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A Study on Blood and Blood Components Transfusion, Adverse Reaction at a Tertiary Care Teaching Hospital, Bangalore

Vidya Shree M, Vithya T, Shankar Prasad and Shobha Rani RH

Background: Blood transfusion is the transfer of whole blood or blood components (red blood cells only or blood plasma only) into the bloodstream directly or into the bone marrow. Blood transfusion is carried out between two identical blood groups only, which otherwise (incompatible blood transfusion) results in agglutination or clumping of the blood leading to haemolysis of RBC and releasing the haemoglobin to the blood plasma.

Blood and blood components: Blood is a liquid connective tissue that consists of blood plasma (liquid) and formed elements (red blood cells, white blood cells and platelets). Blood components are various parts of blood like Red Blood Cells, Granulocytes and plasma separated from one another by conventional blood bank method by centrifugation because of their different specific gravities.

The different cellular components are Red Blood cell (RBC) or Packed Red cells (PCV), Leucocyte depleted Red cells, Platelet concentrate, Platelet Apheresis and Leucocyte depleted Platelet concentrate. The different plasma components are Fresh Frozen Plasma, Cryoprecipitate and Cryo-poor Plasma.

Indications for blood and blood component transfusion: Some of the conditions that demand the transfusion of blood and blood components are red cell replacement in anemia, acute or chronic restoration of oxygen carrying capacity, IgA deficiency, Thrombocytopenia, loss of blood during surgery and delivery and clotting factor deficiency.

Common problems during blood transfusion: Blood transfusions are associated with adverse reactions during or after the transfusion.

The blood transfusion reactions are classified based on the onset of the reaction, acute– immediate and delayed–days to weeks to months. The reactions are as follows:

Acute transfusion reaction: Mild (Category 1) – urticarial reaction.

Moderate (Category 2) – Severe hypersensitivity reaction, Febrile non-hemolytic reactions, Bacterial contamination, Pyrogens.

Severe (Category 3) – Acute intravascular haemolysis, Septic shock, Fluid Overload, Anaphylactic shock, TRAIL (transfusion-associated acute lung injury).

Delayed transfusion reaction: Transfusion Transmissible infections – HIV 1 and 2, Viral Hepatitis B and C, Syphilis, Malaria, HTL V 1and 2, Cytomegalovirus, Chagas Disease. Others - Delayed Haemolytical, Post Transfusion Purpura, GvHD, Iron overload. Thus, the blood transfusions are needed to be monitored carefully. The monitoring has to be done pre-transfusion, during transfusion and post-transfusion for the safety and benefits of the patient.