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Blood Transfusion Safe Practice
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Definition Introduction of new matching blood into the bloodstream or/and of any specific blood components.
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Blood Components Available at KAUH
Packed RBC Platelet Fresh frozen plasma Cryoprecipitate
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Blood Component Preparation
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Red Blood Cells (Erythrocytes)
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Component of choice to maintain adequate supply of oxygen
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Indication Symptomatic anemia (Hb<8g/dl) Acute blood loss
Preoperative (Hb<7-8g/dl) Chronic transfusion patient (Hb<9g/dl)
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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
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Platelets
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Essential for Homeostasis Prevent or Stop Bleeding
Platelets Essential for Homeostasis Prevent or Stop Bleeding
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Indication Bone marrow failure Abnormalities of platelet function
Acute dissemination intravascular coagulopathy –DIC Massive blood transfusion
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Platelets Storage & Administration
Stored for 5 days Give immediately Yellow in colour within minutes Do not store in ward fridge Do not mix with other drug / blood component Bacterial contamination greater than with red cells Volume ml
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Fresh Frozen Plasma (FFP)
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Replaces Clotting Factors Initial Treatment of Massive Bleeding
FFP Replaces Clotting Factors Initial Treatment of Massive Bleeding
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Give each unit over 30 minutes
Stored for 1 year Give each unit over 30 minutes Needs thawing Volume 150 – 250 ml
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Cryoprecipitate
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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)
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Blood Warmers
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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
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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
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Transfusion Process Prescription of blood component (Doctor’s order)
Pre-transfusion sample collection
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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
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Prescription of Blood Component
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Informed Consent Signed
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vital signs monitoring
Prior Transfusion 15 to 20 Minutes After Starting Post Transfusion.
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Blood Transfusion Reaction
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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
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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
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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
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Thank you CSSC
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