IVF and Blood

• Blood Transfusion


  The transfer of blood or blood products from one person (donor) into another person's blood (recipient)
• Components of blood

  • Erythrocytes (RBC)
  • Leukocytes (WBC)
  • Platelets
  • Plasma
• Red Blood Cells

  • Carry oxygen and nutrients to all the organs/ tissues in the body, and take away waste products
  • Haemoglobin (Hb)
  • Lifespan: ~ 120 days
• Total body of water in healthy adult

  Approximately 50 - 60% of the average healthy adult's weight is water
• White Blood Cells

  • Cells of the immune system involved in defending the body against bacterial invasion
  • Neutrophils, eosinophils, monocytes, lymphocytes, basophils
  • Lifespan: ~ 7-14 days
• The volume of total body water remains relatively constant - Weight varies ＜ 0.2kg (0.5lb) in 24 hours, regardless of the amount of fluid ingested
• Platelets

  • Blood coagulation
  • Lifespan: ~ 7-9 days
• Body fluids distribution

  • ICF = intracellular fluid
  • ECF = extracellular fluid
  • ISF = interstitial fluid
  • IVF = intravascular fluid
  • TWB = total body water
• Plasma

  • Contains water, protein, clotting factors, antibodies
• Two major fluid compartments


  • Intracellular Fluid (ICF)
  • Extracellular Fluid (ECF)
• Sources of blood for Transfusion

  • Donor blood (Allogeneic)
  • Autologous blood (auto-transfusion)
• Intracellular Fluid (ICF)

  Bounded by cell membranes, found within the cells of the body, contains ~70% of the total body fluid in adults; ~40% of body weight
• Donor blood (Allogeneic)

  • Blood products obtained from another person
  • Volunteer blood, unpaid donors
  • Designed donor blood (Directed Donation from families or friends)
• Extracellular Fluid (ECF)

  Outside of the cell membrane, found outside the cells, account for about ~30% of total body fluid; ~20% of body weight
• Autologous blood (auto-transfusion)


  • Using the patient's own blood
  • Intraoperative autologous transfusion
  • Postoperative autologous transfusion
  • Hemodilution
  • Apheresis
• Extracellular Fluid (ECF)


  • Intravascular fluid (IVF) (Plasma)
  • Interstitial fluid (ISF) (Fluid in tissue spaces)
• Advantages of Autologous blood (auto-transfusion)

  • Prevent cross infections & diminish transfusion reactions
• Intravascular fluid (IVF) (Plasma)


  Liquid component of the blood, ~25％ of ECF, found within the vascular system
• Disadvantages Autologous blood (auto-transfusion)


  • Expensive, reserve may be inadequate
• Interstitial fluid (ISF) (Fluid in tissue spaces)


  ~75％ of ECF, surrounds the tissue cells
• Blood & Blood component for blood transfusion

  • Whole Blood
  • Packed RBCs
  • Platelets
  • Plasma
  • Cryoprecipitate
• ICF & ECF are separated by capillary walls and cell membranes
• Fluid Balance


  Intake = output/ fluid loss
• Whole Blood


  Consists of RBCs, plasma, plasma proteins, and clotting factors
• Sources of fluid intake

  • Daily ingested water: ~ 1500ml
  • Amount from ingested foods: ~500ml
  • From metabolic oxidation: ~500ml
• Indications for Whole Blood

  • Blood volume replacement
  • Increase oxygen carrying capacity
  • For significant bleeding
• Sources of fluid loss/ output

  • Sensible loss (e.g. Fluid loss during urination, defecation, and wounds)
  • Insensible loss (e.g. Fluid loss from evaporation through the skin & water vapor from the lungs during respiration)
• Packed RBCs


  • Prepared by the centrifugation
  • Consists primarily of RBCs, a small amount of plasma
• Average daily fluid output: ~ 2500ml
• Average daily fluid output

  • Urine from kidneys: ~1500ml
  • Loss from sweat, lungs & faeces: ~1000ml
• Indications for Packed RBCs


  • Symptomatic anemia
  • Cardiovascular failure with a need to increase blood volume and RBCs while avoiding fluid overload
  • Used in patients with massive bleeding
• Fluid intake & losses are about equal
• Haemoglobin (Hb) level

  • 1 unit of packed RBCs increases haemoglobin (Hb) by ~1 g/dL
  • Normal range: Men ~13.3 – 17.1g/dL, Women ~11.5 – 14.8 g/dL
• Electrolytes


  • Sodium/ chloride
  • Potassium/ Calcium
• RBC transfusion reference

  • Hb > 10g/dL: Transfusion might not be necessary
  • Hb 7 – 10g/dL: Transfusion based on patient's risk of inadequate oxygenation
  • Hb < 7g/dL: Transfusion is highly indicated
• Sodium/ chloride


  Not stored by the body, need to consumed daily to maintain normal level
• Platelets


  • Suspended in plasma
  • Freshly prepared and require a constant moving surface to keep them suspended
  • Platelet units must be stored at room temperature at 20-24°C to remain effective Up to 5 days
  • Transfuse in short period of time to prevent clumping during administration
• Potassium/ Calcium


  Stored in cells and bone respectively, when serum level drops, ions will shift out of the storage and "pool" into the blood to maintain adequate serum level for normal functioning
• Indications for Platelets


  • Treatment or prevention of bleeding associated with deficiencies in the number or quality of a patient's platelet count
  • Based on platelet count in CBC (normal range: 150,000 – 450,000 cells/ microliter)
• Main Functions of Electrolytes

  • Maintains fluid balance
  • Maintains acid-base regulation
  • Facilitates enzyme reactions
  • Transmits neuromuscular reactions
  • Changes the permeability of cells
  • Affects body metabolism