transfusion

Transfusion

Definition

Transfusion is the process of transferring whole blood or blood components from one person (donor) to another (recipient).

Purpose

Transfusions are given to restore lost blood, to improve clotting time, and to improve the ability of the blood to deliver oxygen to the body's tissues.

Precautions

For donors, the process of giving blood is very safe. Only sterile equipment is used and there is no chance of catching an infection from the equipment. There is a slight chance of infection at the puncture site if the skin is not properly washed before the collection needle is inserted. Some donors feel light-headed upon standing for the first time after donating. Occasionally, a donor will faint. Donors are advised to drink lots of liquids to replace the fluid lost with the donated blood. It is important to maintain the fluid volume of the blood so that the blood pressure will remain stable. Strenuous exercise should be avoided for the rest of the day. Most patients have very slight symptoms or no symptoms at all after donating blood.For recipients, a number of precautions must be taken. The blood given by transfusion must be matched with the recipient's blood type. Incompatible blood types can cause a serious adverse reaction (transfusion reaction). Blood is introduced slowly by gravity flow directly into the veins (intravenous infusion) so that medical personnel can observe the patient for signs of adverse reactions. People who have received many transfusions can develop an immune response to some factors in foreign blood cells (see below). This immune reaction must be checked before giving new blood. Infectious diseases can also be transmitted through donated blood.

Description

Either whole blood or blood components can be used for transfusion. Whole blood is used exactly as it was received from the donor. Blood components are parts of whole blood, such as red blood cells (RBCs), plasma, platelets, clotting factors, immunoglobulins, and white blood cells. Whole blood is used only when needed or when components are not available. Most of the time whole blood is not used because the patient's medical condition can be treated with a blood component and too much whole blood can raise a recipient's blood pressure. High blood pressure can have medical side effects and should be avoided. Use of blood components is a more efficient way to use the blood supply, because blood that has been processed (fractionated) into components can be used to treat more than one person. Each year, more than 20 million units of blood or blood products are transfused in the United States.Whole blood is generally used when a person has lost a lot of blood. Such blood loss can be caused by injury or surgical procedures. Whole blood is given to help restore the blood volume, which is essential for maintaining blood pressure. Whole blood is also given to ensure that the body's tissues are receiving enough oxygen. Whole blood is occasionally given when a required blood component is unavailable in isolated form.Red blood cells are the blood component most frequently used for transfusion. RBCs are the only cells in the body that transport oxygen. A transfusion of RBCs increases the amount of oxygen that can be carried to the tissues of the body. RBCs that have been separated from the liquid plasma (packed RBCs) are given to people who have anemia or who have lost a lot of blood. Platelets are another component frequently given by transfusion. Platelets are a key factor in blood clotting. The clear fluid that carries blood cells (plasma) also contains blood-clotting factors. The platelets and plasma clotting factors are extracted from donated blood and concentrated for use. These factors are used to treat people with such clotting disorders as hemophilia. Immunoglobulins, also called gamma globulin or immune serum, are collected from plasma for use in temporarily boosting the immune capability of a patient. White blood cells (WBCs) are another infection-fighting component of the blood. White blood cells are given by transfusion only rarely.

Blood donation

Each year in the United States, about 14,000,000 pints of blood are donated. Blood collection is strictly regulated by the U.S. Food and Drug Administration (FDA). The FDA has rules for the collection, processing, storage, and transportation of blood and blood products. In addition, the American Red Cross, United Blood Services, the American Association of Blood Banks, and most states have specific rules for the collection and processing of blood. The main purpose of regulation is to ensure the quality of blood and to prevent the transmission of infectious diseases through donated blood. Before blood and blood products are used, they are extensively tested for such infectious agents as hepatitis and AIDS.DONORS. Blood donors are questioned about their general health, their lifestyle, and any medical conditions that might disqualify them as donors. These conditions include hepatitis, AIDS, cancer, heart disease, asthma, malaria, bleeding disorders, and high blood pressure. Screening prevents blood donation by people who could transmit diseases or by people whose medical condition would place them at risk if they donated blood.The blood pressure, temperature, and pulse of donors are taken to ensure that they are physically able to donate blood. One pint (450 ml) of blood is usually donated, although it is possible to donate smaller volumes. The average man has 10-12 pints and the average woman 8-9 pints of blood. Within hours after donating, most people have replaced the fluid lost with the donated blood, bringing their blood volume back to normal. Replacing donated blood cells and platelets can take several weeks. People with low blood pressure or anemia, and pregnant women should not donate blood or should limit the amount of blood they donate. Generally, people are allowed to donate blood only once every two months. This delay ensures the health of the donor and discourages people from selling their blood. The practice of paying donors for blood has essentially stopped. Donors who sell blood tend to have a high risk for the transmission of infectious agents.BLOOD COLLECTION. Blood is collected from the donor by inserting a large needle into a vein in the arm. Usually, one of the larger veins near the inside of the elbow is used. A tourniquet is placed on the upper arm to increase the pressure in the arm veins and make them swell and become more accessible. Once a suitable vein is identified, the area where the needle will be inserted is sterilized by washing with soap solution or an iodine-containing antiseptic. Sometimes both are used. The donor lies on a bed or cot during the procedure, which takes about 10 minutes. Generally, an 18-gauge needle is used. This needle can easily fit into the veins and yet is large enough that the blood flows easily. Blood will sometimes clot in a smaller needle and stop flowing. Blood is collected in sterile plastic bags that hold one pint (450 ml). The bags contain an anticoagulant to prevent clotting and preservatives to keep the blood cells alive. Properly handled and refrigerated, whole blood can last for 42 days. While emphasis has been on screening of blood donors and testing of blood products before they are released for transfusion, the emphasis is beginning to shift to future techniques designed to cleanse the blood and rid it of possible pathogens or reactants.AUTOLOGOUS TRANSFUSION. Autologous transfusion is a procedure in which patients donate blood for their own use. Patients who are to undergo surgical procedures for which a blood transfusion might be required may elect to donate a supply of blood for the purpose ahead of time. The blood is stored at the hospital for the exclusive use of the patient. This procedure assures that the blood type is an exact match. It also assures that no infection will be transmitted through the blood transfusion.DIRECTED DONATION. Directed donors are family or friends of the patient who needs a transfusion. Some people think that family and friends provide a safer source of blood than the general blood supply. Studies do not show that directed donor blood is any safer. Blood that is not used for the identified patient becomes part of the general blood supply.APHERESIS. Apheresis is a special procedure in which only the necessary components of a donor's blood are collected. The remaining components are returned to the donor. A special blood-processing instrument is used in apheresis. It separates the blood into components, saves the desired component, and pumps all the other components back into the donor. Because donors give only part of their blood, they can donate more frequently. For example, people can give almost 10 times as many platelets by apheresis as they could give by donating whole blood.BLOOD PROCESSING. A sample of the donator's blood is collected at the time of donation and tested for infectious diseases. Blood is not used until the results from these tests confirm that it is safe.BLOOD TYPING. The donated blood is typed. There are major and minor blood types, also called blood groups. The major types are classified by the ABO system. This system groups blood by two substances, called antigen A and antigen B, in the red blood cells. The four ABO blood types are A, B, AB, and O. Type A blood has the A antigen, type B has the B antigen, type AB has both, and type O has neither. These four types of blood are further sorted by the Rh factor. The Rh, or rhesus factor, is also an antigen in the red blood cells. A person who has the Rh factor is Rh positive; a person who does not have the factor is Rh negative. If a person has red blood cells with both the B and the Rh antigens, that person is said to have a B positive (B+) blood type. Blood types determine what blood a patient can receive. Often, patients are limited to receiving only blood of the same ABO and Rh type as their own. An exception is type O, which can be transfused to people of other types. Those who are Rh negative can only receive Rh negative blood (Rh positive recipients also can safely receive Rh negative blood of a compatible ABO type.) This means that people with O negative blood are considered universal donors; their blood type always is in demand at blood centers.Blood can be typed by several other minor antigens, such as Kell, Duffy, and Lewis. These minor antigens can become important when a patient has received many transfusions. These patients tend to build up an immune response to the minor blood groups that do not match their own. Upon receiving a transfusion with a mismatched minor blood group, they may have an adverse reaction. A third group of antigens to which a patient can react are residues from the donor's plasma that have attached to the RBCs. To eliminate this problem, the RBCs are rinsed to remove plasma residues. These rinsed cells are called washed RBCs.

Blood components used in transfusion

Most blood collected from donors is broken down (fractionated) into components that are used to treat specific problems or diseases. Treating patients with blood components is the most efficient way to use the blood supply.RED BLOOD CELLS. Red blood cells (RBCs) carry oxygen throughout the body. They obtain oxygen as they pass through the lungs and give up oxygen to the other tissues of the body as they are pumped through arteries and veins. When patients do not have enough RBCs to properly oxygenate their bodies, they can be given a transfusion with RBCs obtained from donors. RBCs are recovered from whole blood after donation. They are then typed, removed from the watery blood plasma to minimize the volume (packed), and stored. They are given to people who have anemia (including thalassemia), whose bone marrow does not make enough RBCs, or who have other conditions that decrease the number of RBCs in the blood. Occasionally, red blood cells from rare blood types are frozen. Once frozen, RBCs can survive for as long as 10 years. Packed RBCs are given in the same manner as whole blood.PLASMA. Plasma is the liquid portion of blood. It contains many useful proteins, especially clotting factors and immunoglobulins. After they are processed, plasma or plasma factors (fractions) are usually frozen. Some plasma fractions are freeze-dried. These fractions include clotting factors I through XIII. Some people have an inherited disorder in which the body produces too little of the plasma clotting factors VIII (hemophilia A) or IX (hemophilia B). Transfusions of these clotting factors help people with hemophilia stop bleeding. Frozen plasma must be thawed before it is used and freeze-dried plasma must be mixed with liquid (reconstituted). In both cases, these blood fractions are usually small in volume and can be injected by syringe and needle.PLATELETS. Platelets are small bodies in the blood that are essential for clotting. People who do not have enough platelets have bleeding problems. People who have lymphoma, leukemia, or thrombocytopenia, and people who are receiving cancer therapy do not make enough platelets. Platelets have a very short shelf life; they must be used within five days of blood donation. Platelets are packed into bags. A platelet transfusion is given in the same manner as whole blood.IMMUNOGLOBULINS. Immunoglobulins are the infection-fighting fraction of blood plasma. They are also known as gamma globulin, antibodies, and immune serum. This blood fraction is given to people who have difficulty fighting infections, especially people whose immune systems are depressed by diseases, such as AIDS. Immunoglobulins are also used to prevent tetanus after cuts, to treat animal bites when rabies infection is suspected, or to treat severe childhood diseases. Generally, the volume used is small, and the immunoglobulins can be injected.WHITE BLOOD CELLS. White blood cells (WBCs) are another infection-fighting component of the blood. On rare occasions, white blood cells are given by transfusion to treat life-threatening infections. Such transfusions are given when the WBC count is very low or when WBCs are not functioning normally. Most of the time, however, antibiotics are used in these cases.

Preparation

A person receiving a transfusion is treated in much the same way as a blood donor. The site where the needle will be inserted is carefully washed with a soap-based solution, followed by an iodine-containing antiseptic. The skin is then dried and the transfusion needle inserted into the recipient's vein. During the early stages of a transfusion, the recipient is monitored closely to detect any adverse reactions. If no signs of adverse reaction are evident, the patient is monitored occasionally for the duration of the transfusion period. Upon completion of the transfusion, a compress bandage is place over the needle-insertion site to prevent bleeding.

Aftercare

Recipients of blood transfusion are monitored during and after the transfusion for signs of adverse reaction.

Risks

Adverse reaction to mismatched blood (transfusion reaction) and transmission of infectious disease are the two major risks of blood transfusion. Transfusion reaction occurs when antibodies in the recipient's blood react to foreign blood cells introduced by the transfusion. The antibodies bind to the foreign cells and destroy them (hemolytic reaction). Transfusion reaction may also cause a hypersensitivity of the immune system that, in turn, may cause tissue damage within the patient's body. The patient may also have an allergic reaction to mismatched blood. The first symptoms of transfusion reaction are a feeling of general discomfort and anxiety. Breathing difficulties, flushing, a sense of pressure in the chest, and back pain may develop. Evidence of a hemolytic reaction can be seen in the urine, which will be colored from the waste of destroyed red blood cells. Severe hemolytic reactions are occasionally fatal. Reactions to mismatches of minor factors are milder. These symptoms include itchiness, dizziness, fever, headache, rash, and swelling. Sometimes the patient will experience breathing difficulties and muscle spasms. Most adverse reactions from mismatched blood are not life-threatening. The infectious diseases most often acquired from blood transfusion in the United States are hepatitis and AIDS.Patients who are given too much blood can develop high blood pressure, a concern for people who have heart disease. Very rarely, an air embolism is created when air is introduced into a patient's veins through the tubing used for intravenous infusion. The danger of embolism is greatest when infusion is begun or ended. Care must be taken to ensure that all air is bled out of the tubing before infusion begins, and that infusion is stopped before air can enter the patient's blood system.

Resources

Periodicals

Rushton, Alana R., and Patricia R. Jennings. "Issues in Transfusion Safety: Predonation Screening and Deferral Procedures and Postdonation Testing of Blood Samples Protect the Safety of the Blood Supply—but even with High Safety and Surveillance Levels, Transfusion-related Transmission of Disease Remains Possible." Journal of the American Academy of Physicians Assistants May 2004: 39-45.

Other

United Blood Services. http://www.unitedbloodservices.org.

Key terms

ABO blood groups — A system in which human blood is classified by whether the red blood cells contain A or B antigens. Type A blood has the A antigen; type B has the B antigen, AB has both, and 0 has neither.Antibody — A simple protein produced by the body to destroy bacteria, viruses, or other foreign bodies. Production of each antibody is triggered by a specific antigen.Antigen — A substance that stimulates the immune system to manufacture antibodies (immunoglobulins). The function of antibodies is to fight off intruder cells, such as bacteria or viruses, in the body. Antigens stimulate the blood to fight other blood cells that have the wrong antigens. If a person with blood type A is given a transfusion with blood type B, the A antigens will fight the foreign blood cells as though they were an infection.Immunoglobulin — An antibody.Infusion — Introduction of a substance directly into a vein or tissue by gravity flow.Injection — Forcing a fluid into the body by means of a needle and syringe.Rh (rhesus) factor — An antigen present in the red blood cells of 85% of humans. A person with Rh factor is Rh positive (Rh+); a person without it is Rh negative (Rh-). The Rh factor was first identified in the blood of a rhesus monkey.

transfusion

[trans-fu´zhun] the introduction of whole blood or blood components directly into the blood stream. Among the elements transfused are packed red blood cells, plasma, platelets, granulocytes, and cryoprecipitate, a plasma protein rich in antihemophilic factor VIII. The current trend is to transfuse blood components rather than whole blood because by so doing the utility of each unit of blood can be extended and the treatment provided more nearly meets the specific needs of the patient.

Transfusion is most often indicated to maintain or replace blood volume, to provide deficient blood elements and improve coagulation, to maintain or improve transport of oxygen, and in exchange for blood that has been removed in the treatment of Rh incompatibility in the newborn, liver failure in which toxins accumulate in the blood, or in some other types of toxemia.Transfusion Methods. There are several different methods of transfusion. Direct transfusion, in which blood from one person is directly transferred to another person, is now rarely used. The usual method is indirect transfusion, in which blood is drawn from a donor, stored in a sterile container and later given to a recipient. Exchange transfusion, in which blood is removed from a person and simultaneously replaced by donor blood, is used mainly in treating erythroblastosis fetalis.Intrauterine or Fetal Transfusion. Intrauterine transfusion involves direct transfusion of Rh negative packed red blood cells into the fetal peritoneal cavity. It is done for the early treatment of pronounced degrees of fetal isoimmunization before weeks 32 to 34 of pregnancy.

The first step is injection of a radiopaque dye into the amniotic fluid. After the fetus ingests the dye, the intestinal tract can be visualized by radiographic techniques so that it serves as a guidepost for location of the abdominal cavity. A long pudendal needle is then inserted through the mother's abdomen and guided through the uterine wall, through the fetal abdomen, and into the peritoneal cavity. Another radiograph is taken to confirm correct placement of the needle and then the erythrocytes are transfused. The erythrocytes soon pass into the fetal blood stream. This procedure is obviously not without hazard and is done only if the fetus cannot be expected to survive without it. The treatment usually is done every 7 to 10 days until delivery. Once the newborn is delivered, transfusion" >exchange transfusion and supportive therapy are begun.Blood Typing and Crossmatching. Transfusions were not practicable until the four main hereditary blood groups, A, B, AB, and O, were discovered at the beginning of the 20th century. Until these blood types were identified, antigen-antibody reactions could not be predicted and transfusion reactions (often fatal) were a matter of chance. There are certain antigens on the surface of red blood cells which can precipitate a transfusion reaction when incompatible blood types are mixed. In the ABO system the types are dictated by A antigen and B antigen. There is also an allele O that does not code for either A or B antigen. Thus there are four possible groups (A, B, AB, O). A person who is type A has only A antigen on red cells; one who is type B has only B antigen; one who is type AB has both A and B antigens; and one who is type O has neither. All individuals produce antibodies against the A or B antigens that are lacking on their own cells. Thus, type A has anti-B; type B has anti-A; type O has both; and type AB has neither.

Rh negative individuals lack D antigen on red cells. They do not produce anti-D antibodies unless they are directly exposed to Rh positive blood, as may occur from a fetal-maternal hemorrhage or from transfusion of platelet or granulocyte concentrate containing Rh positive red cells.
Another system of blood typing is sometimes considered prior to transfusion of granulocytes or for long-term platelet administration. The typing identifies the hla antigens that occur on leukocytes and platelets. (See also tissue typing.)
Crossmatching is another way in which blood is tested for compatibility prior to transfusion. It involves placing the cells of the donor in a sample of the recipient's serum, and cells of the recipient in a sample of the donor's serum. Absence of agglutination, hemolysis, cytotoxicity indicates that the blood specimens are compatible.Adverse Reactions. Among the most common transfusion reactions are reactions" >antigen-antibody reactions resulting from blood type incompatibility. When blood groups are incompatible there is agglutination (clumping) of cells, hemolysis, and release of cellular elements into the serum. Signs and symptoms indicating such a reaction include burning sensation along the vein where the transfusion is given, facial flushing, chills and fever, headache, low back pain, rash, red urine, and shock. Other reactions include febrile reaction, allergic reaction with hives, wheezing, and anaphylaxis, and response to bacterial contamination. See accompanying table.

Every health care agency in which transfusions are administered should have a written policy regarding the correct steps to take in the event a patient begins to show signs of a reaction. In general, should such signs occur, the transfusion is stopped immediately, the venous line is kept open with normal saline, and emergency care is initiated.
Especially dangerous to patients with either cardiac or renal disease is hyperkalemia, an excess of potassium in the blood. If the condition is not corrected, a flaccid paralysis develops, affecting the muscles of respiration and eventually the heart muscle, which can lead to cardiac arrest. High levels of potassium in donor blood are likely to occur when the bank blood is several days old. It is estimated that the breakdown of red cells in the stored blood increases the level of potassium at the rate of one milliequivalent per liter per day.
Another possible complication is hypocalcemia, which can occur when large amounts of blood containing the additive acid citrate dextrose are given rapidly, as to a bleeding patient. Acid citrate dextrose is an anticoagulant that binds with calcium ions in the recipient's blood, removing them from circulation and thereby reducing the calcium level below that essential for normal coagulation.
Circulatory overload is a possibility any time blood is administered rapidly in large amounts. Patients who are particularly susceptible to this eventuality are the very young, the very old, and those suffering from a pre-existing cardiopulmonary or renal problem. Another difficulty that may be encountered when blood is administered rapidly under pressure is that of air embolism.autologous transfusion reinfusion of a patient's own blood, done by either of two methods: (1) patients having a planned surgical procedure may donate their own blood within six weeks before surgery; the donated blood is processed, frozen, stored, and then thawed for use at the time of surgical need; or (2) blood lost during the operative procedure may be salvaged; this is also called autotransfusion. In the second method, blood and debris from the surgical field are aspirated into a collection chamber containing a dilute solution of heparin or citrated dextrose. The aspirate is filtered and pumped into a centrifuge chamber and the red cells are then washed with a normal saline solution. Centrifugal force separates the red cells from waste products such as debris, plasma, hemolyzed red cells, platelets, most white cells, and solution such as anticoagulant or antibiotic irrigation solution. The washed packed red blood cells are then pumped into a blood infusion bag and reinfused into the patient in the usual manner.exchange transfusion transfusion in a newborn infant of packed cells or fresh whole blood that is type O, Rh-negative, and previously cross-matched with the mother's serum, or Rh negative blood of the same type as the newborn's. Rh negative blood is used because, even though the newborn may have Rh positive blood, maternal antibodies that entered the fetal bloodstream in utero are still present in the newborn and would destroy the transfused blood cells. The blood is transfused via the umbilical vein. Exchange transfusion is used to treat either moderate to severe hemolytic disease of the newborn or hyperbilirubinemia not controlled by phototherapy. Complications may include heart failure due to either hypervolemia or hypovolemia, bradycardia or cardiac arrest from acidosis or hyperkalemia, hypocalcemia, hypothermia, air emboli, thrombolytic emboli, sepsis, intensification of hypoglycemia, and thrombocytopenia if there are repeated exchange transfusions.fetomaternal transfusion transplacental passage of fetal blood into the circulation of the mother; in small amounts it may go unnoticed, but in larger amounts it can cause anemia or edema in the fetus.intrauterine transfusion direct transfer of Rh negative blood cells into a fetus in utero in cases of isoimmunization" >isoimmunization; see transfusion" >transfusion.placental transfusion the transfer of blood from placenta to newborn at the time of birth. Blood flow through the umbilical arteries stops about 45 seconds after birth, but the umbilical vein remains patent longer. Uterine contractions enhance the transfer of blood, the volume of which has significant physiological benefits to the neonate. Since gravity influences this transfer, raising the newborn above the level of the placenta prevents a normally occurring placental transfusion. Conversely, lowering the newborn below the placental level accelerates the process.transfusion reaction any symptoms due to agglutination or hemolysis of the recipient's blood cells when blood for transfusion is incorrectly matched. See discussion under transfusion.

trans·fu·sion

(trans-fyū'zhŭn), Transfer of blood or blood component from one person (donor) to another person (receptor). [L. transfundo, pp. -fusus, to pour from one vessel to another]

transfusion

(trăns-fyo͞o′zhən)n.1. The act or process of transfusing.2. Medicine The transfer of whole blood or blood products from one individual to another.

trans·fu′sion·al adj.

transfusion

Transfusion medicine The administration of a blood product to a recipient–with a relative deficit of the product being transfused. See Transfusion guideline Statistics–transfusion-related infections HBV 1:63, 000; HCV 1:100, 000; HIV 1:675, 000; Chagas' disease, Brazil 10–20, 000/yr. See Autologous transfusion, Blood transfusion, Exchange transfusion, Fetofetal transfusion, Fetomaternal transfusion, Intrauterine transfusion, Massive transfusion, Out-of-hospital transfusion, Platelet transfusion, Single-donor transfusion, Single-unit transfusion.

trans·fu·sion

(trans-fyū'zhŭn) Transfer of blood or a blood component from one person (donor) to another (recipient). [L. transfundo, pp. -fusus, to pour from one vessel to another]

transfusion

The replacement of lost blood by blood, or blood products, usually donated by another person. Blood transfusion is given in cases of shock or severe anaemia and is often life-saving. Blood must be of a compatible group and is invariably checked by CROSS-MATCHING before being given.

trans·fu·sion

(trans-fyū'zhŭn) Transfer of blood or blood component from one person (donor) to another person (recipient). [L. transfundo, pp. -fusus, to pour from one vessel to another]

transfusion

trans·fu·sion

transfusion

trans•fu•sion

trans·fu·sion

transfusion

transfuse

transfusion

transfusion

transfusion

transfusion

transfusion

Transfusion

Definition

Purpose

Precautions

Description

Blood donation

Blood components used in transfusion

Preparation

Aftercare

Risks

Resources

Periodicals

Other

Key terms

transfusion

trans·fu·sion

transfusion

transfusion

trans·fu·sion

transfusion

trans·fu·sion

transfusion

Synonyms for transfusion

noun the introduction of blood or blood plasma into a vein or artery

Synonyms

Related Words

noun the action of pouring a liquid from one vessel to another

Related Words