Blood transfusion

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Taking blood from a vein in the arm

Blood transfusion refers to the intravenous administration (transfer or infusion ) of red blood cell concentrates (erythrocytes = red blood cells) or (very rare today) of (whole) blood . Originate the blood or the blood components from a foreign blood donor , is homologous blood and a foreign blood donation ( Allotransfusion ). Blood donor and blood recipient same person, it is called an autologous blood donation ( autotransfusion ). It is an application of cellular blood products, similar to the administration of platelet and granulocyte concentrates.

A prerequisite for a successful transfusion is that the administered blood or the blood components are blood group compatible. Every blood transfusion requires the patient's consent after a doctor has informed him accordingly, which can only be deviated from in justified emergency situations.

Transferred blood components

Red cell concentrate (cellular blood components)
Platelet concentrate (cellular blood components)

Whole blood transfusions are rarely performed these days. As a rule, the blood is now separated into its components and transfused component by component.

This has two advantages: On the one hand, the patient only receives the blood components that are missing, for example only erythrocytes (red blood cells) in the case of anemia , only plasma in the case of a lack of plasma proteins . On the other hand, the blood components can be stored in separate form for much longer. Whole blood must be stored at at least 4 ° C, otherwise the erythrocytes and especially the blood platelets ( thrombocytes ) will be damaged. At this temperature, many plasma proteins (especially the coagulation factors ) lose their effectiveness within days. On the other hand, if you separate the plasma, you can freeze it and store it for months without any loss of function.

To be transfused:

Indication for the transfusion of blood components

Blood components are used at

Hemoglobin (Hb) is used to measure whether therapy is indicated . The normal Hb values ​​for men are 8.6–11.2 mmol / l (14–18 g / dl), for women 7.4–10 mmol / l (12–16 g / dl). (For the peculiarity of determining the Hb values ​​in mmol / l, see hemoglobin.) There are rare forms of congenital hematopoietic disorders in which the patient has had a very low Hb value since birth but is able to cope well with everyday life. On the other hand, people with pronounced cardiac insufficiency (cardiac insufficiency) and other pre-existing cardiac diseases such as coronary heart disease can already have Hb values ​​below 9.0 g / dl symptoms in the sense of shortness of breath, poor circulation, etc. When a transfusion is to be carried out must therefore be decided individually. Basically, anemia that develops slowly (e.g. over months) is better tolerated by the patient than one that occurs as a result of massive bleeding within hours.

The SANGUIS study commissioned by the EU Commission (1994) found that the decisions about when a blood transfusion should be carried out and how much should be transfused are often made very differently between individual hospitals in Europe. The amount prescribed differed by a factor of 10 depending on the hospital and region. These results are taken as an indication that too much blood is generally being transfused.

Plasma or platelet transfusions can also be used to prevent bleeding in patients with bleeding disorders prior to various surgical procedures. Cochrane Hematology has published some reviews on this.

In addition, platelet transfusions may also be necessary in patients with haematological disorders who are undergoing chemotherapy or a stem cell transplant.

Compatibility (compatible blood groups)

Blood group compatibility with erythrocyte transfusion ("red blood")
receiver Donor
0 0
A. A and 0
B. B and 0
FROM AB, A, B and 0
Blood group compatibility with blood plasma
receiver Donor
0 AB, A, B and 0
A. A and AB
B. B and AB

When transfusing cellular blood products and blood plasma, the various blood group characteristics must be taken into account. Only blood that is compatible with the blood group may be transferred, otherwise there will be a life-threatening immunological reaction to the foreign blood. The AB0 blood group system and the Rhesus factor are particularly important in this context . While in most other blood group systems antibodies against foreign traits are only formed after a transfusion and therefore would not interfere until a few days later at the earliest, in the case of a new transfusion, in the AB0 system such antibodies are basically present against all AB0 traits that the recipient has himself does not have.

If a person with blood type “A” receives a type “B” donation, a hemolytic reaction can be triggered that destroys many red blood cells. When a Rh-negative person is exposed to blood from a Rh-positive donor, they can develop Rhesus antibodies, which cause Rh-positive red blood cells to be destroyed. Because of the substances released from the cells in this way, the destruction of erythrocytes is disadvantageous and can be fatal.

For AB0, the blood group compatibility for transfusion of plasma is exactly the opposite of the transfusion of erythrocytes (see adjacent tables), i.e. precisely when person A can donate red blood to person B, person B can also donate plasma to person A.

Side effects and risks

See also: hemovigilance

As with any other drug, blood products can cause adverse reactions and side effects.

so-called bedside test to check blood groups

Immunological side effects

A serious cause of a transfusion incident is the mix-up of blood supplies. The transfusion of AB0-incompatible blood can lead to an acute haemolytic transfusion reaction (HTR). Therefore, immediately before the transfusion, the bedside test at the patient's bedside is required to test the recipient's (AB0) blood group on a test card. A distinction is made between the acute haemolytic transfusion reaction (AHTR) and the delayed (VHTR).

Nichthämatolytische transfusion reactions (NHTR) include allergic reactions to anaphylaxis , the incidence of purpura , as well as transfusion-related acute lung injury syndrome ( transfusion related acute lung injury , TRALI). This is one of the most dangerous transfusion reactions (frequency 1: 2500 to 1: 100,000). Damage to the pulmonary vessels (trauma, surgery, inflammation, poisoning) with massive fluid overload in the lungs, which leads to lung failure . The treatment is intensive medical care , usually ventilation is necessary. The mortality is up to 15%.

When transmitted to immunocompromised patients, white blood cells capable of replication can also cause the graft-versus-host reaction (transplant-versus-host reaction), in which the foreign leukocytes attack the recipient organism. For this reason, since 2001 only those whole blood preparations , erythrocyte concentrates and platelet concentrates have been marketed in Germany with a leukocyte content of less than 1,000,000 per unit (blood reserve) ( leukocyte-depleted preparations ). Irradiation of blood products can also reduce the risk of a GvH reaction.


Bacteria (e.g. Treponema pallidum ) and viruses ( HIV , hepatitis C virus (HCV), hepatitis B virus (HBV)) and, rarely, protozoa and prions can be transmitted with blood .

Today, thanks to careful donor selection and the introduction of molecular biology testing methods, the risk of transmission of HBV, HCV and HIV is extremely low (less than 1: 1 million each). Until these test procedures were developed in the mid-1980s, over 1,500 people in Germany had been infected with HIV through blood transfusions , hemophiles in particular were affected by HIV and HCV infections. Since 1985, the number of transfusion-related HIV transmissions has decreased dramatically thanks to antibody tests and the highly specific polymerase chain reaction (PCR). Antibody testing was introduced for hepatitis C in 1991. Before that, HCV was the main cause of the not uncommon post-transfusion hepatitis. The most common virus transmissions concern the cytomegalovirus (1:10 to 1:30) and Epstein-Barr virus (1: 200), which is relevant in immunosuppressed patients. From October 2019, tests for hepatitis E will be mandatory .

Bacterial infections almost exclusively affect platelet preparations that must be stored at room temperature.

Other side effects

Other possible side effects are iron overload ( hemosiderosis ) during long-term transfusion therapy and the effects of the citrate contained , hypothermia and volume overload of the body with large transfusion volumes .

So far, it has not been clear whether blood donations from patients with ( subclinical ) cancer pose an increased risk for the recipient of developing cancer himself later. A study published in the journal The Lancet in 2007 showed that this is not the case: even if the blood donor develops cancer at a later date, a blood transfusion does not increase the risk of cancer for the recipient.

In an epidemiological study in the September 15, 2009 issue of the International Journal of Cancer, however, it was shown that administered blood transfusions increase the likelihood of developing lymphatic cancer.

Blood donor

Careful selection of blood donors is critical to the success of a blood transfusion. The following criteria are specified in the haemotherapy guideline:

Examination of the blood donor

  • Age for first donation 18 - 60 years, for repeat donation - 68 years
  • Body weight at least 50 kg
  • Hemoglobin at least 7.75 mmol / l blood in female and 8.35 in male donors
  • Systolic blood pressure : 100 - 180 mm Hg, diastolic: below 100 mm Hg, pulse rate 50 - 110 / min
  • no fever
  • Skin at the puncture site free of lesions (no injury or inflammation)

Donor exclusion for the following diseases

  • severe heart and vascular diseases
  • serious diseases of the central nervous system
  • clinically relevant bleeding disorders
  • repeated fainting or convulsions
  • severe active or chronic diseases of the gastrointestinal, urogenital, hematological, immunological, metabolic, renal or respiratory system
  • malignant, invasive tumors
  • Diabetes mellitus requiring insulin

Donor exclusion for the following infectious diseases

Donor exclusion if there is a risk of spongiform encephalopathy (TSE) transmission

  • after treatment with human pituitary extracts
  • after receiving dura mater or corneal transplants (human meninges or corneas of the eye)
  • in the case of proven or suspected TSE ( Creutzfeldt-Jakob disease or other TSE)
  • Creutzfeldt-Jakob disease or another TSE in blood relatives
  • after staying in the UK for more than 6 months in 1980–1996
  • after surgery or transfusion in the UK after January 1, 1980

Donor exclusion in case of risky lifestyle

  • Drug addiction
  • sexual risk behavior

Temporary deferral of donors

The doctor in charge of the blood donation facility can determine a time-limited donation exclusion for various reasons. Reasons can be, for example, staying in a malaria area or unclear, unexplained symptoms of an illness.

As with all medical interventions, a blood donation may only take place after detailed information about possible side effects and complications and consent.


Autologous hemotherapy

The autologous treatment process means the collection and use of the patient's own blood. This can be done through an autotransfusion or acute normovolemic hemodilution (blood collection and replacement by infusion with subsequent re-transfusion) prior to the operation, as well as automatic autotransfusion (MAT, autologous blood recovery from operating blood) and the use of blood-saving surgical techniques. The combination of different methods increases the effectiveness.

Blood substitutes

Artificial blood substitutes based on perfluorocarbon and hemoglobin preparations are intensively researched, but not yet used routinely.

Plasma substitutes and plasma expanders

Synthetic plasma substitutes offer an alternative to blood transfusions under certain circumstances: Blood loss ( hypovolemia ) can be compensated for by blood-free infusions. Artificially produced colloidal solutions based on dextran , hydroxyethyl starch (HES) or gelatin , which are used to "fill up" the amount of fluid and maintain blood pressure, are suitable . These colloidal volume substitutes can promote acute renal insufficiency.

The advantages are a lower risk of intolerance or infections, cheaper production and storage and acceptance by patients who reject blood transfusions for ideological or ethical or moral or religious reasons (e.g. many Jehovah's Witnesses ). Disadvantages are possible allergic reactions with gelatin-based plasma substitutes, impairment of blood clotting, and the fact that they do not contain any oxygen carriers (hemoglobin).

Legal basis

The transfusion system in Germany is regulated on a legal level by the Transfusion Act. The concrete implementation of the regulations can be found in the hemotherapy guidelines and guidelines of the German Medical Association, some of which specify in great detail how the individual steps from the selection of the donor to the monitoring of the recipient are to be carried out.

Inpatient and outpatient health care facilities that use blood products (e.g. hospitals, medical practices, etc.) are obliged by Section 15 of the Transfusion Act to set up a quality assurance system. Quality assurance encompasses the entirety of the personal, organizational, technical and normative measures that are suitable to secure and improve the quality of patient care and to further develop it in accordance with the medical and scientific knowledge (Sections 135a, 136 and 137 Fifth Book of the Social Code (SGB V)).

As part of the quality assurance system, the qualifications and tasks of the responsible persons must be specified.

It is a legal requirement for all institutions that use blood products to order one

  • Transfusion officers (for the entire facility),
  • Transfusion Officer (for each treatment center / department)
  • Quality officer (for the entire facility).

Facilities with acute care must also set up a commission for transfusion medicine matters (transfusion commission).

Legal requirements

In general, the administration of blood and blood products (cellular and non-cellular blood products) represents the use of a drug. Therefore, these blood preparations are drugs within the meaning of Section 4, Paragraph 2 of the German Medicines Act (AMG) . Therefore, one also counts the sera (non-cellular blood components) from human blood and the cellular blood components that are intended for the production of active substances or preparations, within the meaning of § 2 (1) and § 4 (2 and 3) of the AMG with § 2 No. 3 Transfusion Act (TFG) on medicinal products. They are therefore subject to the provisions of pharmaceutical law.


The beginnings

Very early on, blood was considered something very precious; This is how blood was transmitted in ancient times, but it was administered as a drink (for example, animal blood as a remedy for epilepsy). The administration of animal or human blood (as a drink or rubbing) was based primarily on the idea of ​​being able to transfer strength, vitality, health, character or to achieve a life extension through rejuvenation. The description of the first tentative beginnings of therapy with blood seems gruesome nowadays: In July 1492 the dying Pope Innocent VIII - on the recommendation of a doctor - is said to have drunk the blood of three ten-year-old boys. It was supposedly hoped to rejuvenate the elderly prince of the church. The three children allegedly did not survive the experiment and the Pope remained as ill as before. Since the only report of this blood transfer comes from the pen of the radical anti-papist Stefano Infessura , the veracity is very controversial. But even the Florentine doctor Marsilio Ficino had recommended as a gerocomic "rejuvenation agent " as early as 1489 that old people should suck one or two ounces from the freshly opened left arm vein like the leeches.

The first dose of blood that has been preserved with a citrate solution. On November 9, 1914 at Rawson Hospital in Buenos Aires ( Argentina ) under Luis Agote (1868-1954).
Syringe from World War II for direct blood transfusion between two people

It was not until the English scholar William Harvey discovered blood circulation in the 17th century and intravenous injection was invented in 1656 that the basis for infusions and transfusions could be created.

The Tuscan doctor Francesco Folli (1624–1685) reported in 1680 about a blood transfusion he carried out for the first time in 1654. The British Richard Lower was the first to successfully transfer blood to two dogs in February 1666. A year later, the French Jean-Baptiste Denis and Pièrre Emmerez transferred animal blood (from the lamb) to humans for the first time . However, due to many deaths, the blood transfusion was controversial. The surgeon Lorenz Heister already has a chapter in his textbook from 1718 with the title Chirurgia transfusoria . The first successful transfusion using non-coagulable blood in animals was described in 1821 by Jean Louis Prévost and Jean-Baptiste Dumas . The English obstetrician James Blundell was called the "father of modern transfusion" . In 1825, he successfully transferred human blood to a woman who had been bled in childbirth. The first documented successful blood transfusion in Germany was carried out in 1828 by the Heilbronn doctor Georg Klett . Although only every second transfusion was successful, blood transfusion became the accepted method of treatment for massive blood loss. The French surgeon Alphonse Guérin (1817–1895) developed a method of direct blood transfusion.

Several blood transfusions were carried out in the Franco-Prussian War of 1870/71.

Leonard Landois was a pioneer in the study of blood transfusions. He devoted himself to researching the physiological consequences of heterologous transfusion and described the phenomena of agglutination . In 1875 he showed that when erythrocytes from one species are mixed with blood serum from another species, the red blood cells typically clump together and sometimes burst ( hemolysis ).

The blood was intensively researched by natural scientists in the 19th century. The Viennese doctor Karl Landsteiner laid the foundation for modern transfusion medicine when he and his colleagues discovered blood groups A, B, 0 and AB in 1901 and 1902. Over time, people switched from direct transfusion between two people to indirect transfusion using a bank of blood. This was made possible in 1914 by the addition of sodium citrate, which prevents the blood from clotting outside the body (an attempt was previously made to "defibrinate" the blood by means of long agitation and thus make it incoagulable before the injection via syringes). An addition of sugar made it possible to store blood ( Albert Hustin , Richard Lewisohn ).

The first blood transfusion service

The first blood transfusion service was founded in London in October 1921 - even then with the help of voluntary and unpaid donors. The Red Cross was also involved in the lead back then. The Chamberville Division of the British Red Cross in London received an urgent call from King's College Hospital. The hospital asked if anyone would be willing to donate blood for someone who was seriously ill. Percy Oliver, volunteer secretary for the division, and six other Red Cross employees spontaneously volunteered - one of them had the correct blood type.

In order to be better prepared for such cases in the future, Oliver founded the first blood transfusion service - and even then set the condition: the blood donation had to be voluntary and not paid for.

In the direct transfer from the blood donor to the recipient, for example with the "Becksche Mühle", a small amount was first transferred, then waiting for about ten minutes to see whether symptoms of shock occurred (nausea, fainting, kidney pain), and then the transfusion was continued.

The discovery of other blood group systems, but above all the rhesus trait, by American researchers around 1940 brought additional advances in terms of the safety of blood transfusions and led to the development of a new scientific area, immunohematology. With the division of the blood into its components, the procedure discovered by Cohn and still simplified to this day enabled the targeted and best possible use of a blood donation for the dependent patients from 1941 onwards. The glass bottle was replaced by the multiple plastic bag and “made-to-measure hemotherapy” with blood components established itself worldwide.


1628 William Harvey discovers blood circulation.
February 1666 The English doctor Richard Lower successfully transfuses dogs for the first time.
June 15, 1667 Jean-Baptiste Denis performs the first recorded successful blood transfer from animal blood (a lamb) to human (a 15 year old boy). In the same year Richard Lower also reports a successful lamb-to-human blood transfusion.
1668 The first blood transfusion on German soil was carried out by Matthäus Gottfried Purmann in Frankfurt (Oder) . A gentleman Welslein was transferred lambs blood of leprosy ( leprosy cured) - 200 years before the Vienna pathologist Karl Landsteiner was born of the AB0 blood group system discovered.
September 1, 1818 The first human-to-human blood transfusion took place in London's St. Guy's Hospital. James Blundell's patient received about half a liter of blood from various donors. He did not survive the procedure.
1873 The doctor Franz Gesellius proposed the transfusion of lamb's blood, which Oscar Hasse carried out in several cases that same year . As a result, numerous transfers of lamb's blood to humans are carried out and published in specialist publications. The German Congress of Surgeons in 1874 also dealt with the question of lamb blood infusions on humans.
1875 After detailed physiological studies and the evaluation of case studies, Leonard Landois rejects the lamb blood transfusion and warns of the fatal potential of this operation. Landois describes the process of agglutination or hemolysis without recognizing its meaning.
1884 Salt solution is used as a blood substitute because of the increased defense reactions against milk.
1901 The Viennese pathologist Karl Landsteiner discovered the AB0 blood group system. He received the Nobel Prize in 1930 for this discovery.
1902 Alfred von Decastello and Adriano Sturli discover the fourth main blood group AB.
1907 Ludvig Hectoen suggests the cross test as a tolerance test in order to rule out incompatible combinations. As a result, Reuben Ottenberg recognized the Mendelian inheritance traits and that group 0 could serve as a universal donor.
1914 Luis Agote from Hospital Rawson de Buenos Aires ( Argentina ) successfully applied a blood bank preserved with citrate solution on November 9, 1914.
1915 Richard Lewisohn of Mount Sinai Hospital in New York successfully uses sodium citrate as an anticoagulant. This eliminates the need to transfer the blood directly from the donor to the recipient.
1925 Together with Phillip Levine, Karl Landsteiner discovered 3 other blood groups: N, M and P.
1930s Oehlecker sample , tolerance test (now out of use)
December 8, 1933 Start of blood donation in Germany (direct transfusion with Beck'schen Mühle in Leipzig)
1939/1940 The Rhesus (Rh) blood group system was discovered by Karl Landsteiner , Alexander Solomon Wiener , Philip Levine and Rufus E. Stetson and identified as the cause of most negative reactions. Reliable tests reduce the negative reactions.
1940 Edwin Cohen developed a method to split blood plasma into fractions. As a result, albumin (increases colloid osmotic pressure), gammaglobulin (former name for antibodies ) and fibrinogen (the basis for coagulants such as factor VIII, stops bleeding) became available for clinical use.
Early 1940s Samuel Mitja Rapoport finds an addition that extends the shelf life of the blood reserve to three weeks.
1963 The first intrauterine blood transfusion is achieved by William Liley in New Zealand.
1985 The first HIV tests for blood products are introduced in the USA.
1987 Two indirect tests for hepatitis B are developed and used: the hepatitis B core antigen test (delayed days to weeks) and the alanine aminotransferase (ALT) test, which does not detect the increased ALT until 4 weeks to a maximum of 12 weeks after infection can.
1990 The first test for hepatitis C was introduced.
1992 Donor blood is tested for HIV-1 and HIV-2 antibodies.
1996 Start of tests for the HIV antigen p24. This improved and accelerated the tests, since the antibodies were no longer detected indirectly, which can only be detected 3–5 weeks after infection, but a special virus protein.
1999 The nucleic acid amplification technique (NAT = PCR) is implemented. NAT can directly determine the genetic components of HCV and HIV.
2001 The leukocyte depletion is mandatory.
2003 Introduction of predonation sampling .
2005 Cultivation of hepatitis C viruses
today ... up to 40 characteristics and the tissue antigens responsible for transplant rejection are taken into account when determining tolerance . There are 15 to 19 known blood group systems . Over 400 known red blood cell antigens have been recognized and characterized. Theoretically, up to 300 rhesus blood types can be recognized in the rhesus blood group system.

Blood transfusion in animals


In cats , a blood transfusion may be necessary if there is severe blood loss or anemia from another cause, such as feline neonatal isoerythrolysis or renal insufficiency . A blood group determination is absolutely necessary before the transfusion. Donor animals should weigh more than 5 kg, be free of infectious diseases and regularly dewormed. The hematocrit should be above 35. The blood is taken from the external jugular vein , which usually requires anesthesia. The maximum amount of blood drawn should not exceed 11 ml / kg. The blood is supplied to the recipient animal via the cephalic vein ; in the case of very small cats or difficult access conditions, it can also be transferred to the bone marrow of the thigh bone.

See also


Web links

Portal: Medicine  - Overview of Wikipedia content on medicine
Wiktionary: blood transfusion  - explanations of meanings, word origins, synonyms, translations
Wiktionary: Transfusion  - explanations of meanings, word origins, synonyms, translations

Individual evidence

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