The
Procedures of introducing blood of a donor or blood pre-donated by the
recipient (autologous transfusion) into the bloodstream is written below. This
is employed in obstetrics, surgery, trauma, gastrointestinal bleeding involving
great loss of blood.
1628 William Harvey advanced the theory of the circulation of blood.
Christopher Wren proposed I.V injection using Quill and transfused blood in dog.
1667, the French doctor Jean-Baptiste Denis performed the first recorded transfusion by infusing sheep's blood into a human being. The patient died.
Most later attempts were also unsuccessful (Blood incompatibility).
Blundel of Guy’s Hospital London ,1st successful transfusion in humans.
1628 William Harvey advanced the theory of the circulation of blood.
Christopher Wren proposed I.V injection using Quill and transfused blood in dog.
1667, the French doctor Jean-Baptiste Denis performed the first recorded transfusion by infusing sheep's blood into a human being. The patient died.
Most later attempts were also unsuccessful (Blood incompatibility).
Blundel of Guy’s Hospital London ,1st successful transfusion in humans.
TWO (2) MAJOR PROBLEMS
Blood clotting during transfusion b/c of lack of anticoagulants
Incompatibility leading to severe, often fatal reactions due to lack of blood grouping.
-1900 Karl landsteiner / ABO blood group.
-ABO commonest cause of severe transfusion reaction.
-1927 Landsteiner and Levine MN and P systems.
-1939 Rh system and HDN.
20th century, transfusion became routinely successful (Blood typing).
Effective blood transfusion started after the Second World War.
Transfusions still cause sensitivity and later transfusions.
Transmission of hepatitis B (screening in the 1960s)
Transmission of HIV ( screening 1985).
Whole blood mostly used.
COMPONENTS
Devised in the 1960s.
1970- 1980 blood components used e.g. packed red blood cells for injury or surgery.
In depletion of the circulating blood volume ( severe burn, peritonitis) plasma or, serum albumin, is appropriate.
FFP (long storage but risk of hepatitis) best when blood-clotting factors are needed. Albumin solution is heat-treated to destroy hepatitis infectivity.
Plasma protein fraction can be used for same purposes.
Clotting factors, platelets isolated from blood are used to treat some hereditary bleeding disorders
Synthetic plasma substitutes/ plasma volume expanders e.g dextran, saline solutions, used cases of sudden shock.
Fluosol-DA , 1970s, a synthetic blood-carrying substance successfully used.
Research is being conducted to convert one blood type into another; if developed.
Although blood can be transferred directly, stored blood mostly used.
First large-scale blood bank (1937) Chicago, United States
MASSIVE BLOOD TRANSFUSION
Replacement of the patients total blood volume in less than 24hrs.
Occurs after overwhelming haemorrhage and acute hypovolaemic shock.
Occurs in obstetric emergency operative theatre and accident (trauma victims).
Rapid loss of large quantities of blood will impair tissue perfusion requires urgent correction.
MANAGEMENT
Prompt resuscitation:
Maintain circulating blood volume
Oxygen-carrying capacity
Haemostasis
Oncotic pressure
Blood clotting during transfusion b/c of lack of anticoagulants
Incompatibility leading to severe, often fatal reactions due to lack of blood grouping.
-1900 Karl landsteiner / ABO blood group.
-ABO commonest cause of severe transfusion reaction.
-1927 Landsteiner and Levine MN and P systems.
-1939 Rh system and HDN.
20th century, transfusion became routinely successful (Blood typing).
Effective blood transfusion started after the Second World War.
Transfusions still cause sensitivity and later transfusions.
Transmission of hepatitis B (screening in the 1960s)
Transmission of HIV ( screening 1985).
Whole blood mostly used.
COMPONENTS
Devised in the 1960s.
1970- 1980 blood components used e.g. packed red blood cells for injury or surgery.
In depletion of the circulating blood volume ( severe burn, peritonitis) plasma or, serum albumin, is appropriate.
FFP (long storage but risk of hepatitis) best when blood-clotting factors are needed. Albumin solution is heat-treated to destroy hepatitis infectivity.
Plasma protein fraction can be used for same purposes.
Clotting factors, platelets isolated from blood are used to treat some hereditary bleeding disorders
Synthetic plasma substitutes/ plasma volume expanders e.g dextran, saline solutions, used cases of sudden shock.
Fluosol-DA , 1970s, a synthetic blood-carrying substance successfully used.
Research is being conducted to convert one blood type into another; if developed.
Although blood can be transferred directly, stored blood mostly used.
First large-scale blood bank (1937) Chicago, United States
MASSIVE BLOOD TRANSFUSION
Replacement of the patients total blood volume in less than 24hrs.
Occurs after overwhelming haemorrhage and acute hypovolaemic shock.
Occurs in obstetric emergency operative theatre and accident (trauma victims).
Rapid loss of large quantities of blood will impair tissue perfusion requires urgent correction.
MANAGEMENT
Prompt resuscitation:
Maintain circulating blood volume
Oxygen-carrying capacity
Haemostasis
Oncotic pressure
Blood biochemistry
High morbidity and mortality;
usually related to underlying cause
Prone to DIC (shock, hypotension, obstetric complication)
CAUSES OF DEATH
Underlying cause of haemorhage.
Pr-existing pathological conditions
Complacency
Management by inexperienced staff
Lack of blood bank on site
No agreed protocol in management
BLOOD VOLUME REPLACEMENT
Most important factor in management is restoration of blood volume.
Profound or prolonged hypotension predispose to DIC.
Duration and severity of shock associated with mortality
Blood volume replacement, crysralloid initially
When blood loss has reached 40% of blood volume, red cell replacement is required
Synthetic colloid solution affect crossmatching and heamostasis so crysralloid preferred.
If 4 pints packed cells or more of red cells transfused, and further loss expected, plasma, platelet concentrates and proton required.
Blood components for maximum benefit Prone to DIC (shock, hypotension, obstetric complication)
CAUSES OF DEATH
Underlying cause of haemorhage.
Pr-existing pathological conditions
Complacency
Management by inexperienced staff
Lack of blood bank on site
No agreed protocol in management
BLOOD VOLUME REPLACEMENT
Most important factor in management is restoration of blood volume.
Profound or prolonged hypotension predispose to DIC.
Duration and severity of shock associated with mortality
Blood volume replacement, crysralloid initially
When blood loss has reached 40% of blood volume, red cell replacement is required
Synthetic colloid solution affect crossmatching and heamostasis so crysralloid preferred.
If 4 pints packed cells or more of red cells transfused, and further loss expected, plasma, platelet concentrates and proton required.
RBC plasma reduced or suspended in optimal additive solutions
Uncrossmatched “fresh” blood from walk-in donors dangerous because of lack of screening for transmissible agents and create scarcity of components for haemostatic defects