BY: SANTIAGO,BERMEJO AND VILLAR

What is blood?
Blood is a living tissue composed of two parts: liquid

and solid. The liquid part, called plasma, is made of water, salts, and proteins. Your blood is about 55 percent plasma. The rest of your blood contains cells such as red blood cells, white blood cells, and platelets. Hemoglobin Hemoglobin makes blood look red. It is a protein in red blood cells that carries oxygen from the lungs to the body, and brings the waste product, carbon dioxide, back to the lungs to be exhaled.

Components of Blood
y Red blood cells

Red blood cells carry oxygen to and from tissues and organs. Transfusions of red blood cells help patients with sickle cell disease, thalassemia, aplastic anemia, leukemia, or cancer. Red blood cells may also be needed during and after surgery.

y Platelets

Platelets help blood clot. Platelet transfusions control bleeding in patients with leukemia and cancer. They also help patients after surgery.

White blood cell

y White blood cells, or leukocytes (also spelled

"leucocytes," "leuco-" being Greek for white), are cells of the immune system involved in defending the body against both infectious disease and foreign materials.

y Plasma

Plasma helps blood clot in patients having surgery, and in those with cancer or immune disorders.

What Is a Blood Transfusion?

y A blood transfusion is a safe, common procedure in

which blood is given to you throughan intravenous (IV) line in one of your blood vessels.Blood transfusions are done to replace blood lost during surgery or due to a seriousinjury. A transfusion also may be done if your body can't make blood properly because of an illness

y Hematocrit y Your hematocrit is the percentage of red blood cells in

relation to how much blood you have. A low hematocrit may mean that you have anemia. y Blood group y Red blood cells are covered by proteins that make up a person s blood group. The four major blood groups are O, A, B, and AB.

y During a blood transfusion, a small needle is used to

insert an IV line into one of your blood vessels. Through this line, you receive healthy blood. The procedure usually takes1 to 4 hours, depending on how much blood you need.Blood transfusions are very common. Each year, almost 5 million Americans need ablood transfusion. Most blood transfusions go well. Mild complications can occur. Veryrarely, serious problems develop

Important Information About Blood

The heart pumps blood through a network of arteries

and veins throughout the body. Blood has many vital jobs. It carries oxygen and other nutrients to your body's organs and tissues. Having a healthy supply of blood is important to your overall health. Blood is made up of various parts, including red blood cells, white blood cells, platelets (PLATE-lets), and plasma. Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts.

Blood Types
Every person has one of the following blood types: A, B, AB, or O. Also, every person's blood is either Rh-positive or Rh-negative. So, if you have type A blood, it's either A positive or A negative. The blood used in a transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick. Type O blood is safe for almost everyone. About 40 percent of the population has type O blood. People who have this blood type are called universal donors. Type O blood is used for emergencies when there's no time to test a person's blood type.

y People who have type AB blood are called universal

recipients. This means they can get any type of blood. y If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you should only get Rh-negative blood. Rhnegative blood is used for emergencies when there's no time to test a person's Rh type.

Blood Banks
Blood banks collect, test, and store blood. They

carefully screen all donated blood for possible infectious agents, such as viruses, that could make you sick. Blood bank staff also screen each blood donation to find out whether it's type A, B, AB, or O and whether it's Rh-positive or Rh-negative. Getting a blood type that doesn't work with your own blood type will make you very sick. That's why blood banks are very careful when they test the blood.

 To prepare blood for a transfusion, some blood banks

remove white blood cells. This process is called white cell or leukocyte (LU-ko-site) reduction. Although rare, some people are allergic to white blood cells in donated blood. Removing these cells makes allergic reactions less likely. Not all transfusions use blood donated from a stranger. If you're going to have surgery, you may need a blood transfusion because of blood loss during the operation. If it's surgery that you're able to schedule months in advance, your doctor may ask whether you would like to use your own blood, rather than donated blood.

y If you choose to use your own blood, you will need to

have blood drawn one or more times prior to the surgery. A blood bank will store your blood for your use. y Alternatives to Blood Transfusions y Researchers are trying to find ways to make blood. There's currently no man-made alternative to human blood. However, researchers have developed medicines that may help do the job of some blood parts.

y For example, some people who have kidney problems

can now take a medicine called erythropoietin that helps their bodies make more red blood cells. This means they may need fewer blood transfusions. y Surgeons try to reduce the amount of blood lost during surgery so that fewer patients need blood transfusions. Sometimes they can collect and reuse the blood for the patient.

PREPARING FOR BLOOD TRANSFUSION

y Each year, over 4 million Americans get blood

transfusions. Transfusions are needed for patients having surgery, or for those being treated for blood disorders, cancer, and leukemia. Clinical Center patients need about 5,000 units of red blood cells and 3,000 transfusions of platelets every year.

Complications of transfusions
Transfusions of blood products is associated with

several complications, which can be broadly categorized as immunologic transfusion reactions, or non-immunologic complications. Immunologic reactions include acute hemolytic reactions, delayed hemolytic reactions, febrile nonhemolytic reactions, allergic reactions, and transfusion purpura. Nonimmunologic complications include infections, volume overload, lung injury, hypothermia, and coagulopathy. The risks of complications usually increase with increasing frequency and volume of transfusion.

Immunologic reactions
Acute hemolytic reactions occur with transfusion of red blood cells, and occurs

in about 0.016 percent of transfusions, with about 0.003 percent being fatal.[citation needed] This is due to destruction of donor erythrocytes by preformed recipient antibodies. Most often this occurs due to clerical errors or improper typing and crossmatching. Symptoms include fever, chills, chest pain, back pain, hemorrhage, increased heart rate, shortness of breath, and rapid drop in blood pressure. When suspected, transfusion should be stopped immediately, and blood sent for tests to evaluate for presence of hemolysis. Treatment is supportive. Kidney injury may occur due to the effects of the hemolytic reaction (pigment nephropathy). Delayed hemolytic reactions occur more frequently (about 0.025 percent of transfusions) and are due to the same mechanism as in acute hemolytic reactions. However, the consequences are generally mild and a great proportion of patients may not have symptoms. However, evidence of hemolysis and falling hemoglobin levels may still occur. Treatment is generally not needed, but due to the presence of recipient antibodies, future compatibility may be affected.

 Febrile nonhemolytic reactions are due to recipient antibodies to donor white blood cells, and occurs in about 7% of transfusions. This may occur after exposure from previous transfusions. Fever is generally short lived and is treated with antipyretics, and transfusions may be finished as long as an acute hemolytic reaction is excluded. Allergic reactions may occur when the recipient has preformed antibodies to certain chemicals in the donor blood, and does not require prior exposure to transfusions. Symptoms include urticaria, pruritus, and may proceed to anaphylactic shock. Treatment is the same as for any other type 1 hypersensitivity reactions. A small population (0.13%) of patients are deficient in the immunoglobin IgA, and upon exposure to IgA-containing blood, may develop an anaphylactic reaction.

 Posttransfusion purpura is a rare complication that occurs after

transfusion containing platelets that express a surface protein HPA-1a. Recipients who lack this protein develop sensitization to this protein from prior transfusions, and develop thrombocytopenia about 7 10 days after subsequent transfusions. Treatment is with intravenous immunoglobulin, and recipients should only receive future transfusions with washed cells or HPA-1a negative cells. Transfusion-associated acute lung injury (TRALI) is an increasingly recognized adverse event associated with blood transfusion. TRALI is a syndrome of acute respiratory distress, often associated with fever, non-cardiogenic pulmonary edema, and hypotension, which may occur as often as 1 in 2000 transfusions.[22] Symptoms can range from mild to life-threatening, but most patients recover fully within 96 hours, and the mortality rate from this condition is less than 10%.[23] Although the cause of TRALI is not clear, it has been consistently associated with anti-HLA antibodies. Because these types of antibodies are commonly formed during pregnancy, several transfusion organisations have decided to use only plasma from men for transfusion.[24] TRALI is typically associated with plasma components rather than packed red blood cells (RBCs), though there is some residual plasma in RBC units.[24]

Nonimmunologic complications
Transfusion-associated volume overload is a common complication simply due to the fact that blood products have a certain amount of volume. This is especially the case in recipients with underlying cardiac or kidney disease. Plasma transfusion is especially prone to causing volume overload due to its hypertonicity. Hypothermia can occur with transfusions with large quantities of blood products which normally are stored at cold temperatures. Core body temperature can go down as low as 32 C and can produce physiologic disturbances. Prevention should be done with warming the blood to ambient temperature prior to transfusions.

 Transfusions with large amounts of red blood cells can

lead to an inclination for bleeding. The mechanism is thought to be due to disseminated intravascular coagulation, along with dilution of recipient platelets and coagulation factors. Close monitoring and transfusions with platelets and plasma is indicated when necessary. Metabolic alkalosis can occur with massive blood transfusions due to the breakdown of citrate stored in blood into bicarbonate Hypocalcemia can also occur with massive blood transfusions due to the complex of citrate with serum calcium

Infectious complications
Ever since the advent of HIV testing of donor blood starting in

the 1980s, the transmission of HIV during transfusion has dropped dramatically. Prior testing of donor blood only included testing for antibodies to the HIV virus. However, due to the existence of a window period (a period of time a person is infectious but has not had time to develop antibodies), many cases of HIV seropositive blood were missed. The development of a nucleic acid test for the HIV-1 RNA has dramatically lowered the rate of donor blood seropositivity to about 1 in 3 million units. Despite this, HIV transmission can still occur but with a rate of even less than this. The transmission of hepatitis C via transfusion currently stands at about a rate of 1 in 2 million units. Such low rates has mostly been attributed to the ability to screen for both antibody as well as nucleic acid testing for viral RNA in donor blood. Other rare transmissible infections include hepatitis B, syphilis, Chagas disease, cytomegalovirus infections (in immunocompromised recipients), and HTLV.