Indications and contraindications for blood transfusion

Indications for blood transfusion

Blood transfusion is widely used by surgeons, internists, and obstetrician-gynecologists. The appropriateness of the procedure is determined by strict medical criteria.

Absolute indications include life-threatening conditions:

• Acute blood loss.
• Shock of various etiologies.
• Ongoing hemorrhage.
• Severe anemia.
• Severe, massive, and traumatic surgeries (including procedures using cardiopulmonary bypass).

In addition, there are other indications for which the procedure may be scheduled electively. These include anemias of various origins, specific blood disorders, severe intoxications, and severe purulent-inflammatory diseases.

Contraindications and absolute vital indications

Complications during blood transfusions (up to fatal outcomes) are most often associated with insufficient knowledge of transfusiology fundamentals, technique violations, or incorrect determination of indications and contraindications.

The procedure is contraindicated in the following pathologies:

1. Cardiac decompensation (due to heart defects, myocarditis, myocardial cardiosclerosis).
2. Septic endocarditis.
3. Stage III hypertension.
4. Cerebrovascular accidents.
5. Thromboembolic disease.
6. Pulmonary edema.
7. Acute glomerulonephritis.
8. Severe hepatic impairment.
9. Generalized amyloidosis.
10. Allergic conditions and bronchial asthma.

Important exception: if the patient has absolute vital indications (e.g., acute massive blood loss, shock, severe traumatic surgery, or ongoing hemorrhage), the blood transfusion is performed on an emergency basis, regardless of the presence of any contraindications.

Transfusion history and "at-risk recipients"

Before starting the procedure, a thorough history must be taken to identify past transfusions, reactions to them, and concomitant allergic diseases. The key to success is the meticulous execution of all rules.

Special attention is required for the group of so-called "at-risk recipients", in whom sensitization to the Rh factor should be suspected. This group includes:

• Patients who have already received blood transfusions more than 3 weeks ago (especially if the procedure was accompanied by reactions).
• Women with a burdened obstetric history (spontaneous miscarriages, giving birth to children with jaundice or hemolytic disease).
• Patients with decaying malignant neoplasms.
• Patients with chronic blood system diseases.
• Patients with long-standing purulent processes.

Management tactics: if such patients are identified, the transfusion must be delayed until the situation is fully clarified (screening for Rhesus antibodies). Laboratory cross-matching must be performed without fail using the indirect Coombs test.

Management of allergic history and preparation

The presence of allergic diseases in a patient (e.g., bronchial asthma) requires a special approach:

• Elective transfusion: targeted selection of specific blood components and preliminary prevention are necessary.
• Emergency transfusion: mandatory preliminary administration of desensitizing agents (such as calcium chloride, glucocorticoids, antihistamines). To reduce antigenic activity, thawed and washed red blood cells are used, combined with blood-substituting fluids.
• For scheduled surgeries: the optimal option is the collection and use of the patient's autologous blood.

Preparation of the patient for the procedure:

1. Laboratory tests: precise determination of blood group and Rh factor, as well as a complete blood count 1–2 days before the planned transfusion.
2. Clinical examination: assessment of cardiovascular, respiratory, and urinary system functions to rule out potential contraindications.
3. Immediate preparation: the transfusion is performed in the morning, on an empty stomach or after a very light breakfast. Just before the start, the patient must empty their bowels and bladder.

Class and exam questions

What else to study on this topic

• Mechanisms for determining blood group and Rhesus type.
• Algorithm for performing individual biological compatibility tests.
• Characteristics and clinical significance of the indirect Coombs test.
• Classification and use of blood-substituting fluids.
• Methodology for harvesting and using autologous blood in surgical interventions.

Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.