Blood TransfusionSafe

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

Symptomatic anemia (Hb<8g/dl)

Acute blood loss

Preoperative (Hb<7-8g/dl)

Chronic transfusion patient (Hb<9g/dl)

Indication

Red Cell Storage & Administration

• 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

Store for 35 or 42

days

Administration 3-4 hours

Volume 250 – 350

ml

Platelets

Essential for Homeostasis

Prevent or Stop Bleeding

Platelets

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

Indication

Platelets Storage & Administration

within 15-30

minutesStored for

5 daysYellow in

colourGive

immediately

• 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)

FFP

Initial Treatme

nt of Massive Bleeding

Replaces Clotting Factors

Stored for 1 year

Give each unit over

30 minutes

Volume 150 – 250

ml Needs

thawing

Cryoprecipitate

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)

Stored for 1 year

Volume 15 – 25 ml

Needs thawing

Blood Warmers

The routine warming of blood and blood component is

NOT recommended

Keeping the patient warm is probably more important than warming the infusion blood

limited benefit

potentially dangerous

Blood warmer indicated

Exchange transfusion in infant When transfusion patient with clinically significant cold agglutinationAdult receiving blood at rate greater than 50ml/kg/hrChildren receiving blood at rate greater than 15ml/kg/hrMassive 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

1. Prescription of blood component (Doctor’s order)

2. Pre-transfusion sample collection

Prescription of Blood Component

Prescription form Should include:patient name & IDdate and timepatient diagnosisReason of transfusionnumber of unit to be administeredrate of infusionspecial procedure

Prescription of Blood Component

Informed Consent

Signed

• Prior Transfusion• 15 to 20 Minutes After Starting• Post Transfusion.

vital signs monitoring

Blood Transfusi

on Reaction

1. Stop the Blood transfusion2. Inform the senior Physician3. Start .9% Normal Saline KVO4. Return entire transfusion set up including tubing

( without IV needle) to the blood bank after the physician orders the discontinuation of the transfusion

5. 5 cc of blood from the patient in EDTA (2 purple topped) tube,

6. Obtain first voided urine for analysis, mark “post transfusion”

7. Fill transfusion reaction form 8. Write an OVR send to TQM

What to do?

Transfusion Of Incompatible Blood

1. Transfusion of incompatible blood component is regarded as an error that should be avoided

2. Some situation it is the only option available that can save patient life

3. 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 youCSSC