BLOOD TRANSFUSIONS

Blood transfusion is the process of transferring blood or bloodbased products from one person into the circulatory system of another. Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia caused by a blood disease. People suffering from hemophilia or sickle-cell disease may require frequent blood transfusions.

ANEMIAS
Anemia occurs because of: lack of red blood cell formation

increased red blood cell destruction

blood loss an association with a primary disease deficiences in nutrition blood cells appearance:

Anemias can be divided on three essential categories depending on red normocytic anemias e.g. aplastic anemia

microcytic anemia e.g. iron deficiency, sickle cell anemia.

macrocytic anemias e.g. acute hemorrhage, intravascular hemolytic anemia (megalobalstic anemias commonly caused by B 12 and/or folate deficiency.

ANEMIA

HISTORY
The science of blood transfusion dates to the first decade of the 19th 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.

BLOOD TYPES

 Blood group A If you belong to the blood group A, you have A antigens on the surface of your red blood cells and B antibodies in your blood plasma.

Blood group B If you belong to the blood group B, you have B antigens on the surface of your red blood cells and A antibodies in your blood plasma.

 Blood group AB
If you belong to the blood group AB, you have both A and B antigens on the surface of your red blood cells and no A or B

antibodies at all in your blood plasma.

Blood group 0

If you belong to the blood group 0 (null), you have neither A or B

antigens on the surface of your red blood cells but you have both A and B antibodies in your blood plasma.

Rh FACTOR
Many people also have a so called Rh factor on the red blood cell's
surface. This is also an antigen and those who have it are called Rh+. Those who haven't are called Rh-. A person with Rh- blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance). But a person with Rhblood can develop Rh antibodies in the blood plasma if he or she receives blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood

can receive blood from a person with Rh- blood without any
problems.

Rh FACTOR
This can induce varying degrees of anemia in the foetus, with
hiperbilirubinemia, organ malfunction, etc. Bilirubin deposition in the cerebral basal ganglia (kernicterus)can lead to severe mental

damage. Severe cases of this disease were mortal.

Prevention started in the 60's and nowadays Rh negative pregnant

women receive immunoglobulin doses at several moments during

pregnancy and after childbirth if the baby is Rh positive. Besides, women in fertile age are never transfused Rh positive blood. Thus,

HDN due to Rh antibodies has practically disappeared in developed

countries.

BLOOD TYPES IN THE USA

O positive -38%
O negative - 7 % A positive - 34% A negative - 6% B positive - 9% B negative - 2% AB positive - 3% AB negative - 1%

WHO CAN DONATE BLOOD?

To donate blood, the American Red Cross requires that people be at least 17 years old and weigh more than 110 pounds. Donors must be in good health and will be screened for certain medical conditions, such as anemia. Donors who meet these requirements can give blood every 56 days. People who meet the eligibility requirements will need to give their medical history and pass a physical exam before donating. The medical history includes questions that help blood bank staff decide if there's a risk that donors might have an infection that could be transmitted in their blood.

BLOOD TRANSFUSIONS
Blood can only be administered intravenously. It therefore requires the insertion of a cannula of suitable caliber. Before the blood is administered, the personal details of the patient are matched with the blood to be transfused, to minimize risk of transfusion reactions.

A unit (up to 500 ml) is typically administered over 4 hours. In

patients at risk of congestive heart failure, many doctors administer diuretics to prevent fluid overload. Antihistamines are sometimes given before the transfusion to prevent a transfusion reaction.

BLOOD DONATION
In emergencies, there are certain exceptions to the rule that the

donor's blood type must match the recipient's exactly: Blood type O
negative is the only type of blood that people of all other blood types can receive. This is helpful in emergency situations when the patient needs a transfusion but their blood type is unknown. Because of this, O negative donors are called "universal donors." People who have type AB blood are called "universal recipients" because they can safely receive any type of blood.

BLOOD TRANSFUSIONS

Blood transfusions can be grouped into two main types depending on their source: Homologous transfusions, or transfusions using the stored blood of others. Autologous transfusions, or transfusions using one's own stored blood.

BLOOD DONATION
Blood is most commonly donated as whole blood by inserting a
catheter into a vein and collecting it in a plastic bag (mixed with anticoagulant) via gravity. Collected blood is then separated into components to make the best use of it. Aside from red blood cells, plasma, and platelets, the resulting blood component products also include albumin protein, clotting factor concentrates, cryoprecipitate, fibrinogen concentrate, and immunoglobulins (antibodies). Red cells, plasma and platelets can also be donated individually via a more complex process called apheresis.

COMPLICATIONS AND RISK

Bruise of the needle site- 23 %

Sore arm- 10 %
Fatigue- 8 % Vasovagal symptoms- 5% Hematoma at the needle site- 2 % Sensory changes in the arm used for donation ( pain, numbness)-1 %

TRANSFUSION REACTION
There are risks associated with receiving a blood transfusion, and
these must be balanced against the benefit which is expected. The

most common adverse reaction to a blood transfusion is a febrile

non-hemolytic transfusion reaction, which consists of a fever which resolves on its own and causes no lasting problems or side effects. Hemolytic reactions include chills, headache, backache, dyspnea,

cyanosis, chest pain, tachycardia and hypotension

RISKS ASSOCIATED WITH BLOOD TRANSFUSION

Transmission of viral infection hepatitis B, hepatitis C, HIV

Anaphylactic reactions

Acute hemolytic reactions

Volume overload

Iron overload

BLOOD SUBSTITUTES
As of mid-2006, there are no clinically utilized oxygen-carrying blood
substitutes for humans; however, there are widely available nonblood volume expanders and other blood-saving techniques. These

are helping doctors and surgeons avoid the risks of disease

transmission and immune suppression, address the chronic blood donor shortage, and others who have religious objections to receiving transfused blood. A number of blood substitutes are currently in the clinical evaluation stage. Most attempts to find a suitable alternative to blood thus far have concentrated on cell-free hemoglobin solutions.