Blood Transfusion Safe Practice

Definition Introduction of new matching blood into the bloodstream or/and of any specific blood components.

Blood Components Available at KAUH Packed RBC Platelet Fresh frozen plasma Cryoprecipitate

Blood Component Preparation

Red Blood Cells (Erythrocytes)

Component of choice to maintain adequate supply of oxygen

Indication Symptomatic anemia (Hb<8g/dl) Acute blood loss Preoperative (Hb<7-8g/dl) Chronic transfusion patient (Hb<9g/dl)

Red Cell Storage & Administration Administration 3-4 hours Store for 35 or 42 days Administration 3-4 hours Volume 250 – 350 ml Do not mix with other drug / blood component Change blood filter every 4 hours or after 2 units have been transfused Never store it in ward refrigerator

Platelets

Essential for Homeostasis Prevent or Stop Bleeding Platelets Essential for Homeostasis Prevent or Stop Bleeding

Indication Bone marrow failure Abnormalities of platelet function Acute dissemination intravascular coagulopathy –DIC Massive blood transfusion

Platelets Storage & Administration Stored for 5 days Give immediately Yellow in colour within 15-30 minutes Do not store in ward fridge Do not mix with other drug / blood component Bacterial contamination greater than with red cells Volume 45 - 65 ml

Fresh Frozen Plasma (FFP)

Replaces Clotting Factors Initial Treatment of Massive Bleeding FFP Replaces Clotting Factors Initial Treatment of Massive Bleeding

Give each unit over 30 minutes Stored for 1 year Give each unit over 30 minutes Needs thawing Volume 150 – 250 ml

Cryoprecipitate

Indication fibrinogen deficiency Hemophilia Stored for 1 year Needs thawing Volume 15 – 25 ml Indication fibrinogen deficiency Hemophilia Von will brands disease (bleeding disorder caused by a deficiency of von Willebrand factor factor XIII deficiency Disseminated intravascular coagulation (DIC)

Blood Warmers

potentially dangerous The routine warming of blood and blood component is NOT recommended potentially dangerous limited benefit Keeping the patient warm is probably more important than warming the infusion blood

Blood warmer indicated Exchange transfusion in infant When transfusion patient with clinically significant cold agglutination Adult receiving blood at rate greater than 50ml/kg/hr Children receiving blood at rate greater than 15ml/kg/hr Massive transfusion ( 50% or above of body blood volume Trauma situation Cardiopulmonary bypass surgical procedure Blood and blood component should not be warmed using improvisation such as putting the pack into hot water, in microwave

Transfusion Process Prescription of blood component (Doctor’s order) Pre-transfusion sample collection

Prescription of Blood Component Prescription form Should include: patient name & ID date and time patient diagnosis Reason of transfusion number of unit to be administered rate of infusion special procedure

Prescription of Blood Component

Informed Consent Signed

vital signs monitoring Prior Transfusion 15 to 20 Minutes After Starting Post Transfusion.

Blood Transfusion Reaction

What to do? Stop the Blood transfusion Inform the senior Physician Start .9% Normal Saline KVO Return entire transfusion set up including tubing ( without IV needle) to the blood bank after the physician orders the discontinuation of the transfusion 5 cc of blood from the patient in EDTA (2 purple topped) tube, Obtain first voided urine for analysis, mark “post transfusion” Fill transfusion reaction form Write an OVR send to TQM

Transfusion Of Incompatible Blood Transfusion of incompatible blood component is regarded as an error that should be avoided Some situation it is the only option available that can save patient life The patients physician will always be informed of decision by director of the blood bank

Summary Doctors & Nurses have a major role in blood transfusion practice. They should follow all safety and general precautions throughout all of the steps for administering transfusions. They should adhere to KAUH transfusion policy & procedure

Thank you CSSC