence_179

France, Germany, Austria, Belgium, Australia and Japan established similar services. Blood transfusion_sentence_180

Alexander Bogdanov founded an academic institution devoted to the science of blood transfusion in Moscow in 1925. Blood transfusion_sentence_181

Bogdanov was motivated, at least in part, by a search for eternal youth, and remarked with satisfaction on the improvement of his eyesight, suspension of balding, and other positive symptoms after receiving 11 transfusions of whole blood. Blood transfusion_sentence_182

Bogdanov died in 1928 as a result of one of his experiments, when the blood of a student suffering from malaria and tuberculosis was given to him in a transfusion. Blood transfusion_sentence_183

Following Bogdanov's lead, Vladimir Shamov and Sergei Yudin in the USSR pioneered the transfusion of cadaveric blood from recently deceased donors. Blood transfusion_sentence_184

Yudin performed such a transfusion successfully for the first time on March 23, 1930 and reported his first seven clinical transfusions with cadaveric blood at the Fourth Congress of Ukrainian Surgeons at Kharkiv in September. Blood transfusion_sentence_185

However, this method was never used widely, even in the Soviet Union. Blood transfusion_sentence_186

Frederic Durán-Jordà established one of the earliest blood banks during the Spanish Civil War in 1936. Blood transfusion_sentence_187

Duran joined the Transfusion Service at the Barcelona Hospital at the start of the conflict, but the hospital was soon overwhelmed by the demand for blood and the paucity of available donors. Blood transfusion_sentence_188

With support from the Department of Health of the Spanish Republican Army, Duran established a blood bank for the use of wounded soldiers and civilians. Blood transfusion_sentence_189

The 300–400 mL of extracted blood was mixed with 10% citrate solution in a modified Duran Erlenmeyer flask. Blood transfusion_sentence_190

The blood was stored in a sterile glass enclosed under pressure at 2 °C. Blood transfusion_sentence_191

During 30 months of work, the Transfusion Service of Barcelona registered almost 30,000 donors, and processed 9,000 liters of blood. Blood transfusion_sentence_192

In 1937 Bernard Fantus, director of therapeutics at the Cook County Hospital in Chicago, established the first hospital blood-bank in the United States. Blood transfusion_sentence_193

In setting up a hospital laboratory that preserved, refrigerated and stored donor blood, Fantus originated the term "blood bank". Blood transfusion_sentence_194

Within a few years, hospital and community blood-banks were established across the United States. Blood transfusion_sentence_195

Frederic Durán-Jordà fled to Britain in 1938 and worked with Dr Janet Vaughan at the Royal Postgraduate Medical School at Hammersmith Hospital to establish a system of national blood banks in London. Blood transfusion_sentence_196

With the outbreak of war appearing imminent in 1938, the War Office created the Army Blood Supply Depot (ABSD) in Bristol, headed by Lionel Whitby and in control of four large blood-depots around the country. Blood transfusion_sentence_197

British policy through the war was to supply military personnel with blood from centralized depots, in contrast to the approach taken by the Americans and Germans where troops at the front were bled to provide required blood. Blood transfusion_sentence_198

The British method proved more successful in adequately meeting all requirements, and over 700,000 donors were bled over the course of the war. Blood transfusion_sentence_199

This system evolved into the National Blood Transfusion Service established in 1946, the first national service to be implemented. Blood transfusion_sentence_200

Stories tell of Nazis in Eastern Europe during World War II using captive children as repeated involuntary blood-donors. Blood transfusion_sentence_201

Medical advances Blood transfusion_section_19

A blood-collection program was initiated in the US in 1940 and Edwin Cohn pioneered the process of blood fractionation. Blood transfusion_sentence_202

He worked out the techniques for isolating the serum albumin fraction of blood plasma, which is essential for maintaining the osmotic pressure in the blood vessels, preventing their collapse. Blood transfusion_sentence_203

Gordon R. Ward, writing in the correspondence columns of the British Medical Journal, proposed the use of blood plasma as a substitute for whole blood and for transfusion purposes as early as 1918. Blood transfusion_sentence_204

At the onset of World War II, liquid plasma was used in Britain. Blood transfusion_sentence_205

A large project, known as "Blood for Britain" began in August 1940 to collect blood in New York City hospitals for the export of plasma to Britain. Blood transfusion_sentence_206

A dried plasma package was developed, which reduced breakage and made transportation, packaging, and storage much simpler. Blood transfusion_sentence_207

The resulting dried plasma package came in two tin cans containing 400 mL bottles. Blood transfusion_sentence_208

One bottle contained enough distilled water to reconstitute the dried plasma contained within the other bottle. Blood transfusion_sentence_209

In about three minutes, the plasma would be ready to use and could stay fresh for around four hours. Blood transfusion_sentence_210

Dr. Charles R. Drew was appointed medical supervisor, and he was able to transform the test-tube methods into the first successful technique for mass production. Blood transfusion_sentence_211

Another important breakthrough came in 1937–40 when Karl Landsteiner (1868-1943), Alex Wiener, Philip Levine, and R.E. Blood transfusion_sentence_212

Stetson discovered the Rhesus blood group system, which was found to be the cause of the majority of transfusion reactions up to that time. Blood transfusion_sentence_213

Three years later, the introduction by J.F. Blood transfusion_sentence_214 Loutit and Patrick L. Mollison of acid–citrate–dextrose (ACD) solution, which reduced the volume of anticoagulant, permitted transfusions of greater volumes of blood and allowed longer-term storage. Blood transfusion_sentence_215

Carl Walter and W.P. Blood transfusion_sentence_216

Murphy Jr. introduced the plastic bag for blood collection in 1950. Blood transfusion_sentence_217

Replacing breakable glass bottles with durable plastic bags made from PVC allowed for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of whole blood. Blood transfusion_sentence_218

In the field of cancer surgery, the replacement of massive blood-loss became a major problem. Blood transfusion_sentence_219

The cardiac-arrest rate was high. Blood transfusion_sentence_220

In 1963 C. Paul Boyan and William S. Howland discovered that the temperature of the blood and the rate of infusion greatly affected survival rates, and introduced blood warming to surgery. Blood transfusion_sentence_221

Further extending the shelf-life of stored blood up to 42 days was an anticoagulant preservative, CPDA-1, introduced in 1979, which increased the blood supply and facilitated resource-sharing among blood banks. Blood transfusion_sentence_222

As of 2006 about 15 million units of blood products were transfused per year in the United States. Blood transfusion_sentence_223

By 2013 the number had declined to about 11 million units, because of the shift towards laparoscopic surgery and other surgical advances and studies that have shown that many transfusions were unnecessary. Blood transfusion_sentence_224

For example, the standard of care reduced the amount of blood transfused in one case from 750 to 200 ml. Blood transfusion_sentence_225

Special populations Blood transfusion_section_20

Neonate Blood transfusion_section_21

To ensure the safety of blood transfusion to pediatric patients, hospitals are taking additional precautions to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for Cytomegalovirus. Blood transfusion_sentence_226

Most guidelines recommend the provision of CMV-negative blood components and not simply leukoreduced components for newborns or low birthweight infants in whom the immune system is not fully developed. Blood transfusion_sentence_227

These specific requirements place additional restrictions on blood donors who can donate for neonatal use. Blood transfusion_sentence_228

vnv Neonatal transfusions typically fall into one of two categories: Blood transfusion_sentence_229

Blood transfusion_unordered_list_2

  • "Top-up" transfusions, to replace losses due to investigational losses and correction of anemia.Blood transfusion_item_2_14
  • Exchange (or partial exchange) transfusions are done for removal of bilirubin, removal of antibodies and replacement of red cells (e.g., for anemia secondary to thalassemias and other hemoglobinopathies).Blood transfusion_item_2_15

Significant blood loss Blood transfusion_section_22

A massive transfusion protocol is used when significant blood loss is present such as in major trauma, when more than ten units of blood are needed. Blood transfusion_sentence_230

Packed red blood cells, fresh frozen plasma, and platelets are generally administered. Blood transfusion_sentence_231

Typically higher ratios of fresh frozen plasma and platelets are given relative to packed red blood cells. Blood transfusion_sentence_232

Unknown blood type Blood transfusion_section_23

Because blood type O negative is compatible with anyone, it is often overused and in short supply. Blood transfusion_sentence_233

According to the American Association of Blood Banks, the use of this blood should be restricted to persons with O negative blood, as nothing else is compatible with them, and women who might be pregnant and for whom it would be impossible to do blood group testing before giving them emergency treatment. Blood transfusion_sentence_234

Whenever possible, the AABB recommends that O negative blood be conserved by using blood type testing to identify a less scarce alternative. Blood transfusion_sentence_235

Religious objections Blood transfusion_section_24

Jehovah's Witnesses object to blood transfusions because of their belief that blood is sacred. Blood transfusion_sentence_236

Research into alternatives Blood transfusion_section_25

See also: Blood substitutes Blood transfusion_sentence_237

Although there are clinical situations where transfusion with red blood cells is the only clinically appropriate option, clinicians look at whether alternatives are feasible. Blood transfusion_sentence_238

This can be due to several reasons, such as patient safety, economic burden or scarcity of blood. Blood transfusion_sentence_239

Guidelines recommend blood transfusions should be reserved for patients with or at risk of cardiovascular instability due to the degree of their anaemia. Blood transfusion_sentence_240

In these cases parenteral iron is recommended. Blood transfusion_sentence_241

Thus far, there are no available oxygen-carrying blood substitutes, which is the typical objective of a blood (RBC) transfusion; however, there are widely available non-blood volume expanders for cases where only volume restoration is required. Blood transfusion_sentence_242

These are helping doctors and surgeons avoid the risks of disease transmission and immune suppression, address the chronic blood donor shortage, and address the concerns of Jehovah's Witnesses and others who have religious objections to receiving transfused blood. Blood transfusion_sentence_243

A number of blood substitutes have been explored (and still are), but thus far they all suffer from many challenges. Blood transfusion_sentence_244

Most attempts to find a suitable alternative to blood thus far have concentrated on cell-free hemoglobin solutions. Blood transfusion_sentence_245

Blood substitutes could make transfusions more readily available in emergency medicine and in pre-hospital EMS care. Blood transfusion_sentence_246

If successful, such a blood substitute could save many lives, particularly in trauma where massive blood loss results. Blood transfusion_sentence_247

Hemopure, a hemoglobin-based therapy, is approved for use in South Africa. Blood transfusion_sentence_248

Other uses Blood transfusion_section_26

Minor blood transfusions are used by a minority of nyaope drug addicts in South Africa to economically share the high the drug induces in a practice colloquially known as Bluetoothing, named after the wireless technology of the same name. Blood transfusion_sentence_249

Veterinary use Blood transfusion_section_27

Main article: Blood type (non-human) Blood transfusion_sentence_250

Veterinarians also administer transfusions to other animals. Blood transfusion_sentence_251

Various species require different levels of testing to ensure a compatible match. Blood transfusion_sentence_252

For example, cats have 3 known blood types, cattle have 11, dogs have 13, pigs have 16, and horses have 34. Blood transfusion_sentence_253

However, in many species (especially horses and dogs), cross matching is not required before the first transfusion, as antibodies against non-self cell surface antigens are not expressed constitutively – i.e. the animal has to be sensitized before it will mount an immune response against the transfused blood. Blood transfusion_sentence_254

The rare and experimental practice of inter-species blood transfusions is a form of xenograft. Blood transfusion_sentence_255

See also Blood transfusion_section_28

Blood transfusion_unordered_list_3

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: transfusion.