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Dr. Megan RowleyConsultant in Transfusion Medicine

Blood Transfusion

+What would you like to know?

Is blood safe and what

happens if it goes wrong?

How do you decide

when to transfuse? And how much?

Where does my blood come from?

What happens to blood once it has been collected?

What is in a bag of blood?

Who are all the people who make this work?

+There are lots of people who work hard to get blood to you

EXPERTS

PEOPLE WHO ADVISE ON

BEST PRACTICE

REGULATORS

PEOPLE WHO OVERSEE ADVERSE EVENTS

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Where does my blood come from?www.blood.co.ukLook on the website – lots of interesting facts, figures and video clips

HealthyBlood donors aged 17-65 can donate

every 4 months

Fill out a donor health questionnaire and have a haemoglobin check

Fixed and mobile donor sessions – a masterpiece of organisation!

+What happens to blood once it has been collected?

Blood group ABO D positive or negative Other blood group antigens

Viruses and other infections Hepatitis B and C HIV 1 and 2 and HTLV1 Syphilis (Malaria) (Cytomegalovirus)

1. Tested

+What happens to blood once it has been collected?

No such thing as ‘whole blood’

What we need are ‘components’ RED CELLS PLATELETS PLASMA

And the white cells have to be removed LEUCODEPLETION

2. Processed

+What is in a bag of blood?

Red Cells in Optimal Additive Solution (SAG-M)

Shelf-life 35 days at 4°C

No white cells or platelets and

very little plasma

UK Blood Donors

Blood Group

RhDPositive

RhDNegative Total

OO 37%37% 7%7% 44%44%AA 35%35% 7%7% 42%42%BB 8%8% 2%2% 10%10%

ABAB 3%3% 1%1% 4%4%

Distribution of Distribution of blood groups varies blood groups varies

across the worldacross the world

Distribution of Distribution of blood groups varies blood groups varies

across the worldacross the world

+How do we choose which blood group to give?

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Serological (XM) Serological (XM) is where the patientis where the patient’’s plasma is mixed with the s plasma is mixed with the donordonor’’s red cellss red cellsTakes 40 minutesTakes 40 minutes

Electronic Issue (EI) Electronic Issue (EI) is where the computer checks there are two is where the computer checks there are two patient blood groups that agree, there is a is valid (recent) G&S patient blood groups that agree, there is a is valid (recent) G&S

sample and a negative antibody screen sample and a negative antibody screen Takes 10 minutesTakes 10 minutes

Serological (XM) Serological (XM) is where the patientis where the patient’’s plasma is mixed with the s plasma is mixed with the donordonor’’s red cellss red cellsTakes 40 minutesTakes 40 minutes

Electronic Issue (EI) Electronic Issue (EI) is where the computer checks there are two is where the computer checks there are two patient blood groups that agree, there is a is valid (recent) G&S patient blood groups that agree, there is a is valid (recent) G&S

sample and a negative antibody screen sample and a negative antibody screen Takes 10 minutesTakes 10 minutes

Before transfusion of red cells the blood has to Before transfusion of red cells the blood has to be appropriately matched to the patient be appropriately matched to the patient

The transfusion lab will select the correct ABO/D The transfusion lab will select the correct ABO/D red cell group for the patientred cell group for the patient

Some patients also have ‘special requirements’ Some patients also have ‘special requirements’ e.g. IRRADIATED, KELL NEGe.g. IRRADIATED, KELL NEG

Matching blood

A blood bag with a compatibility label

attached

All the information on the blood bag

label is bar-coded as well as eye readable

Labelling and Issue

+Is blood safe?

Yes! Most of the time….If blood transfusion is the only

treatment for your condition and the consequences of not having a blood transfusion outweigh the the risks of having one then it is then having a blood transfusion is the

right thing to do

Patient blood management

+Patient Blood Management

Minimise anaemia

Patient information and valid consent

Consider and discuss alternatives

Give the right

amount of blood

Consider special

requirements

Review the outcome

+Patient Information and Consent‘Valid’ consent is required for transfusion

(verbal)

Alternatives should be offered if appropriate

If transfused in an emergency, patient must be informed afterwards

Involve patients in the process to ensure they get the right blood and the right ‘special requirements’

+Why and when do we give blood?The decision to transfuse is based

on the whole clinical picture

Is the patient bleeding?

What are the blood results?

Is the patient symptomatic?

Will a transfusion solve the problem?

What are the risks of transfusion?

Are there alternative treatments?

‘The decision to transfuse must be based

on a thorough clinical assessment of the patient and their

individual needs. The rationale for the decision

to transfuse and the specific components to be transfused should be

documented in the patients’ clinical records’

BCSH guidelines 2012

‘The decision to transfuse must be based

on a thorough clinical assessment of the patient and their

individual needs. The rationale for the decision

to transfuse and the specific components to be transfused should be

documented in the patients’ clinical records’

BCSH guidelines 20124mL/kg will typically give a Hb increment of 10g/L = 1unit RBC gives a Hb increment of 10g/L in a 70-80 kg patient

+What happens if it goes wrong?

Investigate incidents locally ROOT CAUSE ANALYSIS

Report serious hazards via a national system SHOT

Clinical audit PROCESS and APPROPRIATNESS of TRANSFUSION

Learn and continuously improve DOCTORS and NURSES TRANSFUSION LABORATORIES BLOOD SERVICES EXPERTS and REGULATORS

+What reactions occur with red cells?

+Serious Hazards of Transfusion 1996-2012 (n=11570)

Getting the wrong

blood

Getting an infection

from blood

Having a reaction to bloodGetting

too much blood too quickly

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Carson J L et al. Ann Intern Med doi:10.1059/0003-4819-156-12-201206190-00429

©2012 by American College of Physicians

Fluid overload

from blood transfusion

and patients with a fever

during transfusion

is quite common

Fluid overload

from blood transfusion

and patients with a fever

during transfusion

is quite common

Hepatitis and HIV

transmitted by

transfusion is very rare

Hepatitis and HIV

transmitted by

transfusion is very rare

Adverse effects of RBC transfusion contrasted with other risks

+Conclusion

Blood is a precious gift given by a blood donor Each bag costs £120 but all of that goes towards collecting

blood making it safe and getting it to the hospital – no money goes to the donor

There are many people working behind the scenes to get you the right blood at the right time, every time If it goes wrong we do our best to understand why and

continually improve

It is important that you understand the risks and benefits of transfusion and give your consent to receive this treatment The team caring for you need to tailor your blood support to

you personally and to check it is having the desired effect