Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products This is an article about the rock music band "Circulatory System" Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood lost during surgery. Treatment of physical trauma is described here and in First aid. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease. Anemia ( AmE) or anæmia/anaemia ( BrE) (from the Ancient Greek grc-Latn anaîmia, meaning “without blood” is defined as a qualitative Thrombocytopenia (or -paenia, or thrombopenia in short is the presence of relatively few Platelets in Blood. Hematology ( American English) or haematology ( British English) is the branch of biology (physiology Pathology, Clinical laboratory People suffering from hemophilia or sickle-cell disease may require frequent blood transfusions. Haemophilia (also spelled as hemophilia Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid Early transfusions used Whole Blood, but modern medical practice is to use only components of the blood. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products

Contents 1 History 1.1 Early attempts 1.2 The first successes 1.3 Development of blood banking 1.4 The modern era 2 Precautions 2.1 Compatibility 2.2 Transfusion Transmitted Infections 2.3 Processing of blood prior to transfusion 2.4 Neonatal transfusion 2.5 Terminology 3 Procedure 4 Blood donation 4.1 Risks to the recipient 4.2 Transformation from one type to another 4.3 Objections to blood transfusion 5 Animal blood transfusion 6 Blood transfusion substitutes 7 References 8 Academic resources 9 See also 10 External links

History

Early attempts

The first historical attempt at blood transfusion was described by the 15th-century chronicler Stefano Infessura. Stefano Infessura (c 1435 &ndash c 1500 was an Italian humanist historian and lawyer Infessura relates that, in 1492, as Pope Innocent VIII sank into a coma, the blood of three boys was infused into the dying pontiff (through the mouth, as the concept of circulation and methods for intravenous access did not exist at that time) at the suggestion of a physician. Pope Innocent VIII (1432 &ndash July 25, 1492) born Giovanni Battista Cybo (or Cibo) was Pope from 1484 until his death The boys were ten years old, and had been promised a ducat each. The ducat (ˈdʌkət is a Gold coin that was used as a trade currency throughout Europe before World War I. However, not only did the pope die, but so did the three children. Some authors have discredited Infessura's account, accusing him of anti-papalism.

With Harvey's re-discovery of the circulation of the blood (which was discovered by Ibn al-Nafis in the 13th century), more sophisticated research into blood transfusion began in the 17th century, with successful experiments in transfusion between animals. William Harvey ( April 1, 1578 – June 3, 1657) was an English Physician who is credited with being the first in TemplateInfobox Muslim scholars --> Ala al-Din Abu al-Hassan Ali ibn Abi-Hazm al-Qarshi al-Dimashqi ( As a means of recording the passage of Time, the 17th Century was that Century which lasted from 1601 - 1700 in the Gregorian calendar However, successive attempts on humans continued to have fatal results.

The first fully-documented human blood transfusion was administered by Dr. Jean-Baptiste Denis, eminent physician to King Louis XIV of France, on June 15, 1667. Jean-Baptiste Denys (c 1640–1704 was a French Physician. He studied in Montpellier and was the personal physician to King Louis XIV. Events 763 BC - Assyrians record a Solar eclipse that will be used to fix the Chronology of Mesopotamian history He transfused the blood of a sheep into a 15-year old boy, who recovered. Denis performed another transfusion into a labourer, who also survived. Both instances were likely due to small amount of blood that was actually transfused into these people. This allowed them to withstand the allergic reaction. In the winter of 1667, Denis performed several transfusions on Antoine Mauroy with calf's blood, who on the third account had died. Much controversy surrounded his death and his wife was accused of his murder; it's likely that the transfusion caused his death. Even though it was later determined that Mauroy actually died from arsenic poisoning, Denis' experiments with animal blood provoked a heated controversy in France. Finally, in 1670 the procedure was banned. In time, the British Parliament and even the pope followed suit. Blood transfusions fell into obscurity for the next 150 years.

Richard Lower examined the effects of changes in blood volume on circulatory function and developed methods for cross-circulatory study in animals, obviating clotting by closed arteriovenous connections. His newly devised instruments eventually led to actual transfusion of blood.

"Many of his colleagues were present. . . towards the end of February 1665 [when he] selected one dog of medium size, opened its jugular vein, and drew off blood, until . . . its strength was nearly gone . . . Then, to make up for the great loss of this dog by the blood of a second, I introduced blood from the cervical artery of a fairly large mastiff, which had been fastened alongside the first, until this latter animal showed . . . it was overfilled . . . by the inflowing blood. " After he "sewed up the jugular veins," the animal recovered "with no sign of discomfort or of displeasure. "

Lower had performed the first blood transfusion between animals. He was then "requested by the Honorable [Robert] Boyle . . . to acquaint the Royal Society with the procedure for the whole experiment," which he did in December of 1665 in the Society’s Philosophical Transactions. On 15 June 1667 Denys, then a professor in Paris, carried out the first transfusion between humans and claimed credit for the technique, but Lower’s priority cannot be challenged.

Six months later in London, Lower performed the first human transfusion in Britain, where he "superintended the introduction in his [a patient’s] arm at various times of some ounces of sheep’s blood at a meeting of the Royal Society, and without any inconvenience to him. " The recipient was Arthur Coga, "the subject of a harmless form of insanity. " Sheep’s blood was used because of 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. Lower wanted to treat Coga several times, but his patient wisely refused. No more transfusions were performed. Shortly before, Lower had moved to London, where his growing practice soon led him to abandon research. [1]

The first successes

The science of blood transfusion dates to the first decade of the 19th century, with the discovery of distinct blood types leading to the practice of mixing some blood from the donor and the receiver before the transfusion (an early form of cross-matching). The 19th century of the Common Era began on January 1, 1801 and ended on December 31, 1900, according to the Gregorian calendar A blood type (also called a blood group) is a classification of Blood based on the presence or absence of inherited Antigenic substances on the Cross-matching, in Transfusion medicine, refers to the testing that is performed to determine the Compatibility of a donated unit of Blood

In 1818, Dr. Year 1818 ( MDCCCXVIII) was a Common year starting on Thursday (link will display the full calendar of the Gregorian Calendar (or a Common James Blundell, a British obstetrician, performed the first successful blood transfusion of human blood, for the treatment of postpartum hemorrhage. James Blundell ( January 19, 1791 Holborn, London – January 15, 1878 St Obstetrics (from the Latin obstare, "to stand by" is the surgical speciality dealing with the care of a woman and her offspring during Pregnancy Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from He used the patient's husband as a donor, and extracted four ounces of blood from his arm to transfuse into his wife. During the years 1825 and 1830, Dr. Events and trends Nationalistic independence helped reshape the world during this decade Greece gains independence from the Ottoman Empire Blundell performed 10 transfusions, five of which were beneficial, and published his results. He also invented many instruments for the transfusion of blood. He made a substantial amount of money from this endeavour, roughly $50 million (about $2 million in 1827) real dollars (adjusted for inflation). The distinction between real versus nominal value occurs in many fields

In 1840, at St. George's Hospital Medical School in London, Samuel Armstrong Lane, aided by Dr. Year 1840 ( MDCCCXL) was a Leap year starting on Wednesday (link will display the full calendar of the Gregorian calendar (or a Leap year St George's University of London ( SGUL) previously known as George's Hospital Medical School ( SGHMS) is a specialist medical college Blundell, performed the first successful whole blood transfusion to treat hemophilia. Haemophilia (also spelled as hemophilia

George Washington Crile is credited with performing the first surgery using a direct blood transfusion at the Cleveland Clinic. George Washington Crile (1864 - 1943 was a significant American surgeon The Cleveland Clinic (formally known as the Cleveland Clinic Foundation) is a multispecialty academic medical center located in Cleveland, Ohio,

Development of blood banking

See also: Blood bank

While the first transfusions had to be made directly from donor to receiver before coagulation, in the 1910s it was discovered that by adding anticoagulant and refrigerating the blood it was possible to store it for some days, thus opening the way for blood banks. A blood bank is a cache or bank of Blood or blood components, gathered as a result of Blood donation, stored and preserved for later use in Blood transfusions Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby The 1910s decade ran from January 1 1910 through December 31 1919 An anticoagulant is a substance that prevents coagulation; that is it stops Blood from clotting Refrigeration is the process of removing Heat from an enclosed space or from a substance and moving it to a place where it is unobjectionable A blood bank is a cache or bank of Blood or blood components, gathered as a result of Blood donation, stored and preserved for later use in Blood transfusions The first non-direct transfusion was performed on March 27, 1914 by the Belgian doctor Albert Hustin, who used sodium citrate as an anticoagulant. Events 196 BC - Ptolemy V ascends to the throne of Egypt. 1309 - Pope Clement V excommunicates Year 1914 ( MCMXIV) was a Common year starting on Thursday (link will display the full calendar of the Gregorian calendar (or a Common year The Kingdom of Belgium is a Country in northwest Europe. It is a founding member of the European Union and hosts its headquarters as well as those Albert Hustin (1882-1967 was a Belgian Medical doctor. He was the second to successfully practice non-direct Blood transfusions with Sodium citrate Sodium citrate usually refers to Trisodium citrate, though it can refer to any of the sodium Salts of Citric acid: Monosodium citrate The first blood transfusion using blood that had been stored and cooled was performed on January 1, 1916. New Year See also New Year The Ancient Romans began their consular year on January 1st since 153 BC Year 1916 ( MCMXVI) was a Leap year starting on Saturday (link will display the full calendar of the Gregorian calendar (or a Leap year Oswald Hope Robertson, a medical researcher and U.S. Army officer, is generally credited with establishing the first blood bank while serving in France during World War I. Oswald Hope Robertson ( 2 June 1886 – 23 March 1966) was an English -born medical scientist who pioneered the idea of Blood banks The United States Army is a military organization whose primary mission is to "provide necessary forces and capabilities. This article is about the country For a topic outline on this subject see List of basic France topics. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All

The first academic institution devoted to the science of blood transfusion was founded by Alexander Bogdanov in Moscow in 1925. Alexander Aleksandrovich Bogdanov Александр Александрович Богданов (born Alyaksandr Malinouski, Аляксандар Маліноўскі( Moscow (Москва́ romanised: Moskvá, IPA: see also other names) is the Capital and the largest city of Year 1925 ( MCMXXV) was a Common year starting on Thursday (link will display the full calendar of the Gregorian calendar. Bogdanov was motivated, at least in part, by a search for eternal youth, and remarked with satisfaction on the improvement of his eyesight, suspension of balding, and other positive symptoms after receiving 11 transfusions of whole blood. Whole Blood is the term used in Transfusion medicine for human Blood from a standard Blood donation.

In fact, following the death of Vladimir Lenin, Bogdanov was entrusted with the study of Lenin's brain, with a view toward resuscitating the deceased Bolshevik leader. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain The Bolsheviks, originally also Bolshevists ( Большевик Большевист (singular, derived from bolshe, "more" were a faction Tragically, but perhaps not unforeseeably, Bogdanov lost his life in 1928 as a result of one of his experiments, when the blood of a student suffering from malaria and tuberculosis was given to him in a transfusion. Year 1928 ( MCMXXVIII) was a Leap year starting on Sunday (link will display full calendar of the Gregorian calendar. Malaria is a vector -borne Infectious disease caused by Protozoan Parasites It is widespread in tropical and subtropical regions including Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Some scholars (e. g. Loren Graham) have speculated that his death may have been a suicide, while others attribute it to blood type incompatibility, which was still incompletely understood at the time. ^[1]

The modern era

Following Bogdanov's lead, the Soviet Union set up a national system of blood banks in the 1930s. The Union of Soviet Socialist Republics (USSR was a constitutionally Socialist state that existed in Eurasia from 1922 to 1991 The 1930s were described as an abrupt shift to more radical and conservative lifestyles as countries were struggling to find a solution to the Great Depression. News of the Soviet experience traveled to America, where in 1937 Bernard Fantus, director of therapeutics at the Cook County Hospital in Chicago, established the first hospital blood bank in the United States. Bernard Fantus ( September 1, 1874 - April 14, 1940) was a Hungarian American physician The John H Stroger Jr Hospital of Cook County (formerly Cook County Hospital and also known as the New Cook County Hospital) is a public urban teaching hospital Chicago (ʃɪˈkɑːgoʊ is the largest City by population in the state of Illinois and the American Midwest of the United States. In creating a hospital laboratory that preserved and stored donor blood, Fantus originated the term "blood bank". Within a few years, hospital and community blood banks were established across the United States. The United States of America —commonly referred to as the

In the late 1930s and early 1940s, Dr. The 1930s were described as an abrupt shift to more radical and conservative lifestyles as countries were struggling to find a solution to the Great Depression. The 1940s decade ran from 1940 to 1949 Events and trends The 1940s was a period between the radical 1930s and the conservative 1950s which also leads the period to be Charles R. Drew's research led to the discovery that blood could be separated into blood plasma and red blood cells, and that the plasma could be frozen separately. Dr Charles Richard Drew ( June 3, 1904 – April 1, 1950) was an American Physician and medical researcher Blood plasma is the Liquid component of Blood, in which the Blood cells are suspended Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood Blood stored in this way lasted longer and was less likely to become contaminated.

Another important breakthrough came in 1939-40 when Karl Landsteiner, Alex Wiener, Philip Levine, and R. Karl Landsteiner ( June 14 1868 &ndash June 26 1943) was an Austrian Biologist and Physician. E. Stetson discovered the Rhesus blood group system, which was found to be the cause of the majority of transfusion reactions up to that time. The term Rhesus (Rh blood group system refers to the 5 main Rhesus Antigens (C c D E and e as well as the many other less frequent Rhesus antigens In Medicine, a transfusion reaction is any Adverse event which occurs because of a Blood transfusion. Three years later, the introduction by J.F. Loutit and Patrick L. John Freeman Loutit CBE FRS Also known as 'Ian' ( 19 February 1910 - 11 June 1992) Mollison of acid-citrate-dextrose (ACD) solution, which reduces the volume of anticoagulant, permitted transfusions of greater volumes of blood and allowed longer term storage. Acid Citrate Dextrose Solution (sometimes called Anticoagulant Citrate Dextrose Solution is a solution of Citric acid, Sodium citrate and Dextrose in water

Carl Walter and W. P. Murphy, Jr. , introduced the plastic bag for blood collection in 1950. A plastic bag or pouch is a type of flexible Packaging made of thin flexible plastic film Year 1950 ( MCML) was a Common year starting on Sunday (link will display the full calendar of the Gregorian calendar. Replacing breakable glass bottles with durable plastic bags allowed for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of whole blood. Glass in the common sense refers to a Hard, Brittle, transparent Solid, such as that used for Windows many Further extending the shelf life of stored blood was an anticoagulant preservative, CPDA-1, introduced in 1979, which increased the blood supply and facilitated resource-sharing among blood banks. Year 1979 ( MCMLXXIX) was a Common year starting on Monday (link displays the 1979 Gregorian calendar)

As of 2006, there were about 15 million units of blood transfused per year in the United States. ^[2]

Precautions

Compatibility

See also: Cross-matching and Blood type

Great care is taken in cross-matching to ensure that the recipient's immune system will not attack the donor blood. Cross-matching, in Transfusion medicine, refers to the testing that is performed to determine the Compatibility of a donated unit of Blood A blood type (also called a blood group) is a classification of Blood based on the presence or absence of inherited Antigenic substances on the Cross-matching, in Transfusion medicine, refers to the testing that is performed to determine the Compatibility of a donated unit of Blood An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor In addition to the familiar human blood types (A, B, AB and O) and Rh factor (positive or negative) classifications, other minor red cell antigens are known to play a role in compatibility. A blood type (also called a blood group) is a classification of Blood based on the presence or absence of inherited Antigenic substances on the The term Rhesus (Rh blood group system refers to the 5 main Rhesus Antigens (C c D E and e as well as the many other less frequent Rhesus antigens Glycosphingolipids are a Subtype of Glycolipids containing the Amino alcohol Sphingosine. These other types can become increasingly important in people who receive many blood transfusions, as their bodies develop increasing resistance to blood from other people via a process of alloimmunization. Alloimmunity is a condition in which the body gains immunity, from another individual of the same species against its own cells.

The key importance of the Rh group is its role in Hemolytic disease of the fetus and newborn. Haemolytic disease of the newborn, also known as Haemolytic disease of the fetus and newborn, HDN, HDFN, or Erythroblastosis fetalis, is an When an Rh negative mother carries a positive fetus, she can become immunized against the Rh antigen. This usually is not important during that pregnancy, but in the following pregnancies she can develop an immune response to the Rh antigen. The mother's immune system can attack the baby's red cells through the placenta. The placenta is an Ephemeral organ present in placental Vertebrates, such as Eutherial Mammals and Sharks during Gestation Mild cases of HDFN can lead to disability but some severe cases are fatal. Rh-D is the most commonly involved red cell antigen in HDFN, but other red cell antigens can also cause the condition. The "positive" or "negative" in commonly heard blood types such as "O positive" is the Rh-D antigen. A blood type (also called a blood group) is a classification of Blood based on the presence or absence of inherited Antigenic substances on the

HDN prevention started in the 1960's when it was noted children of pregnant women who had received anti Rh immunoglobulin did not develop the disease. The 1960s decade refers to the years from the beginning of 1960 to the end of 1969 From then on, Rh negative pregnant women receive immunoglobulin doses at several moments during pregnancy and after childbirth if the baby is Rh positive. In current practice, Rh negative women of fertile age will not receive a transfusion of Rh positive blood except in desperate situations when nothing else is available.

Transfusion Transmitted Infections

See also: HIV blood screening

A number of infectious diseases (such as HIV, syphilis, hepatitis B and hepatitis C, among others) can be passed from the donor to recipient. The risk of transmitting HIV infection to Blood transfusion recipients has been drastically reduced by improved donor selection and sensitive serologic screening An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. Hepatitis C is a blood-borne infectious disease that is caused by the Hepatitis C virus ( HCV) affecting the Liver. This has led to strict human blood transfusion standards in developed countries. Standards include screening for potential risk factors and health problems among donors and laboratory testing of donated units for infection. The lack of such standards in places like rural China, where desperate villagers took part in plasmapheresis programs for money and had others' red blood cells reinjected, has produced entire villages infected with HIV. Plasmapheresis (from the Greek plasma, something molded and apheresis, taking away is the removal treatment and return of (components of Blood

Among the diseases than can be transmitted via transfusion are:

• HIV-1 and HIV-2
• Human T-lymphotropic virus (HTLV-1 and HTLV-2)
• Hepatitis A can be transmitted in blood
• Hepatitis C virus
• Hepatitis B virus
• West Nile virus All units of blood in the U. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome One of the obstacles to treatment of the Human Immunodeficiency Virus is its high genetic variability Human T-lymphotropic virus (HTLV is a Human, single-stranded RNA Retrovirus that causes T-cell Leukemia and T-cell Lymphoma Hepatitis A, (formerly known as infectious hepatitis) is an acute Infectious disease of the Liver caused by Hepatitis A virus which is Hepatitis C is a blood-borne infectious disease that is caused by the Hepatitis C virus ( HCV) affecting the Liver. West Nile virus (or WNV is a Virus of the family Flaviviridae; part of the Japanese encephalitis (JE antigenic complex of viruses it is found in S. are screened for this virus.
• Treponema pallidum (the causative agent of syphilis, usually used as more of a screening test for high risk lifestyle, the last case of transfusion transmitted syphilis was in 1965. Treponema pallidum is a Gram-negative Spirochaete Bacterium. There are at least four known Subspecies: T Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. )
• Malaria - Donors in the United States and Europe are screened for travel to malarial risk countries, and in Australia donors are tested for malaria. Malaria is a vector -borne Infectious disease caused by Protozoan Parasites It is widespread in tropical and subtropical regions including
• Chagas Disease - A screening test has been implemented for this disease in the United States, but is not yet required. Chagas disease (doença de Chagas enfermedad de Chagas mal de Chagas in both languages also called American trypanosomiasis) is a tropical Parasitic
• variant Creutzfeldt-Jakob Disease or "Mad Cow Disease" has been shown to be transmissible in blood products. Creutzfeldt-Jakob disease ( CJD) is a very rare and incurable degenerative neurological disorder ( Brain Disease) that is ultimately No test exists for this, but various measures have been taken to reduce risks.
• Some medications may be transmitted in donated blood, and this is especially a concern with pregnant women and medications such as Avodart and Propecia. Dutasteride (marketed as Avodart, Avidart, Avolve, Duagen, Dutas, Dutagen, Duprost) is a 5-alpha-reductase Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo,
• Cytomegalovirus or CMV is a major problem for patients with compromised immune systems and for neonates, but is not generally a concern for most recipients. Cytomegalovirus (CMV (from the Greek cyto-, "cell" and -megalo-, "large" is a viral

As of mid-2005, all donated blood in the United States is screened for HIV, Hepatitis B and C, HTLV-1 and 2, West Nile Virus, and Treponema pallidum. Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar. The United States of America —commonly referred to as the ^[3][4] Blood which tests positive for any of the diseases it is tested for is discarded.

When a person's need for a transfusion can be anticipated, as in the case of scheduled surgery, autologous donation can be used to protect against disease transmission and eliminate the problem of blood type compatibility. In Biology, autologous refers to cells, tissues or even Proteins that are reimplanted in the same individual as they come from "Directed" donations from donors known to the recipient were a common practice during the initial years of HIV. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome These kinds of donations are still common in developing countries.

Processing of blood prior to transfusion

Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. Examples include:

• Component separation: red cells, plasma and platelets are separated into different containers and stored in appropriate conditions so that their use can be adapted to the patient's specific needs. Red cells work as oxygen transporters, plasma is used as a supplement of coagulation factors, and platelets are transfused when their number is very scarce or their function severely impaired. Blood components are usually prepared by centrifugation. Centrifuge force makes the red cells, leukocytes, plasma and platelets form different layers into the blood bag, according to their different densities. Then, the blood bag is processed to separate those layers into their final container. Temperature also plays a capital role into component storage: plasma must be frozen as soon as possible (-18°C, 0°F or colder), red cells must be refrigerated (1-6°C, 34-43°F) and platelets are kept in continuous shaking platforms at room temperature (20-24°C, 36-75°F). There are several component preparation techniques, but two methods are common for Whole Blood derived platelets: the platelet rich plasma separation technique (mostly used in the USA) and the buffy coat technique (outside the USA).
• Leukoreduction, also known as Leukodepletion is the removal of white blood cells from the blood product by filtration. Leukoreduced blood is less likely to cause alloimmunization (development of antibodies against specific blood types), and less likely to cause febrile transfusion reactions. Leukoreduction is the removal of White blood cells (or leukocytes) from the Blood or blood components supplied for Blood transfusion. Alloimmunity is a condition in which the body gains immunity, from another individual of the same species against its own cells. Also, leukoreduction greatly reduces the chance of cytomegalovirus (CMV) transmission. Cytomegalovirus (CMV (from the Greek cyto-, "cell" and -megalo-, "large" is a viral Leukoreduced blood is appropriate for:^[5]
  • Chronically transfused patients
  • Potential transplant recipients
  • Patients with previous febrile nonhemolytic transfusion reactions
  • CMV seronegative at-risk patients for whom seronegative components are not available

Some blood banks routinely leukoreduce all collected blood. A blood bank is a cache or bank of Blood or blood components, gathered as a result of Blood donation, stored and preserved for later use in Blood transfusions There is some evidence that this reduces the risk of CJD transmission.

• Irradiation. In patients who are severely immunosuppressed and at risk for transfusion-associated graft-versus-host disease, transfused red cells may be subjected to irradiation with a targeted dose of 25 Gy, at least 15 Gy, to prevent the donor T lymphocytes from dividing in the recipient. Graft-versus-host disease (GVHD is a common complication of allogeneic bone marrow transplantation in which functional immune cells in the transplanted marrow recognize The gray (symbol Gy is the SI unit of absorbed radiation dose. ^[6] Irradiated blood products are appropriate for:
  • Patients with hereditary immune deficiencies
  • Patients receiving blood transfusions from relatives in directed-donation programs
  • Patients receiving large doses of chemotherapy, undergoing stem cell transplantation, or with AIDS (controversial). Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer.
• CMV screening. Cytomegalovirus, or CMV, is a virus which infects white blood cells. Cytomegalovirus (CMV (from the Greek cyto-, "cell" and -megalo-, "large" is a viral A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable Many people are asymptomatic carriers. In patients with significant immune suppression (e. g. recipients of stem cell transplants) who have not previously been exposed to CMV, blood products that are CMV-negative are preferred. Leukoreduced blood products sometimes substitute for CMV-negative products, since the removal of white blood cells removes the source of CMV transmission (see leukoreduction above). Leukoreduction is the removal of White blood cells (or leukocytes) from the Blood or blood components supplied for Blood transfusion. The target for leukoreduction is <5x10^6 residual leukocytes for a full unit of Red Blood Cells, and the same amount of unfiltered blood has on the order of 10^9 leukocytes^[7], so this reduces but does not elimate the risk.

Neonatal transfusion

To ensure the safety of blood transfusion to pediatric patients, hospitals are taking additional precaution to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for Cytomegalovirus. Cytomegalovirus (CMV (from the Greek cyto-, "cell" and -megalo-, "large" is a viral Most guidelines recommend the provision of CMV-negative blood components and not simply leukoreduced components for newborns or low birthweight infants in whom the immune system is not fully developed. ^[8] These specific requirements place additional restrictions on blood donors who can donate for neonatal use. Neonatal transfusions are usually top-up transfusions, exchange transfusions, partial exchange transfusions. Top-up transfusions are for investigational losses and correction of mild degrees of anemias, up to 5-15 ml/kg. Exchange transfusions are done for correction of anemia, removal of bilirubin, removal of antibodies and replacement of red cells. Ideally plasma-reduced red cells that are not older than 5 days are used. ^[9]

Terminology

The terms type and screen are used for the testing that (1) determines the blood group (ABO compatibility) and (2) screens for alloantibodies. ^[10] It takes about 45 minutes to complete (depending on the method used). The blood bank technologist also checks for special requirements of the patient (eg. need for washed, irradiated or CMV negative blood) and the history of the patient to see if they have a previously identified antibody.

A positive screen warrants an antibody panel/investigation. An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been phenotyped for commonly encountered and clinically significant alloantibodies. Donor cells may have homozygous (e. g. K+k-), heterozygous (K+k+) expression or no expression of various antigens (K-k+). The phenotypes of all the donor cells being tested are shown in a chart. The patient's serum is tested against the various donor cells using an enhancement method, eg Gel or LISS. Based on the reactions of the patient's serum against the donor cells, a pattern will emerge to confirm the presence of one or more antibodies. Not all antibodies are clinically significant (i. e. cause transfusion reactions, HDN, etc). Once the patient has developed a clinically significant antibody it is vital that the patient receive antigen negative phenotyped red blood cells to prevent future transfusion reactions. A direct antiglobulin test (DAT) is also performed as part of the antibody investigation. ^[11]

Once the type and screen has been completed, potential donor units will be selected based on compatibility with the patient's blood group, special requirements (eg CMV negative, irradiated or washed) and antigen negative (in the case of an antibody). If there is no antibody present or suspected, the immediate spin or CAC (computer assisted crossmatch) method may be used.

In the immediate spin method, two drops of patient serum are tested against a drop of 3-5% suspension of donor cells in a test tube and spun in a serofuge. Agglutination or hemolysis in the test tube is a positive reaction and the unit should not be transfused.

If an antibody is suspected, potential donor units must first be screened for the antibody by phenotyping them. Antigen negative units are then tested against the patient plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read.

If there is no time the blood is called "uncross-matched blood". Cross-matching, in Transfusion medicine, refers to the testing that is performed to determine the Compatibility of a donated unit of Blood Uncross-matched blood is O-positive or O-negative. O-negative is usually used for children and women of childbearing age. It is preferable for the laboratory to obtain a pre-transfusion sample in these cases so a type and screen can be performed to determine the actual blood group of the patient and to check for alloantibodies.

Procedure

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

• Homologous transfusions, or transfusions using the stored blood of others. These are often called Allogeneic instead of homologous.
• Autologous transfusions, or transfusions using the patient's own stored blood. In Biology, autologous refers to cells, tissues or even Proteins that are reimplanted in the same individual as they come from

Donor units of blood must be kept refrigerated to prevent bacterial growth and to slow cellular metabolism. The transfusion must begin within 30 minutes after the unit has been taken out of controlled storage.

Blood can only be administered intravenously. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. It therefore requires the insertion of a cannula of suitable caliber. A cannula (from Latin "little reed" plural cannulae) or canula is a tube which can be inserted into the body often for the delivery or removal

Before the blood is administered, the personal details of the patient are matched with the blood to be transfused, to minimize risk of transfusion reactions. Clerical error is a significant source of transfusion reactions and attempts have been made to build redundancy into the matching process that takes place at the bedside. A clerical error is an error on part of an office worker often a Secretary or personal assistant In Medicine, a transfusion reaction is any Adverse event which occurs because of a Blood transfusion. In Engineering, redundancy is the duplication of critical components of a system with the intention of increasing reliability of the System, usually

A unit (up to 500 ml) is typically administered over 4 hours. In patients at risk of congestive heart failure, many doctors administer a diuretic to prevent fluid overload, a condition called Transfusion Associated Circulatory Overload or TACO. Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply A diuretic is any Drug that elevates the rate of urination ( Diuresis) Acetaminophen and/or an antihistamine such as diphenhydramine are sometimes given before the transfusion to prevent other types of transfusion reactions. Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication A histamine antagonist is an agent which serves to inhibit the release or action of Histamine. Pharmacological action Diphenhydramine (dye fen hye' dra meen works by blocking the effect of histamine at H1 receptor sites In Medicine, a transfusion reaction is any Adverse event which occurs because of a Blood transfusion.

Blood donation

Main article: Blood donation

Blood is most commonly donated as whole blood by inserting a catheter into a vein and collecting it in a plastic bag (mixed with anticoagulant) via gravity. Whole Blood is the term used in Transfusion medicine for human Blood from a standard Blood donation. In the Circulatory system, a vein is a Blood vessel that carries Blood back toward the Heart (as opposed to Artery, a blood vessel An anticoagulant is a substance that prevents coagulation; that is it stops Blood from clotting Gravitation is a natural Phenomenon by which objects with Mass attract one another Collected blood is then separated into components to make the best use of it. Aside from red blood cells, plasma, and platelets, the resulting blood component products also include albumin protein, clotting factor concentrates, cryoprecipitate, fibrinogen concentrate, and immunoglobulins (antibodies). Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood Blood plasma is the Liquid component of Blood, in which the Blood cells are suspended Platelets, or Thrombocytes, are small cytoplasmic bodies derived from cells They circulate in the Blood of Mammals and are involved Human serum albumin is the most abundant Protein in Human Blood plasma. Proteins are large Organic compounds made of Amino acids arranged in a linear chain and joined together by Peptide bonds between the Carboxyl Cryoprecipitate, also called "Cryoprecipitated Antihemophilic Factor" "Cryoprecipitated AHF" and most commonly just "cryo" is a frozen blood product prepared Fibrin (also called Factor Ia) is a Protein involved in the clotting of blood Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily Red cells, plasma and platelets can also be donated individually via a more complex process called apheresis.

In developed countries, donations are usually anonymous to the recipient, but products in a blood bank are always individually traceable through the whole cycle of donation, testing, separation into components, storage, and administration to the recipient. A blood bank is a cache or bank of Blood or blood components, gathered as a result of Blood donation, stored and preserved for later use in Blood transfusions This enables management and investigation of any suspected transfusion related disease transmission or transfusion reaction. In Medicine, a transfusion reaction is any Adverse event which occurs because of a Blood transfusion. In developing countries the donor is sometimes specifically recruited by or for the recipient, typically a family member, and the donation immediately before the transfusion.

Risks to the recipient

Main article: Transfusion reaction

There are risks associated with receiving a blood transfusion, and these must be balanced against the benefit which is expected. In Medicine, a transfusion reaction is any Adverse event which occurs because of a Blood transfusion. The most common adverse reaction to a blood transfusion is a febrile non-hemolytic transfusion reaction, which consists of a fever which resolves on its own and causes no lasting problems or side effects.

Hemolytic reactions include chills, headache, backache, dyspnea, cyanosis, chest pain, tachycardia and hypotension. Dyspnea or dyspnoea (pronounced disp-nee-ah, IPA /dɪsp'niə/ from Latin dyspnoea, from Greek dyspnoia from

Blood products can rarely be contaminated with bacteria; the risk of severe bacterial infection and sepsis is estimated, as of 2002, at about 1 in 50,000 platelet transfusions, and 1 in 500,000 red blood cell transfusions. Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused See also 2002 (disambiguation Year 2002 ( MMII) was a Common year starting on Tuesday of the Gregorian calendar. ^[12]

There is a risk that a given blood transfusion will transmit a viral infection to its recipient. As of 2006, the risk of acquiring hepatitis B via blood transfusion in the United States is about 1 in 250,000 units transfused, and the risk of acquiring HIV or hepatitis C in the U. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. The United States of America —commonly referred to as the Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Hepatitis C is a blood-borne infectious disease that is caused by the Hepatitis C virus ( HCV) affecting the Liver. S. via a blood transfusion is estimated at 1 per 2 million units transfused. These risks were much higher in the past before the advent of second and third generation tests for transfusion transmitted diseases. The implementation of Nucleic Acid Testing or "NAT" in the early 00's has further reduced risks, and confirmed viral infections by blood transfusion are extremely rare in the developed world.

Transfusion-associated acute lung injury (TRALI) is an increasingly recognized adverse event associated with blood transfusion. In Medicine, transfusion related acute lung injury (TRALI is a serious Blood transfusion complication characterized by the acute onset of non-cardiogenic 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. Respiratory failure is a medical term for inadequate Gas exchange by the Respiratory system. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Pulmonary Edema (American English or oedema (British English is swelling and/or fluid accumulation in the Lungs It leads to impaired gas exchange and may cause In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. ^[13] 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%. ^[14]. Although the cause of TRALI is not clear, it has been consistently associated with anti HLA antibodies. Because anti HLA strongly correlate with pregnancy, several transfusion organisations (Blood and Tissues Bank of Cantabria, Spain, National Health Service in Britain) have decided to use only plasma from men for transfusion.

Other risks associated with receiving a blood transfusion include volume overload, iron overload (with multiple red blood cell transfusions), transfusion-associated graft-vs.-host disease, anaphylactic reactions (in people with IgA deficiency), and acute hemolytic reactions (most commonly due to the administration of mismatched blood types). Transfusion-associated Graft versus host disease (TA-GvHD is a rare complication of Blood transfusion, in which the donor T lymphocytes mount an immune Anaphylaxis is an acute systemic (multi-system and severe Type I Hypersensitivity allergic reaction in humans and other Mammals Selective immunoglobulin A (IgA deficiency is a relatively mild genetic Immunodeficiency. Hemolysis (or haemolysis)—from the Greek Hemo-, Greek meaning blood - Lysis, meaning to break open—is the breaking

Transformation from one type to another

Scientists working at the University of Copenhagen reported in the journal Nature Biotechnology in April 2007 of discovering enzymes, which potentially enable blood from groups A, B and AB to be converted into group O. These enzymes do not affect the Rh group of the blood. ^[15][16]

Objections to blood transfusion

Objections to blood transfusions may arise for personal, medical, or religious reasons. For example, Jehovah's Witnesses object to blood transfusion primarily on religious grounds, although they have also highlighted possible complications associated with transfusion. Jehovah's Witnesses is a restorationist, millenialist Christian denomination Jehovah’s Witnesses believe that the Bible prohibits eating blood and that this includes the storage and transfusion of Blood, including in cases of emergency

Animal blood transfusion

Veterinarians also administer transfusions to animals. A veterinarian ( American English) or a Veterinary surgeon ( British English) often shortened to vet, is a Physician Various species require different levels of testing to ensure a compatible match. In Biology, a species is one of the basic units of Biological classification and a Taxonomic rank. For example, cats have 3 known blood types, cattle have 11, dogs have 12, pigs 16 and horses have 34. WikipediaManual of Style (spelling, articles should conform to one overall spelling style of English typically the one most linked to the article topic (if it is geographic Cattle, colloquially referred to as cows, are domesticated Ungulates a member of the Subfamily Bovinae of the family The dog ( Canis lupus familiaris) is a domesticated Subspecies of the gray wolf, a Mammal of the Canidae family of the order Pigs, also called hogs or' swine', are Ungulates which have been domesticated as sources of food leather and similar products since ancient times The horse ( Equus caballus) is a hoofed ( Ungulate) Mammal, one of eight living species of the family Equidae. However, in many species (especially horses and dogs), cross matching is not required before the first transfusion, as antibodies against non-self cell surface antigens are not expressed constitutively - i. e. the animal has to be sensitized before it will mount an immune response against the transfused blood.

The rare and experimental practice of inter-species blood transfusions is a form of xenograft. Xenotransplantation ( xeno- from the Greek meaning "foreign" is the transplantation of living cells tissues or organs

Blood transfusion substitutes

Main article: Blood substitutes

As of mid-2006, there are no widely utilized oxygen-carrying blood substitutes for humans; however, there are widely available non-blood volume expanders and other blood-saving techniques. Blood substitutes, often called artificial blood, are used to fill fluid volume and/or carry Oxygen and other Blood gases in the Cardiovascular system Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Blood substitutes, often called artificial blood, are used to fill fluid volume and/or carry Oxygen and other Blood gases in the Cardiovascular system These are helping doctors and surgeons avoid the risks of disease transmission and immune suppression, address the chronic blood donor shortage, and address the concerns of Jehovah's Witnesses and others who have religious objections to receiving transfused blood.

A number of blood substitutes are currently in the clinical evaluation stage. Most attempts to find a suitable alternative to blood thus far have concentrated on cell-free hemoglobin solutions. Blood substitutes could make transfusions more readily available in emergency medicine and in pre-hospital EMS care. Emergency Medicine is a speciality of Medicine that focuses on the Diagnosis and treatment of acute illnesses and injuries that require immediate medical attention Emergency medical services (abbreviated to the initialism "EMS" in many countries are a branch of Emergency services dedicated to providing out-of-hospital If successful, such a blood substitute could save many lives, particularly in trauma where massive blood loss results.

References

Academic resources

• Transfusion, ISSN: 1537-2995 (electronic) 0041-1132 (paper)

See also

• Blood doping
• Patient safety
• Autotransfusion

External links

• Jehovah's Witnesses Bloodless Videos
• BBC article on blood substitute
• The Serious Hazards of Transfusion (SHOT)
• New Scientist article on transfusion-associated lung injury

• Breakthrough makes all blood types universal - Joyce Howard Price, The Washington Times - April 4, 2007
• Transfusion Medicine: The Basis and the Future - A Review from the Science Creative Quarterly
• Blood Transfusions After Cardiac Surgery Discredited
• Circular of Information, the US standards for blood and blood components for transfusion. Blood doping is the practice of boosting the number of Red blood cells (RBCs in the circulation in order to enhance athletic performance Patient safety is a new healthcare discipline that emphasizes the reporting analysis and prevention of Medical error that often lead to adverse healthcare events Autotransfusion is a process when a person receives their own blood for a transfusion instead of banked donor blood The Washington Times is a daily Broadsheet Newspaper published in Washington D

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