• Anaemia: Severe anemia due to various causes (e.g. malaria, infectious process, chronic kidney disease, bone marrow failure, etc.) may necessitate a transfusion to improve haemoglobin levels and oxygen-carrying capacity.
• Acute blood loss: Significant haemorrhage from trauma, surgery, or gastrointestinal bleeding requires blood transfusion to restore blood volume and maintain haemodynamic stability.
• Haematologic disorders: Conditions like sickle cell disease (SCD), thalassemia, and myelodysplastic syndromes may require regular transfusions to manage chronic anemia and prevent complications.
• Cancer treatment: Patients undergoing chemotherapy or bone marrow transplantation may need transfusions to address pancytopenia resulting from treatment.

• Whole blood: Contains all components of blood, used less frequently today due to the availability of specific blood components.
• Red blood Cells (RBCs): Concentrated RBCs are used to treat anaemia and acute blood loss.
• Platelets: Essential for clotting and is used in patients with thrombocytopaenia or platelet dysfunction.
• Fresh frozen plasma (FFP): Contains clotting factors and is used to treat coagulopathies, liver disease, or during massive transfusions.
• Cryoprecipitate: Rich in fibrinogen, von Willebrand factor, and Factor VIII. It is used in bleeding disorders like haemophilia and disseminated intravascular coagulation (DIC).

• ABO and Rh Typing: Determines the patient's blood type (A, B, AB, or O) and Rh status (positive or negative). Donor blood for transfusion must be properly matched with the recipient as incompatibility can cause severe haemolytic reactions.

Table 1: Blood type compatibility chart

Note: O- is universal donor whereas AB+ is universal recipient.

• Crossmatching: A laboratory test that mixes donor blood with the recipient’s blood to ensure compatibility and prevent transfusion reactions.

• Pre-transfusion Preparation:
  • Verify the indication for transfusion and obtain informed consent from the patient.
  • Perform ABO and Rh typing, and crossmatch the blood.
  • Check for previous transfusion reactions.
• Administration:
  • Use a dedicated intravenous line with appropriate filters.
  • Monitor vital signs before, during, and after the transfusion.
  • Start the transfusion slowly, especially for the first 15 minutes, to monitor for acute reactions.
• Post-transfusion Care:
  • Continue to monitor the patient’s vital signs and clinical status.
  • Document the transfusion details in the patient’s medical record.
  • Watch for any delayed transfusion reactions.

• Acute haemolytic reaction: caused by ABO incompatibility and presents with fever, chills, back pain, and haemoglobinuria. It requires immediate cessation of transfusion and supportive care.
• Febrile non-haemolytic transfusion reaction (FNHTR): caused by recipient antibodies reacting with donor white cells. It presents with fever and chills. It is a relatively common occurrence following whole blood transfusion.
• Allergic reactions: Ranges from mild urticaria to severe anaphylaxis. It is managed with antihistamines or epinephrine for severe reactions.
• Transfusion-related Acute Lung Injury (TRALI): Rare but serious; it presents with acute respiratory distress and is managed by supportive care and oxygen.
• Transfusion-associated Circulatory Overload (TACO): Due to rapid infusion or volume overload, presents with hypertension, dyspnea, and pulmonary edema. It is managed with diuretics and slowing the transfusion rate.
• Infectious complications: Risk of transmission of infections like hepatitis, HIV, and bacterial contamination is minimized with rigorous screening and testing.

• Informed consent: Ensure the patient understands the risks and benefits of transfusion.
• Cultural and religious sensitivities: Be aware of and respect any cultural or religious objections to blood transfusion.
• Resource management: Judicious use of blood products is crucial, especially in resource-limited settings.

 Blood transfusion is a lifesaving intervention with various indications and potential complications. It is important to understand the principles, practice safe transfusion procedures, and manage complications effectively to ensure optimal patient outcomes.