Blood transfusion

Indications for Blood Product transfusion

  • Red cell concentrates
    • Haemoglobin <80g/l or between 80-100g/l if the patient has known CVD, elderly/frail, symptoms indicating myocardial or cerebral hypoperfusion, or continuing blood loss
      • If haemoglobin is >100g/l it is unlikely that the patient requires a transfusion
      • remember also that patients <40 years will tend to tolerate anaemia better than the elderly
    • Significant blood loss (massive haemorrhage ~ >1.5l or ~ >30% blood volume)
    • Symptomatic anaemia (myocardial ischaemia, orthostatic hypotension, tachycardia, shock)
    • Acute sickle cell crisis
  • Fresh frozen plasma
    • DIC; massive haemorrhage; coagulation factor replacement
  • Platelets
    • Low platelet count with bone marrow failure; prior to surgery; acquired or inherited platelet dysfunction; DIC/haemorrhage; Acute ITP
  • CMV negative components should be used in pregnant women or neonates, transplant recipients or any other severely immunocompromised patients.  Irradiated components should be given to patients at risk of graft vs host disease e.g. congenital immunodeficiencies; Hodgkin lymphoma; transplant recipients; intrauterine transfusions.
  • NB For every unit of blood given in an emergency situation, a unit of FFP should also be delivered.

Introduction

  • Wash hands, introduce self, check patient name, DOB and CHI/address.
  • Explain procedure and gain verbal consent (if appropriate)
  • Ensure that the appropriate observations (i.e. SEWS) have been recorded/up to date

Sample collection

  • As per venepuncture BUT
    • Fill in patient details and collection details on the bottle (pink)
    • Fill in the details on the collection bag
    • Ensure the tube reaches the lab promptly

Requesting the Blood Products

  • Include all details
    • patient core identifiers (name and CHI)
    • Transfusion indication; Hb if known
    • Date of transfusion
    • What is to be transfused; how much (volume/’units’) and what rate
      • Packed red cell – normally 1 unit over 2-3 hours; FFP/platelets – 30 mins)
    • Doctor (name, signature); date and ward
  • Consider any additional prescriptions e.g. saline before and after to maintain cannula patency; furosemide (usually 20 or 40mg PO) to prevent fluid overload, particularly in elderly patients with heart failure

Setting up the Blood Transfusion

  • CHECKING
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    • Only remove the blood from the fridge when the patient is ready for transfusion- must be administered within 30 minutes of leaving the fridge
    • Check the bag for any leakes, and the blood for any discolouration/clumping/clotting
    • With another health care professional and the patient; Check the patient ID against the transfusion form
      • ANY DISCREPANCY DO NOT TRANSFUSE
    • With another professional, check the bag for expiry date, blood type and patient details etc
      • AGAIN, IF THERE’S ANY DISCREPANCY, DO NOT TRANSFUSE
    • Check baseline observations
  • Commence the transfusion and sign the appropriate documentation
  • Ensure that observations will be measured every 15 minutes until at least 30 minutes (1 hour preferred) then hourly.

Follow-up/Complications

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  • Other complications include iron overload, acid-base disturbances, coagulopathy
    • To avoid, give calcium every 5 units of RBC
    • Give FFP on a 1:1 ratio (in the acute scenario)
    • Warm blood products prior to infusion
    • Give platelets every 2 units (in the acute setting) to maintain platelet count >100)
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