Transfusion Safety

Workshop:

Good Transfusion Practices

Dr Norris Naim

Pusat Darah Negara

What is blood for?

• Purpose of blood transfusion

– Safe patient life, improve patient

recovery

• Improve O2 carrying capacity

– Red cells (PC, BCPPC, WB)

• Stops bleeding, improve hemostasis

– Platelets, FFP, Cryoprecipitate, factor

concentrates

• Transfusion process

– From vein-to-vein (donor to patient)

Good Transfusion Practice

• Transfusion that is just, indicated and clinically sound with patient best interest at heart

• Transfusion of appropriate type and volume of blood and components

• Transfusion of blood and components that are of good quality

• Transfusion that is performed according to procedures that minimise errors and mistakes that would harm the patient

Good Transfusion Practice

• Patient safety is a priority in blood

transfusion

• It involves correct patient identification:

– when taking pre-transfusion sample

– When transfusing blood to patient

• Also involves patient monitoring during

and after transfusion for any adverse

reactions

Do it right from the beginning

• Taking pre-transfusion sample

– Must follow procedure (no exception)

• Identify patient: by name, IC – ask patient, relatives, check wristband

• Don’t use bed numbers

• Label sample at bedside: do not label away from the patient, do not leave the sample unlabeled and unattended even for a while

• Use hand written labels: don’t use pre-printed labels

• Sampling and labeling must be

performed on one patient at a time

• Label the sample immediately – do not

delay

• Don’t allow yourself to be distracted •

• Those who take the sample, must label

it and must initial the label

• Do it yourself – don’t ask others for

help

Filling in the form

• If you take the sample and label it, write

your name as the person who did it

• Make sure

– Proper diagnosis is written

– Indication for transfusion is filled (eg type of

surgery).

– Avoid using vague reasons (eg for op,

surgery, for intervention)

– Date and time blood is required is written

(for GXM request)

• Avoid calling the Blood Bank

unnecessarily just to ‘confirm’ blood

• What is “confirm blood”?

– ?Sample received by BB

– ?Blood ready for collection

• Use of dispatch book helps you keep

track of the sample sent

– Record the samples sent, who received it

and what time its received at Blood Bank

• When to collect the blood for

transfusion

– Collect when and only when blood is

needed for transfusion

– Non-urgent transfusion: XM blood can be

collected after 2 hours after BB receive the

sample or as written on request form

Pre-transfusion Testing

• Except for a few, all non-emergency requests should be treated as GSH

• Tests performed:

– ABO and RhD grouping, antibody screening

• Antibody positive cases

– Ward will be informed.

– Need to send extra sample (10cc EDTA) for antibody identification

– To d/w BB MO on duty

– All antibody cases will be crossmatched

• Rh negative cases:

– Ward will be informed.

– To d/w BB MO on duty

– Ability of BB to supply Rh neg blood depends on stock

– May need to call in donors; thus delay in supply

• Platelet and plasma request

– New patient: fresh sample for ABO and RhD grouping

– Known patient: attach copy of previous request form (had at least 2 previous transfusions)

• Emergency XM

– For cases that require immediate transfusion

but no sample was sent to BB earlier

– Request for XM just to get blood to OT with

patient, is NOT Emergency XM

– Emergency XM is not as safe as a full

complete crossmatch

– Blood is supplied after ABO and RhD

grouping, and quick crossmatching at RT

• Emergency XM (cont’)

– Antibody screening only performed after

blood is issued out

• chance of supplied blood causing reaction to

patients is higher than normal

– Should only be requested when transfusion

is necessary and require immediately

– If probability of transfusion is minimal or

transfusion is to be performed later, full

crossmatch should be requested instead.

• Collecting Blood

– Bring along written document of the patient’s details, blood component needed and number of unit needed

– When urgent transfusion is needed, save time by calling blood bank to prepare the blood while PPK/porter is sent to collect the blood

– Before taking blood back to ward, check details on request form against that on PPDK1 card and blood bag

• Blood should be taken back immediately

to the ward

– Red cells and Plasma products: ice-

containing box

– Platelets: ice-free box

• Blood must only be collected when its

going to be transfused

– The shorter the period the blood is outside

the BB, the better

Checking the blood at the ward

• Checking of blood – ensure the blood collected is

for the patient intended (tallying info bw blood, form and PPDK card)

– can be performed by SN

• DO NOT sign the PPDK card yet – may initial the card and

request form as indication that checks have been made

• Transfuse blood as soon as it arrived

• Red cell units that are not to be transfused yet, must be stored in blood fridge

• Keep record of movement of the red cell units in and out of the fridge

• Plasma and platelet – transfuse as soon as possible

– MUST NOT be stored in fridge

Transfusion of Blood

• Plasma and platelet: immediately after it arrive to the ward

• Red cell transfusion – DO NOT warm the blood (ie. blood warmer, run

under tap water)

– Take out of blood fridge for 15 minutes before transfusion

– Use administration set: 1 set per 2 units

– Each unit should not be more than 4 hours to complete

– Do not add in any other fluid or medicine through the same iv line (except normal saline)

Before transfusion:

• Check blood JUST BEFORE the transfusion –

at bedside, by two staffs (doctor and SN)

• Document the checking in the checklist form

• Ensure patient is the right pt – check blood

bag against request form, PPDK card,

patient’s wrist band/patient ID, asking patient

• Check each unit the same way before each of

the unit being transfused

THEY MAY LOOK THE

SAME, BUT NOT

NECESSARILY THE SAME

Not Vigilant Enough

Patient Monitoring

• Vital signs (BP, HR, Temp) must be taken

before transfusion of each unit

• Monitoring must be close for first 15 minutes,

then every half to one hour (if no complication)

• Avoid transfusion in the evening especially for

pts in rooms, unless in emergency

• Document the details of the transfusion (vital

signs, blood units transfused, any reactions)

Completion of transfusion

• Complete the PPDK card

only after transfusion is

finished

• Fill in the necessary details

and sign the card (by doctor

or staff nurse)

• Return the card with the

used blood bag to BB

Transfusion Reactions

• Stop transfusion if patient show any reaction

• Investigate all reactions

• Return all used blood bag to BB – empty or not, and any unused blood units

• Should patient needs the transfusion, make a fresh request