1 prepared by : ashwin bhatt through: education department

1

Prepared by :Ashwin Bhatt

Through: Education Department

Blood transfusion is a essential part of modern health care. Blood transfusion is a essential part of modern health care. Millions of lives are saved each year through blood transfusions.Millions of lives are saved each year through blood transfusions.

Blood transfusion can save life but also carries some Blood transfusion can save life but also carries some risk ofrisk of adverse eventsadverse events among some recipients. among some recipients.

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Blood TransfusionSafety

Donor Safety Recepient Safety Healthcare WorkerSafety

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When is a blood transfusion needed ?When is a blood transfusion needed ? A blood transfusion is needed if a person has had significant A blood transfusion is needed if a person has had significant blood blood

lossloss Or the body cannot make or is losing an important component of Or the body cannot make or is losing an important component of

blood.blood.

Blood may be lost through:Blood may be lost through: Injury ( e.g. road accident ) or major surgery ( knee replacement). Injury ( e.g. road accident ) or major surgery ( knee replacement). Bleeding, such as a Bleeding, such as a bleeding ulcer. An illness that destroys blood cells, such as hemolytic anemia.An illness that destroys blood cells, such as hemolytic anemia. When bone marrow doesn't make enough blood, such as aplastic When bone marrow doesn't make enough blood, such as aplastic

anemia. anemia.

Intel

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Processing of donor’s blood at the Blood BankProcessing of donor’s blood at the Blood Bank Donated blood is subjected to screening tests for infectious diseases.Donated blood is subjected to screening tests for infectious diseases. Processed to separate different components from the whole blood.Processed to separate different components from the whole blood.

Transfusing only selected blood components allowsTransfusing only selected blood components allows : : The treatment to be specific.The treatment to be specific. Reduces the risks of side effects.Reduces the risks of side effects. Can efficiently use the different components from a single unit of Can efficiently use the different components from a single unit of blood to treat more than one patient.blood to treat more than one patient.

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Restore the lost of blood volumeRestore the lost of blood volume Enhance the O2 carrying capacity of bloodEnhance the O2 carrying capacity of blood Maintain HaemostatisMaintain Haemostatis

PlateletsPlatelets Coagulation FactorsCoagulation Factors Fresh bloodFresh blood FFP or Appropriate componentFFP or Appropriate component

Blood or Component may be transfused toBlood or Component may be transfused to : :

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WHOLE BLOOD

CELLULAR PLASMA

RBC’SWBC’S PLATELETSFresh Frozen

ApheresisPACKED CELLS

Washed

Frozen

IrradiatedIrradiated

Apheresis

Random donor

Irradiated

Immune globins

Factor concentrates

CryoprecipitateLeucodepleted

SEPARATION OF COMPONENTS

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Blood Transfusion Safety refers to the overall perspective of deliveringBlood Transfusion Safety refers to the overall perspective of deliveringtransfusion care which includes transfusion care which includes mainly two types of risksmainly two types of risks for the for therecipient :recipient : Blood and Blood component risk.Blood and Blood component risk. (infectious diseases, adverse reactions)(infectious diseases, adverse reactions) The risk of human errorThe risk of human error which can occur prior to transfusion during which can occur prior to transfusion during

collecting, storing, testing and administering procedures.collecting, storing, testing and administering procedures.

The greatest risk from blood transfusion is not, as we imagine, beingThe greatest risk from blood transfusion is not, as we imagine, beingexposed to a blood-borne infection, but exposed to a blood-borne infection, but ratherrather receiving the wrong blood.receiving the wrong blood. The reasons for this are almost exclusively The reasons for this are almost exclusively human errorhuman error, and, In, and, Inparticular, particular, failure to complete the proper checks before commencing thefailure to complete the proper checks before commencing thetransfusion.transfusion. Reasons for error can be Reasons for error can be distraction,fatigue,inattention distraction,fatigue,inattention

or or lack of knowledge or information.lack of knowledge or information.

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Transfusion is a multi-department process

There are opportunities for error at a number of critical points during the transfusion process starting with :

The decision to transfuse.The decision to transfuse. Prescribe / Request for transfusion.Prescribe / Request for transfusion. Patient blood sampling.Patient blood sampling. Pretransfusion testing / Cross-match.Pretransfusion testing / Cross-match. Collection of the component from Blood bank refrigerator.Collection of the component from Blood bank refrigerator. Administration to the patient.Administration to the patient.

As healthcare workers we can take precautionary measures to As healthcare workers we can take precautionary measures to avoid avoid errorserrors and make transfusion safer for the recipient and make transfusion safer for the recipient..

PrecautionsPrecautions

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Requesting blood component for TransfusionRequesting blood component for Transfusion

It is a medical responsibility to prescribe blood components or blood products.

The decision to transfuse is based on an assessment of the patient’sassessment of the patient’s clinical conditionclinical condition rather than a given level of hemoglobin.

for e.g. blood transfusion of patients with chronic stable anemia is probably unjustifiable if the hemoglobin level is above 7g per 100ml


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A transfusion requestA transfusion requestform must be filled form must be filled stating the stating the Clinical details Required component Date of intended transfusion Number of units Signature of the requesting doctor.


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Blood sampling for transfusion :Blood sampling for transfusion :Blood samples can be collected by a registered medical practitioner, orBlood samples can be collected by a registered medical practitioner, orby a healthcare worker, nurse or midwife who should be appropriatelyby a healthcare worker, nurse or midwife who should be appropriatelytrained and licenced.trained and licenced.

Sample labeling should beSample labeling should be —"From the Patient, at the Bedside”—"From the Patient, at the Bedside” The identity of the patient must be confirmed before collection. The label on the sample tube must be clearly hand-written by theThe label on the sample tube must be clearly hand-written by the blood collector at the site of blood collection, immediately after collecting blood collector at the site of blood collection, immediately after collecting

the blood –the blood – “On the site of collection by the collector”On the site of collection by the collector”

Never pre-label transfusion sample tubesNever pre-label transfusion sample tubes


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Blood sampling for transfusionBlood sampling for transfusion : : Risky practicesRisky practices

Failure to check patient identity.Failure to check patient identity. Labeling of sample tubes away from the bedside.Labeling of sample tubes away from the bedside. Use of preprinted labels.Use of preprinted labels.Such practices can lead toSuch practices can lead to ‘Wrong Blood In Tube‘Wrong Blood In Tube’ ’ (WBIT).(WBIT).

Drawing the blood sample then carrying it away to a ‘labeling site’ (e.g.,Drawing the blood sample then carrying it away to a ‘labeling site’ (e.g.,a nursing station) invites a nursing station) invites labeling the sample with data from anotherlabeling the sample with data from anotherpatient. patient.

Correcting of details on the Label after sample is dispatched from theCorrecting of details on the Label after sample is dispatched from thecollection site is considered a risky practice the collection site is considered a risky practice the consequencesconsequences of such of suchpractice in transfusion cases practice in transfusion cases can be severecan be severe..Therefore corrected labels, tubes, requests - Therefore corrected labels, tubes, requests - are notare not acceptableacceptable..

Good practices for sample labeling PrecautionsPrecautions

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Compatibility procedures :Compatibility procedures : Done at the Laboratory. Done at the Laboratory.

Error can occur at the laboratory bench while performingError can occur at the laboratory bench while performingcompatibility procedures such as Blood Grouping and Cross Matching.compatibility procedures such as Blood Grouping and Cross Matching.

Group and Cross matching tests must be done by well trained,Group and Cross matching tests must be done by well trained,licenced and experienced technologist.licenced and experienced technologist.

A sample identification or clerical error can occur especially during A sample identification or clerical error can occur especially during urgent or bleeding emergencies. urgent or bleeding emergencies.

Errors can take place outside of ‘core hours’, when staff are fewer in number,and may be relatively inexperienced and working under pressure or distracted by telephone inquiries.


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Standard reagents and appropriate equipment must be used toStandard reagents and appropriate equipment must be used to perform all types of pre-transfusion testing and Cross Matching perform all types of pre-transfusion testing and Cross Matching

procedures.procedures. If doubts persist about Incompatibility - If doubts persist about Incompatibility - the componentthe component must not be released must not be released for transfusion - for transfusion - A senior personnel must A senior personnel must be alerted.be alerted. Transportation of componentsTransportation of components must be done by using suitable must be done by using suitable ice boxes and ice packsice boxes and ice packs


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Dispatching procedureDispatching procedurefrom laboratory fridgefrom laboratory fridge

The technologist must handover the correct blood component to the The technologist must handover the correct blood component to the nurse nurse after checkingafter checking the request form and blood unit details. the request form and blood unit details.

Written documentation including Written documentation including patient’s details, component details, patient’s details, component details, name and signature of the technician and nursing staff and time of name and signature of the technician and nursing staff and time of dispatchdispatch must be noted in the “Blood Dispatch Book”. must be noted in the “Blood Dispatch Book”.


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Component details and patient’s details must be entered in clear handwriting – “ These are legal documents “These are legal documents “


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If a unit is not transfused and returned to the laboratory for any reason, a second entry with time of return and reason for not transfusing, must be noted in the blood dispatch book.


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Compatibility labelCompatibility labelTo be written and signed by the technician inlegible handwriting, filling in the patient’s and unit details correctly.

Compatibility Form Compatibility Form (Cross-match request)(Cross-match request)To be written in legible handwriting (overwriting or using correcting ink is prohibited), date and signature are mandatory.


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Unit groupUnit group

Expiry dateExpiry date

Unit number

Component Type

Screening tests Screening tests performedperformed


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Administration of Blood component to the patientAdministration of Blood component to the patient . Ideally the transfusion should start within thirty minutes of dispatch from the controlled temperature storage (laboratory fridge), extended time can lead to bacterial growth or lysis.

All cellular blood products must be infused through an approved blood administration set which already incorporates an in-line filter (170u). It is recommended that administration sets be replaced every 12 hours to prevent bacterial growth. Only sodium chloride 0.9% (normal saline) must be used for priming and flushing.

Special white cell reduction filters are no longer required ( unless a special sticker is found on the blood unit ) as all blood products are filtered at the Blood Transfusion Centre soon after collection from the donor using highly effective techniques.


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All the Universal safe handling precautions must be observed in order to minimise the risk of infections.


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Safe transfusion requires a final patient identity check at the patient Safe transfusion requires a final patient identity check at the patient bedside,this is vital to ensure thatbedside,this is vital to ensure that right blood is given to the right right blood is given to the right patient. patient.

Recipient's identity can be confirmed by asking the recepient directly his/her name and date of birth.

If the recepient is unconscious or under anesthesia then the identity can be confirmed by the incharge nurse or attending doctor.

If the recepient is a child or infant the identity should be confirmed by asking the parent/relative.

Transfusion should not be started if any discrepancies or doubts persist


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Before transfusion is started, the patient's wristband, blood unitBefore transfusion is started, the patient's wristband, blood unit label, and compatibility test report must be checked at the bedsidelabel, and compatibility test report must be checked at the bedside,,


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Use of Blood WarmersUse of Blood Warmers

Only specially designed and regulated blood warmers with a visible Only specially designed and regulated blood warmers with a visible thermometer and audible warning must be used. thermometer and audible warning must be used.

Blood must not be warmed by any other method, such as immersion Blood must not be warmed by any other method, such as immersion in warm water, as lack of control of the temperature may lead to in warm water, as lack of control of the temperature may lead to dangerous haemolysis. dangerous haemolysis.

Devices that meet international standards must be used.Devices that meet international standards must be used. For faster rates of infusion special warmers may be required.For faster rates of infusion special warmers may be required.


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Before commencing a blood transfusionBefore commencing a blood transfusion : :Any reaction to a previous transfusion should be taken into consideration, Any reaction to a previous transfusion should be taken into consideration, measures must be taken to prevent them happening again.measures must be taken to prevent them happening again.

Temperature, pulse and blood pressure to be measured andTemperature, pulse and blood pressure to be measured andrecorded recorded beforebefore the start of each unit , 15 minutes the start of each unit , 15 minutes afterafter the startthe start of of unit and unit and at the endat the end of each transfusion episode. of each transfusion episode.

More frequent observations may be needed if the patient becomesMore frequent observations may be needed if the patient becomesunwell, shows signs of a transfusion reaction.unwell, shows signs of a transfusion reaction.

Careful monitoring of clinical signs is especially important inCareful monitoring of clinical signs is especially important in unconscious unconsciouspatients.patients.

Adverse EventsAdverse Eventsand Reactionsand Reactions

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A transfusion reaction may be aA transfusion reaction may be a medical emergency.medical emergency.


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Remain with the patient, & watch for the signs of a transfusionRemain with the patient, & watch for the signs of a transfusionreaction, such as fever, chills, & wheezing.reaction, such as fever, chills, & wheezing.


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If such sign develop, record vital signs and If such sign develop, record vital signs and stop thestop thetransfusiontransfusion. Inform the nurse incharge / R.M.O.. Inform the nurse incharge / R.M.O.


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ImmunogenicImmunogenic Non-immunogenicNon-immunogenic InfectiousInfectious

Transfusion reactions :Transfusion reactions : HemolyticHemolytic FebrileFebrile Circulatory over loadCirculatory over load Allergic. Allergic. Reactions can be Reactions can be Major Major oror Minor Minor and can occur and can occur ImmediatelyImmediately or at a or at a

Delayed Delayed time (few hours or even weeks) after transfusion.time (few hours or even weeks) after transfusion.

Transfusion Complications :Transfusion Complications :


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IMMUNOLOGICALIMMUNOLOGICAL

RBC’SWBC’S PLATELETS

HAEMOLYTICAL REACTIONS

Ta-GvHD

TRALI

DELAYEDDELAYED

POST TRANSFUSIO PURPURA (PTP)

ACUTE

FEBRILE

PLASMA

AnaphylactoidAnaphylactoid

NON-NON-IMMUNOLOGICALIMMUNOLOGICAL

VASOACTIVE SUBSTANCES

COLD BLOOD CITRATE TOXICITYPOTTASIUM

TOXICITY AIR EMBOLISM

MICRO EMBOLISMSEPTIC

THROMBOPHL-EBITIS

OVERLOAD HAEMOSIDEROSIS PYROGENS

INFECTIOUSINFECTIOUS

PRIONS

PARASITESPROTOZOES

VIRUSESBACTERIA

COMPLICATIONSCOMPLICATIONS

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Major reactionsMajor reactions : : Are usually a result of administering incompatible Are usually a result of administering incompatible blood and the commonest causes are mistaken identity in blood sampling, blood and the commonest causes are mistaken identity in blood sampling, collecting the wrong blood from the storage refrigerator.collecting the wrong blood from the storage refrigerator.They can be lethal because of resulting immune reaction which can cause They can be lethal because of resulting immune reaction which can cause Disseminated Intravascular Coagulation (DIC) and renal failure.Disseminated Intravascular Coagulation (DIC) and renal failure.

Minor reactions :Minor reactions : Are common and include unexplained minor elevation Are common and include unexplained minor elevation in temperature (to 37.5 deg.C), urticaria, rashes and headaches.in temperature (to 37.5 deg.C), urticaria, rashes and headaches.


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Immediate Immediate Febrile ReactionsFebrile Reactions Urticarial (Allergic) Reactions Urticarial (Allergic) Reactions Severe Allergic (Anaphylactic) Reactions Severe Allergic (Anaphylactic) Reactions Acute Haemolytic ReactionsAcute Haemolytic Reactions Bacterial Contamination Bacterial Contamination Transfusion-Related Acute Lung Injury Transfusion-Related Acute Lung Injury Volume Overload Volume Overload Hypothermia Hypothermia Citrate Toxicity Citrate Toxicity Potassium EffectsPotassium Effects


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Febrile ReactionsFebrile ReactionsSigns :Signs : Fever and chills during transfusion Fever and chills during transfusion Cause :Cause : By recipient antibodies reacting with white cell antigens or white By recipient antibodies reacting with white cell antigens or white cell fragments in the blood product or due to cytokines which accumulate cell fragments in the blood product or due to cytokines which accumulate in the blood product during storage.in the blood product during storage.

Urticarial (Allergic) ReactionsUrticarial (Allergic) ReactionsCause:Cause: Seen in approximately 1% of recipients and caused by foreign Seen in approximately 1% of recipients and caused by foreign plasma proteins. plasma proteins. On rare occasions they may be associated with laryngeal oedema and On rare occasions they may be associated with laryngeal oedema and bronchospasm.bronchospasm.


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Severe Allergic (Anaphylactic) Reactions :Severe Allergic (Anaphylactic) Reactions :Anaphylactic reactions have signs of cardiovascular instability including Anaphylactic reactions have signs of cardiovascular instability including hypotension, tachycardia, loss of consciousness, cardiac arrhythmia, hypotension, tachycardia, loss of consciousness, cardiac arrhythmia, shock and cardiac arrest. shock and cardiac arrest. Cause:Cause: In some cases patients with IgA deficiency who have anti-IgA In some cases patients with IgA deficiency who have anti-IgA antibodies can have these reactions.antibodies can have these reactions.

Transfusion-Related Acute Lung InjuryTransfusion-Related Acute Lung Injury (TRALI) :(TRALI) :Is characterised by acute respiratory distress and bilateral symmetrical Is characterised by acute respiratory distress and bilateral symmetrical pulmonary oedema with hypoxaemia developing within 2 to 8 hours after pulmonary oedema with hypoxaemia developing within 2 to 8 hours after a transfusion. a transfusion. Cause:Cause: Pulmonary vascular effects are thought to occur secondary to Pulmonary vascular effects are thought to occur secondary to cytokines in the transfused product or from interaction between patient cytokines in the transfused product or from interaction between patient white cell antigens and donor antibodies (or vice versa).white cell antigens and donor antibodies (or vice versa).


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Acute Haemolytic Reactions Acute Haemolytic Reactions This are the most serious type of transfusion reaction, but it is very rare. They happen when donor and patient blood types do not match.

Cause: The majority of haemolytic reactions are caused by transfusion of ABO incompatible blood, eg group A, B or AB red cells to a group O patient

A hemolytic reaction A hemolytic reaction can cause deathcan cause death if the transfusion is not stopped as if the transfusion is not stopped as soon as the reaction starts. soon as the reaction starts.

Non-immune haemolysis of RBCs in the blood container or during administration can occur due to physical disruption (temperature changes, mechanical forces, non-isotonic fluid).


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Potassium Effects :Potassium Effects :Cause:Cause: Stored red cells leak potassium proportionately throughout their Stored red cells leak potassium proportionately throughout their storage life. Irradiation of red cells increases the rate of potassium storage life. Irradiation of red cells increases the rate of potassium leakage. Clinically significant hyperkalaemia can occur during rapid, leakage. Clinically significant hyperkalaemia can occur during rapid, large volume transfusion of older red cell units in small infants and large volume transfusion of older red cell units in small infants and children.children.

Bacterial Contamination :Bacterial Contamination :Cause:Cause: Bacteria may be introduced into the pack at the time of blood Bacteria may be introduced into the pack at the time of blood collection from sources such as donor skin, (donor bacteraemia) or collection from sources such as donor skin, (donor bacteraemia) or equipment used during blood collection or processing. Bacteria may equipment used during blood collection or processing. Bacteria may multiply during storage. Gram positive or Gram negative organisms can multiply during storage. Gram positive or Gram negative organisms can been found. Platelets are more frequently implicated than red cellsbeen found. Platelets are more frequently implicated than red cells.


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Volume Overload :Volume Overload : Cause:Cause: Patients with cardiopulmonary disease and infantsPatients with cardiopulmonary disease and infants are at risk of volume overload especially during rapid transfusion.are at risk of volume overload especially during rapid transfusion.

Hypothermia :Hypothermia : Cause:Cause: Rapid infusion of large volumes of stored blood contributes Rapid infusion of large volumes of stored blood contributes

to hypothermia. Infants are particularly at risk during exchange or to hypothermia. Infants are particularly at risk during exchange or massive transfusion.massive transfusion.


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Delayed reactionsDelayed reactions Delayed HaemolysisDelayed Haemolysis AlloimmunisationAlloimmunisation Transfusion associated Graft Versus Host DiseaseTransfusion associated Graft Versus Host Disease Immunomodulatory effects Immunomodulatory effects Iron accumulation Iron accumulation Infectious Disease transmission Infectious Disease transmission


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Delayed Haemolysis :Delayed Haemolysis :Cause: A delayed haemolytic reaction occurs when a patient develops A delayed haemolytic reaction occurs when a patient develops an antibody directed against an antigen on transfused red cells. an antibody directed against an antigen on transfused red cells. Antibodies can occur naturally, or may arise as a consequence of Antibodies can occur naturally, or may arise as a consequence of previous transfusion or pregnancy. previous transfusion or pregnancy. The antibody may cause shortened red cell survival, with clinical The antibody may cause shortened red cell survival, with clinical features of fever, jaundice and lower than expected haemoglobin features of fever, jaundice and lower than expected haemoglobin following transfusion. following transfusion.

Most delayed haemolytic reactions produce few symptoms and may go Most delayed haemolytic reactions produce few symptoms and may go unrecognized, however there are reports of serious consequences in unrecognized, however there are reports of serious consequences in critically ill patients.critically ill patients.


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Alloimmunisation :Alloimmunisation :Patients experiencing alloantibody formation are asymptomatic. Patients experiencing alloantibody formation are asymptomatic. The alloantibody is discovered at the time of pretransfusion testing. The alloantibody is discovered at the time of pretransfusion testing. Appropriate antigen negative blood must be transfused.Appropriate antigen negative blood must be transfused.

Platelets :Platelets :When thrombocytopenic patients do not achieve the expected post-When thrombocytopenic patients do not achieve the expected post-transfusion platelet count increment they are said to be refractory. transfusion platelet count increment they are said to be refractory. This usually occurs in patients receiving frequent platelet transfusions. This usually occurs in patients receiving frequent platelet transfusions. There are clinical and immunological causes of platelet refractoriness.There are clinical and immunological causes of platelet refractoriness. Cause:Cause: Immunological causes include the development of antibodies to Immunological causes include the development of antibodies to human leucocyte antigens (HLA) or human platelet antigens (HPA).human leucocyte antigens (HLA) or human platelet antigens (HPA).


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Transfusion associated Graft Versus-Host Disease (Ta-GVHD) :Transfusion associated Graft Versus-Host Disease (Ta-GVHD) :Cause: Transfusion associated -GVHD occurs when donor lymphocytes in cellular blood products engraft the tissues of recipient.

These donor lymphocytes proliferate and damage target organs especially bone marrow, skin, liver and gastrointestinal tract. The usual onset is 8-10 days post transfusion.

Recipients of blood from biologically related donors are at risk The disease is also reported in immunologically compromised patients.


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Immunomodulatory effects :Immunomodulatory effects :Some studies suggest a link between blood transfusion and increased Some studies suggest a link between blood transfusion and increased risk of infection and cancer recurrence. However this is currently risk of infection and cancer recurrence. However this is currently considered unproven.considered unproven.Cause:Cause: Unknown, possibly mediated by donor white cells or plasma.Unknown, possibly mediated by donor white cells or plasma.

Iron accumulation :Iron accumulation :Cause:Cause: Iron accumulation is a predictable consequence of chronic RBC Iron accumulation is a predictable consequence of chronic RBC transfusion. Organ toxicity begins when reticuloendothelial sites of iron transfusion. Organ toxicity begins when reticuloendothelial sites of iron storage become saturated. Liver and endocrine dysfunction creates storage become saturated. Liver and endocrine dysfunction creates significant morbidity and the most serious complication is cardiotoxicity significant morbidity and the most serious complication is cardiotoxicity which causes arrhythmias, and congestive heart failure. Patients which causes arrhythmias, and congestive heart failure. Patients receiving chronic transfusion usually have their iron status monitored and receiving chronic transfusion usually have their iron status monitored and managed by their physician.managed by their physician.


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Infectious Disease transmission :Infectious Disease transmission :A variety of infectious agents may be transmitted by transfusion.

Viruses :Viruses : HIV-1,2 …HIV-1,2 … HTLV-I,IIHTLV-I,II CytomegalovirusCytomegalovirus Epstein-Barr virusEpstein-Barr virus Parvovirus B19Parvovirus B19 Creutzfeldt-Jakob disease(CJD)Creutzfeldt-Jakob disease(CJD) West NileWest Nile etc.etc.


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ParasitesParasites PlasmodiaPlasmodia Babesia microltiBabesia microlti Trypanosoma cruziTrypanosoma cruzi Toxoplasma gondiiToxoplasma gondii Leishmania donovaniLeishmania donovani

Bacteria Staphylococcus Salmonella Yersinia enterocolitica

Spirochetes Treponema pallidum Borrelia burgdorferi

Infectious complicationsInfectious complications


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If no signs of a reaction appear within first 15 minutes, the flow If no signs of a reaction appear within first 15 minutes, the flow

clamp can be adjusted to the ordered rate and transfusion proceeded.clamp can be adjusted to the ordered rate and transfusion proceeded. Patient should be observed at intervals until all fluid is given.Patient should be observed at intervals until all fluid is given.

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A unit of RBCs may be given within 1- 4 hours, depending on the A unit of RBCs may be given within 1- 4 hours, depending on the ordered rate of transfusion.ordered rate of transfusion.

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A “Record of Transfusion”form must be filled up for each unit A “Record of Transfusion”form must be filled up for each unit transfused and sent to laboratory with the empty bag.transfused and sent to laboratory with the empty bag.

Any reaction/s or abnormalities noted should be well documented.Any reaction/s or abnormalities noted should be well documented.

This form must be filled by the transfusing doctor, mentioning details This form must be filled by the transfusing doctor, mentioning details like Unit No. Component transfused, Amount Transfused and like Unit No. Component transfused, Amount Transfused and Reaction/s if any.Reaction/s if any.

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Is there a substitute for blood?Is there a substitute for blood?There are no widely utilized oxygen-carrying There are no widely utilized oxygen-carrying blood substitutesblood substitutes for humans.for humans.

The human body is the only “manufacturer” of this precious fluid The human body is the only “manufacturer” of this precious fluid literally, the “Liquid of Life.” literally, the “Liquid of Life.” All the money or insurance in the world is valueless if the right type orAll the money or insurance in the world is valueless if the right type orquantity of blood is not available. quantity of blood is not available. ( As quoted by American Red Cross )( As quoted by American Red Cross )

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Minimising the need for blood productsMinimising the need for blood products

Modifications of routine practice can help to minimise the need to Modifications of routine practice can help to minimise the need to transfuse red cellstransfuse red cells

For example :For example : Autologous transfusion in planned surgeryAutologous transfusion in planned surgery Checking for and correcting anaemia before planned surgery (e.g. Checking for and correcting anaemia before planned surgery (e.g.

iron deficiency anaemia).iron deficiency anaemia). Stopping anti-coagulants and anti-platelet drugs before planned Stopping anti-coagulants and anti-platelet drugs before planned

surgery. surgery. Use of special pharmacological agentsUse of special pharmacological agents Minimising the amount of blood taken for laboratory samples. Minimising the amount of blood taken for laboratory samples.

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Iron Supplementation Iron Supplementation Reducing the needReducing the need

for transfusion: for transfusion:Manage Manage

deficiency deficiency appropriately appropriately with oral or with oral or

intravenous ironintravenous iron

Assess iron status in Assess iron status in medical and surgical medical and surgical

patients patients

Iron deficiency Iron deficiency anaemia & iron anaemia & iron depletion are a depletion are a major issue in major issue in

generalgeneral Iron supplements Iron supplements are are inexpensiveinexpensive

compared with red compared with red cell transfusioncell transfusion

Erythropoietin therapy Erythropoietin therapy (EPO)(EPO)

Can be considered in Can be considered in certain casescertain cases

AlternativesAlternatives

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AgentAgent UseUse ActionAction

Fibrin sealantFibrin sealant Liver and orthopaedic Liver and orthopaedic surgerysurgery

Thrombin added toThrombin added tofibrinogen concentrates infibrinogen concentrates inpresence of calcium formspresence of calcium formsclot of fibrin sealant clot of fibrin sealant

DesmopressinDesmopressin Cardiac surgery when Cardiac surgery when Patient is on aspirinPatient is on aspirin

Increases Factor VIIIIncreases Factor VIIILevels. Reduces anti-platelet Levels. Reduces anti-platelet effect of aspirineffect of aspirin

AntifibrinolyticAntifibrinolyticAgentsAgentse.g,Tranexamic e.g,Tranexamic

acidacid

Cardiac, GI bleed, Sub-Cardiac, GI bleed, Sub-arachnoid haemorrhagearachnoid haemorrhage

Competitive inhibitor of Competitive inhibitor of plasmin binding to Fibrinogenplasmin binding to Fibrinogen

Pharmacological Agents


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What does ‘Autologous Transfusion’ mean?What does ‘Autologous Transfusion’ mean?

Autologous transfusion is where the donor and

recipient are the same person.

There are different types of autologous transfusion including: Preoperative autologous donation ( PAD). Intra-operative cell salvage. Post-operative cell salvage. etc.


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TRANSFUSE ONLY WHEN THE BENEFITSTRANSFUSE ONLY WHEN THE BENEFITS

OUTWEIGH THE RISKSOUTWEIGH THE RISKS

Conclusion :Conclusion :

Good clinical practice demands that any blood product should only be Good clinical practice demands that any blood product should only be given when the patient is judged likely to benefit (i.e., the transfusion given when the patient is judged likely to benefit (i.e., the transfusion will do more good than harm)will do more good than harm)

1 prepared by : ashwin bhatt through: education department

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blood bank donated blood

capacity of blood

blood cells

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wrong blood

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blood component risk