BLOOD TRANSFUSION

Boold transfusion presentation

1. Prepared By , Deepu Raj D Staff Nurse Cathlab BLOOD AND BLOOD COMPONENTS TRANSFUSION

2. BLOOD Blood is a constantly circulating fluid providing the body with nutrition, oxygen, and waste removal. Blood is mostly liquid, with numerous cells and proteins suspended in it, making blood "thicker" than pure water. The average person has about 5 liters (more than a gallon) of blood.

3. A liquid called plasma makes up about half of the content of blood. Plasma contains proteins that help blood to clot, transport substances through the blood, and perform other functions. Blood plasma also contains glucose and other dissolved nutrients. About half of blood volume is composed of blood cells: • Red blood cells, which carry oxygen to the tissues • White blood cells, which fight infections • Platelets, smaller cells that help blood to clot Blood is conducted through blood vessels (arteries and veins). Blood is prevented from clotting in the blood vessels by their smoothness, and the finely tuned balance of clotting factors. PLASMA & BLOOD CELLS

4. Normal Complete Blood Counts Red blood cell count Hemoglobin Hematocrit White blood cell count Platelet count Male:  4.35-5.65 trillion cells/L* (4.35-5.65 million cells/ mcL **) Female:  3.92-5.13 trillion cells/L (3.92-5.13 million cells/ mcL ) Male:  13.2-16.6 grams/ dL *** (132-166 grams/L) Female:  11.6-15 grams/ dL (116-150 grams/L) Male:  38.3-48.6 percent Female:  35.5-44.9 percenT 3.4-9.6 billion cells/L (3,400 to 9,600 cells/ mcL ) Male:  135-317 billion/L (135,000 to 317,000/ mcL ) Female:  157-371 billion/L (157,000 to 371,000/ mcL )

5. Red blood cell transfusions are used to treat hemorrhage and to improve oxygen delivery to tissues. Transfusion of red blood cells should be based on the patient's clinical condition. Indications for transfusion include symptomatic anemia (causing shortness of breath, dizziness, congestive heart failure, and decreased exercise tolerance), acute sickle cell crisis, and acute blood loss of more than 30 percent of blood volume. Fresh frozen plasma infusion can be used for reversal of anticoagulant effects. Platelet transfusion is indicated to prevent hemorrhage in patients with thrombocytopenia or platelet function defects. Cryoprecipitate is used in cases of hypofibrinogenemia , which most often occurs in the setting of massive hemorrhage or consumptive coagulopathy .   BLOOD TRANSFUSION

6. Acute complications occur within minutes to 24 hours of the transfusion, whereas delayed complications may develop days, months, or even years later. ALLERGIC REACTIONS Some people have allergic reactions to blood received during a transfusion, even when given the right blood type. In these cases symptoms include hives and itching. Like most allergic reactions, this can be treated with antihistamines. However, a doctor should be consulted if the reaction becomes serious. FEVER Developing a fever after a transfusion is not serious. A fever is your body’s response to the white blood cells in the transfused blood. However, it can be a sign of a serious reaction if the patient is also experiencing nausea or chest pain. Patients should consult their doctors if other symptoms or side effects are present. ACUTE IMMUNE HEMOLYTIC REACTION An acute immune hemolytic reaction is a very serious, but rare, reaction caused by a patient’s body attacking the transfused red blood cells. The attack triggers a release of a substance that damages the kidneys. This is often the case when the donor blood is not a proper match with the patient’s blood type. Symptoms include nausea, fever, chills, chest and lower back pain, and dark urine. Complications

7. BLOOD-BORNE INFECTIONS All donated blood is screened and tested for potential viruses, bacteria, and parasites. However, occasionally these agents can still infect a patient after a transfusion. The risk of catching a virus or any other blood-borne infection from a blood transfusion is very low. HIV. All donated blood is thoroughly tested for HIV. There is a 1 in 2 million chance that donated blood will not only carry HIV but also infect a transfusion recipient. Hepatitis B and C. The odds of catching hepatitis B from donated blood is about 1 in 300,000. The risk with hepatitis C is 1 in 1.5 million. West Nile Virus. The risk of catching West Nile Virus from a blood transfusion is approximately 1 in 350,000. Complications

8. INFORMED CONSENT All Patients must sign an informed consent before transfusion of blood components or blood products Patients should be provided with adequate information that includes a description of blood products, associated risks and benefits. The informed consent for blood transfusion is valid for the duration of that admission, A new consent should be obtained for each admission. KAUH POLICY - APP–BTS-002

9. Physician is the person authorized to order blood products Physician order accurately identifies the patient name, MRN, Blood component, rate of infusion, date, time and special instructions. Ordering Blood Components

10. Unequivocal identification of the recipient and blood component throughout the transfusion chain is mandatory. Verifying patient identification is essential at all times, time of sample collection from the patient, time of issuing of blood components from BTS and delivery to clinical areas and time of blood administration to patient. At the time of sample collection and blood transfusion, the patient full name and MRN must be verified by asking the patient and checking the wrist band. Patient Identification

11. Blood components should be transfused using sterile, pyrogen free sets containing a filter(170 to 260 microns) Blood administration sets should be connected directly to the IV access site. Blood component administration should begin within 30 minutes from the time the component is released from temperature controlled storage. Blood should be returned to BTS immediately if the decision is made not to transfuse (maximum 30 minutes from time of issue) . Blood administration sets should be changed at-least every 4 hours. Administration sets shall be changed between the administration of different blood components. Medications shall not be added directly to a blood component nor to the administration set. Priming of IV tubing before transfusion of blood must be with 0.9 % sodium chloride solution. Blood components and blood products should be visibly inspected for clots, clumps or discoloration immediately before issue. Expiry should be checked. Pushing blood components in syringes for fast administration is not acceptable and increases the risk for hemolysis and hyperkalemia. Aministration of Blood Components.

12. Pre transfusion vital signs shall be monitored and documented prior to transfusion of all blood components. This include body temperature, pulse , Sp02 and blood pressure. Adults : For the first 15 minutes transfuse at the rate of 2 ml per minute. If there is no sign of reaction at 15 minutes , record vital signs and increase the rate of infusion. Pediatrics : For the first 15 minutes transfuse at the rate of 1-2 ml/kg/hr. If there is no sign of reaction at 15 minutes , record vital signs and increase the rate of infusion Administration Rates and Monitoring

13. Component Red Blood Cells Platelets Plasma Cryoprecipitate 2-4 ml per minute(120 to 240 ml per hour) A unit of RBC should not be given less than 2 hours and not to exceed 4 hours. 5 ml per minute (300 ml per hour) 10 – 20 ml per kg perhour 10 – 20 ml per kg perhour ADULT RATE OF INFUSION After 15 minutes

14. Component Red Blood Cells Platelets Plasma Cryoprecipitate 1-5 ml per kg per hour. And not to exceed 4 hours. 10 – 20 ml per kg per hour 10 – 20 ml per kg per hour 10 – 20 ml per kg per hour PEDIATRIC RATE OF INFUSION After 15 minutes

15. Before the transfusion begins Within the first 15 minutes of starting the transfusion At the end of transfusion Monitoring of patient during transfusion

16. The transfusion must be stopped immediately buy clamping the tubing as close to the iv site as possible. Lines should be kept open with 0.9% sodium chloride using a new set. Check vitals and oxygen saturation The name of patient and identification number on the patient identification band shall be confirmed against the cross match bag and document. The treating physician should be notified. Assessment of volume status and chest x ray for patients with respiratory symptoms. Management of Suspected transfusion reaction

17. Ordering blood tests: grouping and antibody screening, CBC, LDH, LFT,DCT and urine analysis. All observed signs and symptoms must be documented on the patients medical record, the cross match tag and adverse transfusion reaction form which is printed from HIS. All Blood component containers with attached administration set and iv solutions, whether empty or not, appropriate blood and urine samples and the transfusion reaction forms shall be returned to BTS as soon as possible for follow up investigation. Management of Suspected transfusion reaction

18. IV line flush Documentation of administration information on HIS Disposal of Blood Container Recording information for each blood component or product issued at BTS Post Administration

19. If the patient condition permits , start the transfusion slowly at 1 ml per minute for the first 15 minutes. The patient must be placed under closed supervision, with the transfusionist for the first 15minutes , monitoring for any signs/ symptoms of a transfusion reaction. If no Symptoms of transfusion reaction are noted after 15 minutes, the patient needs to be monitored according to routine practice in addition to every hour during the transfusion. Transfusion of Incompatible Blood

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21. KAUH Policy APP–BTS-002 Human Anatomy By Matthew Hoffman, MD https://www.redcrossblood.org/ References: