WHAT IS BLOOD TRANSFUSION

DEFINITION

Blood transfusion is the process of transferring blood or blood products from one person into the circulatory system of another.

USES

•   Blood transfusions can be life saving in some situations such as massive blood loss due to trauma.

•  Blood can be used to replace blood lost during surgery.

•    Blood can be used to treat severe anaemia (low HB or thrombocytopenia or low platelet count) caused by a blood disease.

•    Patients with Haemophilia or sickle-cell disease require life long suport with frequent blood transfusions.

TYPES OF BLOOD TRANSFUSION

Blood transfusions can be grouped into two main types depending on source:

(A)  ALLOGENEIC (HOMOLOGOUS)

Transfusions using the stored blood of other persons- THE BLOOD DONOR.

(B)  AUTOLOGOUS

Transfusions using the patient’s own stored blood.

PROCEDURES/PROCESSES

STORAGE

Donated blood must be kept refrigerated at specified temperatures to prevent bacterial growth and to slow cellular metabolism hence extending its shelf life.

Transfusion must begin within 30 minutes after blood being taken out of controlled storage.

BLOOD DONATION

Blood is commonly donated as whole blood by inserting a needle into a vein and collecting it in a plastic bag mixed with anticoagulant. A unit of blood is up to 500mls including the preservative. Red cells, Plasma and Platelets can also be donated individually via a more complex process called Apheresis. This allows for higher product yields and allows doctor to reduce multiple donor antigen exposure of the patient hence improving treatment outcomes and less chances of treatment failure.

BLOOD AND BLOOD PRODUCTS

Collected blood is separated into components to make best use it. Blood components and Blood products include:

(a)   COMPONENTS

(i)                 Red blood cells

(ii)               Plasma

(iii)             Platelets

(b)   BLOOD PRODUCTS

(i)                 Albumin

(ii)               Clotting factor concentrates

(iii)             Cryoprecipitate

(iv)             Fibrinogen concentrate

(v)               Immunoglobulins (antibodies)

ADMINISTRATION

§  Blood can only be administered intravenously, requires that an intravenous canula of suitable size is inserted into a vein.

§  A unit (450mls) is typically administered over 4 hours.

§  In patients at risk of heart failure doctors may administer a diuretic to prevent fluid overload.

§  Antihistamines maybe administered prior to transfusion to prevent allergic transfusion reactions which are common but usually not fatal.

§  Positive patient identification is critical to patient safety. The personal details of the patient are matched with the blood to be transfused to minimise risk of transfusion reactions.

Donations are usually anonymous to the recipient, but the products in the blood bank are always individually traceable through the whole cycle of donation, testing, separation into components, storage and administration to the recipient. This allows investigation of any suspected transfusion related disease transmission or transfusion reaction.

By Dr. Gabriel Muyinda

Executive Director - Zambia National Blood Transfusion Service.

BLOOD TRANSFUSION MILESTONES.

EARLY ATTEMPTS

First historical attempt at blood transfusion was carried out in 1492 on Pope Innocent VIII. Blood of three boys was infused into the dying pontiff through the mouth.  The boys were 10 years old and had been promised payment in return for the donation.  However, not only did the Pope die, but so did the three children.

The first fully documented human blood transfusion was administered by Dr. Jean-Baptisle Denys, personal physician to King Louis XIV of France in 1667. He transfused blood of a sheep into a 15 year old boy who the survived the transfusion. Transfusions in several patients however proved fatal.

Dr. Deny’s experiments with animal blood provoked heated controversy in France and the rest of Europe. In 1670 the procedure was banned and blood transfusion fell into obscurity for the next 150 years.

FIRST SUCCESSFUL TRANSFUSION

§  In 1665, Christian Zagado was able to demonstrate that you could revive a dog that had been exanguinated by transfusion of blood from another dog.

§  Lower performed the first blood transfusion between animals.

§  However Deny’s performed the first transfusion between humans and claimed credit for the technique

§  Lower performed the first human transfusion in Britain using sheep’s blood in a patient afflicted by insanity. Sheep’s blood was used because speculation about the value of blood exchange between species. It had been suggested that blood from a gentle lamb might quiet the tempestuous spirit of an agitated person and that the shy might be made outgoing by blood from more sociable creatures.

1818                James Blundell a British Obstetrician performed the first successful

bloodtransfusion of human blood for the treatment of postpartum

Haemorrhage  (maternal bleeding after childbirth)

1840                  First successful whole blood transfusion to treat Haemophilla – an 

inherited bleeding disorder.

1901                  Karl Landsteiner an Austrian Scientist discovered human blood 

groups. Karl Landsteiner observed that mixing of blood from two individuals can lead to blood clumping or agglutination. The clumped red cells can crack and cause toxic reactions which can have fatal consequences.  Karl Landsteiner’s work made it possible to determine blood groups i.e A, B, AB, O and thus paved the way for blood transfusions to be carried out safely. For this discovery he was awarded the Nobel prize in medicine in 1930.

1914               First non-direct transfusion performed by Belgian Doctor Albert Hustn 

by using sodium citrate as an anticoagulant.

1916                First blood transfusion using blood that had been stored and cooled.

First transfusions had to be made directly from donor to receiver before coagulation.

World War I  First blood bank established in France by U.S Army officer Osward

Hope Robertson.

1925                                First academic institution devoted to the science of Blood transfusion in Moscow by Alexander Bogdanov. Bogdanovu was motivated by a search for eternal youth. He received eleven transfusions of whole blood and remarked on the improvement of his eyesight, suspension of balding and other positive symptoms after the transfusion. He tragically died after receiving blood from a student suffering from malaria and tuberculosis. He had been entrusted with the task of studying Lenin’s brain with a view toward resuscitating the deceased leader.

1930                National system of blood banks set up in the Soviet Union.

1937                First Hospital Blood Bank in the USA established at Cook County Hospital in Chicago by Bernard Fantus who originated the term “Blood Bank”.

Late 1930s      Component separation into plasma and red cells developed by Dr.

Early 1940s    Charles R. Drew.

1939-1940              Rhesus Blood group system discovered by Karl Landsteiner, Alex Weiner, Phillip Levine and R.E Stetson.

1943                Introduction of acid-citrate Dextrose (ACD) solution allowed

Transfusion of greater volumes of blood and allowed longer-term storage. Work done by J. F Loutit and Patrick L. Mollison.

1950                Introduction of plastic bag collection system replacing the breakable

glass bottles allowed the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of whole blood.

1979                Introduction of an anticoagulant preservative CPDA-1 further extended

the shelf life of stored blood, increased the blood supply and facilitated resource sharing among blood banks.

By Dr.Gabriel Muyinda

Executive Director  - Zambia National Blood Transfusion Service

Full Press Statement on the World Blood Donor Day Celebrations in Zambia

On Tuesday 12^th June 2012, the chairman of the Blood Donor Day Celebrations organizing committee in Zambia, Mr. Eddie Mupeso accompanied by the Executive Director of the Zambia National Blood Transfusion Service, Dr. Gabriel Muyinda delivered a press statement in the wake of the World Blood Donor Day Celebration for 2012 which fell on the 14^th June and the upcoming Blood Donor Day celebrations in Zambia which will be officially held on the 25^th August 2012. Click here to Read the full statement