Safe Blood Safe Blood Transfusion Transfusion PracticesPractices

Safe Blood Safe Blood Transfusion Transfusion PracticesPractices

Communication Communication between clinicians and between clinicians and the Blood Bank is vital!the Blood Bank is vital!

Role of the ClinicianRole of the Clinician

•Ensure that the right blood gets to the right patient at the right time•Follow the correct procedures for the ordering, collection and administration of blood/ blood products

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•Complete the blood request form•Order blood in advance,

if possible•Provide clear information on blood products being requested, #units requested, reason for transfusion, urgency

CompatibilityCompatibilityThe clinician should;1. complete all required details on

the blood request form2. accurately label blood sample

tubes3. check the identity of the patient,

the product and the documentation at the patient’s bedside before transfusion.

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Safe Transfusions

Safe Transfusions•Depends on avoiding incompatibility

between the donor’s red cells and the antibodies in the patient’s plasma •Severe acute hemolytic transfusion reactions are nearly always caused by transfusing red cells that are incompatible with the patient’s ABO type and can be fatal•Most often result from errors made in identifying the patient

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2 Main Reasons

for Transfusin

gBlood

2 Main Reasons

for Transfusin

gBlood•Restore or maintain body’s oxygen-carrying capacity

•Maintain the volume of blood circulating around the body

Storing BloodStoring Blood•The storage temperature for

blood is +2ºC and +8ºC•Red cells or whole blood must

never be allowed to freeze

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PlasmaPlasmaFresh frozen plasma (FFP) – plasma that has been separated from a unit of whole blood within 6-8 hours of donation, maintained at a temperature of -20ºC or lower(given to a patient to restore or to help maintain clotting factors)

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•For plasma volume replacement crystalloids and colloids are recommended.

(FFP should be given only when these are unavailable, and as a life-saving procedure)

•Plasma contains water, electrolytes, clotting factors and proteins mostly albumin.

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•Factors VIII and V deteriorate if plasma is not stored at -20ºC or less

Other clotting factors stable at refrigerator temperatures.

•Plasma must be frozen solid at all times There is no lower limit for storage of frozen plasma. It is not important how low the temperature is as long as it is -20ºC or lower.

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TransportingTransporting•Temperature must be maintained at negative 20 degrees Centigrade or lower

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ThawingThawing•Before use, fresh frozen plasma must be thawed in water which is between 30ºC and 37ºC (Use a thermometer)Do not heat to more than 37ºC. (destroys clotting factors and proteins) While thawing, put inside another plastic bag and keep upright.

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After Thawing

After Thawing

•Store in refrigerator at +2ºC and +8ºC.Infuse within 30 minutes… if not, transfuse within 24 hours.•Unused thawed unit, should be discarded, not refrozen.

Warming BloodWarming Blood

•No evidence that warming blood is beneficial to the patient when infusion is slow•Cold blood can cause spasm in the vein used for infusion so apply warm towels locally

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•On average, it takes 30 minutes for a unit of blood to reach 10 degrees Centigrade

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•Blood should be warmed in a blood warmer with visible thermometer and audible warning alarm.•Should not be warmed in a bowl of hot water as this could lead to hemolysis of red cells and liberation of K+ which could be life-threatening

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Warmed blood is most commonly required in:Warmed blood is most commonly required in:

•Large volume rapid transfusionsAdults: infusion of greater than 50ml/kg/hourChildren: greater than 15ml/kg/hour

•Exchange transfusion in infants•Patients with clinically significant cold agglutinins

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If ambient temperature is greater than +25ºC or if there is a chance that the blood will not be transfused immediately, blood should be placed in a refrigerator or should be issued in a cold box or insulated carrier that will keep the temperature under +8ºC

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PLATELET CONCENTRATES

PLATELET CONCENTRATES

Must be kept at a temperature of 20°C to 24°C on a platelet agitator to maintain platelet function

Storage life is restricted to 3 or 5 days (risk of bacterial proliferation)

•Platelets held at lower temperature lose blood clotting capability•Platelet concentrates should NEVER BE PLACED IN A REFRIGERATOR!

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Blood/ Start infusion Complete infusionblood product

Whole blood/ within 30 min. of within 4 hourred cells removing pack (less in high from ambient temp)

refrigerator

Platelet immediately within 20 minconcentrates

FFP within 30 min within 20 min

Time Limits for Infusion

Time Limits for Infusion

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There is a risk of bacterial There is a risk of bacterial proliferation or loss of proliferation or loss of

function in blood function in blood products once they have products once they have been removed from the been removed from the

correct storage correct storage conditions conditions

There is a risk of bacterial There is a risk of bacterial proliferation or loss of proliferation or loss of

function in blood function in blood products once they have products once they have been removed from the been removed from the

correct storage correct storage conditions conditions

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CHECK THE PATIENT’S CHECK THE PATIENT’S IDENTITY AND THE IDENTITY AND THE BLOOD PRODUCT BLOOD PRODUCT

BEFORE BEFORE TRANSFUSIONTRANSFUSION

CHECK THE PATIENT’S CHECK THE PATIENT’S IDENTITY AND THE IDENTITY AND THE BLOOD PRODUCT BLOOD PRODUCT

BEFORE BEFORE TRANSFUSIONTRANSFUSION

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IDENTITY CHECKLISTIDENTITY

CHECKLIST•Ask patient to identify himself by family name, given name, date of birth and other information•If unconscious, ask a relative or a second member of staff to state patient’s identity•Check patient’s identity and gender against:

identity wristband or labelmedical notes

•Check that details on compatibility label attached to blood pack exactly match details on patient’s documentation and identity wristband:

Name, hospital reference number, ward, operating room or clinicblood group

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RECORDING OF TRANSFUSIONRECORDING OF TRANSFUSION

Consent from patient and/or relativesReason for transfusionSignature of the prescribing clinicianPre-transfusion checks of :

patient’s identity, blood pack, compatibility labelsignature of the person performing the check

Transfusiontype and volume of component, donation number, blood group, time at which transfusion commenced,signature of person administering the transfusion

Any transfusion reaction

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BLOOD CHECKLISTBLOOD CHECKLIST1. No discrepancies between ABO and Rh group on: blood pack, compatibility label2. No discrepancies between unique donation number on: blood pack, compatibility label3. Check expiry date on blood pack.4. Examine pack before transfusion. Do not administer if pack is damaged or there is any evidence of deterioration.

•leakage•unusual color•signs of hemolysis

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Monitoring the Transfused Patient

Monitoring the Transfused Patient

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Monitor the patient at the following stages:

Monitor the patient at the following stages:

Monitor carefully ESPECIALLY during the first 15 minutes to detect early signs & symptoms of adverse effects

•Before starting the infusion•As soon as the infusion is started•15 min after starting the infusion•at least every hour during the infusion•on completion of the infusion•4 hrs after completing the transfusion

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At each stage, record the following info in the patient’s chart:

At each stage, record the following info in the patient’s chart:•Patient’s general appearance

•Temperature•Pulse rate•Blood pressure•Respiratory rate•Fluid balance•Oral and IV fluid intake•Urinary output

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RECORDRECORD•Time transfusion is started•Time the transfusion is completed•Volume & type of all products transfused•Unique donation no of all products transfused•Any adverse effects

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PHARMACEUTICALS & BLOOD PRODUCTS

PHARMACEUTICALS & BLOOD PRODUCTS

•No meds and infusion solutions other than normal saline should be added to any blood component . They may contain additives such as calcium which can cause citrated blood to clot.•Dextrose solution (5%) can lyze red

cells. Last word of advice