BLOOD TRANSFUSION

Usage of Blood as a therapeutic tool has reduced considerably, in the 21st Century, with the growing knowledge of likely Complications and the updated guidelines for deploying Blood Components ( esp. Platelets) in critical conditions.  

Why has this SHIFT to RATIONALITY evolved in the last two decades is because of three primary reasons ,  mentioned here  :

  1. Blood is already  recognised as a HIGHLY ANTIGEN LOADED LIQUID , that can harm the recipient, to the extent of ending lives. 
  2. Strict norms for SAFETY TESTING and mandatory SCREENING of Donor Blood by the Blood Banks, which have thereafter reduced in numbers. Neighbourhood Clinical Labs have now discontinued providing this precious commodity.  Blood Donors are always in short supply, which further justifies a rational approach by clinicians. 
  3. Growing realization that BLOOD can be a carrier medium for dreaded Viruses like HIV,  HBV, HCV and others. 

Let’s see how BLOOD can be a FOE rather than a FRIEND to the sick patient and thereby the Doctor in Charge.

This Blog attempts to enumerate the FINER DETAILS of the numerous HAZARDS of Blood Components / Whole Blood therapies.

The undesirable effects of BLOOD fall under two broad categories  :

1.  IMMUNOLOGICAL fallouts :
  • Hemolysis : Red Cell Incompatibilities…… due to ABO, Rh blood group mismatches 
  • Anaphylaxis :  Due to Antibody to IgA in donor plasma. 
  •  Febrile :  Due to  Antibody to Donor Leukocyte Antigen.
  • Urticaria :  Due to  Antibody to Donor Plasma Proteins. 
  • Acute Lung Injury :  Bilateral Lung Infiltrations within 6 hours of completion of the Transfusion, esp. Plasma containing Transfusions. Acute Hypoxemia, which resolves in 2-3 days,  but may require Ventilation support. 
  •  GVHD = Graft Versus Host Disease,  due to functional Lymphocytes in Donor Blood.
2. NON-IMMUNE mediated fallouts :
  • Circulatory Overload esp. in Newborns and Infants. 
  • Septic Shock :  Bacterial Contamination,  esp. with Platelets , as they are stored at 20-24 degree Centigrade,  under constant agitation ( Shelf life of just 5 days) 
  • Hypothermia : Rapid infusion of cold blood. 
  • Air Embolism :  due to fault in Infusion line. 
  • Hyperkalemia : caused by Rapid Infusion of multiple units. 
  •  HypoCalcemia :  due to Citrated blood in excess. 
  • Iron Overload:  due to Multiple Transfusions. 
  • Disease Transmission:  Dreaded Viruses like HIV,  HBV,  HCV,  CMV,  HTLV alongside Malaria and Syphilis.

In PICU , Blood is best avoided because BLOOD is IMMUNO-SUPRESSIVE and the release of Cytokines may contribute to enhanced Inflammatory response and high morbidity. 

Component Therapy is the current and desirable trend,  in order to serve many more Recipients from a single unit of precious Donor Blood.

 APHARESIS is a step ahead, by extracting only the desired Blood Component (  say Platelets ) and returning the remaining Blood to the Donor instantly. 

Dr . Dhananjay Shah
Ped. Practice of 40 years
@ Rajkot. Gujarat.

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