Blood, Blood Products and Blood
• Functions of the blood
• Blood products
• Indication for transfusion
• Maximum surgery blood order schedule (MSBOS)
• blood transfusion: hemovigilance
• Blood transfusion reaction and its management
• Other complications of blood transfusion
• Take home massage
• Blood - connective tissue (fluid) consisting of
plasma and cellular component.
• 8% of total BW
Functions of the blood
• supplies o2 and substances absorbed from the GIT to
• returns co2 to the lungs, and other products of body
metabolism to the kidneys.
• Transport hormones produced by respective glands of
• White cells- preotection of the body againts pathogen
• Platelets- limiting blood lossProtection
• Body temperature
• blood pressure
• pH balanceRegulation
Blood product & Blood Transfusion
• Blood product- A blood product is any
component of the blood which is collected
from a donor for use in a blood transfusion
• Blood transfsusion-is the process of
transferring blood or blood components from
one person into the circulatory system of
• RED CELLS
FRESH FROZEN PLASMA
• Blood taken from a suitable donor using a pyrogen
free anticoagulant container. The major use is used
for blood component separation.
• A component derived by removing part of the
plasma from whole blood
• A component derived from fresh whole blood by
centrifugation which contain majority of the
platelets content in theraputically effective form.
• A component prepared either from fresh whole blood or from plasma
collected by apheresis, frozen at an appropiate temperature to preserve
the activity of labile coagulation factors.
• A component containing the cryoglobulin fraction of plasma obtained by
further processing of fresh frozen plasma prepared from hard spun cell
free plasma and concentrated to a final volumes required.
• A component prepared from plasma by removal of cryoprecipitate
Indication for transfusion of blood
1. Packed red cells
Hematological malignancies To maintain platelet > 20x 109
Massive transfusion Acute bleeding, multiple trauma
DIVC Acute DIC, aim to maintain platelet
CABG/ Ruptured AAA Reserved for post op bleeding
Platelet function disorders If all other measures fail to control the
Maximum surgery blood order
• Reference used to guide clinicians in ordering
blood before surgery.
• The Maximum Surgical Blood Order Schedule
(MSBOS) is a table of elective surgical
procedures which lists the number of units of
blood routinely requested, and cross-matched
for them pre-operatively.
• For cases where blood;
–Not likely to be transfused – GSH is
–Likely to be transfused – GXM is performed.
*However when antibody screen is positive,
compatible blood must be made available in all cases
• The patient's serum is
screened and tested
compatibility with the
red cells of the units of
blood to be transfused.
• Crossmatched blood
will retained for
48hours in blood bank.
Group, Screen, Hold
• Consist of process ABO,
Rh D grouping and
• Serum/plasma is
retained for 48 hours in
the blood bank.
• Crossmatch : transfusion ratio
• An indicator to assess the appropriateness of
cross matching of blood to the units of blood
• Standard value ≤2.5
C: T ratio
• C: T ratio surgical department for the year
JAN FEB MAC APR MAY JUN JUL AUG SEP OKT NOV DIS
GXM 467 497 626 341 569 550 495 538 509 315 270 547
231 235 379 158 289 280 260 280 253 301 231 268
RATIO 2.0 2.1 1.7 2.2 2.0 2.0 1.9 1.9 2.0 1.0 1.2 2.0
Consent of blood transfusion
• Written consent
• Patient should be explained regarding the
benefits and risks of blood transfusion
• The patient’s consent should be obtained for the
planned transfusion and recorded in the patient’s
• Haemovigilance is a system of surveillance and
alarm, from blood collection to the follow-up
of the recipients.
1. Blood taking
2. Giving blood
Management of transfusion reaction
Chest pain, pain at
• If symptoms
subside : resume
• Maintain A, B, C
• Blood reaction kit
(immediate & post 24hr)
• 4ml in plain tube for antibody identification
• 2ml in EDTA tube for FBP
• >10ml urine sample- may have haemoglobin and
• The remaining blood bag, containing the partially
transfused blood, and all the blood bags cross-matched
for the same patient at the same time of the request
should be examined for the presence of free
haemoglobin or discolouration before being sent to the
• The “Report of Reaction to Blood or Plasma
Transfusion” form must be completed.
• Fill up the “Transfusion Adverse Event” form
in duplicate and send to the blood bank. Send
also a copy of this form to the National Blood
• Other adverse transfusion reactions include:
– Fluid overload
– Metabolic disturbances e.G. Hyperkalaemia and
– Iron overload
– Alloimmunisation to red cell, white cell or platelet
– Immunosuppression and immunomodulation
– Transmission of viral infection
Transmitted Infection Incident
HIV 1 : 1,900,000
Hep A 1 : 1,000,000
Hep B 1 : 1,800,000
Hep C 1 : 1,600,000
Bacteria Infection 1 : 3,000
Take home massages
1. Blood product mainly consist of cellular
component and fresh plasma.
2. The decision to transfuse depends on many
factors such as haemoglobin level, anemic
symptoms and risk of bleeding.
3. MSBOS used to guide clinicians in ordering
blood before surgery.
4. The patient’s consent should be obtained for the
planned transfusion and recorded in the
patient’s medical chart.
Take home massage
4. 1 person take blood and label- confirm
patient’s name and identification before
5. Confirm patient’s name and identification
with patient’s note, compatibility label and
request form before transfusion.
6. If an adverse transfusion reaction is
suspected, the transfusion should be stopped
immediately and must be reported.
1. Transfusion Practice Guidelines for Clinical
and Laboratory Personnel 3rd edition March
2008. National Blood Centre, Ministry of
2. Guidelines for the rational use of blood and
blood products. National Blood Centre,
Ministry of Health Malaysia
3. Blood Transfusion guideline (2006), National
Users’ Board Sanquin Blood Supply
Notas do Editor
The circulatory system: the transport system that supplies o2 and substances absorbed from the GIT to the tissues, returns co2 to the lungs, and other products of body metabolism to the kidneys, functions in the regulation of the body temperature, and distribute hormones and other agents that regulate cell functions. Blood id the carries of these subsntances.
An important factor that can be considered in the establishment of an MSBOS is the identification of those procedures that can be accommodated performed. Where blood by the group, antibody screen and hold (GSH) procedure. For cases where blood is likely to be transfused, a group screen and hold is likely to be transfused, a full cross-match is done. However when antibody screen is positive, compatible blood must be made available in all cases before surgery.
Developing MSBOS Data on blood request for all procedures for 6 months is analysed. For each procedure, indicate the number of units cross-matched and the number of units transfused. Calculate the percentage of blood usage: Total No. of Units transfused x 100 = % Total No. of Units cross-matched In procedures where blood usage is less than 30%, GSH are performed. Other procedures are allotted a tariff based on the average number of blood transfused.
How the schedule is generated is basically based on 6months data of all blood requests.
The decision to transfuse is complex and depends on many factors e.g. the cause of anaemia, its severity, chronicity, the patient’s ability to compensate for the anaemia, the likelihood for further blood loss and the need to provide some reserve before the onset of tissue hypoxia.
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