Blood transfusion

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Red Blood Cells

  • ABO blood type (O, A, B, or AB)
    • Most important antigen group
  • RhD group (positive or negative)
    • Second most important antigen group
  • There are more than 30 minor blood group antigens, including Kell (K and k), Kidd (Jk^a^ and Jk^b^), Duffy (Fy^a^ and Fy^b^) and MNS (S and s)

Group & Screen and Crossmatch

  • Group and screen
    • Group tests recipient for ABO and RhD status
    • Screen tests the recipient plasma for unexpected and clinically significant minor antigen incompatibility
    • Takes about 45 minutes, but if the screen is positive then can take days to determine which specific antibodies are causing the problem
  • Crossmatch confirms that a specific unit of RBCs is safe to give to the recipient
    • If screen was negative, an abbreviated crossmatch is done either as immediate spin or as electronic
    • If screen was positive, then a full antiglobulin crossmatch is done

Basics

  • Each unit is about 300 mL with a hematocrit of 65 to 70%, and raises the recipient's hemoglobin by about 10 g/L
  • Usually transfused over 2 hours
    • Can do up to 3 or 3.5 hours in elderly over 70 years old, heart failure, LV dysfunction, prior MI, renal dysfunction, or volume overload (usually with concurrent diuretics at the start of the transfusion)

Indications

  • Acute blood loss
    • Maintain hemoglobin above 70 g/L during active bleeding
    • Maintain hemoglobin higher (e.g. above 80 g/L) during active bleeding in patients with:
      • Unstable or acute coronary syndrome
      • Coronary artery disease
      • Uncontrolled or unpredictable bleeding
  • Anemia
    • Consider for hemoglobin below 70 g/L in stable patients
    • Consider for hemoglobin below 80 g/L in patients undergoing orthopedic or cardiac surgery or with cardiovascular disease