BLOOD TRANSFUSION

1. Blood Transfusion, Blood
Products, and Safety
Protocols
PRESENTER M.UMAIR

2. Introduction
Today's presentation delves into the intricacies of blood transfusion, blood product
management, and the critical safety protocols associated with these processes

3. Blood and its components
Red Cells, Plasma and Platelets
Red cells are used predominantly in treatments for cancer and blood diseases, as
well as for treating anemia and in surgeries for transplants and burns.
Plasma provides proteins, nutrients and a clotting agent that is vital to stop
bleeding - it is the most versatile component of blood.
Platelets are tiny cells used to help patients at a high risk of bleeding. They also
contribute to the repair of damaged body tissue

4. Shelf life of blood products
The shelf life of blood components is as follows:
Red Cells - up to 35 days
Plasma - up to 1 year
Platelets - up to 5 days

5. Prolonged Storage and Red Cell
Changes
- Prolonged storage influences red cell properties, notably ATP and 2,3-DPG levels.
Increased oxygen affinity of red cells due to prolonged storage warrants
consideration for critically ill patients
- Fresh blood remains preferable in critical cases to ensure optimal oxygen release
to tissues.

6. Eligibility Requirements of Blood
Donor
Be in good general health and feeling well
Be at least 18 years old
Weigh at least 110 lbs
Additional weight requirements apply for donors 18 years old and younger.
Donation Type Donation Frequency
Blood (whole blood) Every 56 days
Platelets Every 7 days, up to 24 times/year
Plasma Every 28 days, up to 13 times/year
Double Red Cells Every 112 days, up to 3 times/year

7. Transfusion ten rules
1.Transfusion should only be used when the benefits outweigh the risks and there are no
appropriate alternatives.
2.Results of laboratory tests are not the sole deciding factor for transfusion.
3.Transfusion decisions should be based on clinical assessment underpinned by evidence-based
clinical guidelines.
4.Not all anemic patients need transfusion (there is no universal ‘transfusion trigger’).
5.Discuss the risks, benefits and alternatives to transfusion with the patient and gain their consent.

8. Transfusion ten rules
1. The reason for transfusion should be documented in the patient’s clinical record.
2. Timely provision of blood component support in major haemorrhage can improve
outcome – good communication and team work are essential.
3. Failure to check patient identity can be fatal. Patients must wear an ID band (or
equivalent) with name, date of birth and unique ID number. Confirm identity at
every stage of the transfusion process. Patient identifiers on the ID band and blood
pack must be identical. Any discrepancy, DO NOT TRANSFUSE.
4. The patient must be monitored during the transfusion.
5. Education and training underpin safe transfusion practice.

9. The ABO system
There are four main blood groups: A, B, AB and O.
All normal individuals have antibodies to the A or B antigens that are not present on
their own red cells

10. Safe transfusion – right blood, right
patient, right time and right place
The key principles that underpin every stage of the blood administration process
are:
Positive patient identification
Good documentation
Excellent communication.

11. Guideline on Administration of
Blood Components
Positive patient identification
Positive patient identification at all stages of the transfusion process is essential.
Minimum patient identifiers are:
 Last name, first name, date of birth, unique identification number.
This must exactly match the information on the identity band (or equivalent).
All paperwork relating to the patient must include, and be identical in every detail,
to the minimum patient identifiers on the identity band

12. Patient information and consent for
transfusion
Where possible, patients (and for children, those with parental responsibility)
should have the risks, benefits and alternatives to transfusion explained to them in
a timely and understandable manner.
Standardized patient information, such as national patient information leaflets,
should be used wherever possible.

13. Pre-transfusion documentation
Minimum dataset in patient’s clinical record:
Reason for transfusion (clinical and laboratory data).
Summary of information provided to patient (benefits, risks, alternatives) and
patient consent.

14. Prescription (authorization)
Components to be transfused
Date of transfusion
Volume/number of units to be transfused and the rate or duration of transfusion

15. Requests for transfusion
Must include:
Minimum patient identifiers and gender
Diagnosis, any significant co-morbidities and reason for transfusion
Component required, volume/number of units and special requirements
Time and location of transfusion
Name of requester

16. Blood samples for pre-transfusion
testing
All patients being sampled must be positively identified.
Collection of the blood sample from the patient into the sample tubes and sample
labelling must be a continuous, uninterrupted event involving one patient and one
trained and competency assessed healthcare worker.
Sample tubes must not be pre-labelled.
The request form should be signed by the person collecting the sample.

17. Collection and delivery of blood
component to clinical area
Before collection, ensure the patient (and staff) is ready to start transfusion and
there is good venous access.
Only trained and competent staff should collect blood from blood bank.
Authorized documentation with minimum patient identifiers must be checked
against label on blood component.
Minimum patient identifiers, date and time of collection and staff member ID must
be recorded.

18. Administration to the patient
•Blood components must be administered by registered practitioners who are trained and
competent according to local policies.
•The final check must take place next to the patient, not at the nursing station or another
remote area.
•Either one or two staff performing the bedside check is safer. If two people perform the
check, each should perform it independently.
•Transfusion must only go ahead if the details on the patient identity band (positively
confirmed by the patient if possible), the laboratory-generated label attached to the
component pack and the transfusion prescription are an exact match.
•Any discrepancy must immediately be reported to the transfusion laboratory.

19. Administration to the patient
•Check the expiry date of the component and ensure the donation number and
blood group on the pack matches that on the laboratory-generated label attached to the
pack.
•Any special requirements on the transfusion prescription, such as irradiated component,
must be checked against the label on the pack.
•Inspect the component pack for signs of leakage, discoloration or clumps.

20. Administration to the patient
•The prescription and other associated paperwork should be signed by the person
administering the component and the component donation number, date, time of starting
and stopping the transfusion, dose/volume of component transfused
•Name of the administering practitioner should be recorded in the clinical record.
•To reduce the risk of bacterial transmission, blood component transfusions should be
completed within 4 hours of removal from a controlled temperature environment.
•Non-essential overnight transfusion of blood should be avoided, except in adequately
staffed specialist clinical areas, because of the increased risk of errors.

21. Administration to the patient

22. Monitoring the patient
Patients should be under regular visual observation and, for every unit transfused,
minimum monitoring should include:
Pre-transfusion pulse (P), blood pressure (BP), temperature (T) and respiratory rate
(RR).
Pulse, BP and Temp 15 minutes after start of transfusion – if significant change, check
RR as well.
If there are any symptoms or signs of a possible reaction – monitor and record vitals
and take appropriate action.
Post-transfusion Vitals – not more than 60 minutes after transfusion.

23. Potential Transfusion Reactions
•Temperature ≥ 38.0 C or change of 1°C from pre-transfusion value within 15 minutes after initiation of
transfusion
•Acute or delayed hemolytic transfusion reaction
•Hypotension/shock
•Rigors
•Anxiety
•Back or chest pain
•Nausea/vomiting
•Shortness of breath (dyspnea)
•Bleeding/pain at IV site

24. Potential Transfusion Reactions
•Tachycardia/arrhythmia
•Generalized flushing
•Rash ≥ 25% of body
•Urticaria and other anaphylaxis reactions
•Hemolysis after transfusion
•Virus, parasite, and prion infections
•Non-immunological reactions including infection
•Circulatory overload
•Hypothermia

25. Management Of Blood Transfusion
Reaction
1.Stop the Transfusion: The first step is to immediately stop the blood transfusion as
soon as a reaction is suspected. Inform the healthcare team and document the reaction
in the patient's medical records.
2.Assess the Patient: Evaluate the patient's vital signs, including blood pressure, heart
rate, respiratory rate, and oxygen saturation. Monitor the patient closely for signs of
distress, such as difficulty breathing, chest pain, or changes in consciousness.
3.Provide Supportive Care: Provide appropriate medical interventions based on the
type and severity of the reaction. This may include administering oxygen, fluids,
antihistamines, corticosteroids, and other medications as needed.
4.Document: Thoroughly document all aspects of the reaction, interventions, and patient
responses in the patient's medical records. This documentation is crucial for tracking the
patient's progress and informing future medical decisions.

26. Management Of Blood Transfusion
Reaction
1.Notify the Physician: Contact the patient's physician or healthcare provider immediately to
inform them of the reaction and discuss the appropriate course of action. They may recommend
additional diagnostic tests or treatments.
2.Collect Specimens: If necessary, collect blood and urine samples for further analysis to help
determine the cause of the reaction. These samples can aid in diagnosing the specific type of
transfusion reaction.
3.Manage Symptoms: Administer medications to address specific symptoms. For example, if
the patient is experiencing an allergic reaction, antihistamines can be given. In severe cases,
epinephrine may be needed.
4.Monitor and Reassess: Continuously monitor the patient's vital signs and overall condition.
Be prepared to escalate care if the patient's condition worsens.

27. 1: What is the primary purpose of
using platelets in transfusions?
A) To provide nutrients to the body
B) To enhance the immune response
C) To reduce inflammation
D) To assist patients at a high risk of bleeding

28. 2: What is the shelf life of plasma?
A) Up to 35 days
B) Up to 1 year
C) Up to 5 days
D) Up to 7 days

29. Q3: Which of the following blood components should be
transfused within 4 hours of removal from a controlled
temperature environment?
A) Red Cells
B) Plasma
C) Platelets
D) Fresh Frozen Plasma

30. Q4: What is the key principle that underpins every
stage of the blood administration process?
A) Efficient communication
B) Cost-effectiveness
C) Positive patient identification
D) Rapid transfusion

31. Q5: In the event of a suspected transfusion
reaction, what is the first step a healthcare
professional should take?
A) Administer antihistamines immediately
B) Continue the transfusion at a slower rate
C) Stop the transfusion and inform the healthcare team
D) Increase the patient's oxygen saturation

32. Answer key
1. D) To assist patients at a high risk of bleeding
2. B) Up to 1 year
3. A) Red Cells
4. C) Positive patient identification
5. C) Stop the transfusion and inform the healthcare team