BLOOD TRANSFUSION by Dr ATIQUR RAHMAN KHAN, FRCP

BLOOD TRANSFUSION BY DR ATIQUR RAHMAN KHAN
For ADULTS PAEDIATRICS AND NEONATES

1. BLOOD TRANSFUSION BLOOD TRANSFUSION

2. Objectives To define what is blood transfusion To know about the indications for blood transfusion To discuss about the hospital policy and procedure of blood transfusion To learn about the steps of transfusion To re-educate the staff regarding blood transfusion reaction

3. DEFINITION It is the introduction of blood components into the venous circulation It is a procedure in which a patient receives a blood product through an intravenous line. Process of transferring blood-based products from one person into the circulatory system of another

4. PURPOSE To increasing circulatory blood volume To increase the number or red blood cell and to maintain hemoglobin level To provide plasma clotting factors, to help in controlling bleeding To combat infection due to decrease or defective white cells or antibodies

5. INDICATION After heart or major surgery, trauma or hemorrhage Severe anemia, bleeding disorder( hemophilia) Leucopenia(decrease WBC) Agranulocytosis(bone marrow does not produce enough or mature RBC Organ transplant Rh incompatability in new born babies (exchange transfusion)

6. COMPONENTS OF BLOOD Red cells - carry oxygen and help remove waste products White cells - help your body fight infection Plasma- is the liquid part of your blood Platelets- help your blood clot properly

7. GROUPING AND CROSSMATCHING The Group O (-) is the universal “donor” - people with type O (-) can donate to anyone, regardless of the recipient type because blood 0(-) lacks A,B, and RH antigens, reducing the risk of an immune reaction. The Group AB (+) is the universal “ Recipient”- people with AB (+) can receive blood from any donor, as they have A,B, and RH antigens, meaning their bodies are less likely to reject transfused blood .

8. Types of Blood Transfusion Red cell- given to increase the number of Red Blood Cells in patients with anemia, significant blood loss or conditions affecting red blood cell production. Platelet- used to treat patients with low platelet counts (thrombocytopenia), which can occur due to condition like leukemia, chemotherapy, or bone marrow disorder. Plasma- administered to patient with clotting disorder or massive blood loss, it contains clotting factors and proteins necessary for blood clotting. Cryoprecipitate- this component of plasma is rich in specific clotting factors and is used to treat conditions like hemophilia, von Willebrand disease, or severe bleeding . Whole blood -involves transfusing all components of blood( red cells, white cells, platelets, and plasma). This is less common and usually reserved for cases of massive blood loss where multiple blood components are needed simultaneously.

9. Pediatric Blood Dosing Red cells should be transfused no faster than 5 ml/kg/hour, and ideally 15-20ml/kg total should be given over 3-4 hours for routine top-up. Each unit must be completed within a maximum of 4 hours from removal from the temperature-controlled blood fridge COMPONENT DOSE EFFECT Packed Red Blood Cells 10-15ml/kg Increase hemoglobin by 2-3 g/dl Platelets 5-10ml/kg Increase platelet count by 50.000-100.000 Fresh frozen plasma 10-15ml/kg Factors levels increase by 15%- 20% Cryoprecipitate 1-2 units/kg Increase fibrinogen by 60-100ml/dl

10. TRANSFUSION TIME FRAME BLOOD COMPONENT COMPLETED TRANSFUSION TIME PRBC’S 4 hours Platelet 30 – 60 minutes Plasma 30 -60 minutes

11. NURSING RESPONSIBILITIES Nurse is responsible for safety and effectively administering iv transfusion Nurse must have legal knowledge about transfusion Nurse should do thorough assessment of patients, physical condition, medical history for previous blood transfusion, allergies, and dietary pattern should be known by nurse Nurse should have knowledge about calculation of flow rate and methodical approach Nurse should apply physiological and anatomical and aseptic principles Nurse should have vigilant observation throughout the procedure so as to prevent adverse reactions which can sometimes be fatal

12. Policy Review 1. Handling, Use and Administration of Blood and Blood Products 2. Administration of Blood Components and Blood Products 3. Patient Monitoring during Transfusion Procedure 4. Completion of Transfusion

13. Handling, Use and Administration of Blood and Blood Products (IPP-LB & BB-PC-025 (4) Applicable to registered nurses, medical practitioners, and blood bank staff Only the physician in NNGH can order blood and blood products through VIDA system (LB-BB-64.1(3) The physician in NNGH obtains informed consent for blood transfusion During emergency, the patient/family signs the consent for “transfusion without NAT testing’’ (LB-BB-56 (3)

14. Handling, Use and Administration of Blood and Blood Products (IPP-LB & BB-PC-025 (4) Two staff members verify the patient’s identity prior to drawing blood for cross match and administration of blood The Registered Nurse responsible to practice appropriate transfusion must practice safely, competently and effectively fulfilling his/her professional responsibility within Positive Patient Identification must be observed at all stages of transfusion process.

15. Handling, Use and Administration of Blood and Blood Products (IPP-LB & BB-PC-025 (04) Product Transfusion Timeframe     Blood Component Completed Transfusion Time Red Blood Cells 4 hours Platelets 30-60 minutes Plasma 30-60 minutes

16. Handling, Use and Administration of Blood and Blood Products (IPP-LB & BB-PC-025(04) Prophylactic medication to be given pre/post the transfusion must be prescribed in the patient medication chart. If a patient refuses BT for any reason, a consultant hematologist should be contacted to ascertain any alternative treatment that would be acceptable. Pre-transfusion observation should be performed 30 min prior to start of BT.

17. Administration of Blood Components and Blood Products ( CLBB-LB-BB-002(4) Transfusion of blood product is commenced within 30 min of leaving controlled storage conditions. Prior to transfusion, ensure Positive Patient Identification & administration checking. Ask the patient to state his/her Full Name and DOB .

18. Administration of Blood Components and Blood Products (CLBB-LB-BB-002(3) All details on the patient identification band and MRN must match the details on the following: Compatibility label of blood component pack Compatibility report form in VIDA system with blood component from the laboratory Check blood component pack label if clinical special requirements were met Check the component expiry date Complete administration documentation in VIDA system

19. Patient Monitoring during Transfusion Procedure ( LB-BB-69.1(4) Patient should only be transfused in a clinical area where they can be monitored A set of observation measuring TPR & BP must be recorded Pre-transfusion observations should be performed within 30 min prior to commencing the transfusion . 15 min post commencement of transfusion 30 min post commencement of transfusion hourly thereafter until transfusion completed .

20. Patient Monitoring during Transfusion Procedure (LB-BB-69.1(3) The patient should be observed and monitored if there are signs of a suspected transfusion reaction. Maintain fluid balance chart throughout the transfusion The patient should be asked to report any unusual symptoms if observed. Transfusion Reaction must be considered if there is any deterioration in patient condition during and following transfusion .

21. Patient Monitoring during Transfusion Procedure (LB-BB-69.1(3) In-patients should be observed for late reactions for 24 hours after BT. Day ward patient should be informed on discharge about delayed reactions after BT. If symptoms occur at home they must contact the hospital emergency.

22. Completion of Transfusion (IPP-LB&BB-PC-025) The blood administration set must not be flushed with any fluids after use. BT set should not be used for subsequent infusions post transfusions. Document the following in VIDA system: Time unit was completed Total volume infused Volume transfused if blood component was not fully transfused

23. Completion of Transfusion ( IPP-LB&BB-PC-025)(04) Was a transfusion reaction suspected? Was the suspected transfusion reaction reported? (LB-BB-69.2 (1) Fluid Balance Record Managing transfusion reaction protocol must be followed if transfusion reaction is suspected.

24. Monitoring and Documentation 1. Doctor’s Order 2. Consent 3. Blood Verification 4. Nurse’s Notes 5. Vital Signs Monitoring

25. 1. Doctor’s Order

26. 2. Consent

27. 3. Blood Verification

28. 4. Nurse’s Notes

29. 5. Vital Signs Monitoring

30. 5. Vital Signs Monitoring

31. IF any reaction from blood transfusion Stop the transfusion immediately Assess and Stabilize the patient, check vital sign Inform the physician Remove the BT set and insert another line , take blood sample for CBC, Chemistry, C-profile, Blood group and cross matching. And start normal saline infusion. Collect the first voided urine and send to laboratory send blood culture if the patient temperature rises more 1.5 ° from the baseline temperature together with chills. Complete the report of Suspected Adverse Transfusion Reaction /event in the VIDA SYSTEM and initiate OVR.

32. In case of system downtime utilize Manual Documents

33. CONCLUSION Blood transfusion is a critical medical procedure that can be life -saving in various clinical scenarios such as severe anemia, massive blood loss, and clotting disorders. The process involves the administration of specific blood components - red blood cells, platelets, plasma, or cryoprecipitate-tailored to meet the patient’s needs. Ensuring patient safety during transfusion requires diligent verification, careful monitoring, and thorough documentation by healthcare professionals. Understanding the types of transfusion and the responsibilities associated with them is essential for preventing complications and achieving positive patient outcomes. Overall, blood transfusions are a cornerstone of modern medicine. Significantly improving survival and quality of life for patients with serious health conditions.

34. Thank you