Categories Of People In Need Of Blood Transfusion

There are various conditions that require an individual to receive blood in form of blood transfusion but it can all be centred round having a significant reduction in the entire blood volume within the circulation system or deficiency in any of the blood components which in turn deters their functions.

Transfusion can involve different blood components thus there can be;

  • Red cell transfusion

  • Platelets transfusion

  • Granulocyte transfusion

  • Transfusion of hematopoietic progenitor cells

  • Transfusion of plasma and other plasma concentrates

Categories of people in need of red cell transfusion / indication for red cell transfusion.

Red cell transfusion should be based on careful assessment of each patient’s unique clinical situation. However several guidelines have been issued by several organisations such as National Institute of Health consensus conference on perioperative transfusion of red cells, American society of anaesthesiologists, American College of Physicians and Canadian Medical association. These guidelines recommend that blood not be transfused prophylactically and that for patients who are not critically ill, the threshold for transfusion should be a haemoglobin level of 6-8g/dl while a  threshold of 10g/dl may be considered for patients who are considered high risk.

  1. Hypovolemia( low blood volume) due to haemorrhage (bleeding) in which ?30% of the blood volume is lost. This could be from trauma such as road traffic accident, stab injury, gunshot injury, gastrointestinal bleeding from bleeding peptic ulcer disease, cancers and so on.

  2. Patient undergoing major surgeries in which blood loss is anticipated so as to improve oxygen delivery according to physiologic need of the recipient.

  3. Cases of nutritional deficiency such as can be found in cases of iron, folate, or vitamin B12 . The categories of people at risk of such deficiencies would be malnourished or undernourished population, and pregnant women.

  4. Hereditary red cell disorders; in such cases, there patients have disorders in which the red cells are either not optimally produced or they are not normal. Example of such conditions include

    1. Thalassemias

    2. Bone marrow hyperplasia

    3. Sickle cell disease.

 

Platelet Transfusion.

Platelet transfusion is often life saving when the haemorrhage (bleeding) is caused by thrombocytopenia (decreased platelet level). It is necessary

To prevent haemorrhage (bleeding) in patients with thrombocytopenia or platelet function defects such as in leukaemia, lymphoma, and idiopathic thrombocytopenia

 

Transfusion of Granulocytes.

Category of people that receive granulocyte transfusion are cases of sever neutropenia ( low level of white blood cell) which has been complicated with proven or highly probable bacterial or fungal infection that is unresponsive to antibiotics or antifungal as in case of immunosuppressedpatient such as AIDS. It is not often carried out in our environment though as granulocyte concentrate is not readily available thus whole blood is often transfused in such cases.

Transfusion of Hematopoietic progenitor cells.

Transplantation or transfusion of hematopoietic stem cells derived from bone marrow, peripheral blood, or umbilical cord blood is indicated in persons with;

  1. Myeloma

  2. Malignant lymphoma

  3. Acute myeloblastic leukaemia and other hematologic malignancies.

Transfusion of plasma and plasma concentrates.

They are indicated for use in patients in which the clotting proteins and factors are needed. Examples include

  1. Fresh frozen plasma which is used in patients who are deficient in multiple coagulation factors or in a single factor when the single concentrate is not available. Also used in patients where there is need for reversal of anticoagulant drugs such as warfarin.

  2. Cryoprecipitate which is rich in factor viii and fibrinogen is used in the treatment of conditions such as hypofibrinogenemia and was in the past used for the treatment of haemophilia A.

 

Written and compiled by;

Dr Rafiat Ajala-Lawal

Medical expert and lecturer,

Department of Medical Biochemistry

Nile University of Nigeria.